Half the WorldGender equality in Yemen: women and Health [Archives:2005/859/Culture]
By Women's National Committee
In the last decade, Yemen has achieved progress in improving health with significant improvement in health indicators especially that of infant and under 5 mortality rates. Programs such as dehydration and diarrhea eradication programs, regular vaccination against deadly diseases campaigns (chicken pox, Diftiria, TB, Children Paralysis) contributed to this success. Despite these gains the overall health status of women and children in Yemen leaves much to be desired. We examine some of the key issues such as infant mortality, maternal mortality, reproductive and sexual health in the following section.
Infant mortality and under five mortality
The mortality phenomenon describes death as an element of population transformation. Yet the rate of its occurrence depends on many factors such as age, gender, occupation and social class. This rate reveals many issues relating to standard of living and the health services provided to the population. The above figures reveal an incremental decrease in death of infants.
From the family health census year 2003, figures show that for children below fiver years of age the mortality rate reached 99.8 death care for every 1000 live birth, of which 100.3 are males and 99.3 are females yielding a gender gap of 1%.
Considering rural and urban areas, the figures show that 105.2 deaths per 1000 live births in the rural areas while the same in the cities reaches 79.3%. These numbers can be compared to that of 1990 (122 cases) and in 1997 (105 cases). Keeping in mind that the calculation of these numbers depend on many factors such as registration of deaths and the accuracy of recording age and date of deaths. Important point is urban areas are doing much better than rural areas.
Maternal mortality
Yemen is characterized among the countries with high maternity mortality rates, and among the countries with the highest fertility rate of 5.8. And although there has been visible improvement in medical treatment and precautionary health and family health services, yet Yemen is counted among the countries that spend on the health sector the least. There has been improvement in the general and reproductive health indicators during the nineties; however, there remains many health issues that affect the population in general and mothers and children's health in particular.
The family health survey data show that the average of maternity mortality has reached 366 per 100,000 every live birth in 2003. While 22% deliveries are under qualified medical supervision, 77.4% of the deliveries take place at home through traditional means. Of these, 55% did not refer a doctor, while 54.9% did not receive any medical care at all against 41.6% who did receive medical assistance. Women's access to health services is low with more than 35% women not receiving any medical attention as per the family health survey. Only 16% of poor Yemeni women having access to at least one antenatal visit from a trained health provider falling well short of the WHO recommended four visits. Lack of skilled/trained birth attendants deters poor women in accessing health services during pregnancy and childbirth, contributing to high infant and maternal mortality.
Gender gap in female medical personnel with only 28% medical personnel comprising women is a major obstacle in women's access to health care. Of these 25% are physicians, 39% nurses (and midwives), 21% technical staff and 17% administrative staff (refer Annexure 2 for details). Poor service, poor treatment of women, fear of being treated by male health providers, fear of unfamiliar procedures, costs of transportation and low levels of information exchange between health providers and clients result in poor women's reluctance to access health care even if these exist.
The high morbidity among women compared to men (anaemia, kidney diseases, infectious diseases) is also an important issue of concern. Gender roles and responsibilities render women more vulnerable with 25% of poor women suffering from malnutrition. Women's excess work burden in terms of both household work and productive employment increases women's vulnerability to poor health. Efforts to lower the maternity mortality rates, would have to tackle the issue of access to health care (facilitating reproductive health services) as well as improving women's status in the family and community. Cultural barriers, women's unequal status in terms of reproductive and sexual health, lack of information and access to referral services, low nutrition status, early marriage and repeated child bearing are all contributing factors that need to be taken into account if women's overall health status is to improve in the future.
Reproductive and sexual health
No discussion on gender equality and health would be complete without reference to reproductive and sexual health. This is in keeping with the ICPD consensus where 179 governments agreed that gender inequality influenced health and health care services. Recognition of a need for a life-cycle approach to men and women's health needs was a major achievement. Unless sexual and reproductive health where integrated as part of the primary health care services, it was agreed women's health status would continue to remain low.
