Ban on women's medical training could raise Afghan maternal deaths up to 41%, model finds

Afghanistan's decision to bar women from nursing and midwifery education threatens to reverse two decades of hard-won progress on maternal and newborn survival, according to a modelling study published in The Lancet Global Health on 18 August 2026 [s1]. The analysis projects that as women are pushed out of the health workforce, the women and children who depend on female providers will increasingly go without care — and that the maternal mortality ratio could rise by as much as 41% by 2035 [s1].

The logic runs through the workforce. Between 2001 and 2021, Afghanistan made what the authors call remarkable progress against some of the world's highest maternal and neonatal mortality rates [s1]. Much of that gain rested on a cadre of women nurses and midwives, because in large parts of the country cultural norms mean many women will seek maternal, reproductive and child health care only from female providers. Restrictions banning women from the education that produces those providers therefore threaten not just women's ability to work in health care, but other women's ability to reach it at all.

How the study was built

The researchers constructed four scenarios reflecting slow versus fast attrition among women nurses and midwives, and the differing extent to which male providers might substitute for them, then simulated the resulting changes in care-seeking for six services used by women and children out to 2035 [s1]. Baseline workforce numbers came from Afghanistan's 2023 Human Resources for Health Situational Assessment [s1]. The model estimated care-seeking as a function of health-worker density and the share of women providers, with the degree of acceptable male substitution for each service set by Afghan health workers at provincial level through a structured expert-elicitation exercise, and it translated the resulting coverage changes into deaths using the Lives Saved Tool [s1].

What the scenarios show

The projected fall in maternal and reproductive health care is steep across every scenario. Under the best-case assumptions, women's care-seeking for maternal and reproductive health drops to 50-55% of current levels; under the worst-case assumptions, it falls to as low as 33-35% — roughly a third of what it is now [s1]. Those reductions translate into higher maternal deaths: the maternal mortality ratio is projected to rise by 29% under the best scenario and by 41% under the worst [s1].

Child health services fare somewhat better, because male providers can substitute for female ones more readily in paediatric than in maternal care. Care-seeking for children's services is projected to decline to 76-80% of current levels under the best case and to 56-59% under the worst [s1]. Even with that greater substitutability, the mortality consequences are real: child mortality is projected to rise by 10% to 16%, and neonatal mortality by 12% to 17% [s1].

The gap between the maternal and child projections is itself the finding that matters. It quantifies how much of Afghanistan's health system runs specifically on women treating women — a dependency that is invisible when the workforce is intact and becomes a mortality driver the moment its supply is cut off.

What the numbers do and don't say

The authors are careful about what kind of evidence this is. These are scenario-based projections, not forecasts, and they are highly dependent on the assumptions made about how fast the women's workforce shrinks and how far male providers can stand in [s1]. The range between 29% and 41% for maternal mortality, or between 10% and 16% for child mortality, is not a confidence interval around a prediction; it is the spread between a more and a less optimistic set of assumptions about a policy whose real-world trajectory is still unfolding.

What the modelling does establish is direction and rough magnitude. Every scenario the authors ran points the same way — toward fewer women and children reaching care and more of them dying — and the disagreement between scenarios is over how bad, not whether. The mechanism is straightforward enough that the qualitative conclusion is hard to escape: a health system that depends on female providers to reach female patients cannot lose its pipeline of female providers without losing coverage, and lost coverage in maternal and newborn care shows up as deaths.

The authors frame the policy as one that will restrict women not only from delivering health care but from receiving it, disproportionately affecting women's health and life chances, and they call for sustained advocacy and interventions to blunt the damage [s1]. The study puts numbers to a harm that had until now been argued largely in principle — turning a warning about women's rights into a projection about maternal and child survival.

This article is informational and is not medical advice.

Sources

• The impact of the women's medical education ban in Afghanistan on service coverage and maternal and neonatal mortality: a modelling study — The Lancet Global Health, 18 August 2026.