Hebah Mohammed – Women in Development and Peace
Given the difficult circumstances faced by women in Yemen, national strategies related to reproductive health take center stage in healthcare and women’s empowerment. These strategies aren’t just administrative documents; they represent a vital turning point in improving Yemeni women’s health and social lives.
In this complex context, we question how these national strategies affect the reality of women in Yemen, and whether the desired goals have been achieved.
Reproductive Health Strategies
Several national strategies have been developed in Yemen to promote reproductive health due to its crucial role in improving the health of women, families, and society as a whole. Here are some of Yemen’s main national strategies related to reproductive health.
Over the past years, the Yemeni government has implemented a comprehensive health policy, developing multiple strategies within the Yemen 2025 strategic vision. This led to the development of the National Health Strategy 2010-2025. With the increasing population growth rate, reproductive health became a priority in these strategies. Therefore, the population sector worked to review and update the first national strategy for reproductive health (2006-2010) to align with the national health strategy.
Dr. Zahra Al-Susuwa, a specialist in obstetrics and gynecology, mentioned the national strategy for reproductive health and family planning, which aims to improve reproductive health and increase access to family planning services. This includes awareness about the importance of family planning, providing contraceptives, and offering necessary services in health centers to ensure the health of mothers and children.
She points out that this strategy also aims to encourage women to utilize family planning services and provide support to those who wish to use them, taking into account cultural and religious sensitivities.
She adds, “There’s also the national program for maternal and child health, which focuses on improving the health of mothers and newborns. It provides integrated health services, including antenatal care, postnatal care, vaccinations, and child health care. It strives to reduce maternal and child mortality rates through good healthcare during pregnancy and childbirth.”
She continues, “Because many people in Yemen live in remote rural areas, programs have been developed to improve access to reproductive health services in these areas. These programs include mobile clinics, training rural midwives and nurses, and providing safe delivery and family planning services.”
The Impact of Strategies on Women’s Realities
Dr. Mayada Faisal Nabil, a master’s in public health, PhD in community health, and consultant for grants, partnerships, and research at the Field Medical Foundation, says, “National strategies for reproductive health in Yemen have achieved some improvements, but they haven’t yet been able to sufficiently improve women’s access to reproductive healthcare services, especially given the enormous challenges facing the country.”
She explains that Yemen has been suffering from a long-term humanitarian crisis due to the ongoing conflict, which has led to the collapse of the health system and a deterioration of health services in general, including reproductive health.
She adds, “Despite the existence of national strategies aimed at improving reproductive healthcare services, such as plans by the Ministry of Public Health and Population in cooperation with international organizations like the United Nations Population Fund and the World Health Organization, implementation on the ground faces several challenges.”
Dr. Zainab Al-Badwi, a reproductive health officer at the Ministry of Health, points out that the national strategy for maternal and newborn health and the national midwifery strategy are the first two initiatives from the Ministry of Health that have had tangible results on women’s health.
Al-Badwi mentioned that these strategies improved the situation despite the difficult circumstances Yemen is facing, including conflicts and salary cuts. Significant achievements have been made in several areas, including a reduction in the maternal mortality rate from 500 deaths per 100,000 live births in 2019 to 183 per 100,000 in 2023.
She also explained that these strategies helped reduce neonatal mortality from 26 deaths per 1,000 live births to 21 per 1,000 in 2022. The reduction in deaths and illnesses among mothers and newborns is the main goal of the General Directorate of Maternal and Newborn Health and the Midwifery Program, alongside the expansion of comprehensive and basic maternal and neonatal emergency services.
She also stated that among the tangible achievements is the Yemeni midwifery program, the first national program dedicated to midwifery, contributing to improving the quality of health services in family care.
Maternal and Newborn Health
“The term ‘reproductive health’ has evolved in some Yemeni governorates to encompass ‘maternal and newborn health,’ becoming broader in scope. It’s one of the most important health programs, focusing on mothers and newborns who make up 70% of the population—the most vulnerable and affected by the overall situation. Services range from preconception care and pregnancy to safe delivery and postnatal care,” says Dr. Zainab Al-Badwi.
She continues, “Now, women’s healthcare and prevention of breast and cervical cancers are program priorities. It also includes newborn care from day one to 28 days old. Maternal and newborn healthcare services aren’t just limited to primary and community healthcare; they encompass all secondary and specialized levels, including infertility prevention and treatment.”
Statistics
A February 2023 UNFPA report highlights the urgent need for funding amidst the ongoing humanitarian crisis in Yemen. With governments mobilizing funds, UNFPA’s role in implementing health programs is critical, especially with 12.6 million women needing life-saving reproductive health and protection services. UNFPA launched a $70 million appeal to ensure these vital programs continue.
The report points out Yemen’s extremely high maternal mortality rate. Less than half of births are assisted by skilled medical professionals, and only one in five health facilities provides maternal and child healthcare. UNFPA is the sole supplier of essential, life-saving reproductive health medicines in the country and leads the provision of reproductive health and protection services for women. However, without sufficient funding, 93 health facilities will have to close.
The report notes that the crisis has led to one woman dying every two hours in Yemen during childbirth from preventable causes. It further indicates that 5.5 million women and girls of reproductive age need access to reproductive health services. Additionally, 1.5 million pregnant and lactating women suffer from acute malnutrition, while 7.1 million women urgently need services related to gender-based violence.
These figures reflect the severe humanitarian crisis faced by women and girls in Yemen, demanding urgent international efforts to ensure they receive necessary care and services.
According to a 2023 OCHA report, immunization coverage has drastically worsened. 28% of children under one year old have missed routine vaccinations, leading to outbreaks of preventable diseases like diphtheria, pertussis, measles, and polio across various governorates.
The report explains that the number of unvaccinated children in Yemen has increased over the past three years, placing Yemen first in the Middle East and North Africa region. A total of 272,000 children lack vaccinations; 97,000 have not received the third dose of the DTP (diphtheria, tetanus, pertussis) vaccine, and 176,000 have not received the first dose.
The Challenges
Regarding the biggest hurdles to implementing national reproductive health strategies, Mayada mentioned that the infrastructure of health facilities has been destroyed and is now inadequate due to the conflict, limiting women’s access to services, especially in rural and remote areas.
She continued, “There’s also a huge shortage of funds needed to run and effectively implement health programs, limiting the possibility of improving access to reproductive healthcare. Societal customs and traditions still hinder women from getting reproductive healthcare; in some areas, these services are considered taboo, and there’s a lack of awareness about their importance.”
Al-Badwi mentioned that another challenge is the unstable security situation due to ongoing conflicts in various Yemeni governorates and their repercussions, the gradual withdrawal of foreign aid, a significant shortage of midwives, and a high rate of unnecessary C-sections, which has placed a huge burden on the Ministry of Health in terms of the risks caused by C-sections.
She added, “The challenges also include an increase in the rate of health complications, such as obstetric fistula, stemming from midwifery institute graduates having insufficient training programs lasting only six months to a year, leading to a health crisis.”
In general, the strategy developed by the Population Sector at the Ministry of Public Health aims to strengthen partnerships with local communities in decision-making, increase the capacities of health offices in governorates, promote a culture of reproductive health in schools and youth clubs, support reproductive health centers in universities and health facilities, organize media campaigns to raise awareness about the benefits of reproductive health and family planning, create an effective referral system, and expand maternal and newborn health services at the home and community levels.