By Jeff Baron

Midwife Samira Qaed recalls a woman who came to her village clinic in Yemen at the end of pregnancy. Like many Yemenis, she had gone into labor never having had a checkup.

The woman’s placenta was positioned badly, and she was bleeding severely and unable to move. “The distance, searching for a car, absence of her husband, not being prepared for this—all complicated her case,” Qaed says. “It was a miracle that we saved this mother’s life. We immediately took her to the hospital. Thanks to Allah, she underwent a Caesarean operation and she was fine.”

Qaed and other midwives are on the front lines of the fight in Yemen to save women and their babies, and she says the biggest obstacle to good maternal health is getting patients to see a midwife. “She [the midwife] is the one saving the mother and the baby,” Qaed says.

Beyond the immediate goal of saving lives, Yemen’s midwives and an international effort supporting them are pursuing something even greater: to make healthy mothers and healthy babies the norm, and to push Yemeni society and its emerging government responsive to their needs.

A leader in that fight is Jamila Alraabi, a physician who serves as Yemen’s Deputy Minister of Health and Population. She laid out the challenges:

  • Yemen has one of the world’s highest maternal mortality rates. Seven Yemeni women a day die of complications from pregnancy or childbirth – leaving seven families in danger of collapse in the absence of a mother – and nearly all of the deaths are preventable.
  • Many Yemenis live in remote villages, where trained midwives are scarce and hospitals nonexistent.
  • Because of cultural norms, most Yemeni women are unwilling to be treated by male doctors.
  • Seventy percent of Yemeni women are illiterate, which makes providing them with health information more difficult – and cuts down on the number who can become midwives or physicians.
  • Yemen has a high birthrate, especially among its hardest-to-reach women. Illiterate women account for more than 90 percent of maternal deaths.

Efforts to attack maternal mortality are paying off, but Dr. Alraabi says part of the long-term cure must be a change in attitudes.

She says only 36 percent of pregnant Yemeni women have at least four prenatal visits for health services – the minimum that international health groups say is appropriate – often because they or their husbands do not consider more than one visit necessary.

As a result, Dr. Alraabi says, dangerous complications in pregnancy, such as high blood pressure or diabetes, often are discovered too late to get the woman proper care, and women can go into childbirth in high-risk situations far from a hospital or emergency obstetrical center.

And Alraabi says women need a stronger voice. In many cases, the pregnant woman can’t make the decision to see a midwife without the approval of her husband or older women in her family. “She should be very empowered and educated in order to say that ‘I need services and I have to ask for it,’” Alraabi says.

Suad Qasem, president of the National Yemeni Midwives Association, says more midwives are needed in Yemen’s rural areas, where her members are the only source of pregnancy care. Her group also is advocating for better training for midwives; many in rural areas have just two years of training after nine years of basic education, and the national standard is three years.

“If she is trained well, she will give good care for a pregnant woman,” Qasem says.

RGP provides training, advocacy

With support from the U.S. Agency for International Development (USAID), the Responsive Governance Project (RGP) is providing in-service training to improve the skills and knowledge of midwives. And it’s helping Qasem’s group and others become advocates for constructive changes in Yemeni society and government policy, especially for women and youths.

Abdul Karim Alaug, RGP’s Deputy Chief, says one of the priorities it identified was the expansion of emergency obstetrical care to ensure that every Yemeni woman has access to it.

RGP – which is led by Counterpart International – is designed to help connect Yemen’s government, civil society and the population so together they can identify a common agenda and ways to improve the country. Alaug says women and youths especially have sought to become participants, not merely recipients, in developing the policies designed for them, and the governance program is building the strength of civil society organizations vital to bringing about needed changes peacefully.

Dr. Alraabi, the Deputy Health Minister, says RGP has been instrumental in helping her agency and local health councils strengthen policies on maternal health. And says she is optimistic that the progress will continue.

“It will come by partnership with all developmental partners, with other governmental institutions and with the civil society,” she says. “No one can work alone, and no one can achieve success alone. It should be a partnership, and this is our hope in Yemen, that we will not have a woman die from preventable causes.”