Our national scourge: Dead mothers [Archives:2002/12/Health]
BY ISMAIL AL-GHABRI
YEMEN TIMES STAFF
While Yemen has improved its health care is some ways during the past 30 years, its high rate of mothers dying during childbirth continues to be a national scourge.
National information about maternal mortality is scarce and data is based on scattered studies and primary estimates, or estimates from outside agencies.
According to the World Health Organization (WHO) and UNICFE, the maternal mortality rate in Yemen is estimated to be 1,400 per 100,000 live births. Other international studies indicate the rate may be as high as one in nine women dying during childbirth.
That means that maternal mortality rate in Yemen is one of the highest rations in the world, and is an indicator of the poor medical services in the country.
Yemeni health officials confirm that women here continue to have a high number of pregnancies with a short period, and 35% of births occur at unsafe ages to teens and to women aged more than 35.
All this has contributed to a high birth rate, which is now between six and seven children per woman.
Based on the 1996 estimates of the Central Statistical Organization, the contraceptive use prevalence rate for all methods including breast-feeding has increased from 10% in 1992 to 12%.
Previous demographic surveys on maternal and child health show, however, it is hard for women to access family planning services.
The three major providers of family planning methods are the Ministry of Public Health, The Yemeni Family Care Association, and the pharmacies, but a high prevalence of illiteracy especially among women, a lack of knowledge of family planning methods, husbands disapproval, and religious prohibitions all are preventing such family planning.
The most widely used method of birth control in Yemen is the pill, which is used by 33% of all married women who are currently using contraceptives.
Birth control is higher among urban women, among women with education and among couples when one or both husband and wife are working. As a result, these families are smaller.
In general, according to current estimates, only 28% of the total need for family planning in Yemen is being met.
The goal: 10 years ago
Ten years ago, the goal of officials was to increase the rate of contraceptive use rate to 36% of married couples by this year, and to decrease the total fertility rate to six children per family.
In order to attain these objectives, there is still a need for leaders to support reproductive health services.
There is an urgent need to improve the quality of the family planning services including the mix of safe and reliable family planning methods, to provide counseling for couples enabling them to free and informed choice through implementation and proper supervision of medical standards.
It is also essential to pay more attention to train all providers in family planning aspects, including communication, education and counseling.
Educating the public about breast-feeding and the prevention and treatment of infertility are also part of family planning services, and will improve the maternal and child health and increase the survival rate of both mothers and children.
Controlling sexually transmitted diseases and getting men more involved in reproductive health care are also issues that need to be dealt with, according to Yemens health care officials. So is closing the health care gap in different regions.
Lack of awareness
One study on risk factors for maternal mortality among women using a hospital in North Yemen revealed a maternal mortality ration of 753 per 100,000 live births.
It was found that hepatitis, hemorrhage, pregnancy-related infections, and pregnancy-induced hypertension, in that order, are the main causes of maternal deaths.
Regarding the maternal morbidity, there is a lack of a general awareness on the extent of the problem. However, studies show that there in five women who were pregnant for at least three months at the time of study have had various health problems: 23% reported swollen ankles and fingers, 47% had persistent headaches, 15% had high blood pressure, 6% had bleeding, and 30% had convulsions.
These conditions occur regardless of whether the women are urban or rural, or if theyve had antenatal care. In the last five years preceding the survey, mothers received antenatal care for only 26% of all births.
Antenatal care increases with the increase in mothers level of education. Greater antenatal care utilization was observed in urban areas (57% of births) than in rural areas (20% of births).
Women who had births in the five years prior to the survey reported receiving one or two doses of tetanus toxoid for only 15% of births. A doctor or a midwife assists in only 16% of deliveries (14% of deliveries take place in health facilities).
Postnatal care is sought by mothers for only 6% of births.
Complex web needs broad initiatives
The poor maternal health in Yemen is the result of a complex web of low socioeconomic status of women and weak maternal health services. Unorganized reproductive behavior, a high illiteracy rate, heavy workloads, harmful cultural practices, lack of health awareness, and low status of women in the family and the community are all the factors which keep Yemeni women from using available health services.
At the same time, maternal health services are limited in coverage (20% of health facilities are providing maternal care). The situation of these facilities does not encourage women to use them.
Health officials stress that the most important initiatives to combat the high maternal deaths are to:
Upgrade existing health facilities to provide high quality of maternal heath care, including comprehensive reproductive health care of essential obstetrics care at the district level
Offer basic and continuous manpower training especially for females;
Establish a referral system with participation of communities, so there is fresh information on maternal mortality and morbidity from health facilities, in addition to national surveys, confidential inquiries, and operational research. Referrals are essential because improving the quality of services cannot be fulfilled without establishing links and integration between different projects and service provision facilities.
Promote supportive systems as logistics and supplies supervision.
We are optimistic that over time we will have success and Yemen will have better reproductive health. But there is still a huge unmet need, and we need to move fast to save the lives of some, and bring a better quality of life to others.