Women’s Health & Politics in Yemen [Archives:1998/18/Health]
This is the second part of a research paper submitted at the Exeter University conference on Yemen (April 1-4) by Ms. Ilse Worm of the Berlin Free University.
3. Health and Politics in Yemen
As the Yemeni government was faced in the beginning of the ’90s with the social realities of a population steadily rising while internal and external economic resources were rapidly shrinking, health and in particular women’s health, increasingly became a subject of political debate. The fast population growth and the return of some 800,000 Yemeni migrants in the aftermath of the Gulf War pressured the government to deliver social services. Furthermore, as Saudia Arabia and Kuwait cut their support, the failure of the public health sector to meet the essential needs of Yemeni citizens became evident.
In August 1991, the government reacted to this changing reality by endorsing a National Population Strategy, which is justified by the need to reduce the gap between population growth and economic resources and to depart from the prevailing laissez-faire approach in population issues. The improvement of the social and economic status of Yemeni women was central to this strategy, as it assumed a positive relationship between the enhanced access of women to health and education services, the integration of women into the labor market, the reform of family law and the decrease of fertility (CSO 1992). After the first National Population Policy Conference was held in Sanaa with the support from international donors in October 1991, the National Population Strategy was further developed into a Population Action Plan, and in July 1992, the government established an inter-ministerial National Population Council as a coordinating and supervising body for the implementation of the official population policy.
As a result of the political liberalization process which took place at the beginning of the ’90s, health became a subject of competition between political parties. In opposition to the government, the Islah party, between 1990 and 1993, regularly blamed the government for the deterioration of medical services in the country. The Islamist weekly, As-Sahwa, thus criticized that although the government proclaimed cost-free treatment, in reality most patients could not have access to medical service without intermediaries. Public health facilities were described as suffering from financial and administrative mismanagement, lack of motivated health staff and bad maintenance. Women were seen as the main victims of the system: entering hospitals to deliver under bad conditions and treated by either foreign nurses or by men without respect for their privacy (As-Sahwa 15.02.90, 8.08.91, 15.04.93). As-Sahwa even urged the Ministry of Public Health “to force all health facilities, public and private, to employ enough female staff.” (As-Sahwa 6.02.92). On several occasions, the magazine attacked international agencies such as USAID and the World Bank for financing the family planning programs in Yemen and following a deliberate plan “to tear apart the Yemeni family” and “destroy the Islamic world.” (As-Sahwa 11.07.91, 8.08.91, 25.06.92)
The election campaign in the spring of 1993 focused on the unification process, constitutional reform and political liberalization, however, the provision of social services was an issue as well (Detalle 1993: 9). In their election programs, all three main parties committed themselves to develop sufficient primary health care services, especially in deprived rural areas. All three parties further advocated the development of health manpower and the promotion of private investments in the curative sector. The YSP, in accordance with its call for decentralization, moreover emphasized the participation of the local councils in the supervision of health services. More than the other parties, Islah set health as having a close relationship to the preservation of the moral integrity of Yemeni society: It mentioned the need to fight infectious diseases, especially AIDS, by controlling immigration and setting up quarantine clinics. Cultural and information policy in the social field was to focus on health education towards mothers, and as such to be free of disruptive and immoral influences.
When Islah entered the government beside the PGC and the YSP after the elections of April 1993, it was given the Ministry of Public Health. The new Minister, Dr. Najib Said Ghanim, adopted a pragmatic approach by describing the core priorities of his policy as administrative and financial reform, the development of health manpower, as well as the improvement of coordination mechanisms between the Ministry of Health, other sectoral ministries or health related institutions and donor organizations. (As-Sahwa 5.08.93)
In the Ministry of Public Health itself, Islah had at the beginning great difficulties in gaining support and legitimacy from those public servants who were members of either the PGC or the YSP or had affinities with those parties. Especially at the central and higher levels of the health administration, officials mistrusted each other, feared political and ideological control and competed over donor resources. The lines of conflict were not only related to political affiliation, but also to diverging understandings of management: In contrast to the Minister, many high-ranking health officials had long experience in the health ministries either of North or South Yemen and held higher degrees in public health administration. These factors, together with the overall power struggle between the northern and southern ruling elites, led to a gradual paralysis of the Ministry of Public Health.
Despite these conflicts, the Ministry managed to convene the First National Conference for Health Development in February 1994. Although, the conference received the official support of the Islah party, it was mainly prepared and organized by representatives of the Islah-critical wing in the Ministry. The conference brought together officials from the central and governorate health administration, representatives from other ministries and Yemeni non-governmental and donor organizations.
One of the main outcomes of the conference was a document, which was published in a draft version under the title “Forward-looking Policies and Strategies for Health Development in the Republic of Yemen.” This paper, while referring to the National Population Strategy endorsed by the government in 1991, set health, and in particular women’s health, in a broad social and economic context and recognized the need to link health services with other developmental efforts. (Forward-looking Policies 1994: 5-6)
After the war ended in July 1994 with the defeat of the YSP, Islah asserted its position in the health administration at central and governorate level: Critical officials gradually left the Ministry and were replaced by persons whom the Minister trusted. However, the health policy making process went on after the war, both at international and national levels. The Islah party hereby adopted a pragmatical approach by participating in the international debate on population, health, women and development and exerting ideological influence in the frame of existing institutions.
The Yemeni government participated in both the International Conference on Population and Development in Cairo 1994 and in the Fourth World Conference on Women in Beijing 1995 and agreed to the respective final resolutions and action programs. However, after both conferences, official representatives made clear that Yemen would interpret international documents in the light of its national legislation and hence would not implement any regulation which contradicted the Sharia, whereby most of these conflictual matters were related to personal status and family law, especially parental power and inheritance rights. In Cairo, the Yemeni delegation, moreover, accepted the final Program of Action with several reservations, in particular regarding abortion and the provision of sexual health education to adolescents. Basically, the same reservations were brought forward by the Yemeni delegation in Beijing.
At a national level, the discussion on health and population issues were increasingly related to the structural adjustment program, which was signed with the International Monetary Fund and the World Bank in 1995 and partly implemented since. At the end of 1995, the Ministry of Public Health, on request by the Ministry of Planning and Development, worked out a Five Year Plan for Health Development.
In its policy preamble, the Five Year Health Plan showed the ideological influence of Islah insofar as health-specific strategies were not linked anymore to other efforts to improve women’s status. (Five Year Plan 1995: 14; 32-33) An even more restrictive interpretation of women’s health was brought forward in the “Shari’a Guidelines for Family Planning,” which was issued by the Minister’s office in May 1996. In this document, women’s health and the use of contraceptive methods were clearly subordinated to the need to protect the moral integrity of Yemeni society as a whole. (Shari’a Guidelines)
These radical positions obviously did not gain much support in the Government as a whole, which was preoccupied with the social costs of the structural adjustment program. Thus, in a speech celebrating the anniversary of the 1962 revolution, Yemen’s president, Ali Abdullah Saleh, highlighted the negative effects of the population growth on the structural reform program. (Al-Thawra 26.09.96)
In October 1996, the Second National Population Policy Conference was held in Sanaa, which confirmed the validity of the National Population Strategy adopted in 1991 and drafted a new Population Action Plan. Besides giving emphasis to poverty alleviation, this plan introduced the international concept of reproductive health to the Yemeni context. Although less explicit than the former Population Action Plan of 1991, especially in matters related to family law, it nevertheless reaffirmed the need to improve the social and economical status of Yemeni women. (Population Action Plan 1996: 1-3).