Nasima’s labour pains began in late December 2025. She was 30 years old, a mother of two, living in a remote village in Ashtarlay district, Daikundi province. Like many women in rural Afghanistan, she expected to give birth at home.
But after two days of worsening contractions, Nasima’s family brought her to the district clinic. Health workers told them her blood pressure was dangerously high, a warning sign of pre-eclampsia. The condition can be serious and often requires medical intervention, but the clinic lacked the equipment to assist her delivery. They urged the family to rush Nasima to the provincial hospital in Nili, three hours away.
“She died in the car before we reached the hospital,” Nasima’s sister, Noria*, 47, told us over the phone. “Both her and her baby.”
Nasima’s death was preventable. Measuring blood pressure during pregnancy is a basic prenatal check that flags risks early. But routine care is increasingly out of reach for millions of Afghan women. Health workers across the country have told us that the already fragile health system has been pushed into free fall as an existing shortage of female health workers collided with Taliban restrictions on women’s education and employment and Donald Trump’s suspension of USAID, which has halted major humanitarian health programmes and forced hundreds of clinics to close. The impact has been particularly catastrophic in Afghanistan’s rural provinces.
“We don’t have the people, we don’t have the equipment, we don’t have the space,” said one doctor at one of Afghanistan’s largest public hospitals, who spoke to us on condition of anonymity out of concern for their safety. “Our hospital has 100 beds, but we are receiving more than 200 patients a day. For one bed, we have to admit three to four patients.”
The strain is most visible in maternity wards. The doctor said their hospital handles around 90 births a day – more than double its capacity amid “a huge shortage” in the necessary equipment and personnel. They estimated that around 80 infants die in their care each month and that, on average, ten of these deaths are due to the hospital’s lack of resources.
This crisis is unfolding within a broader collapse of reproductive healthcare in Afghanistan. Access to contraception has sharply declined in recent years, clinics have closed, and poverty and malnutrition have deepened. This year, women told investigative Afghan news site Zan Times of being trapped in cycles of forced pregnancies, untreated complications and violence, unable to seek care or prevent risk. In this context, without proper prenatal care, pregnancy can become a life-threatening condition as infections, blood clots or complications such as preeclampsia escalate rapidly and lead to maternal death.
This downward spiral can be seen in the latest report from Richard Bennett, UN special rapporteur on the situation of human rights in Afghanistan, which was published in February. Health workers told Bennett that “shortages of essential medicines, combined with insufficient trained staff, inadequate facilities, weak referral systems, and a lack of women health workers, particularly in rural areas, are contributing to preventable maternal and neonatal deaths”.
The number of women working in the healthcare system has rapidly declined since the Taliban banned women from attending university in December 2022, with drastic staffing shortages already well documented even before last year’s USAID cuts.
Of the 367 specialist doctors working in government hospitals in 16 provinces, just 66 were women, according to a 2023 report by Afghan news agency Pajhwok, based on data from public health directorates. Two provinces – Nuristan and Panjshir, together home to up to 365,000 people – had no female specialist doctors at all. Pajhwok found a total shortage of at least 107 specialists across the 16 provinces, and highlighted shortages of medicines and medical equipment, with a Taliban official commenting that only 90 of Afghanistan’s 400 or so districts had district-level hospitals.
The following year, the UN’s Bennett noted that “the acute shortage of essential medical personnel – especially women health workers – has led to the systematic weakening of vital public health functions”. As a result, he said, two out of three Afghan women do not have access to reliable healthcare.
This has fatal consequences. The World Health Organization estimated that 521 mothers died for every 100,000 live births in 2023, more than double the global average. This figure was estimated to have risen to 638 deaths per 100,000 births in 2024, according to Bennett’s report. Afghan health workers say USAID cuts have since acutely worsened the situation, causing clinics to abruptly suspend operations and the annual national maternal mortality survey to be abandoned – masking the current scale of the crisis.
The United Nations Population Fund, a sexual and reproductive health agency, has warned that continued disruption to health services could lead to 1,200 additional maternal deaths by 2028.
‘If you were here, she would be alive’
Two UN Health Cluster mapping updates show how quickly Afghanistan’s healthcare system has unravelled since USAID was suspended and dismantled following an executive order by Trump in January 2025. By 27 May 2025, 422 health facilities across 30 provinces had been suspended or closed, affecting an estimated 3.08 million people. Seven months later, the number of closures had risen to 445 facilities in 33 provinces, affecting 3.79 million people.
While access to medical treatment varies between provinces, those in rural districts are the most underserved. Some 13.2 million people across 34 provinces have no primary healthcare services within a one-hour walk, according to a 2024 UNHCR analysis.
These remote areas were once heavily dependent on Mobile Health and Nutrition Teams (MHNTs), which often served as the only maternal health providers: assisting with prenatal care, deliveries and emergency referrals. But such teams are being rapidly shuttered, with 203 having closed in December last year, up from 153 in May 2025.
Twenty-seven-year-old Banafsha* was a midwife with MHNT that served 13 remote villages in Yaftal district before closing in February 2025. Each team included a female doctor, midwife, vaccinator, counsellor, social worker and a driver, all of whom travelled from the city of Faizabad to rural villages up to 90 kilometres away. They would stay overnight and treat pregnant women whose families brought them on ladders used as stretchers, or journey on horseback or on foot to particularly remote women.
