Miles of Thanks: Safe Motherhood

2008-09-17T05:08:00.000-07:00

The information and analysis on this page come from the research I, Diana Schaffner, have conducted over the past twelve months, in both Yemen and Oman. My research was made possible through my CLEA and Fulbright Research Grants and I will be forever grateful to the Fulbright program for this incredible opportunity. Originally, I went to Yemen to study women and legal reform but over several months working with the Women’s National Committee (WNC) I became interested in reproductive and maternal health policy. Maternal health issues primarily affect women, but maternal mortality and morbidity also affect entire communities. It is unconscionable to me that global maternal mortality rates continue to be so high when we possess the knowledge and expertise in how to make motherhood safer for all women. It is my hope that the work of the YFCA and its partner organizations will improve the maternal health situation in Yemen to the point where Yemeni and American women face the same low-level of risk when giving birth.

Introduction

2008-09-07T03:44:00.000-07:00

Safe Motherhood is, at its simplest, the overall effort to make motherhood safer. Family planning, antenatal care, obstetric care, postnatal care, post-abortion care, and STI (sexually transmitted infection)/HIV care are all part of Safe Motherhood services. Issues of maternal health and Safe Motherhood effect entire communities; the children of women who die following childbirth are 3 to 10 times more likely to die within two years than those with both living parents. (WHO, 2005) Disability resulting from pregnancy or labor, most notably fistula, wreck further havoc on families and the lives of women the world over. Of the women who die annually of maternal health related causes 99% of them live in the developing world.

The Yemen Family Care Association’s (YFCA) Safe Motherhood Project is a multi-year effort to combat the various obstacles women face in regard to maternal and reproductive health care. Through this portion of the blog MOT hopes to introduce our readers to the maternal health issues facing women in Yemen and to the projects and means by which YFCA is working to make motherhood safer for all Yemeni women.

YFCA's Work

2008-09-07T00:02:00.000-07:00

The maternal health situation in Yemen is slowly improving, and gradually more women are gaining access to reproductive health services. Current educational and awareness-raising campaigns utilize a variety of methods to spread information and to target young people in particular. In the last decade the total fertility rate of the country has decreased and the median age of marriage for both genders has increased. Yet, the overall maternal and reproductive health situation in Yemen remains tenuous.

The YFCA is the oldest and most respected Yemeni NGO dealing with reproductive health and population issues. Women make up more than 50% of the members of YFCA’s Voluntary Board of Directors of the Association, and gender equality is a stated core value of the organization. YFCA is a major services provider throughout Yemen, complementing public and local health units, especially in remote areas. Importantly, YFCA considers access to information and health services a right of every Yemeni, and is dedicated to advocacy work to make this right attainable for all.

Ways YFCA is Making a Difference:

Mobile Clinics: In 1997 YFCA launched a community based service program with the operation of its first mobile clinic. Currently, YFCA has seven such mobile clinics working in a scheme which covers 140 points in under-served communities spread over 11 governorates. These mobile reproductive health clinics are an effective, proven, way to reach remote populations otherwise excluded from health services. The mobile clinics provide antenatal and postnatal care, immunizations, family planning services, etc.

Fixed Clinics/Hospital: In addition to its fleet of mobile clinics, the YFCA runs seven fixed reproductive health clinics and the Safe Motherhood Hospital in Sana’a. These fixed clinics offer antenatal care, a gynecology clinic, family planning services (including IUD insertion and removal), counseling and management of STIs, treatment of pediatric diseases, vaccination of pregnant women and children, HIV/AIDs Voluntary Counseling and Testing (VCT) and early detection of cervical carcinoma (PAP smear). The Safe Motherhood Hospital in Sana’a is equipped to deal with complicated cases and has an ambulance to transport such cases from rural health centers to Sana’a. MOT donations will go towards the procurement of medical equipment for the Safe Motherhood Hospital.

