This story was originally published by Reasons to be Cheerful
9 min read
In Helmand province in southern Afghanistan, Ram Bibi, a 30-year-old mother now pregnant with her sixth child, counts herself as one of the lucky ones. She gets regular prenatal checkups at the Qari Safed family health house not far from her home. Here, midwife Marzia screens her for anemia, provides supplements and vaccinations, and has taught her to recognize danger signs in pregnancy. When her time comes, Bibi plans to deliver her baby at the family health house.
In another remote village in northwestern Afghanistan, when 40-year-old Manawara began bleeding in her 38th week of pregnancy, she was able to access immediate care at the nearby family health house. The attending midwife found that her baby was in breech position. Medication and emergency protocols helped stabilize Manawara and she delivered a healthy baby.
Such care may not seem extraordinary, but in Afghanistan, considered one of the most dangerous places in the world to be a mother, baby or child, Bibi and Manawara are outliers. In 2024, a study logged how many Afghans accessed health care services and found that thanks to a deteriorating public health system and severe restrictions on women’s movement, less than one-third are able to access health care. In fact, Bibi’s previous children were all born at home without skilled assistance, and both she and her newborns suffered infections.
Bibi and Manawara were able to get safe care through their local family health houses (FHHs), known in the local language Dari as Ashiana-e-Sehi. Part of a program initiated by the United Nations Population Fund UNFPA in 2009, over 450 of these friendly community clinics have become crucial access points for essential maternal and newborn care.
Globally, community medicine has often been used to improve health care access, especially in low-income countries. For example, Bangladesh has over 13,000 community clinics to deliver primary health care to people’s doorsteps, not just for women and children, but serving the entire community. Maternity waiting homes in Malawi, Zambia, Kenya and other African countries allow women from remote areas to stay near a hospital during the final weeks of pregnancy, avoiding the dangerous journey when labor begins. A 2025 review found that maternity waiting homes were linked with more facility-based deliveries and better chances of survival for both mothers and infants.
When the community steps in
“Most of our FHHs are in what we call ‘white areas,’ where health access is particularly difficult,” says Najeebullah Afghan, health and nutrition specialist at UNFPA. Places classified as white areas are at least 10 kilometers (or a three-hour walk) from the nearest basic health facility. Built on community-owned land, each FHH serves about 1,500 to 4,000 people living nearby and has a trained community midwife recruited from the local population who provides reproductive, maternal, newborn and child health services. With basic medical equipment and 35 medical and non-medical items necessary for maternal health care provided by UNFPA, these community clinics are often the only health care facilities available to women like Bibi and Manawara.
For example, the Arkalik FHH in northern Afghanistan’s Farhan province is an hour’s drive from the nearest hospital. It is run by midwife Laila Amini, who sees up to 70 patients a day, even though the FHH was originally built to service 300 patients a month. “Several years ago, a young girl died of pregnancy-related complications because her family couldn’t get her to the hospital in time,” she says. “Since then, I have been monitoring the health of all the women and children in the FHH.”
Similarly, at the Masyam FHH in Herat province, western Afghanistan, midwife Monika Rahmati caters to the needs of dozens of women every day. For any health emergencies, patients need to travel over 80 miles on mountainous roads to Herat City. “That’s why our FHH serves a very important role in the community,” she says.
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An assessment of the usage of FHHs in six provinces by the International Planned Parenthood Federation found that nearly three-quarters of women surveyed lived within one kilometer of their local FHH, and 82 percent could walk to it.
Many FHHs have had a far-reaching impact on the villages they service. Amini says proudly that they have not seen a single pregnancy-related death in the last seven years. The IPPF assessment found that 88.7 percent of respondents rated FHHs as “very important” for accessing sexual, reproductive, maternal and child health services.
However, in a country where two-thirds of women have no access to health care, UNFPA’s 450 FHHs can only do so much. Bringing a midwife closer to home removes one major barrier to care, but it cannot fix a health system in crisis.
