Finding ways to help women to get access to healthcare in Afghanistan

Afghanistan is one of the countries where mortality rates among mothers and children are among the highest in the world. Première Urgence Internationale has been working in the country since 1979 to improve the population’s health care, and in particular women’s health in Afghanistan. To achieve this, projects must take local culture into account.


They call him the mahram. He is a man who is trusted within a family. He can be a father, a brother or a father-in-law. He accompanies one or more women in the family on every trip they make. Without the mahram, it is impossible for them to leave the village, and even to go to a health centre. These women’s schedules are intimately linked to his. ‘In the areas where we work, in Nangarhar and Kunar, women are not the only ones that decide if they want to go out,’ said Catherine Goudouneix, assistant to the Afghanistan mission leader.  ‘There are many challenges when it comes to access to healthcare for women in this country. We are developing specific projects so that they can be looked after by specialists, and so they do not have to stay at home with inadequate care.’

In these Afghan provinces, if a woman goes to hospital, she will only be cared for by female staff. ‘Male doctors sometimes check female patients’ blood pressure, but nothing more.’


On Monday, a mobile clinic managed by Première Urgence Internationale, composed of doctors, a nurse and a midwife, is setting up for the day in a village in the Kama district of Nangarhar province. The team sets up the tent and screens and check, before consultations begin, that there is nothing can be seen from the outside, while ensuring it is light enough for consultations to be carried out. Shortly after everything is set up, a small group of women heads towards the tent. ‘Our mobile clinics visit the villages. On the whole, women can move around in the streets of their own village in a group.’ This means that the mahram can be bypassed. It is obviously difficult sometimes to talk about certain health concerns with a brother or father-in-law.


Mobile clinics also mean that financial obstacles can be overcome. Patients sometimes go to health centres by taxi. The fare for the trip spirals quickly. While the driver is waiting near the hospital, the meter keeps running. Première Urgence Internationale is currently developing a compensation system. It covers the transport costs for women going to hospital to give birth.


In the province of Kunar, next to some health centres, homes are being kept by for female medical staff. ‘We are offering accommodation to midwives to ensure patient care 24 hours a day.’ The health centre is actually only open for eight hours a day. In an emergency, staff need to be called as quickly as possible. Finding female medical staff at any time of the day and night is almost ‘mission impossible’. ‘With this system, you can knock on the midwife’s door at 23:00 if there is an emergency.’


To further complicate the situation, t19he midwife herself must be accompanied by a mahram. ‘We have to inflate wages a little for female medical staff to compensate the mahram who needs to accompany them all day.’ Recruitment of women is not easy. As Catherine concludes when she talks about health care access for women in Afghanistan, ‘We have to be creative.’

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