Afghanistan's disappearing female doctors

In a small clinic somewhere between the highlands and the southern plains of Afghanistan, a woman waits outside a locked door. She has travelled for hours, accompanied by a male relative because she is not permitted to move alone. Inside, there may or may not be a female health worker who can see her. If there isn't, she goes home. This is the daily arithmetic of a healthcare system that is running out of the one resource it cannot manufacture quickly: trained women.

Since the Taliban returned to power in 2021, restrictions on women's education and employment have tightened in stages; first universities, then secondary schools, and by December 2024 the door finally closed on medical training itself, when women were barred  from studying nursing, midwifery, pharmacy, dentistry and laboratory sciences. Roughly 17,000 female trainees were affected by that single order, according to reporting from the BBC, while a Health Ministry source cited by AFP put the number of women enrolled across medical training centres at closer to 35,000. Either figure represents a pipeline that has now been sealed shut.

Mr Nima Yaghmaei, an epidemiologist at the KIT Institute in Amsterdam who has spent years studying health information systems in fragile and conflict-affected settings including Afghanistan, argues that the conversation about this crisis has become too narrow. Most coverage, he says, treats the ban as a maternal health story, and understandably so, since Afghanistan already has one of the highest maternal mortality rates on the planet, estimated at 521 deaths per 100,000 live births in 2023, among the worst outside sub-Saharan Africa. But Mr Yaghmaei points out that half the population is female, and women suffer from the same infectious diseases and non-communicable conditions as men. Cutting off the training of female clinicians is not only a maternal health issue, it is a broader crisis of who is allowed to deliver care to half the country at all.

There is also a quieter, slower catastrophe building beneath the headlines, one that Mr Yaghmaei describes as a hollowing out of institutional memory. Even if restrictions were lifted tomorrow, he notes, there would be an entire missing cohort of women who never trained, never apprenticed under senior clinicians, and never absorbed the accumulated clinical judgment that only comes from years on the ward. Senior female specialists are retiring or leaving the country, and there is no generation behind them to inherit what they know. That kind of expertise, once lost, cannot simply be reinstated by policy reversal. It has to be rebuilt from scratch, one training cohort at a time, over a decade or more.

The damage, however, is not distributed evenly across the country. Afghanistan is often discussed as though it were a single healthcare market, but the United Nations recognises roughly 8 distinct ethnolinguistic regions within it, with at least 3 carrying entirely different languages, customs and social structures. The southern and southeastern provinces consistently rank at the very bottom of national health indicators, including vaccination coverage. The pattern is largely a demand-side one, reflected across a range of documented data points: how much autonomy women in a given region have to seek care in the first place, how early they marry, how many children they have, rates of vaccine hesitancy, and whether a community health worker, who is very often a woman, is present to act as the bridge between a family and a clinic.

That bridge is now at risk of disappearing. On the numbers, Afghanistan has not historically lacked interest in midwifery training. The workforce study behind these figures was conducted jointly by Mr Yaghmaei and Dr Narges, his co-technical lead on the project from the World Health Organization, and found that enrolment in midwifery programmes ran somewhere between 10,000 and 20,000 women a year, yet the country ended up with only around 6,000 midwives working in the public system and roughly 1,500 in the private sector, an enormous gap between how many women trained and how many ended up practising. Part of the explanation, he suggests, is cultural rather than political: many Afghan women stop working once they marry, and paid midwifery positions are scarce to begin with, so even before the current bans, the system was leaking talent it had already invested in training.

The economic dimension of this crisis rarely makes it into the health reporting at all. Restricting girls from secondary education alone is estimated to have already cost the Afghan economy at least half a billion dollars in a single year. Layer onto that the unpaid care work that falls to Afghan women, who absorb the burden of nursing sick relatives at home with no access to paid sick leave, and the picture becomes one of a national economy quietly subsidised by women's uncompensated labour, even as those same women are priced out of formal healthcare through overwhelmingly out-of-pocket payment systems. International funding covers, on average, less than twenty dollars of health spending per Afghan citizen, and with shifting geopolitical priorities reducing the resources major donors are willing to commit, that figure is unlikely to rise.

What emerges from speaking with someone who has spent years inside this data is not a single crisis but a compounding one: an education ban that becomes a workforce shortage, a workforce shortage that becomes a quality-of-care collapse, and a quality-of-care collapse that will outlast any single policy for a generation to come.

Further information and opportunities to engage with organisations working in this area are listed below:
Women for Afghan Women
Afghanistan | Our Work & How to Help | Doctors Without Borders
Afghanistan: Humanitarian Aid, Healthcare and Emergency Relief

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