Midwives: YFCA has trained and qualified hundreds of midwives to provide quality care to local communities. These trained midwives are crucial to YFCA’s goal to increase the number of women who give birth with a skilled attendant present. Midwives are in traditional skills set as well as on subjects like reproductive health counseling, and the insertion and removal of IUDs. Female midwives are particularly valuable as same-gender care is especially appealing to women from more conservative or traditional families.

Involving Men: Educational campaigns targeting men are an important part of YFCA’s work. Men are a crucial missing link, as in many cases men rather than women make decisions related to a couple’s reproductive and sexual health.

Youth: Insufficient access to information can lead adolescents to seek information on reproductive health from unspecialized sources, and contribute to widespread misconceptions about reproductive health issues. The YFCA Youth Development Center (YDC) in Sana’a works to improve young peoples’ knowledge about reproductive health issues, and to provide a means by which youth can improve their computer, English language, and vocational skills. YFCA conducts information sessions, training workshops, and youth conferences all over Yemen in an effort to share reliable information about reproductive health.

Women’s Empowerment: Safe Motherhood and reproductive health issues are closely tied to the legal rights of women within their communities. Advocacy work by YFCA and other groups in Yemen continues to push for measures like a legal minimum age of marriage, meant to empower women. Taking into account cultural and social factors, the YFCA works to develop strategies meant to encourage women’s participation in dealing with issues which impede their access to health services. Recognizing the strength and resourcefulness of Yemeni women the YFCA continues to petition national leaders for sound reproductive health policies.

Yemen-Specific

2008-09-06T10:36:00.000-07:00

Yemen has one of the highest maternal mortality ratios (MMR) in the world, 430 deaths per 100,000 live births. The lifetime risk of maternal death for women in Yemen is 1 in 39. To put this figure in perspective, the lifetime risk of maternal death of a woman in the United States is 1 in 4,800, in the United Kingdom it’s 1 in 8,200, in Cuba it’s 1 in 10,500, and in Canada it’s 1 in 11,000.(WHO-2005)

Poverty is widespread in Yemen, the GNI was $760 in 2006, and the high costs of health services puts them out of the reach of many women. Lack of resources also affects a woman’s access to education; 48% of Yemeni women are illiterate. (UNICEF) This high level of illiteracy makes educational and awareness-raising campaigns about reproductive health all the more challenging. Poverty also contributes to the high level of malnutrition among Yemeni youth. 25 % of Yemeni women of reproductive age suffer from malnutrition, which increases their risk of anemia during pregnancy. (CEDAW-Yemen)

The poor state of, or lack of, transportation and health care infrastructure in many regions in Yemen also impedes a woman’s ability to seek timely medical services. Yemen’s varied and often rugged terrain doesn’t lend itself to centralized planning and contributes to the isolation of many rural women.

Early marriage and subsequent early childbearing pose a formidable obstacle, especially as such unions take place most often in rural regions least equipped to deal with obstetric emergencies. In Yemen 64% of women aged 25-29 were married before the age of 18.(UNICEF-ID) Early childbearing brings increased risks of maternal death, premature labor, complications during delivery, lower birth weights, and the chance that the newborn won’t survive. (UNICEF-ID) Girls giving birth before the age of 15 face a heightened risk of fistula, both Vesico-Vaginal Fistula (VVF) and Recto-Vaginal Fistula (RVF), caused by prolonged or obstructed labor.

Yemen has a total fertility rate of 5.6 children per woman, and the high social value given to large families often puts pressure on women to bear many children with little time between pregnancies. (UNICEF) In rural areas especially large family size is highly regarded. The prevalence of early marriage in Yemen only extends the reproductive period for young brides, leaving them more vulnerable to the complications that accompany frequent childbearing.

Certain cultural practices and traditions affect women’s health in Yemen. Early marriage and the reluctance of many families to allow women to be examined by male doctors are both examples of such practices. Distrust of modern contraceptive methods, or the belief that they are impermissible in Islam, is another example and one that often pits a woman against her husband. Safe Motherhood policies in Yemen must take such social and cultural factors into account in order to be successful.