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HRW Warns Against Further 'Life-Threatening' Cuts In Afghan Health System

A child receives a measles vaccine at the Indira Gandhi Children's Hospital in Kabul.

Human Rights Watch (HRW) has warned that falling international donor support to Afghanistan has reduced women's access to essential health care, and that it expects further cuts in the coming months as foreign forces prepare to withdraw from the country.

In a report published on May 6, the New York-based human rights watchdog outlines the barriers Afghan females face in trying to obtain health care, as well as the health-care system's deterioration due to falling support from international donors.

The drop in funding "has already had a harmful -- and life-threatening -- impact on the lives of many women and girls, as it affects access to and quality of health care," it said.

"International donors are locked in a waiting game to see whether the withdrawal of foreign troops will result in the Taliban gaining greater control of the country," Heather Barr, interim co-director of women's rights at HRW, said in a statement.

"But this is no excuse for cutting funds for essential services that aid groups have managed to deliver in insecure and Taliban-controlled areas."

Over the past two decades, the Afghan government has relied on international-donor funding for essential services.

But HRW said this support has been falling for years and "will likely continue to do so, perhaps precipitously" following President Joe Biden's announcement in April that the United States will withdraw all of its forces from Afghanistan by September 11. NATO has said it will follow the same timetable.

In 2013, member countries of the OECD Development Assistance Committee contributed $141 million to health and population assistance in Afghanistan, HRW noted, adding that by 2019 the figure had dropped by more than one quarter to $105 million.

And with more than 75 percent of its budget coming from international donors, the Afghan government has little ability to move toward self-sufficiency in the short term.

For its 39-page report, titled "I Would Like Four Kids -- If We Stay Alive": Women's Access to Health Care in Afghanistan, HRW said it had interviewed 56 people in Afghanistan in March and April, including 34 women and 18 other Afghans working in the health sector.

Among the barriers Afghans face in obtaining health care, it cited a lack of funds for hospitals, which meant that they are charging for supplies that previously were free, and the fact that many patients cannot afford transportation to a health facility that may be far away.

Afghan women and girls "struggle to get even the most basic information about health and family planning," according to the report, while "there is an unmet need for modern forms of contraception, and prenatal and postnatal care is often unavailable."

"Modern cancer and fertility treatment and mental health care are largely unavailable. Routine preventive care such as pap smears and mammograms are almost unheard of; and a large proportion of births are still unattended by a professional."

In addition, women "face risky pregnancies because of lack of care" and undergo procedures that "could be done more safely with more modern techniques," leading to "very high" maternal and infant mortality.

HRW urged donors to "prioritize meeting the urgent needs of Afghans, including those of women and girls for health care."

And the United States and other countries with troops in Afghanistan should "not use political and security developments to justify disengaging when the need for international assistance is greater than ever," it said.

Barr insisted that international funding for the health system "is a life-and-death issue -- and whenever cuts are made women will die."

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