As Shahnaz went into labor, her husband, Abdul, urgently sought a taxi to transport her to the only medical facility within their reach.
“She was in a lot pain,” Abdul recounted.
The clinic, a 20-minute drive to Shesh Pol village in Afghanistan’s northeastern Badakhshan province, was where their two older children had been born.
Abdul sat beside Shahnaz, offering comfort as they traversed the gravel tracks in a desperate attempt to reach medical aid.
“But upon arriving at the clinic, we found it closed. I was unaware of its closure,” he said, his face reflecting profound distress.
Warning: Readers may find some details in this article distressing.
The Shesh Pol clinic stands as one of over 400 medical facilities shuttered in Afghanistan, a nation grappling with severe poverty. These closures followed the Trump administration’s decision to cut nearly all U.S. aid earlier this year, a drastic move implemented after the dismantling of the U.S. Agency for International Development (USAID).
The clinic, a modest single-story structure with four small rooms and peeling white paint, is adorned with USAID posters offering guidance to pregnant women and new mothers.
Despite its unassuming appearance, the clinic served as a vital lifeline in Badakhshan’s mountainous terrain, where limited access to healthcare has historically contributed to high maternal mortality rates. It was part of a broader initiative during the U.S.-backed government’s tenure aimed at reducing maternal and newborn deaths.
The clinic employed a trained midwife who assisted with approximately 25-30 deliveries each month. It maintained a stock of essential medicines and injections and provided basic healthcare services.
Other medical facilities were prohibitively far from Abdul’s village, and the journey on rough roads posed risks to Shahnaz. Furthermore, Abdul lacked the funds for a longer journey; the taxi fare of 1,000 Afghani ($14.65; £12.70) represented roughly a quarter of his monthly income as a laborer. Consequently, they made the difficult decision to return home.
“But the baby was coming and we had to stop by the side of the road,” Abdul recounted.
Shahnaz delivered their baby girl in the car. Tragically, she died shortly afterward due to excessive bleeding. A few hours later, before she could be named, their baby also passed away.
“I wept and screamed. My wife and child could’ve been saved if the clinic was open,” Abdul lamented. “We had a hard life, but we were living it together. I was always happy when I was with her.”
He is now left without even a photograph of Shahnaz to cherish.
While there is no guarantee that the mother and baby would have survived if treated at the clinic, its absence eliminated any chance of survival, underscoring the undeniable impact of U.S. aid cuts in Afghanistan.
For decades, the United States has been the foremost donor to Afghanistan. In 2024, U.S. funds constituted a staggering 43% of all aid entering the country.
The Trump administration justified the withdrawal, citing “credible and longstanding concerns that funding was benefiting terrorist groups, including… the Taliban,” who now govern the country. The U.S. government further stated that they had reports indicating that at least $11 million were “being siphoned or enriching the Taliban.”
The report referenced by the U.S. State Department was produced by the Special Inspector General for Afghanistan Reconstruction (SIGAR). It stated that $10.9 million of U.S. taxpayer money had been paid to the Taliban-controlled government by USAID partners in the form of “taxes, fees, duties, or utilities.”
The Taliban government denies that aid money was being diverted to their coffers.
“This allegation is not true. The aid is given to the UN, and through them to NGOs in provinces. They identify who needs the aid, and they distribute it themselves. The government is not involved,” asserted Suhail Shaheen, head of the Taliban’s political office in Doha.
The Taliban government’s policies, particularly its severe restrictions on women, have resulted in its continued lack of recognition by most of the world after four years in power. This is also a major factor in donors increasingly withdrawing from the country.
The U.S. insists that no deaths have resulted from the aid cuts. The deaths of Shahnaz and her baby, along with countless others, remain unrecorded.
The BBC has documented at least half a dozen firsthand accounts of devastating consequences in areas where USAID-supported clinics have been forced to close.
Adjacent to Shahnaz’s grave, villagers pointed to two other graves, identifying them as those of Daulat Begi and Javhar, women who died in childbirth within the past four months. Their babies survived.
