The book's foundation is built on the relationship between ten-year-old Abdullah and his three-year-old sister Pari and their father's decision to sell her to a childless couple in Kabul, an event that ties the various narratives together.

Continuing the familial theme established in his previous novels, The Kite Runner and A Thousand Splendid Suns, And the Mountains Echoed centers on the rapport between siblings.

Besides Abdullah and Pari, Hosseini introduced two other sibling and sibling-like relationships—the children's stepmother Parwana and her disabled sister Masooma and an Afghan-American doctor named Idris and his cousin Timur.

While there, he heard stories from several village elders about the deaths of young, impoverished children during the winters, which gave the foundation for the fundamental event of the novel: a parent's choice to sell a child to prevent this from occurring.

"[6] Hosseini originally planned for it to be written in a linear fashion similar to his previous novels, but, during the writing process, it was expanded to cover a series of interconnected stories surrounding a large number of characters not directly related to each other.

[7] "Slowly, a family began to take shape in my mind-not unlike the many I had visited-one living in a remote village, forced to make a painful choice that most of us would find unbearable.

[2][9] In January 2013, Publishers Weekly announced the publication date as May 21 of that year, and Riverhead Books released a statement that the novel was about "how we love, how we take care of one another, and how the choices we make resonate through generations".

Saboor, an impoverished farmer from the fictional village of Shadbagh, decides to sell his three-year-old daughter Pari to a wealthy, childless couple in Kabul.

While camping out for the night, Saboor tells the children a story about another poor farmer who was forced to give up a beloved child, but the significance of the tale doesn't register with Abdullah.

While there, Timur makes a great show of publicly distributing money to street beggars while Idris privately bonds with Roshi, an Afghan girl who suffers from a horrific injury and whose family was murdered by her uncle.

Later chapters focus on Adel, a boy learning that his father is a war criminal and that his house is built on land that previously belonged to Saboor, and Markos, a Greek aid worker in Afghanistan and acquaintance of Nabi.

In this chapter, Iqbal, Saboor's and Parwana's son, is an older man and he tries to obtain the documents proving he is the owner of the land, but Adel's father pays off a judge to say they were burned in a fire.

However, he is suffering from Alzheimer's disease and is unable to remember her echoing the conclusion of the story their father told them so many years ago as children on their last night together in Afghanistan.

Khaled Hosseini chose to tell the story in a "fragmented and fluid" form;[15] each of the nine chapters is told from a different character's perspective, and each narrative provides an interconnection with the others'.

However, towards the end of the book, Pari is informed that she was adopted and that she has a brother, Abdullah; she locates him in the United States only to discover that he is suffering from Alzheimer's disease and has forgotten her.

"[14] She stated the theme of dependence also extended to the story of Nabi, the brother of Parwana who arranges the selling of Pari and who is later left as the sole caretaker of his paralyzed employer.

There are a dozen things I still want to say — about the rhyming pairs of characters, the echoing situations, the varied takes on honesty, loneliness, beauty and poverty, the transformation of emotions into physical ailments.

[4] In general, the novel was received well, with Los Angeles Times critic Wendy Smith finding it "painfully sad but also radiant with love".

[15] Fran Hawthorne of The National described the book as "masterful storytelling" and a "haunting portrayal of war-ravaged Afghanistan and insight into the life of Afghan expatriates".

"[26] Soniah Kamal of Atlanta Arts was particularly favorable towards Amra, the Bosnian aid worker who cares for and adopts Roshi, as she "stuns with her hope in humanity no matter what callousness she has witnessed".

[28] The structure of the book drew mixed reactions, with Toronto Star's Kim Hughs describing it as "the novel's most defining feature and its most exasperating conceit".

[29] The Independent's Arifa Akbar stated, "The changing points of view and leaps in time can confuse and confine, leaving characters clearly defined but lacking depth.

"[30] Michiko Kakutani from The New York Times thought the novella-like storytelling was handled well and wrote, "Khaled Hosseini's new novel, And the Mountains Echoed, may have the most awkward title in his body of work, but it's his most assured and emotionally gripping story yet, more fluent and ambitious than The Kite Runner (2003), more narratively complex than A Thousand Splendid Suns (2007).

[27] Scoop Empire's Sherine El Banhawy added that the focus on multiple characters allowed to readers to gain a better understanding of the diversities of Afghan culture.