Women’s reproductive health in Yemen: Are they in a dilemma? [Archives:2008/1183/Community]

August 21 2008

By: Dr. Walid Nasser Abdullah
[email protected]

Women in Yemen certainly experience a terrible situation regarding their reproductive lives.

Numerous health indicators reflect not only the deterioration of basic health care, particularly prenatal care and safe childbirth services, but also women's social inferiority in various aspects of their lives, such as the right to receive an education, proper nutrition, occupational opportunities and access to health care.

The following essay discusses three important issues related to Yemeni women's reproductive health.

1) Female circumcision

Yemen has no valid statistics regarding female genital circumcision because Ministry of Health and Population regulations forbid the procedure at health care facilities; thus, it is performed at home by folk medicine practitioners.

The most reliable estimate, according to a 1997 national survey, is that it is performed on 23 percent of the population.

The incidence of female genital circumcision is wide-ranging in Yemen, according to its different regions. For example, it is done in the coastal governorates due to that area's social links to Africa, while it is seemingly absent in the nation's mountain governorates.

The underlying motivation for the phenomenon of female genital circumcision within Yemeni society is relative, as numerous interrelated factors, including social, cultural, racial and geographic variations, may be behind a family's decision to perform the procedure on its female members.

2) Early marriage of young girls

Another form of violence many Yemeni women suffer is the marriage of young girls, which seriously and negatively impacts their reproductive health. However, tackling this societal and health problem is no easy task because it's a complex matter rooted in social, economic and cultural factors.

A teenage girl's parents and relatives typically undertake the decision to marry her off – with or without her approval – and is commonly observed in poor and/or non-law abiding families.

3) Use of family planning methods

Yemen's rapid population growth rate (4.4 percent in 2001) is attributed to its people's deferment to underlying social, economic and religious factors that encourage fertility (Yemen's overall fertility rate was 7.6 percent in 2001) and population expansion.

In fact, the country's population explosion is expected to accelerate even more over the next few years, thereby yielding an economic and demographic crisis.

In this regard, the prevalence of family planning methods among married women is low (23 percent in 2003), despite the availability of these services at health care centers. Many Yemenis actually are antagonistic toward family planning, depending on their level of education, their beliefs and misinterpretation of Islamic texts.

Many Muslims accept the use of family planning methods by a married woman, but not by couples.

While some fundamentalists refuse its use, even by married couples, others don't discriminate between family planning and limiting fertility, including both female and male sterilization, which is unacceptable to a majority of the Yemeni population.

From a medical standpoint, the goal of family planning is to avoid successive pregnancies. Allowing an interval between each pregnancy is very important for the mother to restore her health, while also allowing time to breastfeed and nurse the new baby.

Yemen's high number of offspring per woman is associated with a high rate of maternal deaths (an estimated 366 per 100,000 live births) due to complications during pregnancy, childbirth and the postnatal period.

Many factors contribute to Yemen's high maternal mortality rate, one of which is its weak health care system, particularly at the level where basic health care services are in contact with the people. The Yemeni system offers poor quality prenatal health care in addition to an absence of essential obstetric services in the country's remote areas.

The higher illiteracy rate (68 percent) among Yemeni women, particularly in rural areas where it is 90 percent, further contributes to the low usage of family planning methods.

A Yemeni wife typically has no right to take contraceptive pills; in fact, her husband may refuse, even if she suffers poor health and is under medical supervision.

Concerning such a medically unfit wife and her risks of becoming pregnant, it's a real shame that she can't decide to regulate her own conception. Additionally, she also may not have the right to discuss with her husband even when to conceive a child.

A decision to kill the other marriage partner

One common ethical dilemma doctors and surgeons face are hospital regulations regarding maternal health and human rights, including whether to perform a Cesarean section, an abortion or female sterilization (under medical advice) during a critical emergency when a pregnant woman is in the operating room.

Thus, a Yemeni woman's life is based solely upon her husband's decision, as his signature is required to allow his consent or the necessary procedure won't be performed. He even has the right to go to court and charge the doctors if the operation is done without his consent.

A husband sometimes may refuse or it may take hours to satisfy him in order to obtain his approval, so what if he doesn't agree? How can we handle such cases? Who gives him the right to make such a decision? How can we solve this problem?

How about modifying these hospital regulations to give this right to the woman herself, her father or mother or another close relative if her husband refuses to give his approval for the procedure?

Frequent stories happen at numerous hospitals and the woman is always the victim. A husband sometimes may refuse his wife an abortion, against the advice of the hospital's medical team, thereby causing her death.

One such story involved a young girl suffering heart valve disease who died in labor. Her doctor had advised her husband at the beginning of her pregnancy to terminate it as early as possible in order to avoid risks and complications in childbirth, but the husband's unyielding mind was the problem.

He refused to do so in the mistaken belief that abortion is completely forbidden in Islam for any reason. However, in such cases, the Islamic position is very clear, that is, a married woman may have an abortion if her life is in danger, but it should be performed only upon medical advice.

This is a matter of saving lives. It's a matter regarding unfair regulations encountered in our daily lives as doctors, as well as an ethical and medical problem related to women's reproductive health and the rights of a human being. A human life shouldn't be a matter of personal opinion or a decision left solely to the other marriage partner.

It's time to protect not only the lives of these mothers, but also the destiny of those children within a family. It's time for the Yemeni Parliament to issue legislation to protect our mothers, sisters and daughters from all forms of violence, but particularly those issues relating to their reproductive health.

It's time to give women their rights within the context of our Islamic religion, which respects their rights in all aspects of life, treating them as human beings within society.

Dr. Walid Nasser Abdullah is an assistant professor and community medicine specialist at Aden University's women's research and training center.