Not far from the graveyard, we encountered Khan Mohammad, whose 36-year-old wife, Gul Jan, died in childbirth five months prior. Their baby boy, Safiullah, died three days later.
“When she became pregnant, she would go to the clinic for check-ups. But midway through her pregnancy it shut down. During the delivery she had a lot of pain and blood loss,” Khan Mohammad recounted. “My children are sad all the time. No one can give them the love of a mother. I miss her every day. We had a sweet and loving life together.”
A roughly five-hour drive from Shesh Pol, in Cawgani, another village where a USAID-backed clinic closed, Ahmad Khan, the grief-stricken father of Maidamo, showed us the room in their mud and clay home where she died giving birth to baby Karima.
“If the clinic had been open, she might have survived. And even if she had died, we would not have had regrets knowing the medics tried their best. Now we’re left with regret and pain. America did this to us,” he said, tears streaming down his face.
In another home a few lanes away, Bahisa recounted the terror of giving birth at home. Her three other children were born in the Cawgani clinic.
“I was so scared. In the clinic, we had a midwife, medicines and injections. At home I had nothing, no painkillers. It was unbearable pain. I felt like life was leaving my body. I became numb,” she said.
Her baby girl, named Fakiha, died three days after she was born.
The closure of clinics in villages has led to a surge of patients at the maternity ward of the main regional hospital in the provincial capital, Faizabad.
Reaching the hospital through Badakhshan’s treacherous landscape is perilous. We were shown a horrifying photo of a newborn baby, delivered en route to Faizabad, whose neck was tragically broken before reaching the hospital.
Having visited the hospital in 2022, we witnessed scenes of unprecedented overcrowding this time around.
Each bed accommodated three women. Imagine enduring labor or experiencing a miscarriage without even the privacy of your own bed.
This was the reality for Zuhra Shewan, who suffered a miscarriage.
“I was bleeding severely and didn’t even have a place to sit. It was really hard. By the time a bed is free, a woman could die bleeding,” she said.
Dr. Shafiq Hamdard, the hospital’s director, stated, “We have 120 beds in the hospital. Now we’ve admitted 300 to 305.”
Compounding the influx of patients, the hospital has also faced significant funding cuts.
“Three years ago our annual budget was $80,000. Now we have $25,000,” Dr. Hamdard said.
By August of this year, the number of maternal deaths recorded had already equaled the total for the entire previous year, indicating a potential increase in maternal mortality of as much as 50% over last year.
Newborn deaths have already increased by roughly a third in the past four months compared to the beginning of the year.
Razia Hanifi, the hospital’s head midwife, expressed her exhaustion. “I have been working for the past 20 years. This year is the toughest due to the overcrowding, the shortage of resources, and the shortage of trained staff,” she said.
The Taliban government’s restrictions on women have further exacerbated the situation, hindering the arrival of reinforcements. Three years ago, all higher education, including medical education, was banned for women. Less than a year ago, in December 2024, training for midwives and female nurses was also prohibited.
In a discreet location, we met two female students who were midway through their training when the ban was imposed. They requested anonymity for fear of reprisal.
Anya (name changed) explained that both were enrolled in graduate courses at university when the Taliban took control. After those programs were closed in December 2022, they pursued midwife and nursing training as the only remaining path to education and employment.
“When that was also banned, I became depressed. I was crying day and night, and I wasn’t able to eat. It’s a painful situation,” she said.
Karishma (name changed) added, “There is already a shortage of midwives and nurses in Afghanistan. Without more being trained, women will be forced to give birth at home, which will put them at risk.”
We questioned Suhail Shaheen of the Taliban government about the justification for bans that effectively restrict healthcare access for half the population.
“It is our internal issue. These are our issues, how to handle them, how to consider them, how to take decisions, this is something internal. That is up to the leadership. Based on the needs of the society, they will take a decision,” he stated.
With their access to medical services severely restricted by a series of devastating setbacks, the right to health, and indeed life itself, is gravely threatened for women in Afghanistan.
Additional reporting, photography and video: Aakriti Thapar, Mahfouz Zubaide, Sanjay Ganguly
Top image shows Abdul with his daughter and son in Shesh Pol.