An assessment of the policy context on women’s reproductive health rights in Afghanistan

Afghanistan faces a high burden of maternal mortality. Sexual and reproductive health rights are vital for sustainable development, while social determinants of women’s reproductive health play a key role in advancing the uptake of health services and preventing avoidable deaths. It was unclear to what extent public policy in Afghanistan addresses the social determinants of women’s reproductive health rights. This study applied a documentary review to (i) describe social determinants of women’s reproductive health rights relevant to Afghanistan; (ii) explore communities’ engagement in policy development; (iii) explore Afghan policy or lack thereof across government sectors affecting women’s reproductive health rights; and (iv) determine policy deficiencies. A Boolean search in 4 databases yielded 178 sources. A PRISMA was employed, which produced 165 sources for inclusion in this study.Social determinants were identified across governance; macroeconomics; socio-cultural values; social cohesion and social capital; living and working conditions; behavioural factors; and health system: quality, access and utilization. Civic engagement was described in terms of policy development, policy implementation and monitoring and evaluation. Current public policies affecting women’s reproductive health rights across 7 Afghan line ministries were explored against identified social determinants. For each of the social determinants, sectoral policies were classified into directly, indirectly, or not addressed or conflicting law sources. Policy deficiencies were identified in terms of women’s participation in governance and development, in terms of protection for adverse socio-cultural norms and values, in terms of social cohesion and social capital, and terms of the health system. In broad terms, current Afghan public policies do address key social determinants of women’s reproductive health. However, what was often not available was the translation of policy into action plans. In absence of action plans and resources and barriers created by persistent social-cultural norms, policies are at risk of being unable to achieve their full potential.