Health implications of Afghanistan’s women’s rights roll back

As women’s rights and empowerment are rolled back across Afghanistan, there is good reason for health leaders to be concerned. Exemplars in Global Health research, and my own research across Afghanistan, adds to the significant body of evidence demonstrating the critical role of women’s empowerment as a driver of improved health outcomes.

From Bangladesh’s reduction in under-five mortality, to Peru’s reduction in stunting, women’s empowerment has helped Exemplar countries expedite progress toward their health goals.

In Afghanistan, over the past 20 years, women’s increasing empowerment has played an outsized role in the country’s modest health improvements. As women’s rights and roles in society are under question across Afghanistan, it is important to recognize the multitude of ways this will likely reverse the hard-won health gains over the past decades.

While there are a variety of ways to measure women’s empowerment. Below, I’ll walk through three key aspects of women’s empowerment: financial autonomy, education, and social autonomy and connect them to health outcomes.

Let’s take financial autonomy first. If women have money at their disposal, they can purchase the goods and services needed to protect their own health and the health of their family. From nutritious foods and soap for handwashing to a taxi ride to the nearest health clinic, health-boosting goods and services are more accessible to women with financial autonomy. Research indicates that women are more likely than men to spend the resources at their disposal to support the health and education of their children.

In one interesting study in Benin, for example, women who were financially dependent on their husbands said they were unable to purchase an insecticide treated bed net for themselves or their children unless their husband prioritized the use of bed nets. The study found that when women did earn an income and had control over this income, they were much more likely than men to purchase an insecticide treated bed net.

Recognizing women’s role as household health promoter and protector, many health leaders around the world have sought to strengthen women’s financial autonomy through conditional cash transfer programs (such as in Brazil, Mexico, and Peru). These programs typically provide mothers with income they can use to support improved family nutrition. The programs have helped improve nutrition and, in the case of Peru, were a key driver of reducing the country’s high childhood stunting rates.

Women’s education is another key determinant of women’s empowerment. Women need to know about nutritious foods and know how to keep themselves and their family safe and healthy. Primary and secondary education is critical, but so too is counseling on nutrition and family planning. Each of these enables women to make informed health and nutrition decisions.

But the impact on health extends far beyond the knowledge girls gain in the classroom. Research demonstrates that keeping girls in school is one of the most powerful tools for reducing child marriage and teen pregnancy – both of which contribute, not only to the violation of girls’ fundamental rights, but also harms her health and the health of her children. Global research on this has been unequivocal, older mothers are typically healthier and better positioned to care for their children and advocate for their own and their children’s needs. As Exemplars research in Peru found, when women delay childbearing and avoid adolescent pregnancy, they can fully grow, protect their own health, and meet their own nutrient needs – benefiting their own health and that of their future children. Exemplars News has previously written about how improvements in girls’ education helped drive stunting reductions in Ethiopia, Nepal, Peru, and Senegal.

Despite progress on reducing adolescent pregnancy in Afghanistan over the past 20 years, about one-third of all pregnancies in Afghanistan still occur in adolescence. Data shows that these teen mothers are shorter, and more underweight than older mothers (between the ages of 20-49). As the Taliban curb girls’ education across the country, we will likely see an increase in child marriage, adolescent pregnancy, and consequently, an increase in child and maternal undernutrition.

Lastly, let’s tackle the fascinating pathways through which social autonomy can also influence health. On the most basic level, we need to recognize that men are not always in the household. They're out in the fields, they're working, they're sometimes gone for 16 hours a day, so women are often at home by themselves. Studies have shown that when women feel empowered to make healthcare decisions, benefits include long-term reduction in fertility, higher child survival rates, and more household resources allocated to support children’s health and education.

It is difficult to overstate the importance of improving women’s social autonomy not just in Afghanistan, but around the world. Consider a recent study from Senegal that found that only six percent of women had decision-making autonomy in relation to their own health. For 80 percent of the surveyed women, their husbands/partners made health-related decisions for them. Unfortunately, this is not unusual in low- and middle-income countries and contributes to the roughly 300,000 women who die in pregnancy or childbirth each year.

Afghanistan, yet again, is undergoing a historic political transition and the role and rights of girls and women are particularly vulnerable during this shift. It is important for the global community including donors, civil society, and advocacy groups to diligently work with the new government to ensure, at minimum, that girl’s and women’s education is protected at all costs. The Islamic Emirate’s new government frequently cites Islamic ideology as their fundamental basis for deciding on women’s roles in society – it would be prudent for the global community to draw on lessons from Muslim majority countries (and there are many success stories here include Bangladesh’s success reducing under-five mortality and establishing its high-performing community health worker program and Senegal’s success reducing under-five mortality and stunting) that have managed to maintain religiosity while at the same time also improve women’s empowerment. Afghanistan can learn much from these exemplar stories.