Transcript The Current Situation of Yemeni Women`s Health Care

The Current Situation
and Challenges of Yemeni
Women’s HealtH Care
Dr. Md Abdullah HADI
The Current Situation of Yemeni
Women’s HealtH Care
Yemen is classified as a
‘least developed country’
and it is the poorest
country in the Arab world.
Dr. Md Abdullah HADI
The Current Situation of Yemeni
Women’s HealtH Care
 Yemen ranks last in the World
Economic Forum’s Global Gender
Gap Index and the UNDP’s gender
empowerment measure.
 It ranks 133 out of 177 countries in the
2010 .
 UNDP Human Development Index (0.439).
 76% of the total population; and lack of basic
infrastructure,
Dr. Md Abdullah HADI
National Indicators
Population
22,198,000 (2008)
Population Growth Rate
3% (2004)
Life expectancy at birth
62 (2009)
Ratio of urban population to rural
population
3:7 (2008)
 GDP Growth rate (at fixed Prices)
4.7 (2009)
 Maternal mortality rate on birth per
100,000 births
365 (2009)
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Dr. Md Abdullah HADI
Health
2000
2005
2010
Literacy rate, adult female (% of females
ages 15 and above)
..
35
45
Contraceptive prevalence (% of women ages 1549)
..
28
..
Unmet need for contraception (% of married
women ages 15-49)
..
24
..
Pregnant women receiving prenatal care (%)
..
47
..
Births attended by skilled health staff (% of
total)
..
36
..
Dr. Md Abdullah HADI
Health Expenditure indicators
GDP per capita US$ exchange rate
926
Total expenditure on health (per capita) Average
US$ exchange rate
57
Government expenditure on health (per capita)
Average US$ exchange rate
15
Total expenditure on health of % of GDP
5.6
General government expenditure on health as %
of total health expenditure
27.0
Out-of-pocket expenditure as % of total health
expenditure
66.3
Dr. Md Abdullah HADI
General government expenditure on health as %
of total government expenditur
3.6
2009
2009
2009
2009
2009
2009
2009
The Current Situation of Yemeni
Women’s HealtH Care
Many Yemeni children
and women are victims
of neglect, abuse, and
exploitation.
Dr. Md Abdullah HADI
The Current Situation of Yemeni
Women’s HealtH Care
 Early marriage is Yemen’s biggest single
development challenge but the national
debate about setting a minimum marriage
age is highly politicized.
 An estimated one in four girls in Yemen
will be married by the age of 15. Girls are
commonly married as young as 8 years
old, often as second or third brides for
much older men.
Dr. Md Abdullah HADI
Reproductive Health
 The reproductive health in Yemen, is the less
fortunate in the Arab world, where die 365 women
per 1000000live births as a result of
complications that occur during pregnancy and
childbirth and the period after birth, making
maternal mortality the biggest cause of death (42%)
among women of reproductive age in Yemen,
 Estimated neonatal mortality rate of 37 per 1000 live
births, accounting neonatal mortality of 49% of the
total infant mortality rate,
 The total fertility in Yemen is among the highest in the world
with an estimated fertility rate in Yemen to 6.3%
Dr. Md Abdullah HADI
Indicators Related to
Maternal Mortality and Care
Dr. Md Abdullah HADI
VReproductive
S
VIEW_SH
311
SHARED
IEW_SH
health
Yemen, Rep.
1990
2000
2005
2009
Contraceptive prevalence (% of women ages 15-49)
10
..
28
..
Unmet need for contraception (% of married women
ages 15-49)
..
..
24
..
26
..
47
..
Pregnant women receiving prenatal care of at least
four visits (% of pregnant women)
9
..
14
..
Newborns protected against tetanus (%)
..
..
52
63
16
..
36
..
Maternal mortality ratio (modeled estimate, per
100,000 live births)
540
340
250
210
Maternal mortality ratio (national estimate, per
100,000 live births)
..
..
365
..
23
48
72
91
8.7
6.5
5.8
5.3
..
..
25
..
..
21
22
..
Pregnant women receiving prenatal care (%)
Births attended by skilled health staff (% of total)
Lifetime risk of maternal death (1 in: rate varies by
country)
Fertility rate, total (births per woman)
Age at first marriage, male
Age at first marriage, female
Dr. Md Abdullah HADI
Reproductive Health
 Yemen is featured with high fertility
rates (5.2 for each woman),
according to the Cluster Survey of
2006, due to early marriage and
repeated pregnancy that
deteriorates women's health, in
addition to the dominating culture
that discourage uses of family
planning means.
Dr. Md Abdullah HADI
Uses of Contraceptives
 The prevalence of current use of family
planning methods among married
women is estimated at 28% in urban
areas and 2.9% in rural areas.
 That 30% of women use modern methods of
family planning if facilitated access,
 That a quarter of women in Yemen do not
agree to the use of family planning methods
Dr. Md Abdullah HADI
Uses of Contraceptives; as showed in Health
Survey 2003,
Cluster Survey 2006 and Target in year 2015
Dr. Md Abdullah HADI
Major Obstacles that Limit Women
Accessibility to Health Services:
1. Lack of Female Health Workers,
2. High Cost of Health Care
3. The situation in Yemen is
exacerbated by the lack of access to
health care.
 Only 28% of women are able to
give birth with the help of trained
medical personnel.
Dr. Md Abdullah HADI
Health Care Access
Dr. Md Abdullah HADI
Availability of Medical Services
 Only 26% of all Yemeni
men and women report
that medical services in
their area are easily
available.
