The Yemeni girl, Najwa, in her twenties, did not realize that her pregnancy with her firstborn would lead her behind the walls of Al Salam Hospital in Khamer District, Ammran Governorate, which is supported by Doctors Without Borders, to undergo a caesarean section. According to what her husband, Mohammad Hamoud, told "Khuyut".
Najwa is not the only one; before that, Sawsan (22 years old), had gone to Al-Sabeen Hospital in Sana’a, to perform some periodic pregnancy tests. However, she was surprised that the doctors decided that she has to undergo a caesarean section because she would not be able to give birth naturally. She confirmed to "Khuyut".
Najwa and Sawsan; are two girls out of 3,136 caesarean sections cases, which were performed at the Al-Sabeen Hospital in Sana’a for Maternity and Childhood, during the year 2020 out of a total of 10,503 births. While in 2019, the same hospital performed about 3629 caesarean sections out of a total of 11,562 natural births, according to a statistic obtained by “Khuyut”.
Avoidance of the natural childbirth pain
Women in Yemen accept caesarean sections, especially those who live in cities, in order to avoid the pain of natural childbirth, but this is not the main reason for the spread of the phenomenon of caesarean section. In fact, many hospitals deliberately deliver women by caesarean section for the sake of increasing their profits. According to the statement of the citizen, Abdu Al-Sallam Naji, to "Khuyut".
On the other hand, many parents and husbands expressed their dissatisfaction with some hospitals deliberately performing caesarean sections for pregnant women at the time of delivery, under insubstantial justifications, such as lack of oxygen whereas the truth is otherwise. It became obvious that the purpose behind that is to obtain additional revenues, without taking into account that this would It might put their lives at risk without a compelling medical reason to resort to such type of operation.
The obstetric emergency department receives about 400 deliveries per month, while the number of caesarean sections does not exceed 150 cases; so that the percentage of caesarean sections does not exceed 30% of the total cases admitted to Palestine Hospital (previously known as Zayed hospital), which is the percentage allowed globally.
In response to these accusations and complaints; Dr. Majeda Al-Khatib, director of the Al-Sabaeen Hospital for Maternity and Childhood in Sana'a, told "Khuyut" that the number of caesarean sections in the hospital exceeded 25%.
She justified this by saying that "the hospital is a reference for all cases of women and childbirth, which are mostly critical cases with complications, or for pregnant women who underwent previous caesarean sections, and therefore these women cannot give birth naturally so that a caesarean section must be performed."
The director had also confirmed that the hospital is abided by all scientific protocols and medical standards, and it is a teaching hospital where all types of deliveries are carried out. She also noted that the treatment of delivery cases is consulted in a daily morning meeting attended by women's consultants and specialists. The director explained that the costs of the childbirth operations in the hospital are very low compared to other maternity hospitals, and that most of the revenues are turned to operational expenses so that the hospital continues to provide its services under war conditions, and the medical staff in the hospital receives humble wages as incentives.
Procedures of the operations
In turn, Dr. Nada Al-Wajman, Director General of Zayed Hospital in Sana'a, which has become the (Palestine Hospital), denies any increase in the number of caesarean sections compared to the number of natural births.
Al-Wajman explained in a statement to "Khuyut", that "the emergency obstetric department receives about 400 births per month, and the number of caesarean sections does not exceed 150 cases, which means that the percentage of caesarean sections does not exceed 30% of the total cases admitted to the hospital, which is within the permissible percentage. In addition, any case that undergoes a caesarean section is done after consultation between specialists and medical counsellors of the hospital staff to decide the most appropriate method of delivery for the mother and her child.
Moreover, she continues: "The hospital is considered a reference health facility for many nearby hospitals and medical centers in the districts of north-east of Sana'a and its environs in the governorates of Ammran, Al-Jawf and Ma'rib, as confirmed by its managers. She added that Palestine hospital receives the most difficult cases that have been difficult to give birth after many attempts, as it is equipped with a qualified cadre of consultants, specialists, general practitioners, midwifery staff, anesthesiologists, doctors and technicians who work 24 hours a day. She further indicated that most of the cases referred to the hospital arrive in the late stages, sometimes after complications such as uterine rupture; This requires a surgical intervention to save the mother and her fetus.
Furthermore, Al-Wajman noted that such rumors were raised in 2017, and a committee was assigned by the Health Bureau to verify its accurateness. However, the committee did not find any caesarean sections that were performed without a medical justification, and concluded that the percentage of caesarean sections for natural births does not exceed the permissible percentage globally, she concluded.
For his part, Dr. Fouad Butj, Director of Al-Salam Hospital in Khamer District - Ammran Governorate, confirmed to "Khuyut" that the rate of caesarean sections for women admitted to the hospital is about 5% of the total daily deliveries.
He added that these caesarean sections operations are carried out in the hospital for free, as a result of health problems in the pelvis, which pregnant mothers suffer from, or at the request of their husbands and relatives, fearing for the lives of the delivering women.
In this regard, the cost of performing a natural birth in Yemeni government hospitals exceeds about 200,000 riyals, but in the case of a caesarean section, the amount doubles 3 or 4 times, depending on the complexity of the pregnant mother's medical condition.
It is worth noting that Yemen has one of the highest maternal mortality rates in the Arab region where a woman dies every two hours as a result of complications of pregnancy and childbirth, according to the United Nations Population Fund.
In 2019, the Ministry of Public Health and Population in Sana’a issued a decision to take off the duty of the director and deputies of Zayed Maternity and Childhood Hospital (Palestine, as its name was changed by the Ansar Allah (Houthis) authority in 2020), as well as gynecologists and obstetricians who were referred for investigation on the grounds of the increase in Caesarean section rate.
On the other hand, the former spokesman of the Ministry of Health, Yousef Al-Hadhiri, admitted that births by caesarean section amounted to 50% of the total number of births that take place in the hospital. He pointed out that the Minister of Health was surprised - when he reviewed the medical records - by the increase in the percentage of caesarean sections for women, which raised his doubts about its medical justifications.