Against the odds: An Afghan health worker’s fight to save mothers and children

“Being a woman in Afghanistan is already a challenge,” said Nilofar*. “Being a woman pursuing a professional career is even more difficult.”

Nilofar, a dedicated nurse, is committed to bringing nutrition and maternal health services closer to women and children across Afghanistan.

"All women in Afghanistan should be well informed about the basic services available to them,” she said. “They should have unrestricted access."

Nilofar is driven by a sense of purpose. She grew up in Charikar City, the capital of Parwan Province, in a family that encouraged education. After training as a general nurse, Nilofar discovered her passion in maternal and child health while working with a non-governmental organization (NGO). 

For the past six years, she has been working with different organizations to provide essential healthcare services. These include a wide range of services, from medical check-ups, prenatal and postnatal care, vaccinations to advising families on preparing affordable and nutritious meals. Most of her patients are mothers and children aged under five, in the country's capital region, which includes six provinces.

Reaching remote communities

For four of the six years, Nilofar travelled with mobile health and nutrition teams, navigating remote areas to reach isolated communities. "On the map, some of these areas don’t seem far from Kabul, lots of communities are very isolated," she explained. "Many villagers are still unfamiliar with the term vaccination."

Nilofar is a strong advocate for the participation of Afghan women health workers in the humanitarian response. For her, being a woman is crucial in providing care to other women, especially when addressing reproductive health concerns. 

“Women open up when we talk. They ask me questions because they trust me. Men cannot make the same connection,” she said. 

Nilofar is proud of her influence on communities where many women lack access to essential health services. 

She recalled one of the most unforgettable moments of her career when a frail six-month pregnant woman arrived at a nutrition centre with her 18-month-old child, who had a bloated belly – a symptom of the severe malnutrition condition called Kwashiorkor. Even before taking their vitals, Nilofar knew they needed urgent care. The woman and her son were immediately hospitalized. Her husband was working in Iran as a day labourer. After a month of inpatient care, the mother – now healthier and in her final trimester – returned to thank Nilofar for saving their lives. 

Overcoming challenges

Despite her dedication, Nilofar faces constant challenges from the de facto authorities. Recent decrees have made transportation difficult. As an unmarried woman, she often lacks a mahram – a male guardian – to accompany her. Her employer provides joint transportation for women and men, but they are frequently questioned at checkpoints. 

Logistical challenges are not the only issue. Women healthcare workers are under intense scrutiny. Previously exempt from the bans on women working for NGOs and the UN, their roles are now being further restricted. 

On 2 December 2024, the de facto Ministry of Higher Education announced the closure of all medical education institutions for women, including semi-professional and higher education programmes. This decree threatens the long-term impact on the country's public health. 

Afghanistan already has one of the highest maternal mortality rates in the world. According to UN estimates, more than 600 women die per 100,000 live births, nearly three times the global average.

Resilience in the face of uncertainty

Whenever Nilofar feels overwhelmed, she turns to her family and friends for support and exercises to de-stress. She admits that at times she has shown signs of depression, but she is determined to continue her work, supported by her male and female colleagues.

Despite the obstacles, her vision for Afghanistan’s future is where women and men work together to develop the country. “Men cannot cover all needs and vulnerabilities. Women need to study. They need to work in all fields,” she said.

*Name has been changed.