Dr. Md Abdullah HADI
Dr. Md Abdullah HADI
Dr. Md Abdullah HADI
Dr. Md Abdullah HADI
Quality of Medical Care
 Yemeni women rate their health care as higher
quality than do men.
 A quarter of men rate their medical care as
bad, and 9% rate it as very bad, compared to
11% and 4% of women respectively.
 More women than men also rate their care as
good quality (32% vs. 19%).
 Neither men nor women receive very good
quality care however – only 4% of women and
2% of men rate it as such
Dr. Md Abdullah HADI
Dr. Md Abdullah HADI
Yemen faces long-term
challenges
 high fertility rates
 rapid population growth
 lack of access to livelihood opportunities for the
rural population, which counts 76% of the total
population;
 lack of basic infrastructure, such as schools,
water scheme, health facilities, access roads and
markets in many rural areas.
 Yemen continues to face considerable
development challenges. It ranks 133 out of 177
countries in the 2010 UNDP Human
 Development Index
(0.439).
Dr. Md Abdullah HADI
Female Genital Mutilation
(FGM)
 Major efforts are exerted to abandon FGM,
where the Supreme Council for Motherhood
and Childhood has adopted National Work
plan for 2008-2012 years, to reduce the rate
of this practice to 30 percent in 2012.
 "Analytical Study on FGM in Yemen" by
Gender Studies and Researches Center, at
Sana'a University in cooperation with Yemeni
Women Union in 2008. The Study concluded
that:
Dr. Md Abdullah HADI
Female Genital Mutilation
(FGM)
 FGM is a common practice at 5 governorates out of
22. The communities of these governorates stressed
that FGM is related to religion and culture;
 71.4 percent of females support continuation of this
practice, compared to 48 percent of males, and
illiterate females are more supportive than females
with secondary and high school education;
 Wide spread of FGM among urban areas; i.e. Sana'a
with 45.5 percent;
 More researches are needed to understand the sociocultural context of the communities impacted with
this practice.
Dr. Md Abdullah HADI
Female Genital Mutilation
(FGM)
 In addition to conduct specific studies on:
 explore knowledge, attitudes and practices in the
5 governorates;
 health, psychological and social damages resulted
from this practice;
 religious context "justification" of this practice;
 to raise awareness campaign on the devastating
impact of this practice in the 5 coastal
governorates, the plan is to abandon this practice
by 50 percent to grandmothers at the age of 40-70
years and parents at the age of 15-45 years, by
the year 2012. Dr. Md Abdullah HADI
Millennium
Development Goals
(MDG)
Progress in Yemen
Dr. Md Abdullah HADI
Dr. Md Abdullah HADI
Target One: Ensure that
all boys and girls
complete a full course
of primary school
by 2015
Dr. Md Abdullah HADI
Major challenges to ensuring universal
primary school education include:
 A lack of adequate educational services;
 Low levels of income;
 A lack of basic services meaning some children are
required to work;
 Negative attitudes towards girl’s education;
 Internal school inefficiency;
 Low quality of school curricula; and
 The inability of the school system to address problems
such as overcrowding in classes, improper distribution
of teachers and poorly equipped schools.
Dr. Md Abdullah HADI
Dr. Md Abdullah HADI
Target One:
Eliminate gender
disparities in primary and
secondary education
preferably by 2005, and
at all levels by 2015
Dr. Md Abdullah HADI
The following issues are hindering
Yemen’s efforts to aCHieve tHis mDG:
Poverty forces many girls to leave education;
Drop-out rates are high among girls;
Early marriage and pregnancy is common;
There is a lack of female teachers;
There is a lack of awareness about the importance of
girls education;
 There is a lack of proper training opportunities and
facilities for women; and,
 Cultural believes about gender roles impede girls’
access to education.
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Dr. Md Abdullah HADI
Dr. Md Abdullah HADI
Target One: Reduce by
three quarters the
maternal mortality
rate by 2015
Dr. Md Abdullah HADI
Many factors contribute to the high maternal
mortality rate in Yemen includinge:
Early marriage and pregnancy;
Malnutrition;
Poor quality health services;
The large number of women who are
anaemic during pregnancy; and
 Poor distribution of health services.
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Dr. Md Abdullah HADI
Recommendations
1. Construct more health facilities at governorates and
districts that lacks such services on equal basis;
2. Enhance health care services, maternal and
reproductive health services in addition to
vaccination services in rural areas in particular;
3. Employ more females at health facilities and
midwives in rural areas in particular, and encourage
female workers at rural areas to ensure their
sustainability;
4. Establish mechanisms to follow-up and assess
implementation of free provision of basic health
care/services, pregnant care, and delivery under
medical attendance;Dr. Md Abdullah HADI
Recommendations
5. Develop and update health statistic database
and indicators and integrate gender in its
outputs;
6. Revise and improve the free distribution
policy of the contraceptives;
7. Identify marriage age to reduce maternity
mortalities among below 20 years age group
of mothers;
8. Implement free provision of deliver
Dr. Md Abdullah HADI
Recommendations
9. The government should increase budget allocations to the
public health sector, with a focus to health care and
reproductive health needs of women in rural areas
10. The government should work with women's rights
organizations and legislators on the amendment of all
discriminatory laws against women.
11. Enhance public and private communication channels to
develop awareness with gender issues;
12. Government and non-governmental women's rights that the
development of programs bugs awareness of the rights of
women to make women aware of their rights and their
protection under the laws of And the Constitution of Yemen.
Dr. Md Abdullah HADI
Dr. Md Abdullah HADI