Maternal Health in Yemen
The Yemen civil war, which began in early 2015 and still devastates the nation today, has created the world’s worst humanitarian crisis. A total of 24 million people require assistance. This crisis affects all aspects of life in Yemen, including healthcare. Millions are without access to life-saving medical treatment and supplies, leading them to die of preventable diseases, such as cholera, diabetes and diphtheria. Pregnant women and infants are particularly vulnerable during this health crisis as adequate medical care throughout pregnancy and birth is essential. Maternal health in Yemen is of the utmost concern now.

Yemen has one of the highest maternal mortality rates in the world with 17% of the female deaths in the reproductive age caused by childbirth complications. Maternal health in Yemen has never been accessible to all women. This crisis has escalated even further during the Yemeni civil war. However, global organizations are acting to save the lives of these pregnant women and infants who desperately need medical care.

Yemen’s Maternal Health Crisis: Before the Civil War

Even before the war began in 2015, pregnant women were struggling to get the help they needed. Yemen is one of the most impoverished countries in the world — ranking at 177 on the Human Development Index (HDI). Poverty is a large factor in the insufficiency of maternal health in Yemen as impoverished women lack the finances, nutrition, healthcare access and education to deliver their babies safely.

Many Yemeni women are unaware of the importance of a trained midwife during childbirth. Of all the births in rural areas, 70% happen at home rather than at a healthcare facility. Home births increase the risk of death in childbirth as the resources necessary to deal with complications are not available.

The Yemeni Civil War Increased the Maternal Health Crisis

Since the civil war began, the maternal mortality rate in Yemen has spiked from five women a day in 2013 to 12 women a day in 2019. A variety of factors caused this spike. The war has further limited access to nearly every resource, including food and water. This, in turn, depletes the health of millions of women and thus their newborns.

Also, the civil war has dramatically decreased access to healthcare across the nation. An estimated 50% of the health facilities in the country are not functional as a result of the conflict. Those that are operational are understaffed, underfunded and unable to access the medical equipment desperately needed to help the people of Yemen. This especially affects pregnant women — who require medical care to give birth safely.

Organizational Aid

Though the situation in Yemen remains dire, various global organizations are acting to assist pregnant women and newborns. The United Nations Children’s’ Emergency Fund (UNICEF) is taking the initiative to help millions across Yemen, including pregnant women. The organization has sent health workers and midwives into the country’s rural areas to screen and treat pregnant women for complications.

Similarly, USAID trained more than 260 midwives and plans to send them into Yemeni communities to help pregnant women and infants. USAID is partnering with UNICEF, the World Health Organization (WHO), the Yemen Ministry of Public Health and Population and other organizations to ensure that maternal health in Yemen, as well as all types of healthcare, are adequate and accessible for all affected by the civil war.

Maternal health in Yemen, while never having been accessible for many, is now in crisis as a result of the Yemeni civil war. While the situation is still urgent, organizations such as USAID and UNICEF are fighting to ensure that all pregnant women and infants in Yemen have access to the medical care they desperately need.

Daryn Lenahan
Photo: Flickr

Maternal Mortality
Maternal mortality refers to the death of a woman due to causes related to or aggravated by her pregnancy and/or childbirth. Almost all (99%) of maternal deaths occur in developing countries, and 68% occur in Sub-Saharan Africa alone. The Trends in Maternal Mortality 2000-2017 report is a joint effort by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Its statistics showcase huge global health disparities that leave African mothers extremely vulnerable, showing that maternal mortality in Sub-Saharan Africa is a prevalent issue.

Health Inequality in Maternal Healthcare

Almost all maternal deaths are preventable, yet in 2017, Sub-Saharan Africans suffered from the highest maternal mortality ratio (MMR) of 533 maternal deaths per 100,000 live births, or 200,000 maternal deaths a year. All three countries with the highest MMR globally with over 1,000 deaths per 100,000 live births, considered an extremely high rate, are in Sub-Saharan Africa: South Sudan (1,150), Chad (1,140) and Sierra Leone (112). In comparison, the 2017 MMR in North America and Western Europe was 18 and five.

The fact that MMR is under 10 in many countries means that current technology and medical knowledge are already capable of reducing MMR to almost zero. The global imperative is to improve health infrastructure and education in developing nations so that they, too, can access services and resources available to protect mothers in the developed world.

