ShareTo assess the availability and utilization of emergency obstetric and neonatal care (EmONC) facilities in Afghanistan, as defined by UN indicators, a cross-sectional study of 78 first-line referral facilities located in secure areas of Afghanistan, EmONC service delivery was evaluated by using Averting Maternal Deaths and Disabilities (AMDD) Program assessment tools. Gaps remain with 42% of peripheral facilities not performing all 9 signal functions required of comprehensive EmONC facilities. However, progress has been made in Afghanistan over the past 8 years in improving the quality, coverage, and utilization of EmONC services. Re-examination of the criteria for selecting and positioning EmONC facilities is recommended, as is the provision of high-quality, essential maternal and neonatal health services at all levels of the healthcare system, linked by appropriate communication and functional referral systems.