Ibrahimi Sahra, Yeo Sarah, Yusuf Korede, Akrami Zarah, Roy Kevin
Department of Global Health, Denison University, 100 West College Street, Granville, OH 43023, USA.
University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85719, USA.
Healthcare (Basel). 2025 Apr 27;13(9):1006. doi: 10.3390/healthcare13091006.
: This study identifies barriers to maternal and child healthcare access in Afghanistan under the Taliban and proposes solutions using the WHO Health System Building Blocks Framework. : Midwives and mothers were recruited via chain-referral sampling. After obtaining IRB and the participants' informed consent, in-depth virtual interviews, guided by Social Cognitive Theory, were recorded, transcribed, and analyzed using content analysis in MAXQDA 2020. : Data analysis revealed four primary consequences of the political unrest in Afghanistan that have exacerbated barriers to accessing maternal and child healthcare: (a) Taliban-imposed restrictions on women's education and mobility, reducing female healthcare providers and limiting mothers' access to care; (b) increased poverty, preventing women from attending perinatal visits due to out-of-pocket costs; (c) the deterioration of healthcare services, including medicine shortages, weakened health financing due to donor withdrawals, lack of insurance, and poor governance; and (d) the increased perpetuation of misinformation and harmful practices, such as the use of clergymen for medical advice instead of doctors. Using the WHO Health Systems Framework, we recommend solutions that address issues in service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. : This is the first qualitative study capturing Afghan mothers' and healthcare providers' experiences under Taliban rule. Our findings can inform international efforts to advocate for women's healthcare and education rights and guide global aid programs in strengthening Afghanistan's healthcare system in alignment with Sustainable Development Goal 5.
本研究确定了塔利班统治下阿富汗在获得母婴保健服务方面的障碍，并使用世界卫生组织卫生系统构建模块框架提出了解决方案。通过链式推荐抽样招募了助产士和母亲。在获得机构审查委员会（IRB）批准和参与者的知情同意后，以社会认知理论为指导，进行了深入的虚拟访谈，并进行了录音、转录，然后在MAXQDA 2020中使用内容分析法进行分析。数据分析揭示了阿富汗政治动荡带来的四个主要后果，这些后果加剧了获得母婴保健服务的障碍：（a）塔利班对妇女教育和行动的限制，减少了女性医疗服务提供者，并限制了母亲获得护理的机会；（b）贫困加剧，由于自付费用，妇女无法进行围产期检查；（c）医疗服务恶化，包括药品短缺、由于捐助者撤资导致的卫生筹资削弱、缺乏保险以及治理不善；（d）错误信息和有害做法的持续增加，例如向神职人员而非医生寻求医疗建议。利用世界卫生组织卫生系统框架，我们建议采取解决服务提供、卫生人力、卫生信息系统、基本药物获取、筹资和治理等问题的方案。这是第一项定性研究，记录了塔利班统治下阿富汗母亲和医疗服务提供者的经历。我们的研究结果可为倡导妇女医疗和教育权利的国际努力提供参考，并指导全球援助计划按照可持续发展目标5加强阿富汗的卫生系统。