The Importance of Access

Lack of access to health facilities and medical professionals is among the main reasons for maternal deaths. Currently, in Africa, there are 985 people for every nurse/midwife and 3,324 people for every medical doctor. This means that many pregnant women do not receive antenatal, delivery and newborn care, which greatly increases their risk of dying from severe bleeding, infections or other complications. Ensuring that there are accessible and affordable health facilities for all women would eliminate risks of preventable and treatable deaths.

Adolescent Pregnancy

Improving sexual health education is key to eliminating adolescent pregnancies, which account for a significant portion of maternal mortality in Sub-Saharan Africa. Adolescent girls, especially those under 15, have a higher risk of maternal mortality compared to older women. In 2014, there were 224 adolescents per 1,000 cases of pregnancy in the Democratic Republic of Congo – the highest teenage pregnancy rate in the world, followed by Liberia (221) and Niger (204). Improvements in sexual health education would inform young girls of contraceptive options, family planning methods and safe abortion facilities.

Progress Tracker

Significant efforts have succeeded in reducing maternal mortality in Sub-Saharan Africa. From 2000 to 2017, Sub-Saharan Africa has achieved a substantial reduction of 39% of maternal mortality (from 870 to 533 maternal deaths per 100,000 live births). A significant number of countries in this region have reduced their MMR by more than half, such as Rwanda (79%), Mongolia (71%), Eritrea (63%), Zambia (60%) and Cabo Verde (51%).

WHO has stated that improving maternal health remains one of their key priorities. In 2015, the global health organization launched the Global Strategy for Women’s, Children’s and Adolescents’ Health aimed at ending all preventable deaths of women, children and adolescents. The UN’s Sustainable Development Goal target 3.1, also launched in 2015, aims to reduce global MMR to less than 70 per 100,000 live births by 2030. While the current MMR in Africa is still seven times less than the target, promising results from past and current campaigns indicate that a better future is within reach.

– Alice Nguyen
Photo: Flickr

Healthcare in Nigeria
Healthcare in Nigeria leaves a lot for people to desire. The system is inefficient and inequitable, although there are some stories of success. Here are eight facts about healthcare in Nigeria.

8 Facts About Healthcare in Nigeria

  1. Prior to the European colonization of Nigeria, the healthcare system consisted entirely of herbal medicine treatments. This system relied on the knowledge of practitioners and a strict apprenticeship program. Understanding the background of Nigerian healthcare is an important prerequisite for assessing the modern system.
  2. After Nigeria gained independence in 1960, the country put a radical new healthcare system in place. Primarily a welfare-based system, it was progressive for its time. The government offered free or heavily subsidized treatments and medicines. However, the subsequent downturn in oil prices destroyed this system. Augmented by political corruption, the government could not afford to continue subsidizing healthcare.
  3. Currently, Nigeria’s healthcare system ranks among the lowest in the world. A study from 2018 in the Lancet of Global Health Care Access and Quality looked at 195 countries around the world; Nigeria ranked 142nd.
  4. One of the biggest problems facing Nigeria is the lack of qualified workers in the healthcare sector. The densities of nurses, midwives and doctors are ineffective for a country the size of Nigeria. There are only 1.95 qualified healthcare workers per 1,000 citizens in Nigeria.
  5. The healthcare statistics in Nigeria are abysmal. Maternal mortality in Nigeria is among the worst in the world with a whopping 19% of global maternal deaths occurring in the country. Additionally, the infant mortality rate is far too high at 19 deaths per 1,000 births. In addition, the mortality rate of children under 5 is 128 per 1,000. Moreover, life expectancy in Nigeria is an incredibly low 54.4.
  6. Healthcare expenditures accounted for 3.7% of Nigeria’s GDP in 2016. Of total healthcare expenditures, 71.7% is from out-of-pocket spending – expenses that do not receive coverage from insurance or government subsidies.
  7. One of the biggest problems plaguing healthcare in Nigeria is inequality. For example, most of the healthcare workforce works in urban areas, specifically in the southern parts of the country. As a result, rural healthcare lags behind with fewer healthcare workers. Fortunately, Nigeria has identified this problem and is working to mitigate it. A successful approach that Nigeria initiated was the Midwifery Service Scheme. This program, started in 2009, took unemployed, retired and recently graduated midwives and placed them in rural areas for a year of community service. Simply getting more qualified healthcare workers in rural areas is proving to be a huge success.
  8. Healthcare in Nigeria is not all bad. Recent infrastructure improvements are helping end polio and fight diseases, such as Ebola and COVID-19. For example, Nigeria has implemented a decentralized disease control network and better vaccine storage methods.

