Afghanistan, a country with 32 million residents, has been engagedin constant conflict for the past 30 years. This instabilityand insecurity have resulted in a stark economic climate anda very low life expectancy. More than half of the people inAfghanistan live in poverty, and 40% of the adult labor forceis unemployed. Life expectancy is 44 years, and annual mortalityis 20 per 1000 residents.1 The situation in Afghanistan hasbeen grave for more than a generation. Since the 1980s, thecountry has endured Soviet occupation, civil war, Taliban rule(which means educational and employment restrictions for women),and war with the United States and its allies. However, in 2001a democratic government was established that has since signedon to international conventions and developed federal policiesdesigned to improve health and human rights, particularly forwomen and girls. In 2001, Afghanistan signed the Bonn Agreement,demonstrating a commitment to the establishment of a fully representativegovernment sensitive to issues affecting women. In 2003, thecountry ratified the Convention on the Elimination of Discriminationagainst Women (CEDAW), and in 2004 it signed the MillenniumDeclaration to promote equality of the sexes and improve maternaland child health. Also in 2004, the Afghan constitution wassigned into effect, granting women full citizenship, with legalrights and duties equal to those of men. In 2005, Afghanistansigned the Protocol for the Elimination of Forced and ChildMarriage, and in 2006, it put forward the Afghanistan NationalDevelopment Strategy, which includes as goals the eliminationof discrimination against women and the promotion of women inleadership. Today, women make up 27% of the National Assemblyin Afghanistan.
Sadly, these commitments and efforts do not appear to be translatinginto safer and healthier conditions for Afghan women and girls.The United Nations Development Fund for Women reports that 70to 80% of female Afghanis are forced into marriages, and 57%are married before 16 years of age; 84% of women are illiterateas compared with 69% of men, and women are half as likely asmen to have completed primary school.2 Afghan women have a fertilityrate of 7.5 births per mother,3 and with a skilled birth attendantpresent at only 14% of births,2,3 the country's maternal mortalityis the second highest in the world.2 Although there are no reliablestatistics on the prevalence of sexual or physical violenceagainst Afghan women, the available indicators suggest thatit is a major problem, primarily perpetrated by husbands andin-laws.2 In addition, there is increasing recognition of yetanother related tragedy among Afghan girls and women: self-immolation.
Self-immolation is the act of burning oneself as a means ofsuicide. Although reliable data on the scope of this practiceare difficult to obtain in Afghanistan and elsewhere, thereare indications that self-immolation is occurring at a notableand steady rate. In 2004, in response to an apparent increasein cases of self-immolation in the country, the Afghan government,the Afghanistan Independent Human Rights Commission (AIHRC),and the United Nations Assistance Mission in Afghanistan undertookseparate reviews of identified cases to try to determine whythe practice was occurring. Although formal analyses and reportswere not generated from these reviews, researchers involvedin them report that forced and child marriages, as well as violenceperpetrated by husbands, in-laws, and husbands' other wives,were common precursors to acts of self-immolation. More recentdata highlight the pervasiveness of the practice: the AIHRCand the Afghan Ministry of Women's Affairs report the identificationof 106 cases of self-immolation in 2006; if these events areconsidered instances of violence against women, they accountfor 5 to 6% of all such violence reported that year.2
In 2006, Medica Mondiale, a German nongovernmental organizationdedicated to supporting women and girls in regions involvedin conflicts, undertook a more systematic analysis of self-immolationcases, collecting data from all central hospitals — theonly hospitals equipped to handle serious burn cases —in Kabul, Wardak, and Herat, Afghanistan. The cases of femaleburn patients from within each hospital were reviewed, and patients'acts were identified as self-immolation if the burns were nonlocalizedand occurred in a pattern indicative of self-infliction, asdetermined by members of the medical staff. Families or othercontacts associated with female victims, or the victims themselvesif they survived, were contacted for interviews to obtain informationrelated to the woman's family and her life situation. Data collectedduring the interviews were reviewed to identify recurrent themes,including poverty, history of violence against women, familyconflict or disputes, and migration.
Hospital medical records available for review — for 2005to 2006 for Kabul, 2000 to 2006 for Wardak, and 2003 to 2006for Herat — indicate that 77 cases of female self-immolationwere reported, 35 of them in Kabul, 5 in Wardak, and 37 in Herat.In Kabul and Herat, the number of cases identified more thandoubled between 2005 and 2006 (see graph). All identified casesinvolved women or girls 12 years of age or older, with morethan half of the patients (55%) being 16 to 19 years old. Inalmost two thirds of the cases (61%), the patients sustainedburns over 70% or more of their bodies, and 80% of the casesresulted in death. The majority of patients (80%) were married;95% reported having little education and low or no literacy.
Number of Girls or Women in Three Afghan Provinces Who Committed Self-Immolation in 2005 and 2006.
Data are from Medica Mondiale.
The predominant causes or precipitating events of self-immolationidentified by survivors or contacts were various forms of oppressionof or violence against women. Forced marriage or engagementduring childhood was identified in almost one third of the cases(29%); bad or badal, practices involving forced marital exchangeto settle a conflict between families or tribes, in 18% of cases;and abuse from in-laws in 16% of cases (these categories werenot mutually exclusive). Although abuse by husbands was describedas a common circumstance in the lives of these women and girls,few identified this abuse as the proximate cause of self-immolation.Often, self-immolation was said to have occurred after victimsspoke out against or sought help in alleviating the violenceto which they were subjected — but were ignored. As thesister of one victim explained, "My 18-year-old sister did notwant to marry this man and asked my father several times notto give her to the farmer. But he ignored her pleas. One dayI heard that my sister had taken petrol and committed self-immolation."
These findings suggest that despite substantial efforts towardimproving health and human rights in Afghanistan, persistentconditions permit violence against women, and Afghan women andgirls continue to turn to the desperate remedy of self-immolation.Women and girls appear to see this horrifying act as a meansof both escaping from intolerable conditions and speaking outagainst abuse, since their actual voices do not bring aboutchanges that would allow them to lead safe and secure lives.More programmatic work is clearly needed to prevent and intervenein violence against women and to support existing policies aimedat improving the lives of Afghan women and girls.
No potential conflict of interest relevant to this article wasreported.
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Dr. Raj is an associate professor in the Department of Social and Behavioral Sciences at the Boston University School of Public Health, Boston. Ms. Gomez is a women's rights and political lobby project manager at Medica Mondiale, Cologne, Germany. Dr. Silverman is an associate professor in the Department of Society, Human Development, and Health at the Harvard School of Public Health, Boston.
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