The Current Situation and Challenges of Yemeni Women’s Health Care

Dr. Md Abdullah HADI

The Current Situation and Challenges of Yemeni Women’s

Health Care

Yemen is classified as a ‘least developed country’ and it is the poorest country in the Arab world.

The Current Situation of Yemeni Women’s Health Care


Yemen ranks last in the World Economic Forum’s Global Gender Gap Index and the UNDP’s gender empowerment measure. It ranks 133 out of 177 countries in the

2010 . UNDP Human Development Index (0.439). 76% of the total population; and lack of basic

infrastructure,

The Current Situation of Yemeni Women’s Health

Care


http://www.weforum.org/pdf/gendergap/ggg08_yemen.pdf

National Indicators Population 22,198,000 (2008) Population Growth Rate 3%

(2004) Life expectancy at birth 62

(2009) Ratio of urban population to rural

population 3:7 (2008)

GDP Growth rate (at fixed Prices) 4.7

(2009) Maternal mortality rate on birth per

100,000 births 365 (2009)


Health 2000 2005 2010

Literacy rate, adult female (% of females ages 15 and above) .. 35 45

Contraceptive prevalence (% of women ages 15-49) .. 28 ..

Unmet need for contraception (% of married women ages 15-49) .. 24 ..

Pregnant women receiving prenatal care (%) .. 47 ..

Births attended by skilled health staff (% of total) .. 36 ..



Health Expenditure indicators GDP per capita US$ exchange rate 926 2009

Total expenditure on health (per capita) Average US$ exchange rate

57 2009

Government expenditure on health (per capita) Average US$ exchange rate

15 2009

Total expenditure on health of % of GDP 5.6 2009

General government expenditure on health as % of total health expenditure

27.0 2009

Out-of-pocket expenditure as % of total health expenditure

66.3 2009

General government expenditure on health as % of total government expenditur

3.6 2009

budgetMinistry of health budget as % of government

4.5a 2009

Many Yemeni children and women are victims of neglect, abuse, and exploitation.


Care


Early marriage is Yemen’s biggest single development challenge but the national debate about setting a minimum marriage age is highly politicized.

An estimated one in four girls in Yemen will be married by the age of 15. Girls are commonly married as young as 8 years old, often as second or third brides for much older men.


Care


The reproductive health in Yemen, is the less fortunate in the Arab world, where die 365 women per 1000000live births as a result of complications that occur during pregnancy and childbirth and the period after birth, making maternal mortality the biggest cause of death (42%) among women of reproductive age in Yemen,

Estimated neonatal mortality rate of 37 per 1000 live births, accounting neonatal mortality of 49% of the total infant mortality rate,

The total fertility in Yemen is among the highest in the world with an estimated fertility rate in Yemen to 6.3%Dr. Md Abdullah HADI

Reproductive Health

Indicators Related to Maternal Mortality and Care


Reproductive health Yemen, Rep.

1990 2000 2005 2009

Contraceptive prevalence (% of women ages 15-49) 10 .. 28 ..

Unmet need for contraception (% of married women ages 15-49) .. .. 24 ..

Pregnant women receiving prenatal care (%) 26 .. 47 ..

Pregnant women receiving prenatal care of at least four visits (% of pregnant women) 9 .. 14 ..

Newborns protected against tetanus (%) .. .. 52 63

Births attended by skilled health staff (% of total) 16 .. 36 ..

Maternal mortality ratio (modeled estimate, per 100,000 live births) 540 340 250 210

Maternal mortality ratio (national estimate, per 100,000 live births) .. .. 365 ..

Lifetime risk of maternal death (1 in: rate varies by country) 23 48 72 91

Fertility rate, total (births per woman) 8.7 6.5 5.8 5.3

Age at first marriage, male .. .. 25 ..

Age at first marriage, female .. 21 22 ..


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Yemen is featured with high fertility rates (5.2 for each woman), according to the Cluster Survey of 2006, due to early marriage and repeated pregnancy that deteriorates women's health, in addition to the dominating culture that discourage uses of family planning means.


Reproductive Health

The prevalence of current use of family planning methods among married women is estimated at 28% in urban areas and 2.9% in rural areas. That 30% of women use modern methods of

family planning if facilitated access, That a quarter of women in Yemen do not

agree to the use of family planning methods

Uses of Contraceptives


Uses of Contraceptives; as showed in Health Survey 2003,

Cluster Survey 2006 and Target in year 2015


1. Lack of Female Health Workers,2. High Cost of Health Care3. The situation in Yemen is

exacerbated by the lack of access to health care. Only 28% of women are able to

give birth with the help of trained medical personnel.


