By Kazim Ehsan
Maryam, a woman in her late thirties, bears the physical and mental strain of a life shaped by extreme poverty and consecutive childbirths. Though still relatively young, she appears worn and aged beyond her years. Maryam recounts the toll that her many pregnancies have taken on her health and the well-being of her children. “I have had several children in succession. Now my legs, back, and all my joints hurt. The children have not been properly nourished and cared for. We cannot even provide for their food and clothing now.”
With eleven children to her name, the gap between each child being less than two years, Maryam admits that she gave little thought to birth control for her first eight children and became unintentionally pregnant with the last three. Her family, formerly residing in Ghor province, relocated to Kabul two years ago in search of a better life amid rising conflict and insecurity. However, their hope has dwindled with each passing day without employment and a stable income.
Before the fall of Kabul, Maryam’s family led a relatively stable life with modest needs. Now, they struggle to secure even a single daily meal. As a result, Maryam has begun to consider preventing unwanted pregnancies. She credits access to contraception for the four-year gap between her youngest child and her other siblings.
Maryam’s story is not unique in Afghanistan, where thousands of families grapple with the challenges of large families and burgeoning populations. Cultural norms and conservative religious beliefs, coupled with Afghanistan’s Islamic law, contribute to prohibiting abortion in cases of unwanted pregnancies. According to Afghanistan law enacted by the previous government, destroying an embryo, considered a living being, 48 hours after conception is equated with deliberate murder.
As families like Maryam’s continue to struggle, the mounting poverty and uncontrolled population growth in Afghanistan remain pressing concerns that demand attention and action.
Limited access to family planning and health services
In Afghanistan, where only 22 percent of married women use modern contraceptives, the country has one of the world’s lowest birth control rates. Over the past two decades, the former Afghan government, in partnership with the international community, endeavored to raise awareness about family planning and expand access to health services, including contraception. Yet, many families continue to have unintended children due to inadequate awareness and limited access to contraceptive methods.
Maryam, the mother of eleven children, recounts living five hours away from the nearest health center in Ghor province. Despite the distance, she found that her visits to the center did not yield the necessary information and guidance about family planning. “In rural areas, people are not properly informed about contraceptive methods and the dangers and consequences of uncontrolled childbirth,” she explained. Maryam added that health workers seemed well-trained but did not prioritize providing proper guidance when families visited the health center. Consequently, she took medications without appropriate prescriptions or, at times, did not take them at all.
Afghanistan grapples with one of the world’s highest fertility rates, averaging 4.8 children per woman. This can be attributed partly to cultural factors, such as the belief that large families symbolize wealth and status. However, the scarcity of family planning services also plays a significant role. Dr. Aqila Rahimi (not her real name), a gynecologist at a government hospital in Kabul, explains, “There is a lack of awareness about family planning in Afghanistan.” She adds, “Even when women are aware of family planning, they often do not have access to the services they need.”
On February 15, 2023, the Taliban’s de facto government allegedly announced a ban on the sale of contraceptives and birth control items. The CIA World Factbook estimates that Afghanistan has the highest child mortality rate globally, with 103.6 deaths per 1,000 children. The ban on contraceptives and birth control items is expected to exacerbate this issue, as more women will be unable to access essential health services and prevent unintended pregnancies. This can lead to increased risks for mothers and infants, including complications during pregnancy, unsafe childbirth, and higher infant mortality rates.
A recent World Health Organization report revealed that Afghanistan has one of the world’s highest maternal mortality rates. With 620 fatalities per 100,000 live births, the country has the highest rate in Asia, where most developing countries have made steady progress in improving maternal healthcare.
Rise in twin and multiple births.
According to obstetricians and gynecologists, the oral and careless use of contraceptives for unintended pregnancies contributes to the country’s rapid population growth and the increase in twin and multiple births.
Dr. Nafisa Sahak, head of the Reproductive Health and Fertility Department at the Taliban Ministry of Public Health, points to factors such as genetics, twin ovulation, fertility treatments, and irregular prevention methods as reasons for the rising rate of twin and multiple births in the country.
Malalai, a mother of five from Kabul, shares her experience of unintentionally becoming pregnant with triplets for the third time. “I wasn’t prepared for pregnancy. My belly grew daily until I went to the doctor, who informed me I was pregnant with triplet girls.”
Malai admits to using contraceptive pills without a doctor’s prescription or guidance, relying solely on her personal intuition. She speculates that oral contraceptive use may have impacted her fertility, potentially contributing to her multiple pregnancies.
Pressure and the pursuit of male heirs
Additionally, decades of conflict and tribal and religious culture in Afghanistan contribute to families’ unintended increase in children. Many families repeatedly attempt to have children in hopes of having a son, with some even resorting to polygamy to achieve this goal.
Leila, a mother of nine, had seven daughters in her pursuit of providing her only son with a brother. She recounts the painful experiences of being taunted by her husband’s family and the degrading, unequal treatment of her daughters. Leila says one reason her husband’s family pressured her to have another son was tribal rivalries, as having a male child symbolizes power and a bright future for the family.
Dr. Aqila Rahimi notes that many men contribute to the rise in unintended children, including girls, often overlooking the relatively accessible contraceptives and unwanted pregnancy prevention options available for men. In numerous cases, when a mother gives birth to an undesired girl, both the mother and the baby girl are subjected to lifelong violence and discrimination.
“I’ve witnessed numerous instances where mothers are rejected by their husbands and family upon giving birth to a girl. In many cases, they either abandon the mother and child at the hospital or request that we give the baby girl to anyone willing to adopt her,” Rahimi says.
Humanitarian Crisis Deepens Amid Poverty and Rapid Population Growth
The International Rescue Committee estimates that 97% of Afghanistan’s population is at risk of poverty, with over 90% of household income spent solely on food. This leaves little to no resources for other essential aspects of life, including healthcare and family planning programs. Despite this dire situation, many families in the impoverished country continue to have more children, leading to unplanned and rapid population growth. The combination of these factors and expanding poverty has resulted in an alarming crisis, further worsened by the coronavirus pandemic and political instability.
While precise statistics on Afghanistan’s population growth rate are unavailable, Countrymeters, which tracks global population growth trends, estimates that the rate will be around 3.02% in 2023. This places Afghanistan among the countries with the highest population growth rates worldwide. The country faces a humanitarian crisis, with millions needing food, water, and shelter. The Taliban government is struggling to provide basic services, and the economy is in a state of freefall.
According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), more than 28 million people (~70% of Afghanistan’s 40 million population) require humanitarian assistance to survive, with approximately 15.3 million (~55%) of them being children. The need for urgent action and support has become increasingly evident as Afghanistan grapples with the consequences of widespread poverty and rapid population growth.