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Yemen Faces Older Birth Pangs As Well

Yazeed Kamaldien

SANA'A, May 17 2011 (IPS) - An estimated 2,555 women in Yemen die annually during childbirth because they do not have access to proper health facilities or experienced medical professionals.

Most of these women live in rural areas of the Arab world’s poorest and least developed country. The National Yemeni Midwives Association (NYMA) said at a seminar in the capital city Sana’a this month that the country would require at least 20,000 midwives – women who are trained to help other women give birth – if it is to combat these preventable deaths.

The association’s statistics show that at least 365 women in Yemen die for every 100,000 who give birth.

Suad Qasem, president of the NYMA, which was established in 2004, said that it wants to ensure that the required number of midwives is available across Yemen by 2012. She said that there were an estimated 5,000 trained midwives currently working in the country. They worked mostly in areas where hospitals are not available.

“We need more midwives saving lives in remote rural areas which are far from hospitals,” Qasem said at the conference. “Any untrained woman delivers babies in these areas. If we train more midwives we can prevent women dying.”

“The association helps midwives to establish a midwife clinic in their homes. We provide her with furniture and delivery instruments,” said Qasem. She related an incident of how one rural midwife was called to a house where a family thought that a baby had died shortly after being born.

“The midwife arrived at a house and the family said that the baby has died and that they were waiting for the father to come and bury the child. The midwife found that the baby wasn’t getting oxygen because there was a lot of water in his mouth and nose. All she had to do was clean the baby. He was only unconscious,” she said.

The United Nations Population Fund (UNFPA) office in Yemen confirmed that “more than one in three women in developing countries give birth alone or with only relatives to oversee what is one of the most dangerous passages they will ever undergo.”

Babatunde Osotimehin, UNFPA executive director, said in a statement that “in some of the poorest countries, as few as 13 percent of all deliveries are assisted by a midwife or a health worker with midwifery skills.

“Every day, 1,000 women die and 5,500 newborns die in the first week of life for lack of adequate medical care…the current global shortage of some 350,000 professional midwives means that women and their newborns die from complications that could have been easily prevented by a health worker with the right skills, the right equipment and the right support,” said Osotimehin.

UNFPA will host the Triennial Midwives Congress in Durban, South Africa, in June to “highlight the crucial role midwives play in saving lives and strengthening national health systems.” At this conference it will release the first ‘State of the World’s Midwifery’ report.

Qasem and a team of midwives here confirmed that they planned to attend the June conference. She said that they hoped to learn from other countries how they were combating maternal mortality.

Fatoom Noor al-Deen, general secretary of the NYMA, said that midwives face a “bad situation” in Yemen as many women do not prioritise antenatal care.

“We tell women that they need to do four visits to our midwives or clinics before they give birth,” said Noor al-Deen. “This happens only in cities but never in rural areas.

“Women only come to us if they have problems during delivery. If they think everything is normal then they will give birth at home and anyone – her mother or grandmother – will wait and wait until the baby comes out. Then they will just cut (the umbilical chord) and then it’s done. They think there are no dangers. They only come to us when there are problems.”

The midwife clinics are seen as a solution. Noor al-Deen explained that a midwife running a clinic with the association should “have experience, a good relationship with her community, be able to refer cases to hospitals and contact doctors who can help.”

Arwa Ahmed Yusufi is a mid-wife running a clinic from her home in the rural outskirts of Sana’a province. She completed midwife training in 1986 and started working in the field that same year. In July 2010 she opened a midwifery clinic as part of the NYMA at her home. She said that in the first three months of operation she assisted 150 women during childbirth.

“Most of the women that I see live in remote areas. If there is an emergency I have to do first aid. If I see that is not effective I have to take them to the hospital. I don’t have a car but we find someone in the community who can help us. Sometimes I even take my own money and take them to the hospital. They are very poor,” she said.

“I have to be available in the community 24 hours every day. I have three children and people keep on knocking at my door for help. It is difficult but God helps us.”

In Yemen, midwives are often called to assist mothers during labour even in areas where hospitals are available – some women prefer to give birth at home. This means that more midwives like Huda Hussein Sinnah, who works in Sana’a, are needed.

“Most of the women even in cities prefer childbirth at home. This is because of traditional and religious reasons. Families believe that there are male doctors at hospitals who will see the women. They say the women want the privacy of their homes,” said Sinnah.

“I work in a hospital and go to women’s houses. Home births are not a problem as long as there is a skilled person with the women during the delivery. If there is a midwife they can refer the woman to the hospital if there is a problem. I think the hospital is best but in the community there are many women who prefer to give birth at home.”