Half the WorldGoing through death to give birth [Archives:2005/879/Reportage]

September 22 2005

By Nisha
Seventeen years old and visiting a doctor for the first time in her life, Amira, married a few months back, finds out that she is pregnant. She remembers that about to years back, the health worker had advised her to take vitamins because she used to feel fatigued. Today, the doctor tells her that she is anaemic. Her blood test suggests that her haemoglobin level is as low as 6g/dl. The doctor tells Amira's mother-in-law that she will have to be careful about Amira's food and care, otherwise, Amira and her foetus may not be able to pull through. Amira's mother-in-law is insisting that the doctor should give her daughter-in-law some tablets. But the doctor replies that it may not be good idea because Amira is already suffering from diarrhoea and the medicines used in cases of anaemia have a tendency to cause constipation or diarrhoea may aggravate her condition. Amira is angry. She can't understand why she has to go through this when other girls her age are going to the school, and do not have to worry about anything. The doctor tells her that she is in this situation because she is married and pregnant while her friends may not be. He explains that at 17 she is still growing; her own body requirement of red blood [haemoglobin] is high. Pregnancy at this age means far more increased demand for red blood [haemoglobin] to meet the needs of the foetus. Since her body is producing more blood to meet the needs of the foetus without having enough iron in her food, it is causing wateriness in the blood. “it is like adding water to blood to meet the quantity requirement but it reduces redness in blood and causes all the trouble that she is facing”, the doctor explained.

Amira's village falls within the service catchment area of a health centre. The centre is not far from her home. “It is useful for children”, says Amira about the centre. Her family did not want her going to the centre when Amira complained of dizziness a couple of times. This centre has no facilities for women's health other than an examination room. Amira did not complain about it, “I don't like to go to the health centre, anyway”. But her family took her to the centre when she developed persistent irregular bowel movements. The health worker prescribed her medicines meant for diarrhoea. Amira's mother-in-law patiently listened to her grumblings and cajoled her to take the medicines as prescribed by the health worker. Two days later Amira fainted. Her husband collected his savings and decided to take her to a private hospital in a neighbouring town. Her mother-in-law gathered a few things that may be needed in case they have to hospitalize Amira. She loves Amira. She frequently asked her son to be gentle with Amira and showered extra affection on her thinking she is a delicate girl who is having difficulty adjusting to the married life.

Safiah, Amira's mother-in-law is around 40 years old. She is dressed in a black abaya and a black pair of gloves which reflect her family's modest condition. The opening in her naqab for the eyes has lost its shape and is partly covering her left eye. When the doctor was explaining Amira's condition, she could feel a lump in her throat. She couldn't help breaking into loud sobs when Amira's angry voice asked why she has to go through this. Safiah is not convinced with the doctor's explanation. So while the doctor was explaining she interjected many times to tell the doctor as well as Amira that it is women's fate to go through death to give birth. Like many traditional Yemeni women, Safiah believes motherhood is a holy duty that every woman must perform even if it means risking her life. But she is desperate to protect Amira. Once they came out of the doctor's room, she dragged her son to one side and asked him to pray so that Amira's first child birth goes smoothly. In a slight indirect way, she asked him to give Amira some rest.

“We did what we could do. We are doing what we can do. Allah will save Amira like he saved me”, Safia says in a voice, which shows that she is trying to reconcile to the reality of the situation. Amira's husband, a 25 year old brick-maker is Safiah's first live born. She was lucky that her parental family was relatively well-off. She remembers that her father often told her mother to feed her well. But the first pregnancy nearly killed her. She still remembers the long painful labour at the end of which she fainted. When she regained consciousness, her mother told her between cries that her child is with Allah. She remembers taunts and stigma that she had to bear till she gave birth to a son, Amira's husband. In all, she went through 14 pregnancies of which nine survived. Only her youngest son, now eight years old, was born in a hospital. She had to be rushed to the hospital when her water broke but she was unable to push the baby out. These multiple pregnancies have taken a toll on her. She is glad that her husband finally heeded to the doctor's advice to use protection to save her life. She remembers that her stepmother was not so lucky. Barely two-three years older than Safiah, she suffered and finally succumbed to death while giving birth to her first child at home. She was barely 17 or18 years old. As always safiah mutters a prayer for her stepmother and her thoughts move to one of her three married daughters.

Safiah's three daughters were married by the time they reached 17 years of age. Two of them became mothers within first year of their marriages. Safiah's second daughter, Arwa who was married at 16 years of age, could not adjust to the life after marriage. She wanted to finish basic schooling and join the secondary school. Her parents-in-law and husband prohibited her from studying and reprimanded her every time she failed to do any of the household chores. Fatigued and pregnant with her first child, Arwa ran away to her parents' house. She was forced by her father to go back to her husband. A few days later, she had a miscarriage. Her health deteriorated rapidly. There is no government hospital close to her marital village and the cost of treatment in a private hospital was something her husband refused to bear. In a matter of months Arwa was divorced. She has been at her parents' house since then.

I narrated this intergenerational story to highlight how near absence of knowledge of women's health among health centre staff, unavailability of women health workers and doctors, early marriage, lack of knowledge and sensitivity among decision-makers in the family, and many other such reasons take a toll on women's lives. Yemen is one of the countries with the highest rates of maternal deaths during childbirth and infant mortality. In areas where some preventive women's health programmes are available, shortage of women paramedics and doctors and cultural resistance to examination by men, early marriage leading to early pregnancy, scarce resources and many other such reasons practically push women to death. Yemeni women will continue to die unless the government, development organizations and society become sensitive towards women and begin to believe that terrible realities of women's lives can be changed and must be changed.