Table 5 Geographic, demographic and social factors that impact health service inequity in Afghanistan

Regions in Afghanistan vary dramatically in culture, climate, geography and terrain and socioeconomic conditions- all factors which could impact the levels of health service coverage and inequalities [21].

Provinces in the Southern region suffer from lower literacy and income relative to the rest of the nation, and this is compounded by a deteriorating and unstable security situation that exists not only in the South, but also South East and Eastern regions. Moreover, despite the fact 72 % of total population of Afghanistan is living in rural areas, rural conditions vary across regions and within regions. Geographical barriers such as mountainous terrain and desert pose a threat to equitable delivery and access of health services in many regions, particularly the North and Central Highlands. These factors further impact climate, with some regions experiencing harsh and prolonged winters which adversely impact agriculture and mobility. Scattered populations across the mountains and deserts of Afghanistan are often difficult to reach and as a result exhibit lower coverage of services. Evidently, Afghanistan’s unique and complex geography epitomises conditions which severely convolute and constrain gains in health services access and delivery.

Cultural factors vary across regions in Afghanistan; Pashtuns occupy the South, Southeast and Eastern parts of the country, while Tajik, Uzbeks, and Hazara (among others) reside throughout other regions. Varying languages and cultural practices across these unique ethnicities could be factor leading to differences in women seeking and receiving health services for themselves and their children.