Female reproductive health problems include lowering of uterus experienced by 22.1% women, while 11.3% have a problem with urine control and 16.0% have inflammation of the vagina. These are largely ignored and unaddressed. Cancer is considered the main cause of death second to heart and cardiac diseases, with breast and uterus cancer being the most common among women. Breast cancer is generally diagnosed at its late stages, increasing the chances of death and disability. Uterine cancer comprises 51% of female malignant tumors. Cancer of the uterus comprises 8%, followed by ovarian cancer 6% and vaginal cancer 1%.
Also, Yemen's high fertility rate of 5.8 poses a major challenge to women's health with repeated child bearing undermining overall health status. However, prevailing social and cultural norms constrain use of different family planning techniques. Despite this, there has been slow increase in family planning from a mere 10% in 1992 to 22% in 1997 and 23.1% which include traditional forms and modern contraception in 2003. Statistics also show that use of modern contraceptives has increased from 6.1% in 1992, to 10% in 1997 and to 13.3% in 2003. Thus, equality, dignity, access to information and choice are important requirements for building effective health services and for promoting health in the future.
HIV/AIDS
The Ministry of Public Health sought to tackle HIV/AIDS by establishment of a supreme unit to eradicate HIV/AIDs in 1995. The national program for combating HIV/AIDS was drawn up in 1998. The focus was to decrease the percentage of incidence (cases) and limit the disease. Main emphasis was on testing of blood and awareness campaign targeting 60% of the population.
Periodical reports and statistical data availed from the epidemic centre and the national program for combating AIDS, indicate a continual increase in the incidence and reported cases. In 2003 alone, there were 1379 reported cases, of which 797 are males and 474 females, while 108 cases remain un-identified. Studies conducted between 1998-2000, reveal that the chances of contracting the infection increases among blood donators by seven folds.
Yemen suffers from lack of basic services for safe and secure transmission of blood. These services are still unorganized and centralized and not consistent with approved international standards. Current practices in giving, testing and storing of blood fall far short of the basic safety measures. This renders women particularly vulnerable to disease transmitted through blood (hepatitis B and C, and HIV). Women's reproductive ability heightens her need for safe and accountable health care provisions. Women's vulnerability to transmission during delivery as well as their overall poor health status make this a valid concern. Otherwise she runs the risk of contracting infection through medical facilities that do not take adequate precautions.
If the HIV/AIDS epidemic is to be contained interventions need to address the particular concerns of women. Mother to child transmission poses a major challenge in some parts of Africa where the epidemic is widespread. Culturally sensitive norms that prevent women from discussing issues of sexual health and sexuality are important if HIV/AIDs awareness campaigns are to reach women. Moreover, decision-making on matters related to sex are often made by men, giving women fewer options in taking adequate precautions and safeguards against the disease. Women's role as carers when any member of the family fall ill are particularly relevant in these discussions. This becomes more acute in the case of poor households unable to afford health facilities. In the rare case when women have been identified with HIV/AIDs, she runs the risk of being abandoned by the family due to the taboos associated with the disease.
Health care costs
The majority of healthcare expenditure in Yemen is now funded privately, mostly from out-of-pocket expenditure. In 2001, 65.9% of total health expenditure was accounted for by private expenditure (and 88.7% of this was out-of-pocket expenditure), while the government contributed 34.1% and external funding covered the remaining 3.7%. An estimated 1.66% of households are affected by these high costs annually in 1998. Introduction of user fees has had a detrimental effect on health care especially for poor households. The Oxfam study conducted in collaboration with MoPH&P in 2000 revealed that as many as one in two persons could not afford health care. End result being they had to either forego treatment or encounter indebtedness, getting further enmeshed in poverty. User fees further erode poor women's ability to access and use health facilities and services. Given women's weaker access to resources, income and employment privatisation of health is a major setback to improving women's health status. Male health and well-being are given priority especially in circumstances of scarce resources. In view of this future policy interventions that seek to achieve gender equity in health would need to tackle all these issues.
——
[archive-e:859-v:13-y:2005-d:2005-07-14-p:culture]