Major Obstacles that Limit Women Accessibility to Health

Services:

Health Care Access


Availability of Medical Services Only 26% of all Yemeni

men and women report that medical services in their area are easily available.





Quality of Medical Care

Yemeni women rate their health care as higher quality than do men.

A quarter of men rate their medical care as bad, and 9% rate it as very bad, compared to 11% and 4% of women respectively.

More women than men also rate their care as good quality (32% vs. 19%).

Neither men nor women receive very good quality care however – only 4% of women and 2% of men rate it as such



high fertility rates rapid population growth lack of access to livelihood opportunities for the

rural population, which counts 76% of the total population;

lack of basic infrastructure, such as schools, water scheme, health facilities, access roads and markets in many rural areas.

Yemen continues to face considerable development challenges. It ranks 133 out of 177 countries in the 2010 UNDP Human

Development Index (0.439).

Yemen faces long-term challenges


Major efforts are exerted to abandon FGM, where the Supreme Council for Motherhood and Childhood has adopted National Work plan for 2008-2012 years, to reduce the rate of this practice to 30 percent in 2012.

"Analytical Study on FGM in Yemen" by Gender Studies and Researches Center, at Sana'a University in cooperation with Yemeni Women Union in 2008. The Study concluded that: Dr. Md Abdullah HADI

Female Genital Mutilation (FGM)

FGM is a common practice at 5 governorates out of 22. The communities of these governorates stressed that FGM is related to religion and culture;

71.4 percent of females support continuation of this practice, compared to 48 percent of males, and illiterate females are more supportive than females with secondary and high school education;

Wide spread of FGM among urban areas; i.e. Sana'a with 45.5 percent;

More researches are needed to understand the socio-cultural context of the communities impacted with this practice.



In addition to conduct specific studies on: explore knowledge, attitudes and practices in

the 5 governorates; health, psychological and social damages

resulted from this practice; religious context "justification" of this

practice; to raise awareness campaign on the

devastating impact of this practice in the 5 coastal governorates, the plan is to abandon this practice by 50 percent to grandmothers at the age of 40-70 years and parents at the age of 15-45 years, by the year 2012.




Millennium Development Goals (MDG)

Progress in Yemen



Target One: Ensure that all boys and girls

complete a full course of primary school

by 2015

A lack of adequate educational services; Low levels of income; A lack of basic services meaning some children

are required to work; Negative attitudes towards girl’s education; Internal school inefficiency; Low quality of school curricula; and The inability of the school system to address

problems such as overcrowding in classes, improper distribution of teachers and poorly equipped schools.


Major challenges to ensuring universal primary school education include:



Target One: Eliminate gender

disparities in primary and secondary

education preferably by 2005, and at all levels

by 2015

Poverty forces many girls to leave education; Drop-out rates are high among girls; Early marriage and pregnancy is common; There is a lack of female teachers; There is a lack of awareness about the

importance of girls education; There is a lack of proper training opportunities

and facilities for women; and, Cultural believes about gender roles impede

girls’ access to education.


The following issues are hindering Yemen’s efforts to achieve this

MDG:



Target One: Reduce by three quarters

the maternal mortality rate by

2015

Early marriage and pregnancy; Malnutrition; Poor quality health services; The large number of women who

are anaemic during pregnancy; and Poor distribution of health services.


Many factors contribute to the high maternal mortality rate in Yemen includinge:

1. Construct more health facilities at governorates and districts that lacks such services on equal basis;

2. Enhance health care services, maternal and reproductive health services in addition to vaccination services in rural areas in particular;

3. Employ more females at health facilities and midwives in rural areas in particular, and encourage female workers at rural areas to ensure their sustainability;

4. Establish mechanisms to follow-up and assess implementation of free provision of basic health care/services, pregnant care, and delivery under medical attendance;


Recommendations

5. Develop and update health statistic database and indicators and integrate gender in its outputs;

6. Revise and improve the free distribution policy of the contraceptives;

7. Identify marriage age to reduce maternity mortalities among below 20 years age group of mothers;

8. Implement free provision of deliverDr. Md Abdullah HADI

Recommendations

9. The government should increase budget allocations to the public health sector, with a focus to health care and reproductive health needs of women in rural areas

10. The government should work with women's rights organizations and legislators on the amendment of all discriminatory laws against women.

11. Enhance public and private communication channels to develop awareness with gender issues;

12. Government and non-governmental women's rights that the development of programs bugs awareness of the rights of women to make women aware of their rights and their protection under the laws of And the Constitution of Yemen.


Recommendations


Documents

The Current Situation and Challenges of Yemeni Women’s Health Care