THREAD
Key findings of the recent report by @hrw on "Women’s Access to Health Care in Afghanistan"
Some Staggering facts. Impressive reporting by @heatherbarr1, @TamanaAyazi, and team. Read the full report here: https://www.hrw.org/news/2021/05/06/afghanistan-health-care-women-hit-aid-cuts

Afghanistan has 4.6 medical doctors, nurses, and midwives per 10,000 people, far below the threshold for critical shortage of 23 healthcare professionals per 10,000 people as defined by the @WHO.

In 2019, the World Bank reported that Afg spent $8 per person per yr on health, with on-budget health expenditure representing about 1.5% of GDP. This contrasts with global benchmarks recommending that countries should spend amounts ranging from over 5% up to 7% of GDP on health.

Women often struggle to access care due to costs, including for transportation to a health facility, and for
medications and supplies for which patients are
obliged to pay. When they can obtain care, it is often of poor quality.

Distance remains a problem for a significant proportion of the population; almost 10 percent of people cannot reach a health facility within 2 hours and 43 percent must travel more than half an hour.

Lack of access to adequate care drives Afghans to spend US$285 million a year on medical tourism, mostly to Pakistan and India, draining funds from the health sector.

Progress on some key indicators, such as accessing prenatal care and skilled birth attendance, is now stagnating or even reversing. Corruption at all levels threatens the delivery of health services and demands for bribes drive people away from seeking care.

Staff of a hospital said that they had not yet been paid their salaries for over 3 months, and hospital midwives said they were told their salaries might be cut from the current 13,000 Afs ($169) to 7,500 Afs a month ($97). The annual budget of hospitals declined by 30%.

The maternal mortality rate (638 deaths per 100,000 births) still puts Afghanistan in a category the @UNICEF calls “very high.” Afghanistan is the only country in Asia in this category. UNICEF estimated there were 7,700 maternal deaths in Afghanistan in 2017.

By contrast, the UN documented 3,438 civilian deaths due to military attacks the same year.
The 2018 Health Survey found 59% of deliveries were with skilled attendance and found that this figure had stalled or slightly reversed, particularly among women in deepest poverty.

The experience of Muraweet, now 40, and married at age 10, is typical. She had no prenatal care during the first seven of her nine pregnancies, because she could not afford transportation, and she gave birth to the first seven children at home, unattended.

One factor contributing to Afghanistan’s high rate of maternal mortality is the prevalence of child marriage. 35% of girls in Afg marry before age 18, and 9% before age 15. Many of the women interviewed had married as children; among them the youngest age of marriage was 10.

Women & girls outside of Kabul face greater barriers & scarcity of services, & in rural areas, the situation is even more dire. In 2014, the WHO reported that Afghanistan had only 1.9 doctors per 10k people. Rural facilities are often understaffed or have few or no female staff.

More than half the Afghan population, including survivors of conflict-related violence, experience depression, anxiety, & post-traumatic stress, but fewer than 10% receive adequate psychosocial support from the state. Women & girls face particular barriers in accessing services.

One woman, who had just given birth, described trying to take her own life seven times during the late stages of her pregnancy after she faced domestic violence, a loved one was murdered, and another diagnosed with cancer.

Freshta, 38, from Shamali, said her husband had borrowed 15,000 Afs ($195) to pay for the travel expenses & medicines and supplies she needed to receive surgery for ovarian cysts at a government hospital in Kabul. “This is the first time in a hospital in my whole life,” she said.

“I thought everything was free, but I had to pay for gloves, food, medicine, and go outside the hospital to do blood tests, and pay for that.”

“When I was pregnant last time, they said it would be a C-section, and I was calling for 3 days to try to borrow to pay for it, but everyone refused,” said Sediqa, 33, a mother of 4. “It costs $195 to $260 for a C-section—you have to pay for transportation, food, medicine..."