Rabia is cradling her newborn baby, just days after giving birth at a small hospital in Nangarhar province in Afghanistan’s east. “This is my third child, but the experience was totally different. It was horrible,” she says.

In a matter of weeks, the birthing unit Rabia delivered her baby in had been stripped down to its bare basics. She was given no pain relief, no medicine and no food.

The hospital sweltered in temperatures topping 43C (109F) – the power had been cut and there was no fuel to work the generators. “We were sweating like we were taking a shower,” says Rabia’s midwife Abida, who worked tirelessly in darkness to deliver the baby by mobile phone light.

“It was one of the worst experiences I’ve ever had in my job. It was too painful. But this is our story every night and every day in the hospital since the Taliban took over.”

Surviving childbirth means Rabia is one of the lucky ones. Afghanistan has one of the worst maternal and infant mortality rates in the world, according to the World Health Organization (WHO), with 638 women dying per 10,000 live births.

It used to be worse. Yet the progress made on maternal and neonatal care since the US-led invasion in 2001 is quickly unravelling.

“There is now a great sense of urgency and desperation. I really feel the weight of that,” says United Nations Populations Fund (UNFPA) executive director Natalia Kanem.
The UNFPA estimates that, without immediate support for women and girls, there could be 51,000 additional maternal deaths, 4.8 million unintended pregnancies, and twice as many people who won’t be able to access family planning clinics between now and 2025.

“Primary health facilities across Afghanistan are collapsing… maternal mortality rates, child mortality rates, will increase, unfortunately,” says Dr Wahid Majrooh, chief of public health, who is the only minister remaining in post since Kabul fell last month. He’s pledged to fight for the health of Afghans, but faces an uphill battle.

The landlocked nation has become cut off from the world. When foreign troops began withdrawing, the Taliban’s rise to power led to a freeze on foreign aid which heavily finances Afghanistan’s healthcare system. Western donors, including the US and groups such as the WHO, cite difficulties in delivering funds to the Taliban and medical supplies to a chaotic Kabul airport.

Access to life-saving supplies and medicines for women’s reproductive health is being significantly affected. The timing is doubly unfortunate given the spread of coronavirus. “There is no preparation for the possibility of a fourth wave of Covid,” says Dr Majrooh.

At Abida’s birthing unit, the freeze on funds means they’re also unable to run their ambulance service. There’s no money for fuel.

“Just a few nights ago, a mother was close to labour and urgently requested an ambulance because she was in too much pain. We had to tell her to find a taxi, but none were available.

“When she finally managed to find a car, it was too late – she gave birth in the car and became unconscious for several hours because of the severe pain she was in and the extreme heat. We didn’t think she’d survive. The baby was also in a very dangerous condition, and we had nothing to provide for either of them,” Abida says.

Fortunately, the woman’s newborn daughter survived. After three days recovering in the severely underfunded hospital, the woman was discharged.

“We’re working overtime, day and night, to patch together a system but we need the funds,” says the UNFPA’s Dr Kanem. “Even before the dramatic events of the past few weeks, an Afghan woman dies in childbirth every two hours.”
The UNFPA is seeking $29.2m (£21.1m) as part of the broader UN appeal for $606 million to respond to the lifesaving needs of Afghan women and girls. It’s confident that, given the desperate need for humanitarian assistance, safe passage will be granted to transport vital medical and healthcare goods and deploy mobile health clinics.

The UNFPA is concerned that the increasing risk of child marriage will further drive up the mortality rate. Spiralling poverty, anxiety over girls being unable to attend school, and fears over forced marriages between militants and girls or young adolescent women, is compounding the issue. “If you’re a young mother, your chances of survival shrink immediately,” Dr Kanem says.

The Taliban’s new restrictions on women are further crippling an already fragile healthcare system. In many areas of Afghanistan, women are having to cover their faces with a niqab or burka.