In spite of some moderate progress in some areas, women’s health needs continue to be unmet in Afghanistan. “Afghanistan is one of the most dangerous places in the world to be pregnant,” states a report on maternal mortality by the Afghan Ministry of Health, UNICEF, and the U.S. Centers for Disease Control and Prevention. This statement is supported by statistics that show that in Afghanistan one woman dies every 27 minutes from a pregnancy-related condition that is preventable, in most cases, with adequate health facilities and medical care.

Other statistics are equally alarming. Afghanistan has the highest infant mortality rate in the world, and the second highest maternal mortality rate, according to U.S. government’s statistics. Hemorrhaging and prolonged or obstructed labor cause the largest number of Afghan maternal deaths, which could be easily prevented by the presence of a trained midwife during childbirth. However, it is estimated that only 14% of women receive skilled medical attention during that time.

The situation is particularly serious in rural areas, where clinics and hospitals may be hours away on foot. To make matters worse, many clinics lack such fundamental supplies as clean water, lighting and other elements for surgery, blood pressure instruments and equipment to test donated blood for HIV contamination.

Travel is complicated by bad weather conditions, lack of security, difficult roads and rough terrain. It is no surprising, then, that the average life expectancy rate for women in Afghanistan is only 44 years.

Women don’t fare better in the educational front. It is estimated that 87 percent of Afghan women are illiterate. Many girls fear going to school for lack of security. Although some aspects of their lives have improved, women are still at a clear disadvantage with men. “Women who try to advocate for their rights in public life are being subject to violence and physical attacks,” said Zia Moballegh, acting country director for the International Centre for Human Rights and Democratic Development.

“Violence targeting women and girls is widespread and deeply rooted in Afghan society,” stated last November Norah Niland, chief UN human rights officer in Afghanistan. Rape, that brutal form of sexual violence, is also a frequent problem. “Our field research finds that rape is under-reported and concealed, and a huge problem in Afghanistan. It affects all parts of the country, all communities and all social groups,” stated Ms. Niland.

It is estimated that one in three Afghan women experience physical, psychological or sexual violence at some point in their lives. Paradoxically, shame is usually attached to the victims, who often find themselves prosecuted for adultery, than to the perpetrators. While adultery is punishable by jail, no provision in the Afghan penal code criminalizes rape.

A sad result of the oppressive atmosphere in their lives is that an increasing number of women in Afghanistan are choosing suicide as a way to escape the violence and abuse in their daily lives, according to a human rights report prepared by Canada’s Foreign Affairs Department. “Self-immolation is being used by increasing numbers of Afghan women to escape their dire circumstances, and women constitute the majority of Afghan suicides,” states de report completed at the end of 2009.

According to the director of a burn unit at a hospital cited in the report, in 2008 more than 80 women tried to commit suicide by setting themselves on fire in the province of Heart. Many among those women died. Last January, two women fled their homes to escape from domestic violence in the Ghor Province in Southwestern Afghanistan. The two women were later arrested; one of them was beaten in public and the other was confined in a sack with a cat, according to Ghor’s Governor.

“I poured fuel over my body and set myself ablaze because I was regularly beaten up by my husband and insulted by my in-laws, said Zarmina, a young woman of 28 told IRIN, a project of the UN Office for the Coordination of Humanitarian Affairs.

The abuses to women throughout the country are a serious call of attention to the government. It shows that it not only needs to enact laws protecting women but make sure that these laws are properly followed. It is one of the Karzai’s government most urgent tasks.

Cesar Chelala, MD, PhD, an international public health consultant, is a co-winner of an Overseas Press Club of America award.