In Rural Afghanistan, Childbirth Often Means Death, Not Life

This article is co-published with Rukhshana Media.

When labor pains begin, no ambulance is on the way, and no doctor is waiting at the door. The only companions a woman has are her cries and the trembling hands of an elderly grandmother. This is the reality for many pregnant women in the Kuran wa Munjan district of Badakhshan province during childbirth.

Gulnisa, a 28-year-old mother of three from the Pas-Kuran region of Badakhshan, lost her fourth child during childbirth in January. With no nearby medical care, she was taken to the nearest clinic along unkempt roads by donkey after a long and agonizing night. She nearly died from the procedure herself. By morning, it was too late for her newborn.

“We called an old woman from the village to help, but the baby suffocated before birth,” Gulnisa’s sister told More to Her Story. “The road is so bad, and we had no transport. Even if we did, it costs 2,000 to 3,000 Afghanis ($28–42),” she said, adding that it’s a cost many families in the region simply cannot afford.

Gulnisa is a mother of three. Her sister, who lives in Faizabad, told More to Her Story that Gulnisa's fourth child died from suffocation during childbirth:

“At night, when her labor pains began, they called for a woman in the village who had spent her life helping women give birth and had delivered many babies there,” she said. 

“But the baby died before it could be born. She endured a very difficult delivery, and by morning, they took her to the clinic on a donkey. The roads are in terrible condition, and there is no regular transportation. 

Mahgul, who was expecting her first child, died from severe bleeding on her way to the clinic in Kuran wa Munjan. She was traveling by donkey to give birth, but in March 2024, she passed away along the route before reaching help, and her baby didn’t survive either.

“We have no clinic, no medicine, no treatment, no doctor, and the roads are destroyed. My sister is not the first woman to die during childbirth — many women have lost their lives the same way,” Ahmad Shah, Mahgul’s brother, said.

Afghanistan has one of the highest maternal mortality rates in the world and the highest overall in Asia, with 620 deaths per 100,000 births. This is especially true for mothers in remote and mountainous regions of the country, where around 71 percent of Afghans live. This is in part due to an ongoing and severe lack of access to healthcare in remote and mountainous regions, which claims more women’s lives than in urban areas.

According to a United Nations report, Afghanistan has the highest maternal mortality rate in Asia, with 638 mothers dying for every 100,000 live births.

Mahbegum, a 28-year-old teacher from Aywim in Kuran wa Munjan, said that the situation in their village is catastrophic.

“Women here face many problems, especially pregnant women. For example, when they fall ill, they often self-medicate,” she said. 

“Pregnant women face numerous challenges,” said Mahbegum, a 28-year-old teacher from Aywim in Kuran wa Munjan, adding that many rural regions do not readily have access to doctors or medical support, forcing many to lean on self-medication or self-directed births. “Just this March, two women from our village lost their babies during childbirth because they had common ailments like headaches or body pain.” 

“They took whatever medicine was available at home or from neighbors, hoping it would help them recover,” she said, adding that in her area alone, more than ten newborns and four to five mothers lost their lives during childbirth last year.

“This is the number I’ve witnessed, and it could be even higher. Since the distance between villages is as great as a day’s journey, making it hard to accurately discern the spread of news about local births and deaths. “It has become a norm for births to go wrong, or for babies to die,” she said.

Nearly a month ago, Afghanistan’s Tolonews also reported, citing local sources, that in the year 1403 (2024–2025), at least 20 women had died during childbirth in just one village of Kuran wa Munjan district.

Abdulhad, a 24-year-old resident of the Pas-Kuran council in Kuran wa Munjan district, stated that due to the long distances and limited access to healthcare, most women give birth at home.

“We don’t have any health center, and if someone gets sick, we’re forced to walk two to four hours just to reach the clinic in the district,” he said. 

“People can’t afford to travel to the district center for childbirth, so most deliveries happen at home, traditionally. The cost of traveling from our village to the district center is between 2,500 to 3,000 Afghanis, and people here don’t have that kind of money.”

Homaira, a 32-year-old mother of one, said maternal deaths in their village have become the new norm. 

During childbirth, mothers often suffer heavy bleeding, and sometimes the placenta doesn’t come out until four or five days later, causing serious complications. Just last month, one of our relatives gave birth—her baby was born alive but died just a few minutes later,” she said. “Women rely only on God, hoping for the best.”

She said in just the past two months, one mother in Pas-Kuran and another in Shah-Pari village died during childbirth.

Janki, a 25-year-old resident of Kuran wa Munjan, echoes the same concern.

“Women in Kuran wa Munjan have no access to healthcare services, and 80 percent of them give birth at home,” she said. 

She also shared what she witnessed herself.

“Wazir Begum was 28 years old and one of our neighbors. Just a month ago, when her labor pains began, her condition quickly worsened and she started bleeding heavily,” she said. 

“Her husband decided to take her to the clinic, but on the way, before they could even reach the clinic, both she and her baby passed away.”

A doctor at the Badakhshan Provincial Hospital, who requested anonymity, told More to Her Story that the patients in her district are extremely poor and often do not come to her hospital unless their condition becomes critical.

Only when they realize the patient might die do they consider making the journey. These people are struggling just to afford a piece of bread,” she said.

In Kuran wa Munjan, childbirth has not always marked the beginning of life, but often its end. Women, with no hospital or doctor in sight, place their trust in chance, facing each birth not with hope, but with fear, unsure whether it will bring life or take it away.