In Nimruz province located in southwestern Afghanistan, 17-year-old Shazia was at full term in her pregnancy when she died on the way to the hospital in the capital, Zaranj. Her mother, Zarmina, weeps every day as she looks at a photo of her newlywed daughter. In the image, Shazia is still a child, smiling and vibrant amid a grove of trees.
“When her labour pains began, her husband ran in every direction to find a vehicle, but there was nothing. Eventually, they took her cousin’s car and we set off for Zaranj,” her mother tells Zan Times. “My daughter died before my eyes within two hours.”
In Nimruz, there are now so few health centres that women must spend hours on rough mountain or desert roads. There are no ambulances, so pregnant women travel on foot, on animals, or in rudimentary vehicles to reach clinics. Often they arrive too late, like Shazia.
“Amid pain and blood, she gave birth in the car. Then she lost consciousness. When we reached the hospital, the doctors tried everything: injections, ice packs, and blood transfusions. It was too late,” her mother recounts. “My daughter was buried with a world of dreams. Zarmina’s grandchild survived only one day with the help of an oxygen machine before also dying.”
The sharp decline in international aid, including this year’s slashed funding from the United States, has pushed Afghanistan’s health sector to the breaking point. In recent months, more than 60 percent of rural clinics in Nimruz province have either shut down completely or are operating without midwives, doctors, or essential medicines. The inevitable and tragic result of such funding cuts is a soaring number of maternal and newborn deaths. At least 10 women and 25 newborns died on their way from rural districts to Zaranj hospital in 2024, according to statistics from the local public health department.
“Women who die in villages go unreported. The government has no data, and neither do international agencies,” explains a doctor in Nimruz, who asked not to be identified. “Just in our provincial hospital last year, we saw at least 10 maternal deaths that were never registered anywhere. So imagine the situation in the districts.”
Last winter, 18-year-old Zainab, already a mother of one, went into labour in the village of Mowlana. It was midnight, so her husband Abdullah used the flashlight of his mobile phone to try to find transportation in the dark. Before they could get halfway to the hospital, Zainab took her final breaths in his arms. “If there had been a doctor in our village, my wife would still be alive,” says Abdullah, his voice choking with grief. “We have a clinic but no doctor. And if there is a doctor, there’s no medicine. We are poor people. The government doesn’t care about villages like ours.”
Zainab’s death and that of her baby are an example of the thousands of preventable tragedies occurring across Afghanistan because so many parts of the nation lack accessible basic healthcare services. Many of the clinics that have closed recently were funded by international aid. Now, as countries are pulling back from the help that they offer Afghanistan, the impact of such decisions in governments thousands of kilometres away are being felt in the rural towns and villages of Nimruz and other provinces.
Halima believes her 20-year-old sister, Monessa, died in childbirth because they lived in the Chakhansur district in the heart of Nimruz. Their local clinic “had only one midwife, no medicine, no equipment. She couldn’t handle the delivery,” explains Halima. “On the fifth day, in her final breaths, Monessa asked to be taken to the city hospital. The baby was born there, but my sister’s heavy bleeding took her life.” Her baby, Yasin, is now two months old.
According to the best available UN estimates, Afghanistan has one of the highest maternal mortality rates in the world. For every 100,000 live births, approximately 620 women die most of them in rural areas, due simply to a lack of basic care. Experts consulted by Zan Times believe the death toll has grown significantly since the Taliban returned in 2021 and made it increasingly difficult for international aid agencies to operate in Afghanistan, including forbidding Afghan women from working for foreign NGOs.
Dr. Susan, an obstetrician-gynecologist, who has worked in Afghanistan for years, tells Zan Times: “Since the Taliban came to power, the state of healthcare services for women has become drastically worse. If aid organizations had continued their support, if midwives hadn’t been dismissed, if there had just been one full-time midwife in each district, we wouldn’t be witnessing this many deaths. Now, even if there is a clinic, it either lacks medicine, doesn’t have a doctor, or has just one midwife who works only until 4 p.m. At night, if a woman goes into labour, there’s no one to help her and she is sentenced to death. These deaths have become normal. No one is shocked anymore. And that, that is the most terrifying part of all.”
Nadima, an experienced midwife in Nimruz, shares harrowing stories of mothers who die but whose deaths aren’t recorded in official statistics: “Once, a baby was brought in who had suffocated during birth and was struggling to breathe. When we asked where the mother was, they said she had delivered at home and died. Fearing the baby wouldn’t survive either, they rushed him here. He spent five days on oxygen before finally stabilizing.”
Fatema is a determined and tireless midwife who works every day to save women’s lives in the district of Chahar Burjak in southern Nimruz. She is 27 and has worked in both Zaranj city and outlying districts for the past five years. “We work with the bare minimum. Sometimes we don’t even have gloves or paracetamol,” she says to Zan Times. “No mother should die giving birth. These deaths are preventable if only there were training and support, if only we had the resources.”
She celebrates when a birth is successful, such as Safia, the baby girl she had safely delivered before talking to Zan Times. With every healthy birth or mother saved, Fatema hopes for the day when death is no longer the destiny of Afghan mothers.
Names have been changed to protect the identity of the interviewees and writer. Hamasa Haqiqatyar is pen name of a freelance journalist and a Zan Times mentee in Afghanistan.
