Reproductive health services idle in rural areas [Archives:2008/1118/Health]

A recent report by the government's National Population Council criticizes the lack of reproductive health services in rural Yemeni areas.

Despite an expansion of health services, studies show that reproductive health coverage in Yemen is barely 68 percent.

One key factor responsible for such suboptimal performance is the concentration of reproductive coverage in urban areas rather than in rural areas, where more than 71 percent of Yemenis reside.

A second factor undermining reproductive health coverage in Yemen is insufficient and incompetent mobile health clinics and teams.

Launched in an effort to offer maternity care and family planning services in 10 Yemeni governorates, initiatives have been inadequate and have failed to yield the desired results.

Due to lack of adequate facilities and resources, mobile health clinics have been able to offer coverage only to easily-accessible areas, thereby excluding rugged terrain. Therefore, such health initiatives have proven to be provisional and hence can't be considered an alternative to primary health services.

It's well known that available obstetrical care significantly reduces both maternal and infant mortality rates; however, in the absence of such vital services, pregnant women are 15 times at risk of death during labor.

Unfortunately, half of Yemeni women, particularly those in rural areas, receive no parental health care; i.e., 30.8 percent of those living in urban centers and 61.7 percent in rural areas.

According to the 2003 National Family Health Survey, most maternal deaths in Yemen occur in rural women and account for 80 percent of all deaths among Yemeni women, while the percentage of women with no access to prenatal care is estimated at 70 percent.

These figures may be attributed to the fact that approximately 84 percent of all Yemeni births occur at home without skilled medical supervision.

As most deliveries occur at home, those done in the absence of skilled birthing attendants account for 82.2 percent in rural areas and 59.5 percent in urban areas.

Additionally, postnatal care is extremely low, accounting for only 12.6 percent, as most Yemeni women neither seek nor receive such care. Percentages are even higher for rural women.

In line with the above, the 2003 Family Health Survey indicated that the increase in home deliveries mainly is attributed to the following: women's desire to give birth at home, the unavailability of obstetric care, the high cost of obstetric services and health facilities' mistreatment of pregnant women.

Regarding maternal mortality, hemorrhaging was the main cause of death in Yemen women, accounting for 39 percent of total deaths, while obstructed labor involved an estimated 23 percent.

To prevent such casualties, it's important that prenatal care be made available in order to diagnose complicated cases early and refer them to specialists. Even more important is the availability of specialists and trained midwives capable of treating and dealing with obstetrical complications by providing emergency obstetric services in such serious cases. There's nothing of this sort in Yemen's obstetric facilities.

Government health facilities essentially are responsible for providing reproductive health services. Health centers can provide basic emergency obstetrical services, whereas larger facilities like hospitals offer patients comprehensive emergency obstetrical services.

Other reproductive health providers include non-governmental organizations and the private sector. However, the problem is that the role of private health organizations – such as the Yemen Organization for Family Health Care – remains rather limited, as their work focuses more on family planning services rather than emergency obstetrical services.

During the 1990s, private health facilities witnessed great expansion as a result of government health reform policies being initiated and espoused at that time; however, due to absence of supervision and monitoring of such private health services, information is lacking regarding the level and type of services offered there.

In the absence of strategic planning and effective coordination between the public and private health sectors, the latter concentrated in cities, specializing in more complicated services and in high financial revenues such as surgical operations.

While being a tough competitor to the public sector, such action exacerbated Yemen's problem by concentrating health facilities in urban areas and thereby depriving rural areas of such services.

Assessment of obstetrical services

Obstetric care is very limited and poor in quality, based on surveys regarding the availability of such services conducted in five Yemeni governorates with a total population of approximately 6.9 million.

The surveyed governorates have only 11 health facilities offering comprehensive emergency obstetric care and three providing basic emergency obstetric care, whereas according to international standards, they should have at least 14 facilities for comprehensive emergency care and 56 for basic care.

There also was extreme scarcity of maternal and neonatal (newborn infant) health care in the governorates surveyed.

Additionally, only 18 percent of births occur under the assistance of skilled birthing attendants and less than 10 percent of women with obstetrical complications receive emergency obstetrical care, while the rate of Caesarean sections is barely 0.6 percent, although it supposedly involves one in every five to 15 births.

Most hospitals in those areas surveyed don't have an ambulance or any means of referring those women with obstetrical compilations to specialized health facilities; instead, patients' families mostly are responsible for arranging their own transportation in such emergency cases.

Limited access to health care is made even harder and more complicated by Yemeni citizens' dire economic circumstances, especially those living in rural areas.

Other factors influence the demand for and use of reproductive health services by Yemeni women and families; for example, there are economic factors, including the high costs of treatment and medication.

According to an other study conducted in five governorates, a large proportion of health officials and local council representatives only heard about the decree, with few receiving actual copies of it. The same is true of the public, as most women and adolescents frequenting health centers had no idea about the decree.
——
[archive-e:1118-v:15-y:2008-d:2008-01-07-p:health]