Yemen: Making Pregnancy a Choice, Not a Risk
03/01/2010
ESD Project on reducing maternal and infant mortality
Couples family planning counseling at Al Saba'een. Photos by Laurel Lundstrom
Lahej Governorate is in southern Yemen, just north of Aden - a place as much known for its sand and surf, as for the bombing of the USS Cole less than a decade ago. Most of those living in Lahej are poor and illiterate, and experience death as often as they bring new life into this world.
Getting to Lahej's Ibn Khaldoun Hospital, perched close to the Aden border, and far from the region's most rural areas, is one of the only hopes women have for safely delivering their babies, and not losing their newborns or themselves in the process.
"We know that women in Yemen are suffering much more than men," said Dr. Omar Zain, the general director of health for Lahej. "One of our greatest problems is a high maternal mortality rate and high neonatal mortality rate, which result from a high fertility rate."
"Thirty percent of pregnancies are unwanted, which is the result of an inability of women to get a contraceptive method," he said.
An incredibly rural and conservative country, more Yemeni women die as a result of childbirth than in most Middle Eastern countries. And despite the high risks, women have an average of six children in their lifetime, have little access to family planning choices, and lose more of their newborns, infants and children than their neighbors on the Arabian Peninsula and beyond.
Through an intervention supported by the Extending Service Delivery (ESD) Project, and managed by the Basic Health Services (BHS) Project, the care given to mothers and newborns at Ibn Khaldoun Hospital vastly improved over the past year, signaling progress to families in Lahej, and to service providers from across Yemen that with new life, death may become less inevitable.
By employing eight best practices in obstetric, newborn and postpartum care that can be easily implemented with little extra financial and human resources, midwives at Ibn Khaldoun now ensure all newborns are resuscitated, immunized and, if premature, placed directly on their mothers' chests for what is called "kangaroo mother care." Because of the best practices, mothers receive Vitamin A after delivery, leave the hospital with a contraceptive and knowledge about breastfeeding, and are comprehensively counseled within two hours postpartum, usually in the company of their husbands.
Mariam Mukbel is one of these women. Last January, she arrived at Ibn Khaldoun to deliver her ninth baby. Married at age 20, and estimating her current age as between 30 and 35, Mariam has had a child every year or two since marriage. Out of the eight she gave birth to, three died.
Because of the care she received at Ibn Khaldoun, she and her ninth baby arrived safely to the postpartum ward, and she left the hospital - for the first time in her life - with a package of contraceptive pills.
Another woman lying across from Mariam did not find her visit as advantageous. She arrived at the hospital too late to save the baby in her stomach. She gave a defeated glance -"I will use the breast milk for the one-year-old at home."
Even with improved care, not all the stories at Ibn Khaldoun have happy endings. By spreading the best practices across Yemen, especially to rural health facilities, the government hopes that over time less women will risk their lives to give birth, and more women will exchange time spent pregnant for time spent learning to read.
Married early and baring children frequently, only 29 percent of Yemeni women know how to read and write.
"Women are not economically independent and culturally cannot express their needs openly, especially with reproductive health issues, so it is not easy for women to seek these services," said Dr. Jamila Raebi, Yemen's deputy minister of health who has been one of the key champions for scaling-up the eight best practices to health facilities throughout Yemen. "Education, therefore, is important" - and, in a sense, has already begun.
Through a partnering program, progressive religious leaders in Lahej preach the merits of family planning in mosques, while midwives from Ibn Khaldoun meet with women's groups to discuss their contraceptive choices. Prior exposure to these issues increases couples' acceptance of the best practices when they arrive at the hospital.
Ibn Khaldoun, however, isn't the pioneer. It merely replicated what was successfully being demonstrated at BHS's demonstration site, Al Saba'een Hospital in Sana'a -Yemen's main referral facility for deliveries.
After realizing the transformation the simple, low-cost practices had on service delivery at Al Saba'een, BHS chose five more target facilities, including Ibn Khaldoun. ESD trained a few key staff members at each facility on the best practices and the value of quick adoption. The trainees then became managers of the best practices, and developed a plan for spreading them to area facilities, including rural hospitals, primary health care centers and the few private midwifery clinics. This approach created a sense of local ownership over the best practices, and produced an impassioned group of providers and administrators.
"The best practices helped us a lot to increase knowledge, and benefit of all this goes back to the mother and children," said Saida, a midwife practitioner from Al Saba'een. "It is a big step to the front."
BHS and the Ministry of Public Health and Population have a plan to spread the best practices to 138 health facilities, mostly in rural areas. Because 80 percent of Yemeni women deliver at home, reaching all tiers of the health-care continuum is paramount.
Laurel Lundstrom is a communications officer with the ESD Project, managed by Pathfinder International.
Which 8 best practices are followed? Women leaders should be aware of these and encouraged to motivate mothers to adopt these simple methods.
— Dr.Sadhu Charan Panda on 2010-03-29
This program was featured in the latest post of the APHA International Health section blog: http://aphaih.wordpress.com/
— Jessica Keralis on 2010-04-16
The 8 best practices are:
family planning counseling for women immediately after delivery
Vitamin A provision to mothers after labor
infection prevention controls
kangaroo mother care for premature babies
exclusive and immediate breastfeeding
active management of the third stage of labor
tetanus and polio vaccines for newborns
newborn resuscitation.
The Yemeni government is now interested in adding more best practices to the list, focusing on postpartum hemorrhage, prevention and management of eclampsia and childhood diseases.
— Laurel Lundstrom on 2010-04-20
Dr Sadhu, Thank you for mentioning the importance of educating women leaders about these practices.
NSMA (Yemen’s National Safe Motherhood Alliance, affiliated with WRA, the Global White Ribbon Alliance) has started training and activities related to this goal and it would be great to do even more.
The Basic Health Services Project of ESD/Pathfinder also has an active community education effort with wide dissemination of key MNH messages, some related to the above healthy practices.
BTW the neonatal vaccines highlighted in the Best Practices work are OPV and BCG [not tetanus].
— Dr. C. Briggs on 2010-04-21
NGHA Primary Healthcare Centers are working on providing the best precautionary and therapeutic services as well as contributing in serving patients and reducing pressure on the NGHA hospitals..
— Primary Health Care Centers on 2010-05-17
Thank you, To learn more about Primary Health Care Centers in King Abdulaziz Medical City ,please enter
<a href=”
http://www.ngha.med.sa/English/MedicalCities/AlAhasa/Pages/PHCC.aspx “> Primary Health Care Centers
— Primary Health Care Centers on 2010-05-24
Awareness is necessary for all women about pregnancy.
— tubal reversal on 2010-07-27