When Shahnaz went into labour, her husband, Abdul, and their two young children set out for the nearest medical facility in Shesh Pol village, a 20-minute drive over gravel tracks in Afghanistan's mountainous Badakhshan province. The clinic that had served the area for years — where the couple's older children were born and a trained midwife handled about 25–30 deliveries a month — was closed. The taxi ride cost 1,000 Afghanis, roughly a quarter of Abdul's monthly income; without the clinic open, the family stopped at the side of the road. Shahnaz delivered a daughter in the car and bled to death shortly after. The newborn died within hours.
Local residents and health workers said Shahnaz's death is one of several in recent months that they attribute to the abrupt closure of more than 400 medical facilities across Afghanistan after the United States cut nearly all bilateral aid and halted most USAID-funded programmes earlier this year. For decades the United States was Afghanistan's largest donor; US funds made up about 43% of all aid going into the country in 2024.
Abdul and others in Shesh Pol described a cascade of consequences after the closures: displaced patients, longer and more costly journeys to regional hospitals, home births without skilled attendants, and growing pressure on Faizabad provincial hospital. Khan Mohammad, another villager, said his wife, Gul Jan, died during childbirth five months ago after the clinic closed, and their newborn died three days later. Ahmad Khan, from a different district, blamed the US funding decision after his daughter, Maidamo, died in labour.
The closures have forced many women to seek care at the regional hospital in Faizabad, which administrators say is operating well beyond capacity. Dr. Shafiq Hamdard, the hospital director, said the facility has 120 beds but has admitted 300–305 patients. He said the hospital's annual budget fell from about $80,000 three years ago to $25,000 this year.
Hospital staff and local health officials reported a sharp rise in maternal and newborn deaths in the months since the funding suspensions. By August, recorded maternal deaths for the year equalled the total for the whole of the previous year, and newborn deaths were about a third higher in the past four months compared with the start of the year, according to figures provided by hospital staff. Midwives said conditions on the wards are dire: women sometimes share beds three to a bed, and those suffering heavy bleeding may wait without a space to lie down.
Health workers also face long-term capacity constraints. Razia Hanifi, Faizabad's head midwife, said she has worked for 20 years and that this year has been the toughest because of overcrowding, shortages of supplies and a lack of trained staff. The shortages are likely to worsen after the Taliban government banned midwifery and nursing training for women in December 2024, part of wider restrictions on women's education and employment that have sharply curtailed professional pathways for female health workers.
Two women who were enrolled in midwifery training before the ban said the closure of their courses left them without a profession and exacerbated fears about future care for pregnant women. "There is already a shortage of midwives and nurses in Afghanistan," one of the women said. "Without more being trained, women will be forced to give birth at home which will put them at risk."
The Trump administration justified the funding cuts by citing concerns that aid was benefiting hostile groups, including the Taliban. US officials said reports showed at least $11 million had been "siphoned or enriching the Taliban." The State Department cited a report by the Special Inspector General for Afghanistan Reconstruction (SIGAR) that said partners of USAID had paid $10.9 million to the Taliban-controlled authorities in the form of taxes, fees, duties or utilities. The Taliban government denies it benefited from aid, saying assistance is channelled through the UN and non-governmental organisations.
The US government has maintained that no deaths have been directly caused by the aid reductions. Independent reporting by journalists and interviews with residents, local health workers and hospital records show multiple unreported and sometimes unrecorded deaths in areas served by USAID-supported clinics that have closed.
Aid organisations and health workers say the sudden withdrawal of funds has disrupted a fragile network of primary health-care centres that provided prenatal care, clean deliveries and basic emergency obstetric services in remote areas. In Badakhshan's terrain, long distances and treacherous roads make timely access to care difficult even when clinics are operating.
Observers warn that the combined effects of funding cuts and Taliban restrictions on women's education and work are likely to raise maternal and newborn mortality further. Dr. Hamdard said the hospital's reduced budget has hampered the purchase of medicines and supplies and limited staff hiring. Midwives said morale is low and that many experienced female health workers are unable to continue training or practice because of the restrictions.
The families in Shesh Pol and neighbouring villages described grief and anger at what they saw as preventable deaths. Several villagers pointed to graves of women who died in childbirth in the past months. "My wife and child could've been saved if the clinic was open," Abdul said. "We had a hard life, but we were living it together. I was always happy when I was with her."
International donors and humanitarian agencies face a fraught calculation: whether and how to channel funds to sustain essential services in a country governed by an administration that remains unrecognised by most governments and has imposed strict rules on women. The loss of USAID-supported primary services has left remote communities particularly exposed, health workers said, underscoring the fragility of maternal and newborn care in Afghanistan.
Humanitarian agencies say that restoring services would require predictable funding and safe access for female health workers. Until that happens, doctors, midwives and families in Badakhshan and other provinces warn that the gains made over years to reduce maternal and newborn deaths risk being reversed.
Additional reporting and photography by Aakriti Thapar, Mahfouz Zubaide and Sanjay Ganguly.