Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative study

Despite efforts to promote gender equality in Afghanistan from 2002 to 2021, the country continues to face significant challenges in women's health, including high rates of unassisted homebirths and maternal mortality. This study explores the influence of gender norms on unassisted homebirths i...

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Main Authors: Ahmad Rashed Wassif, Maisam Najafizada, Shree Mulay
Format: Article
Language:English
Published: Elsevier 2025-12-01
Series:SSM: Qualitative Research in Health
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Online Access:http://www.sciencedirect.com/science/article/pii/S2667321525000794
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author Ahmad Rashed Wassif
Maisam Najafizada
Shree Mulay
author_facet Ahmad Rashed Wassif
Maisam Najafizada
Shree Mulay
author_sort Ahmad Rashed Wassif
collection DOAJ
description Despite efforts to promote gender equality in Afghanistan from 2002 to 2021, the country continues to face significant challenges in women's health, including high rates of unassisted homebirths and maternal mortality. This study explores the influence of gender norms on unassisted homebirths in Afghanistan, where conservative societal norms often dictate women's roles and access to healthcare. A qualitative case study design was employed to explore unassisted homebirths in Afghanistan. Data were collected from Afghan refugee men and women who had relocated to Canada. In-depth interviews were conducted with nine women who had experienced unassisted homebirths, and focus group discussions were held with six men and eight women to gather their experiences and observations of homebirths in their communities.The findings highlight a range of factors, including gender norms that burden women with exhaustive household and agricultural responsibilities, financial dependence on male family members that restricts their autonomy, and male-dominated decision-making processes that severely limit their agency in health-related choices. Additionally, social norms requiring women to seek permission from husbands or a male family member and have a mahram (husband or a permissible male companion) to access healthcare were found to compound barriers to skilled birth attendance.The research underscores the need for gender-sensitive strategies that engage family members, particularly male relatives and mothers-in-law, to promote skilled birth attendance and empower women through health education and improving their economic opportunities to make autonomous health decisions. Addressing these gender norms and power dynamics is crucial for reducing unassisted homebirths.
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spelling doaj-art-defbcfc7c91c4aa79a51990e059a30e62025-08-20T03:28:14ZengElsevierSSM: Qualitative Research in Health2667-32152025-12-01810060110.1016/j.ssmqr.2025.100601Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative studyAhmad Rashed Wassif0Maisam Najafizada1Shree Mulay2Memorial University, Montclair Stat University, Balkh University, Afghanistan; Division of Population Health and Applied Health Sciences, Faculty of Medicine Building, 4th Floor, Office#M4M202, Memorial University, 39 Clinch Crescent, St. John’s, NL Canada A1B 3V6; Corresponding author. Memorial University, Montclair Stat University, Balkh University, Afghanistan, Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University. Office# M4M202. 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada.University of Ottawa, Balkh University, Afghanistan; Division of Population Health and Applied Health Sciences, Faculty of Medicine Building, 4th Floor, Office#M4M202, Memorial University, 39 Clinch Crescent, St. John’s, NL Canada A1B 3V6Division of Population Health and Applied Health Sciences, Faculty of Medicine Building, 4th Floor, Office#M4M202, Memorial University, 39 Clinch Crescent, St. John’s, NL Canada A1B 3V6; McGill, CanadaDespite efforts to promote gender equality in Afghanistan from 2002 to 2021, the country continues to face significant challenges in women's health, including high rates of unassisted homebirths and maternal mortality. This study explores the influence of gender norms on unassisted homebirths in Afghanistan, where conservative societal norms often dictate women's roles and access to healthcare. A qualitative case study design was employed to explore unassisted homebirths in Afghanistan. Data were collected from Afghan refugee men and women who had relocated to Canada. In-depth interviews were conducted with nine women who had experienced unassisted homebirths, and focus group discussions were held with six men and eight women to gather their experiences and observations of homebirths in their communities.The findings highlight a range of factors, including gender norms that burden women with exhaustive household and agricultural responsibilities, financial dependence on male family members that restricts their autonomy, and male-dominated decision-making processes that severely limit their agency in health-related choices. Additionally, social norms requiring women to seek permission from husbands or a male family member and have a mahram (husband or a permissible male companion) to access healthcare were found to compound barriers to skilled birth attendance.The research underscores the need for gender-sensitive strategies that engage family members, particularly male relatives and mothers-in-law, to promote skilled birth attendance and empower women through health education and improving their economic opportunities to make autonomous health decisions. Addressing these gender norms and power dynamics is crucial for reducing unassisted homebirths.http://www.sciencedirect.com/science/article/pii/S2667321525000794Unassisted homebirthsGender normsSkilled birth attendanceGender patriarchyQualitative studyAfghanistan
spellingShingle Ahmad Rashed Wassif
Maisam Najafizada
Shree Mulay
Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative study
SSM: Qualitative Research in Health
Unassisted homebirths
Gender norms
Skilled birth attendance
Gender patriarchy
Qualitative study
Afghanistan
title Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative study
title_full Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative study
title_fullStr Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative study
title_full_unstemmed Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative study
title_short Influence of gender norms on unassisted homebirths in Afghanistan: A qualitative study
title_sort influence of gender norms on unassisted homebirths in afghanistan a qualitative study
topic Unassisted homebirths
Gender norms
Skilled birth attendance
Gender patriarchy
Qualitative study
Afghanistan
url http://www.sciencedirect.com/science/article/pii/S2667321525000794
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AT shreemulay influenceofgendernormsonunassistedhomebirthsinafghanistanaqualitativestudy