A health system in crisis
Patient loads are often untenably high. The Arkalik FHH, for example, sees more patients in a week than it was designed to treat in a month. In the IPPF assessment, many midwives describe seeing 20 to 60 clients a day and keeping long hours. It also finds that there are periodic shortages of medicines, and 55.7 percent of the people surveyed said they wanted FHHs to provide additional services such as vaccination, laboratory testing and treatment for minor illnesses.
The shortage of trained staff is another challenge, and something community health centers are often criticized for. In Bangladesh, for example, the perceived quality of care received in community clinics is often poor as they sometimes lack qualified staff.
In Afghanistan, since the December 2024 ban on women’s medical education, ongoing training and support of midwives has become even more challenging. Najeebullah says that digital learning has been their only viable option. In 2023, UNFPA and the Maternity Foundation launched the Safe Delivery App in the local language Dari (the version in Pashto will be launched later this year). The app provides step-by-step guidance, instructional videos and evidence-based protocols for emergencies including postpartum hemorrhage, neonatal resuscitation, infection prevention and Kangaroo Mother Care. It also works during power outages and can be downloaded for use without internet access.
The app has been downloaded 5,127 times by midwives in Afghanistan in 2026, and Najeebulah says it has been used to train and support around 1,200 midwives. Research on the use of this app in other countries indicates that health worker knowledge and self-confidence in basic emergency obstetric and newborn care increased significantly three months after it was introduced, compared with health workers who did not use it.
Nasima Niazi, reproductive health manager at UNFPA’s local partner, Agency for Assistance and Development of Afghanistan, has trained 171 midwives, including Rahmati, to use the Safe Delivery App. “It is easy to use the app, but I wish they would add more content in the local languages Dari and Pashto,” she says.
Even so, UNFPA claims that it has had a life-saving impact. “In Kandahar, midwife Freshta used the app to support her before and during a high-risk delivery, successfully preventing a life-threatening complication. And in Kapisa, midwife Parween used [the app] to convince a family to transfer a premature newborn (1.1 kilograms) to hospital, and the baby survived and thrived,” Najeebullah says.
Amini and Rahmati find themselves using the app every day, and say it has proved especially useful in dealing with labor complications. They also access UNFPA’s free helpline, staffed around the clock by gynecologists, midwives and a psychosocial counselor.
Many cultural obstacles to women seeking or delivering health care remain. The rule that women can’t leave home without a Mahram (male family member who acts as an escort) applies to health seekers as well as health workers, Najeebullah says. FHHs have adapted by providing midwives with accommodation at the facility, allowing them to remain available around the clock. Where possible, UNFPA also employs their mahrams as drivers or cleaners.
Rahmati and Amini say that however close the FHH, family attitudes will determine whether a woman seeks care at all. “The older women, especially mothers-in-law, say, ‘We gave birth at home, why should the daughter-in-law go to hospital now?’” Rahmati adds.
Although the European Union, Japan and other countries funded this program after the recent USAID cuts, the biggest challenge to the long-term sustainability of the FHH model is its heavy dependence on external donor funding. A significant change could be underway. Afghanistan’s National Health Policy for 2025 to 2030 puts primary health care and community-level services at the center of its ambition for universal health coverage. Although the policy does not specifically mention FHHs, Najeebullah hopes that this could give them a much-needed boost.
Meanwhile, the UNFPA and Maternity Foundation are working on a Pashto version of the Safe Delivery App and aim to train over 3,000 more midwives by 2027. And despite all the constraints on their work, Amini and Rahmati say they are motivated to go to work every morning.
“Zero maternal deaths in my village in seven years represents the success of my work,” Amini says.
“Every time I’m able to deliver a healthy infant, it makes me happy,” Rahmati says. “Even though things are difficult right now, a new, healthy life always brings hope and joy.”
Additional research by Calypso Lloyd-Davies
The post How Afghan Women Are Rebuilding Reproductive Health Care appeared first on Reasons to be Cheerful.
