The impact of the women’s medical education ban in Afghanistan on service coverage and maternal and neonatal mortality: a modelling study

Résumé fourni par la source

BACKGROUND: Afghanistan has made remarkable progress in addressing its high maternal and neonatal mortality rates between 2001 and 2021. Recent restrictions banning midwifery and nursing education for women risk reversing these gains. Using scenario-based modelling, this study examined the potential long-term impact of the ban on service coverage and mortality. METHODS: In this modelling study, we developed four scenarios reflecting slow versus fast attrition among women nurses and midwives and the possibility of male substitution and simulated projected changes in care seeking for six services accessed by women and children. Projections were from 2022 to 2035. Baseline data were collected from the 2023 Human Resources for Health Situational Assessment. We used a mathematical model that estimated care seeking as a function of health worker density and the proportion of women providers, accounting for varying levels of gender sensitivity to male substitution for each service as assessed by provincial-level Afghan health workers through a subjective expert elicitation exercise. Mortality outcomes were estimated using the Lives Saved Tool. FINDINGS: Our model projected decline in women's workforce entry, resulting in reduced service utilisation. We projected relative reductions in women's care seeking for maternal and reproductive health to 50-55% of current levels under the best-case scenarios to as low as 33-35% of current levels under the worst-case scenarios. These reductions translate into significant increases in the maternal mortality ratio, ranging from 29% under the best scenario to 41% under the worst scenario. Child health services would also suffer, but with greater substitutability of male providers to a lesser degree, with projected declines in care seeking to 76-80% under the best-case scenario and to 56-59% under the worst-case scenario. The resulting increase in child mortality rates could range between 10% and 16% and in neonatal mortality rates between 12% and 17%. INTERPRETATION: These findings represent scenario-based projections rather than forecasts and are highly dependent on assumptions regarding workforce attrition and substitution. Nonetheless, they show that the ban on women's medical education in Afghanistan will severely restrict women not only from providing health care but from accessing it as well. The policy threatens to reverse hard-won gains in maternal and child survival, with women's health and life chances disproportionately affected. Sustained advocacy and interventions are therefore urgently needed. FUNDING: The Global Financing Facility Trust Fund.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.