BBC investigates Afghan maternal deaths after US support cuts

When Shahnaz went into labour, her husband Abdul referred to as a taxi to take them to the one medical facility accessible to them.

“She was in loads ache,” he says.

A 20-minute drive away, the clinic was in Shesh Pol village in Afghanistan’s north-eastern Badakhshan province. It was the place their two older kids had been born.

Abdul sat subsequent to Shahnaz comforting her as they drove over gravel tracks to achieve assist.

“However after we reached the clinic, we noticed that it was closed. I did not realize it had shut down,” he stated, his face crumpling with agony.

Warning: Readers could discover some particulars on this article distressing.

The clinic in Shesh Pol is one in every of greater than 400 medical services that closed down in Afghanistan, one of many world’s poorest nations, after the Trump administration minimize almost all US support to the nation earlier this yr, in a drastic and abrupt transfer following the dismantling of the US Company for Worldwide Improvement (USAID).

A single-storey construction with 4 small rooms, white paint peeling off its partitions, the Shesh Pol clinic has USAID posters tacked up in every single place with data and steerage for pregnant ladies and new moms.

It does not appear to be a lot however in Badakhshan’s mountainous, unforgiving terrain, the place an absence of entry has been a serious cause for traditionally excessive maternal mortality charges, the clinic was a crucial lifeline, a part of a wider programme carried out through the tenure of the US-backed authorities within the nation, to scale back maternal and new child deaths.

It had a skilled midwife who assisted round 25-30 deliveries each month. It had a inventory of medicines and injections, and it additionally offered fundamental healthcare providers.

Different medical services are just too removed from Abdul’s village, and it was not with out danger for Shahnaz to journey on bumpy roads. Abdul additionally did not have cash to pay for an extended journey – renting the taxi price 1,000 Afghani ($14.65; £12.70), roughly 1 / 4 of his month-to-month revenue as a labourer. In order that they determined to return dwelling.

“However the child was coming and we needed to cease by the aspect of the street,” Abdul stated.

Shahnaz delivered their child woman within the automobile. Shortly after, she died, bleeding profusely. A number of hours later, earlier than she might be named, their child additionally died.

“I wept and screamed. My spouse and youngster may’ve been saved if the clinic was open,” stated Abdul. “We had a tough life, however we had been dwelling it collectively. I used to be all the time joyful after I was along with her.”

He does not also have a photograph of Shahnaz to carry on to.

There is no certainty the mom and child would’ve survived in the event that they’d been handled on the clinic, however with out it, they did not stand an opportunity, underlining the plain impression of US support cuts in Afghanistan.

For many years, America has been the most important donor to Afghanistan, and in 2024, US funds made up a staggering 43% of all support coming into the nation.

The Trump administration has justified withdrawing it, saying there have been “credible and longstanding considerations that funding was benefiting terrorist teams, together with… the Taliban”, who govern the nation. The US authorities additional added that that they had reviews stating that at the very least $11m had been “being siphoned or enriching the Taliban”.

The report that the US State Division referenced was made by the Particular Inspector Basic for Afghanistan Reconstruction (SIGAR). It stated that $10.9m of US taxpayer cash had been paid to the Taliban-controlled authorities by companions of USAID in “taxes, charges, duties, or utilities”.

The Taliban authorities denies that support cash was going into their arms.

“This allegation will not be true. The help is given to the UN, and thru them to NGOs in provinces. They determine who wants the help, and so they distribute it themselves. The federal government will not be concerned,” stated Suhail Shaheen, the top of the Taliban’s political workplace in Doha.

The Taliban authorities’s insurance policies, particularly its restrictions on ladies, the harshest on the earth, have meant that after 4 years in energy, it’s nonetheless not recognised by many of the world. It is also a key cause donors have been more and more strolling away from the nation.

The US insists nobody has died due to support cuts. Shahnaz and her child’s deaths aren’t recorded anyplace. Neither are numerous others.

The BBC has documented at the very least half a dozen first-hand, devastating accounts in areas the place USAID-supported clinics have shut down.

Proper subsequent to Shahnaz’s grave, villagers who had gathered round us pointed to 2 different graves. They informed us each had been of ladies who died in childbirth up to now 4 months – Daulat Begi and Javhar. Their infants survived.

Not removed from the graveyard, we met Khan Mohammad whose spouse, 36-year-old Gul Jan, died in childbirth 5 months in the past. Their child boy Safiullah died three days later.

