One of the worst places on Earth for women

by Cesar Chelala

NEW YORK — In spite of moderate progress in some areas, women’s health needs continue to go unmet in Afghanistan.

“Afghanistan is one of the most dangerous places in the world to be pregnant,” states a report on maternal mortality by the Afghan Ministry of Health, UNICEF, and the U.S. Centers for Disease Control and Prevention.

This statement is borne out by statistics that show that in Afghanistan one woman dies every 27 minutes from a pregnancy-related condition that is preventable, in most cases, with adequate health facilities and medical care.

Other statistics are equally alarming. Afghanistan has the highest infant mortality rate in the world, and the second-highest maternal mortality rate, according to U.S. government statistics.

Hemorrhaging and prolonged or obstructed labor are blamed for the largest number of Afghan maternal deaths, which could be easily prevented if a trained midwife were present during childbirth. It is estimated that only 14 percent of women receive skilled medical care when giving birth.

The situation is particularly serious in rural areas where clinics and hospitals may take hours to reach on foot. To make matters worse, many clinics lack fundamentals such as clean water, lighting and basic elements for surgery, blood-pressure monitoring instruments and equipment to test donated blood for HIV contamination.

Travel is complicated by weather conditions, lack of security, difficult roads and rough terrain. It is not surprising, then, that the average life expectancy for a woman in Afghanistan is only 44 years.

Women don’t fare any better in education. It is estimated that 87 percent of Afghan women are illiterate. Many girls fear going to school for lack of security. Although some aspects of their lives have improved, women are still at a clear disadvantage with men.

“Women who try to advocate for their rights in public life are subject to violence and physical attacks,” said Zia Moballegh, acting country director for the International Center for Human Rights and Democratic Development.

“Violence against women and girls is widespread and deeply rooted in society,” Norah Niland, chief U.N. human rights officer in Afghanistan, said last year.

“Our field research finds that rape is under-reported and concealed, a huge problem in Afghanistan,” Niland added. “It affects all parts of the country, all communities and all social groups.”

It is estimated that one in three Afghan women experience physical, psychological or sexual violence at some point in their lives. Paradoxically, shame is usually associated with the attacks, and the victims often find themselves prosecuted for adultery rather than the perpetrators. While adultery is punishable by jail sentence, no provision in the Afghan penal code criminalizes rape.

A sad result of this oppressive atmosphere is that an increasing number of women in Afghanistan are choosing suicide as a way to escape the violence and abuse in their daily lives, according to a human rights report prepared by Canada’s Foreign Affairs Department. “Self-immolation is being carried out by increasing numbers of Afghan women to escape their dire circumstances, and women constitute the majority of Afghan suicides,” states a report completed at the end of 2009.

According to a hospital burn-unit director cited in the report, in 2008 more than 80 women tried to commit suicide by setting themselves afire in the province of Heart. Many of those women died.

Last January, two women fled their homes to escape domestic violence in Ghor province, southwestern Afghanistan. The two were later arrested; one was beaten in public, and the other was confined in a sack with a cat, according to Ghor’s governor.

“I poured fuel over my body and set myself ablaze because I was regularly beaten up by my husband and insulted by my in-laws,” said Zarmina, 28, told IRIN, a project of the U.N. Office for the Coordination of Humanitarian Affairs.

The abuses suffered by women nationwide are a serious call for attention. The government must enact laws to protect women and then make sure the laws are followed. It is one of the most urgent tasks facing the Karzai government.

Cesar Chelala, M.D., Ph.D., an international public health consultant, is a cowinner of the Overseas Press Club of America award.