Almotamar.net IRIN - SANAA - A radical proposal by Yemen’s Supreme Council for Motherhood and Childhood (SCMC) to rise the legal age of marriage to 18 could see the country’s high maternal mortality rate drop drastically, its supporters say.
“We have made the proposal to the cabinet and we are now awaiting its approval,” said Fathia Mohammed, assistant secretary general of the SCMC, a government body.
Early marriage combined with illiteracy, poor health services and poverty make Yemen’s maternal mortality the highest in the Arab world, Yemeni officials and specialists say.
Yemen’s most recent Demographic, Maternal and Child Health Survey (DMCHS), conducted in 1997, showed that 48 percent of women between the ages of 20 and 24 were married before the age of 18. In the poorest 20 percent of the population, 57 percent of girls were married before 18 and even among the richest families more than 35 percent were married early. Overall, 14 percent were married before 15.
Yemen’s Ministry of Health estimates that eight women die every day during child birth and 366 women die for every 100,000 live births. The situation is compounded by the fact that Yemen’s fertility rate is one of the highest in the world, with an average of seven children per woman. Health specialists project the country’s current 20 million population will reach 35 million in 2025.
Specialists have singled out early marriage as one of the main causes of Yemen’s high rate of maternal mortality. “When a girl is married at the age of 13 or 14, then she becomes at risk of maternal death. This is very common in Yemen, especially in rural areas,” said Fathia.
According to her, girls getting married at an early age are not ready to give birth, because “a girl’s body is not mature and developed at this stage, and this also leads not only to death, but also to other complications such as hemorrhaging”.
Home births
Approximately 75 per cent of maternal deaths are preventable, occurring because of a lack of access to - and availability of - high-quality reproductive health services, said officials at the United Nations Population Fund (UNFPA) in Yemen. UNFPA says that 84 per cent of all births in Yemen take place at home and only 20 per cent of these births have trained attendants present.
“There are also cases where a husband refuses to take his wife to hospital for delivery,” Fathia said, as they are unaware of the delivery risks or because they don't like their wives to give birth with the help of mid-wives.
In Yemen, doctors and health centres are not equally distributed. There is only one doctor per 10,000 people as doctors tend to be concentrated only in main cities, namely Sana’a, Aden and Taiz.
“Health services reach only 60 percent of the population,” Yahya al-Babeli, Senior Health Advisor at the Basic Health Services Project, which is funded by USAID, told IRIN. The project includes a free two-year course for midwives employed in health institutions.
Al-Babeli also criticised the Ministry of Health for not employing more midwives. “There is a huge reservoir of midwives, but the ministry of health has not hired them due to its complicated administrative system,” he said.
According to al-Babeli, the USAID project has trained 120 midwives over the past two years in Amran, Marib, and Shabwa provinces. He added that it was necessary for there to be a large number of trained midwives - even if they are not employed by the Ministry of Health - to prevent women dying while giving birth.
“We will also aim to train 500 midwives in those provinces, in addition to Saada and al-Jawf provinces, where health indicators are very weak,” he added.