Today, Nigeria faces an uphill battle. The country needs to address healthcare inequality and a lack of a qualified healthcare workforce to continue developing on a global scale. The country has taken some measures to modernize its healthcare infrastructure and more are on the way.

– Evan Kuo
Photo: Flickr

Women's Rights in Bangladesh
Since achieving independence in 1971, Bangladesh has lifted 15 million citizens out of poverty and made great strides in tackling food insecurity. However, while its government has been tirelessly working to develop economically, it has also been fighting another battle for women’s rights in Bangladesh.

Despite a patriarchal social framework, Bengali women have held the right to vote since 1947, and the country elected its first female Prime Minister in 1991. Women fought for their country in Bangladesh’s Liberation War, and the constitution that the country subsequently adopted promised equal opportunities for women in all areas. The following six facts about women’s rights in Bangladesh explain how the country has tried to uphold that promise, and what challenges remain.

6 Facts About Women’s Rights in Bangladesh

  1. The government has enacted numerous policies over the past decade focused on women’s rights in Bangladesh. The Ministry of Women and Children Affairs has increased allowances for widows, eased the burden on lactating mothers in urban areas and provided job training in fields such as agriculture and electronics. The National Women Development Policy of 2011 aimed to establish equal rights for men and women but also included specific goals such as assistance for female entrepreneurs. To oversee the implementation of the development policy, the government formed a 50-member National Women and Child Development Council chaired by Prime Minister Sheikh Hasina. Hasina has also vocally supported women’s empowerment in global forums such as the UN.
  2. Men still dominate the country’s political system. With Hasina leading the country since 2009 and the main opposition party also being led by a woman, Bangladesh might appear to be a model for women’s empowerment in politics. However, out of 350 seats in the Bangladeshi parliament, only 22 currently belong to directly elected female legislators while 50 are reserved for women who are not directly elected. Female politicians and activists have described a culture of exclusion within the two main political parties, reinforced by male politicians who view their female colleagues as inferior. Still, the proportion of women in parliament has continued to rise over the past decade and women hold seats in 12,000 local political offices.
  3. Maternal mortality has dropped 60% since 2000. This drop has been the result of effective investments in prenatal care. The Government and United Nations Population Fund (UNFPA), the UN’s sexual and reproductive health agency, has provided critical support by coordinating midwife training programs. Trained midwives alleviate a major risk factor for maternal mortality, which is a lack of healthcare access for pregnant women. More than half of Bengali women opt to give birth at home, but the proportion of births in which trained health personnel are present has been growing and now makes up more than half.
  4. Violence against women and child marriage remain major problems. Two out of three married women in Bangladesh have experienced domestic violence at some point in their lifetime. Religious law dictates customs such as marriage and cements discrimination against women. Almost 60% of girls are married before their 18th birthday, and their husbands’ families may abandon them if they are unable to bear children. Grassroots and international NGOs have attempted to change this status quo; for example, Girls Not Brides Bangladesh is a partnership of 25 organizations that lobbies the government and promotes advocacy. The government has answered by passing the Domestic Violence Prevention and Protection Act in 2010 and the Child Marriage Restraint Act of 2017, but the results of these efforts have yet to materialize.
  5. Civil society organizations have played a key role in improving women’s rights in Bangladesh. An example of a nonprofit that is supporting Bengali women is the South Murapa Underprivileged Women’s Cooperative Society. This organization provides medical care to women in Cox’s Bazar district. The group’s chairperson, Kulsuma Begum, escaped an abusive husband at the age of 16 and immediately set out to help pregnant women in disaster zones. Apart from domestic organizations like Begum’s, international charities such as Save the Children have made large gains in infant health and early childhood education.
  6. The COVID-19 pandemic has exacerbated existing inequities. An interagency evaluation by UN Women identified several factors that could erode women’s rights in Bangladesh due to the pandemic, including lack of healthcare access, unequal care work burden and a lack of decision-making power in the pandemic response. Experts also documented a rise in gender-based violence during the initial shutdown, fueling a spike in calls to national trauma hotlines. Luckily, local organizations on the ground have organized cash-for-work activities for women, such as mask making.

The Road Ahead

In the months to come, the COVID-19 pandemic will continue to present challenges for Bangladesh, especially the country’s women. However, Bengali women have long borne the brunt of their country’s struggles while still relentlessly pushing for change. Hopefully, their resilience will ultimately shine through.

 – Jack Silvers
Photo: Flickr