Afghanistan: "Honour" Rules Deny Care to Mothers and Babies

Bibi Afghan has given birth 11 times, but not once in a hospital. The 35-year-old, from the Sayed Khel district of Parwan province north of Kabul, said that on each occasion, she went through labour at home with no medical care.

“Men here consider it shameful to take their women to hospital to give birth,” she said.

Bibi Afghan explained that doing so would be seen a loss of a man’s “ghairat”, meaning “honour”.

Many men here refuse to allow their wives to seek antenatal care for fear that this could damage their personal standing. One factor seems to be the possibility of women coming into contact with male medical staff.

“Women and children are sacrificed for the meaningless honour of these men,” Bibi Afghan said.

Four of her babies died during childbirth, she said, and women often did not survive traumatic deliveries.

“Two years ago, my cousin’s wife was in a bad way during labour, and she should have been taken to hospital, but my cousin wouldn’t allow that. So that woman, aged 30, died before our very eyes,” she said.

The maternal mortality rate has fallen significantly since the overthrow of the Taleban regime.  Official statistics from 2000 showed that 1,600 out of 100,000 women died during childbirth. By 2013, Afghanistan’s health ministry found that the figure had fallen to 327 deaths per 100,000 births.

Despite these advances, Afghanistan still has one of the highest rates of maternal death in the world.

Parwan is one of the securest provinces in Afghanistan. But although officials and civil society groups have made efforts to increase women’s access to healthcare, old prejudices persist. Health workers say conservative views on “shame” and “honour” contribute materially to the high mortality rate.

Mohammad Qasim Saidi, head of Parwan’s department of health, says attitudes are changing, but estimates that around a third of men living in more remote parts of the province refuse to let their wives go to hospital to give birth.

“Although we don’t have any accurate statistics, I can state that thousands of women in Parwan province have died in the past ten years for reasons that include being denial of medical care during childbirth,” he told IWPR. This was particularly worrying, he said, given that there were now 70 health centres functioning across the province.

Like Bibi Afghan, Hosai, 24, lives in the Sayed Khel district. There is a clinic right next to her house, yet she says her husband has never allowed her to visit it.

“It’s true that life and death are in the hands of God, but in Afghanistan, life and death are in the hands of men,” she said. “I am pregnant right now and I’m sick and I’m spending whole days in pain, But my husband won’t allow me to go to the clinic, because of ‘ghairat’,” she said. “I don’t see the difference between ‘ghairat’ and ignorance.”

Nadira Giyah, head of Parwan’s department of women’s affairs, said her office did its best to let the authorities and the media know of cases in which women died as a result of being denied medical treatment during childbirth. They also put a lot of resources into awareness-raising work.

“We travel out to various districts along with religious scholars, civil society activists and doctors, and we meet women and their husbands,” she said. “We explain the great benefits to society and family of ensuring that a mother is healthy, and that access to healthcare is a legal right for every woman.”

Nonetheless, Giyah said, it was still common practice to prevent women from getting medical attention in the more remote parts of the province.

“Most people [there] believe that taking a woman to hospital to give birth is really dishonourable, because their fathers and grandfathers considered it to be so. They also believe that God has determined our fates, while forgetting that He has also created a solution to every problem,” Giyah added.

Juma Gul, a 40-year-old who lives in the Bagram district of Parwan, is unapologetic about upholding restrictive practices.

“Our fathers and grandfathers didn’t take their wives to hospital. The hospitals are a new thing,” he said. “Whatever happens is due to God’s will. It is a lie to say, take [women] to hospital and they will not die. If it’s their time to die, they will also die in hospital. We cannot accept the dishonour of having people in our tribe gossiping about us because we take our wives to hospital to give birth.”

Some Afghans believe the custom forms part of Islamic law, but scholars say that this is a misinterpretation.

Mufti Mohammad Ibrahim, a religious scholar in Parwan province, said that Islam did not restrict a woman’s right to medical treatment.

“In our religion, a male doctor is even allowed to treat a woman to save her life,” he said, adding, “If the husband would rather let his wife die than visit a doctor, then in the Islamic faith, the husband is considered a murderer. If the husband carries out such an act unintentionally, it is still a major sin.”

Parwan health director Saidi said women should have at least four medical check-ups during pregnancy.

“Our mobile teams run continuous awareness programmes in remote areas of this province to inform people about proper hygiene and encourage them to visit medical clinics and hospitals,” he said. “These efforts have had good results, but fighting traditional beliefs take a long time.”

On the whole, women in urban areas of Parvan enjoy better access to health care.

Nasima Khanum, 23, lives in the main provincial town, Charikar. She gave birth to her two sons and her daughter in the 100-bed hospital there, with full medical supervision.

“Most of the medical staff in the gynaecology and maternity sections of hospitals are now women. There is no problem with women visiting doctors during pregnancy or when giving birth. My husband has taken me to hospital many times during my pregnancies,” she said.

“Honour is when a man saves someone’s life, rather than taking a life.”

Ahmad Farid Tanha is an IWPR-trained reporter in Parwan.

This report was produced under IWPR’s Promoting Human Rights and Good Governance in Afghanistan initiative, funded by the European Union Delegation to Afghanistan.