*Note: this entry started out as a piece highlighting Endometriosis care and support in Afghanistan. It has since morphed into health care, in general, for women in Afghanistan. And my heart breaks. This is not a political piece about religion, tradition, the war, or it’s casualties. I’ve known my fair share of military men and women who were shipped off to Afghanistan; some who didn’t make it back alive…but I won’t let their experiences or deaths color my opinion of this entry.*
I have a few readers from Afghanistan, and today want to focus on the treatment and support available to Afghan women in their home country (hopefully focusing on Endometriosis facts and stats). As you likely know, the country of Afghanistan is a war-torn one, scarred by decades of combat.
Afghanistan is located in Southern Asia, bordered by China, Pakistan and Iran (to name a few). It’s slightly smaller than the state of Texas with 31,000,000 people and the capital of Kabul is home to 4.6 million of those people! According to the CIA, the living standards of the Afghanistan people are among the lowest in the world. It may be due, in part, to the economic and infrastructure instability caused by war and terrorist repression. A staggering 36% of the population lives beneath the poverty line.
During the rule of the Taliban (which fell in 2001), girls and women were not allowed to pursue an education, work outside of their homes, or seek health care. Women were also forbidden from going into public without a male family member escorting them; a task which, for some, was impossible due to the casualties of war. Hospitals were segregated by sex; the only hospital in Kabul where women were permitted to work housed just 35 beds. Additionally, male healthcare workers were not permitted to “[lift] women’s burqas, touching women except through their clothing, or looking at women’s bodies.” Since women were no longer able to be educated, that meant no more females learning healthcare practices. This educational embargo has impacted, and will continue to impact, the future of Afghanistan’s healthcare system for years to come. America’s war in Afghanistan was officially ended in 2014; however, troops still remain to assist in the protection and rebuilding of the country. Although the fighting is still ongoing in many areas, the people (and women) of Afghanistan are slowly rebuilding their educational and professional presence, as well as their lives.
In 2002, it was estimated that there was 1 doctor per every 50,000 Afghan people…and Afghanistan has been labeled the worst country for healthcare for women. It’s estimated that 500,000 Afghan women die each year during childbirth, and it is the leading cause of death of childbearing-aged women in Afghanistan. Why? A lack of available medical resources, understanding, staff, and education.That being said; however, I cannot purely blame the Taliban for the lack of healthcare available to the women of Afghanistan. In 2007, six years after the fall of the Taliban, a man in Southwestern Afghanistan told a reporter that he refused to bring his wife to a male doctor, even if she was dying, purely because it went against his traditions. And how many female doctors worked in the province where he and his wife lived? Zero…
With many poor health services, the average lifespan of an Afghan woman is only 52 years. Fifty-two. Courtney Pendray summed it up perfectly in her paper about Afghanistan healthcare, “[a]s women’s health is essential to the health and productivity of future generations of our country, it is essential that we address this issue immediately.”
There are some theories out there that the women of third world countries, especially South Vietnam and Afghanistan, have a lower occurrence of Endometriosis. This may be, in part, because of the lack of resources to receive a formal diagnosis. An article featured in the Manchester Evening News stated that many women in Asian countries are afraid to seek help due to cultural reasons; that the birth control treatments may lead people to assume these women are sexually active or how internal examinations may jeopardize their proof of virginity. Not to mention the cultural stigmas and traditional beliefs that we’ve read about already today.
Organizations, such as the Abbott Fund, the Afghan Institute of Learning, the Bayat Foundation, the Fistula Foundation, Health Policy Project, USAID, and Women for Women International are working to improve health care available to women and children in Afghanistan. A study published in 2014 noted that no amount of funding provided will succeed to improve the lives of women unless there was a full understanding of the cultural and social contexts of a given culture. This will include the stigmas, traditions, and belief systems of the people and professionals in Afghanistan. It also noted that the health care providers face high workloads and are at risk of facing humiliation, blame, and loss of employment; threats which may subdue their motivation to provide satisfactory health care. Even with the progress already made with healthcare in Afghanistan, many women are still afraid to seek treatment.
However, there is hope. A 2016 article published in The Hill states that now 65% of Afghans have access to basic healthcare (compared to 8% during the Taliban’s rule), 40% of school children are now female, and of the 75,000 people now attending universities, 35% are women! Education of the generations will hopefully help the people obtain more readily available and better health care.
What started as a research project to find facts and treatments for Endo and Afghan people has turned into something far darker. Although Endometriosis is a very painful and incurable condition, I am humbled by the plight of these women. My health issues are nothing compared to theirs.
You may also remember seeing the image of “The Afghan Girl” featured on the cover of National Geographic Magazine in 1985. The photographer located her 17 years later and shares her story. I may have painted a bleak image of Afghanistan for women…but I do want you to know that some women embrace the culture and their lives there. Please read her story here.
Central Intelligence Agency – The World Factbook : Afghanistan
Global Post – (2012; Article) Afghan Women Largely Lack Healthcare, Education
IRIN – (2009; Article) Little Health Care for Women in Paktika Province
Living with Endometriosis – Myths about Endometriosis
Management Sciences for Health – (2015, Article) Good Governance Improves Women’s Health in Afghanistan : One Village’s Story
Manchester Evening News – (2010; Article) Asian Women Less Likely to Seek Treatment for Endometriosis
National Geographic – (2002; Article) A Life Revealed
NIH Record – (2003; Article) NIH Hosts Women Instructors from Afghanistan
Obstetrics & Gynaecology – (2014; Article) Understanding Afghan Healthcare Providers : a Qualitative Study of the Culture of Care in a Kabul Maternity Hospital
PBS – (2002; Article) Afghanistan’s Health Crisis
Taboo Memories, Diasporic Voices – excerpt (2006) regarding a lack of Endometriosis in Afghanistan and South Vietnamese women
The Hill – (2016; Article) Afghan Women Need the Support of US Forces Now More Than Ever
UNICEF – (2003; Article) Afghanistan is Among Worst Places on Globe for Women’s Health, say UNICEF and CDC
United States Institute of Peace – The Current Situation in Afghanistan
USAID – Afghanistan : Health
Washington College of Law; American University – The Health Care Crisis Facing Women Under Taliban Rule in Afghanistan
World Health Organization – Humanitarian Health Action Afghanistan
~ Again, I am a layman. I do not hold any college degrees, nor mastery of knowledge. Please take what I say with a grain of salt. If curious, do your own research Validate my writings. Or challenge them. And ALWAYS feel free to consult with your physician. Always. Yours ~ Lisa