“When she grew to become pregnant, she would go to the clinic for check-ups. However halfway by her being pregnant it shut down. Through the supply she had lots of ache and blood loss,” Khan Mohammad stated. “My kids are unhappy on a regular basis. Nobody can provide them the love of a mom. I miss her on daily basis. We had a candy and loving life collectively.”

A roughly five-hour drive from Shesh Pol, in Cawgani, one other village the place a USAID-backed clinic closed down, Ahmad Khan, the grief-stricken father of Maidamo confirmed us the room of their mud and clay dwelling the place she died giving beginning to child Karima.

“If the clinic had been open, she might need survived. And even when she had died, we might not have had regrets realizing the medics tried their finest. Now we’re left with remorse and ache. America did this to us,” he stated, tears rolling down his face.

In one other dwelling a number of lanes away, Bahisa tells us how terrifying it was to provide beginning at dwelling. Her three different kids had been born within the Cawgani clinic.

“I used to be so scared. Within the clinic, we had a midwife, medicines and injections. At dwelling I had nothing, no painkillers. It was insufferable ache. I felt like life was leaving my physique. I grew to become numb,” she stated.

Her child woman, named Fakiha, died three days after she was born.

The closure of clinics in villages has resulted in a surge of sufferers on the maternity ward of the primary regional hospital within the provincial capital Faizabad.

Attending to it, by Badakhshan’s treacherous panorama is dangerous. We had been proven a horrifying photograph of a new child child, who was delivered on the way in which to Faizabad, and whose neck snapped earlier than he bought to the hospital.

We had visited the hospital again in 2022, and whereas it was stretched then, the scenes we noticed this time had been unprecedented.

In every mattress, there have been three ladies. Think about having gone into labour, or simply having gone by a miscarriage, and never even having a mattress to your self to lie in.

It is what Zuhra Shewan, who suffered a miscarriage, needed to endure.

“I used to be bleeding severely and did not also have a place to take a seat. It was actually onerous. By the point a mattress is free, a lady may die bleeding,” she stated.

Dr Shafiq Hamdard, the director of the hospital, stated: “Now we have 120 beds within the hospital. Now we have admitted 300 to 305.”

Whereas the affected person load is swelling, the hospital, too, has confronted sharp cuts in its funding.

“Three years in the past our annual finances was $80,000. Now we’ve got $25,000,” Dr Hamdard stated.

By August this yr, there had been as many maternal deaths recorded as there have been for the entire of final yr. Which signifies that at this fee, maternal mortality may improve by as a lot as 50% over final yr.

New child deaths have already elevated by roughly a 3rd up to now 4 months, in contrast with the beginning of the yr.

Razia Hanifi, the hospital’s head midwife, says she’s exhausted. “I’ve been working for the previous 20 years. This yr is the hardest, due to the overcrowding, the scarcity of assets and the scarcity of skilled workers,” she stated.

However no reinforcements are coming due to the Taliban authorities’s restrictions on ladies. Three years in the past, all greater training, together with medical training was banned for ladies. Lower than a yr in the past, in December 2024, coaching for midwives and feminine nurses was additionally banned.

At a discreet location, we met two feminine college students who had been halfway by the coaching when it was closed. They did not need to be recognized for concern of reprisal.

Anya (identify modified) stated they each had been in graduate programs at college when the Taliban took over. When these had been closed in December 2022, they started midwife and nursing coaching, because it was the one path left to getting an training and a job.

“When that was additionally banned, I grew to become depressed. I used to be crying day and night time, and I wasn’t capable of eat. It is a painful state of affairs,” she stated.

Karishma (named modified) stated: “There may be already a scarcity of midwives and nurses in Afghanistan. With out extra being skilled, ladies will probably be pressured to provide beginning at dwelling which is able to put them in danger.”

We requested the Taliban authorities’s Suhail Shaheen how they will justify bans which successfully curb entry to well being for half the inhabitants.

“It’s our inner subject. These are our points, the way to deal with them, the way to contemplate them, the way to take selections, that is one thing inner. That’s as much as the management. Based mostly on the wants of the society, they are going to take a call,” he stated.

With their entry to medical providers severely restricted, by wave after wave of crushing blows, for Afghanistan’s ladies, their proper to well being, and life itself, is at grave danger.

Further reporting, images and video: Aakriti Thapar, Mahfouz Zubaide, Sanjay Ganguly

Prime picture reveals Abdul along with his daughter and son in Shesh Pol.