Banafsha recalled a case from 2024 when a woman nearly died after her placenta remained inside her for two days. The MHNT removed it and stopped the bleeding. The woman survived. “Now they call us to say women are dying,” she said. “They tell us, ‘If you were here, she would be alive.’”
Babies are also dying as a result of the teams’ closures. In Baghlan, where 14 health centres – including 10 MHNTs – have closed, one district clinic recorded around 500 births last year; around ten newborns died after birth. In Takhar province, where five health centres, including two MHNTs, have closed, one clinic serving more than 24,000 people recorded 960 births in 2025. The clinic has no inpatient beds and only 19 staff members, including four midwives. In January 2026, two newborns died within minutes of birth due to a lack of oxygen, a source reported.
In Daikundi, the impact is visible on the ground. Until the funding stopped last year, 28-year-old Laila* worked as a midwife with a MHNT in Ashtarlay, the same district where Nasima died. Laila’s six-person team had examined up to 150 women and children a day, checking blood pressure, monitoring high-risk pregnancies and referring women before complications escalated.
“When the clinic closed, everything stopped,” she said. “Women had no one to check them.” Nasima was one of these women. Without the visits of a mobile maternal health team like Laila’s, there was nobody to spot the early warning signs of pre-eclampsia.
Closures have also affected Family Health Houses: small, community-based clinics that provide maternal, child, and reproductive health services, especially in rural and hard-to-reach areas. They are usually staffed by trained midwives and female health workers, making them vital for women who cannot easily access hospitals. In Daikundi province alone, 21 of the 24 closed facilities were Family Health Houses – making routine prenatal care inaccessible for thousands of women.
In Badakhshan, where 29 health facilities – including 17 Family Health Houses – have closed, similar patterns are emerging, compounded by mountainous terrain and limited services. Zainab*, 32 and pregnant with her fifth child, went into labour one evening in Sabzdara village. A traditional birth attendant, typically an elderly woman who has no formal medical training, tried to manage the bleeding but told Zainab’s family that she needed a doctor. There was no electricity or phone signal, and the nearest clinic, which was three hours away, lacked staff and often closed at night. By morning, they found a driver, but Zainab collapsed when they reached the clinic. With no midwife present, a male doctor was forced to attempt surgery – a sign of how desperate the situation was as men in Afghanistan do not typically intervene in childbirth except when it is very urgent. Both Zainab and her baby died.
“If there had been a clinic and a doctor that night, my wife would be alive,” her husband said.
It is a similar story in Takab district, home to around 40,000 people, where a local elder told us the district has only one clinic. Since the Taliban takeover, he said, it closes at night and lacks equipment, meaning most women give birth at home. The man said that in recent months, five women and newborns had died in Sabzdara alone.
Bennett’s report also notes that “shortages of female health workers, reduced operating hours, facility closures, and weak referral systems – especially in rural areas – limit women’s ability to seek care at all, particularly urgent services at night”.
In areas where services have not closed entirely, they are stretched far beyond capacity. Take western Herat, a province of approximately 3.7 million people, where 23 health centres have been suspended or closed. One major hospital recorded 9,600 births between March 2025 and early February 2026, including referrals from surrounding districts, according to data shared with us by a doctor from the hospital who wished to remain anonymous. During that period, the data showed, 420 newborns died – more than 4% – along with 13 mothers.
In March 2025, 23-year-old Khatera* went into labour in Gharibabad village, around six months after the local clinic shut down. The nearest maternity facility was in Herat City, which is cut off from Gharibabad by a river that is swollen for much of winter and spring. With no access to transport, her husband was forced to carry her across the raging waters, both of them submerged up to their shoulders. It took them more than 12 hours to reach the hospital; five hours later, doctors informed Khatera’s husband that both she and their baby had died of complications from a prolonged labour.
The doctor we spoke to in Herat said the province’s maternal and newborn deaths stem from reduced international aid, which has left local clinics without supplies, along with maternal malnutrition, food insecurity, limited transportation, young maternal age, delays in reaching better-equipped centres and lack of awareness about prenatal and postnatal care.
An NGO director we spoke to in Bamyan province, where only one in four women received prenatal care last year, noted that 28 nutrition sites that once provided essential supplements to pregnant women and infants were shut down after US funding cuts. A local health worker told us that poverty further compounds the crisis after birth; postnatal care often fails because mothers cannot afford the transport to follow-up visits. Families delay treatment, fearing costs.
Nationwide, the pattern is consistent: shrinking access, collapsing infrastructure and an eroding workforce. The shortage of female health workers, already severe, has deepened since the Taliban banned women from midwifery and nursing in December 2024. Clinics that rely on women staff cannot replace them. NGOs say the gap will grow for years.
The direction is unmistakable, although the exact toll remains unknown; maternal and infant deaths are not recorded in any national database. Like too many others, Nasima’s passing exists only in her family’s memory.
“When God takes our life, we die. If he doesn’t, we live,” her sister said, summing up a reality where survival now depends less on medical care than on chance.
Hamasa Haqiqatyar, Farshid Aram and Mahdi Hashemi contributed to this report.
Azada Azada, Atia FarAzar and Rad Radan are pseudonyms of three Zan Times freelance journalists.
