Breaking Barriers: Strengthening Maternal Healthcare to Prevent Congenital Heart Disease in Afghanistan

By guest contributors Massoma Jafari, Ilja Ormel,  Samira Shahzad, Faiza Rab, Carla Taylor, and Salim Sohani

Every Afghan mother dreams of a healthy child, but for too many, that dream turns into a fight for survival. Congenital heart disease (CHD) is a silent thief, stealing the futures of countless children before they even have a chance to live. Improved maternal healthcare access could prevent many of these deaths, yet Afghan mothers remain underserved.

An estimated 128,000 children in Afghanistan are living with CHD, with thousands more going undiagnosed each year due to gaps in maternal and newborn healthcare and limited access to the health system. CHD remains a significant cause of infant mortality, exacerbated by inadequate maternal and newborn healthcare. With only 33% of Afghan women receiving the recommended four prenatal care visits , many mothers go through pregnancy unaware that their unborn child may soon be battling a life-threatening condition. Limited antenatal care (ANC), combined with maternal anaemia and lack of access to essential medications like iron and folic acid, means many newborns with CHD remain undiagnosed, reducing the chances of timely intervention. In rural areas, access to health services is limited, early CHD detection is rare, and preventable fatalities are common. From 1990 to 2021, deaths from congenital heart disease in Afghanistan rose by approximately 34%, with a 228% increase in prevalence.

Immunization and prenatal screenings are key to reducing CHD risk. However, there is limited data on Afghanistan immunization rates against rubella, a known risk factor for congenital heart defects. In 2023, the incidence rate of congenital rubella syndrome was 4 per 10,000 live births.

Genetic factors play a key role in CHD, with consanguineous marriages (marriages between close relatives) increasing the risk of congenital anomalies. Given this cultural practice, there is a critical need for innovative, culturally accepted counselling solutions. In the absence of widespread genetic testing, even in urban areas, tailored educational programs could help families- especially those with a history of genetic conditions – understand the potential health consequences and make informed reproductive choices.

Families face financial barriers, leaving many with no choice but to watch their child endure health problems. Afghanistan lacks dedicated paediatric cardiac surgery centers, meaning that families must seek expensive treatment abroad – an option that, even for those who can afford it, often comes at the cost of sacrificing other essential needs, and remains entirely out of reach for many. Referral programs offer temporary relief, but paediatric cardiac care centers are urgently needed. Investing in specialized cardiac-care facilities and capacity-building for midwives and other health professionals to ensure early diagnosis and timely referrals, strengthening primary healthcare (PHC) is essential. Enhancing community-based ANC can help address some of the root causes of CHD by ensuring access to critical interventions such as iron and folic acid supplementation, vaccinations, and proper maternal care.

Mobile health teams can bring vaccinations, prenatal check-ups, and CHD screenings to those who need them most, ensuring that no mother feels abandoned by the system. Mobile health teams staffed with female midwives can serve as a crucial interim solution while strengthening the PHC system. These teams can enhance antenatal, natal, and postnatal care, bridging gaps in maternal and newborn health until a more robust healthcare infrastructure is in place. Expanding these services alongside midwifery-led care can reduce CHD-related mortality. Integrating maternal health services with newborn screenings and vaccinations every child has a fair chance at survival. The path forward requires a coordinated effort involving government bodies, NGOs, and international partners to invest in maternal and newborn health infrastructure. Additionally, engaging the private sector and social services is crucial—not only to expand healthcare access but also to educate communities on preventive measures, such as the risks of consanguineous marriages, which can contribute to congenital disorders.

Recent changes in women’s rights in Afghanistan have exacerbated the challenges women face in accessing healthcare. Social and economic barriers, combined with restrictions on women’s autonomy, limit their ability to access essential maternal and child health services, including CHD prevention and early detection. Addressing these gender-based barriers is vital to improving healthcare access and outcomes for both women and children.

Organizations like the Afghan Red Crescent Society (ARCS) and the Afghan Midwives Association (AMA) are at the forefront of ensuring that maternal and newborn healthcare services reach those who need them most. Midwives and ARCS can work together to integrate CHD screenings within maternal health services and offer high-quality ANC and vaccination services in remote areas, improving early detection, outcomes, and ensuring essential services reach those in need. ARCS and AMA have made progress in expanding maternal and newborn health services, but a broader collaborative effort is necessary to scale up relevant initiatives effectively. A collective effort to address CHD is the only way to bridge the gap and ensure every child has a fighting chance at life.

About the authors:

Massoma Jafari is a volunteer with the Canadian Red Cross and a PhD candidate in Health Professions Education Research at the University of Toronto. She is also a PhD Fellow at the Wilson Centre. Originally trained as a midwife in Afghanistan, her research focuses on midwifery education in Afghanistan. Her broader interest lies in advancing maternal and child health in humanitarian and crisis-affected environments.

Ilja Ormel is a humanitarian worker and health researcher, currently Senior Manager for Global Health and Research at the Canadian Red Cross. She has worked in different humanitarian response settings as a heath promoter, logistician and researcher. Her experience includes disease outbreaks, emergency response, and health promotion.

Samira Shahzad is a research volunteer with the Canadian Red Cross, holding an MBBS from Khyber Medical University and an MSc in Public Health from the London School of Hygiene and Tropical Medicine. Her work spans local and global humanitarian settings, supporting refugee health initiatives and public health emergency responses through evidence-based, culturally sensitive approaches.

Faiza Rab is a Senior Manager for Global Health and Research at the Canadian Red Cross, specializing in strengthening health systems in fragile and conflict-affected regions. As a physician with advanced training in bioethics, epidemiology, and health systems research, she focuses on improving health outcomes for vulnerable populations through evidence-based and ethically grounded approaches.

Carla Taylor is currently the Head of Asia Pacific for Canadian Red Cross and has been working as a humanitarian for 15 years across Asia, Pacific, Africa, and the Americas. In her current role, Carla works with Red Cross / Red Crescent National Societies to deliver humanitarian services before, during and after crisis across the region.

Salim Sohani is a Senior Director, Global Health & Research at Canadia Red Cross. He is leading a multidisciplinary team of advisors, researchers and academic volunteers. HE has 35 years of experience working in various contexts in Asia, Africa and Latin Americas and is recipient of 2017 Lifetime Achievement in Global Health award from Canadian Society of International health.

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