Despite the happy beginning that heralds the arrival of a newborn baby, the requirements for reproductive health and the associated rise in the prices of medicines and the lack of some essential types of them steal the joy from families, as is the case for Umm Sultan with her firstborn, whom she gave birth to after suffering during the pregnancy period. She was unable to buy essential medicines or proper nutrition.
Samar (31 years old) gave birth to her first child a few months ago in a rural district in Sana'a governorate, but his health condition is a constant concern for his mother, whose husband lost his main source of income during the war. The child suffers from problems that hinder growth and movement, which doctors say are due to nutrition and a weakness of essential items related to the mother's health during pregnancy and the family’s living conditions.
Umm Sultan's case is one of the multifaceted sufferings of quite a few Yemeni families, whose health and living conditions have been worsening for years. It does not stop at the limits of medicines for pregnant mothers and reproductive health in general, but rather it is an issue that goes beyond the health of the mother to the health of newborns, in light of the difficult humanitarian and living conditions experienced for years, with which cases of abortions and even deaths are increasing among mothers.
“Yemen has the highest maternal mortality rates in the region. Only less than half of the births are attended by skilled health personnel, and only one in every five health facilities provides maternal and child health care services.”
Furthermore, official data from the Ministry of Health in Sanaa, analyzed by “Khuyut”, reveals that 11,214 deaths among newborns were recorded in the period between 2018 and 2020, out of more than half a million births in only ten Yemeni governorates.
The analysis of the data from the ministry's annual reports also reveals that abortion ranks first for complications experienced by pregnant mothers, followed by obstructed childbirth second, and manual removal of the placenta third.
On the other hand, doctors and specialists attribute the deterioration in the reproductive health situation to factors related to the effects of the war in Yemen on the health sector and on the conditions of families whose living income level has been affected, and thus on their ability to access healthy food and reliable medicines, of which citizens complain about the lack of many types and the high prices.
Frightening Figures Reveal the Severity of the Crisis
Women and girls in Yemen bear the brunt of the crisis. Yemen has one of the highest maternal mortality rates in the region. Only less than half of the births are attended by skilled health personnel. Maternal and child health services are also available in only one hospital out of every five health facilities that are still operating. More than one and a half million pregnant and lactating women may experience acute malnutrition in 2023. As a result of increasing food insecurity, these women face the risk of giving birth to children with poor growth and caring for malnourished newborns.
"Khuyut", based on numerous reports and data, monitors the serious impact of the crisis in Yemen on women and girls—in numbers—with about 12.6 million women in need of protection and reproductive health services. The data obtained by "Khuyut" reveals that one woman dies every two hours in Yemen during childbirth due to usually preventable causes, and that 5.5 million women and girls of childbearing age need access to reproductive health services. In addition, about one and a half million pregnant and breastfeeding women suffer from acute malnutrition.
7.1 million women need urgent access to gender-based violence services, while women and children make up two-thirds of Yemen's 4.5 million IDPs, the majority of whom have been displaced more than once.
As a matter of fact, the war has exhausted Yemen's national health system, leaving buildings and equipment destroyed and health workers without wages. Yemen has the highest maternal mortality rate in the region. Only less than half of the births are attended by skilled health personnel, and only one in every five health facilities provides maternal and child health care services.
About 5.5 million women and girls of childbearing age in Yemen have limited or no access to crucial reproductive healthcare services and need urgent support.
Corporate Migration
“Khuyut” monitors this crisis by searching for the roles of some medical bodies and syndicates, such as the Community Pharmacy Owners Syndicate, which in turn confirmed that there are important medicines for chronic diseases, some of which are serious, that are not actually available in Yemen, attributing the reason to the fact that they are affiliated with international branded medicine companies.
According to the Community Pharmacy Owner Syndicate (CPOS), 90% of branded pharmaceutical companies have migrated from Yemen due to the war and sanctions; however, maternity medications can be provided by commercial companies to cover the deficit with items and types that are generally acceptable.
Good and Bad Alternatives
In this context, Dr. Samira Muthanna, an obstetrics and gynecology consultant at a private hospital, confirms in her interview with "Khuyut" that the health situation of mothers and pregnant women has deteriorated like the rest of the health situation in Yemen, due to the war and the lack of important medicines, "and with the availability of alternative medicines, "some of which are good", there are others that are" not good", as some medicines are of unknown origin or are not approved by the Supreme Board of Drugs and Medical Appliances. In addition, she also believes that most of the Indian and Turkish medicines on the market, unfortunately, are not good.
As for the role of doctors in the crisis, Muthanna says: "As doctors and pharmacists, we choose only the necessary effective medications that the patient needs without exaggeration by dispensing medications, vitamins, and the well-known and approved pharmaceutical companies".
The United Nations Children's Fund (UNICEF) states that there are 1.1 million pregnant and breastfeeding women in Yemen in need of treatment for severe acute malnutrition, recalling that “access to quality ante- and post-natal health services is key to newborn and maternal survival.”
Further, UNICEF warns of the absence of adequate services due to the inability to access such services and the unaffordable costs of transportation, which makes the approach to health providers a last resort for women and children, especially in remote, rural, and war-affected areas.
“Yemen's health sector is suffering from the consequences and repercussions of conflict, economic deterioration, and institutional collapse, all of which have been going on for a long time. The availability of functioning health infrastructure facilities, such as hospitals and primary care centers, has become difficult to provide.”
In this regard, the pharmacist, Louay Ahmed, who works for a reproductive health organization, says to “Khuyut”, that he has been working for ten years and that there has never been a crisis like the current one in the lack of medicines. He believes that a large part of what is happening is the result of the rise in their prices due to political circumstances and the double customs and levies.
He adds, "These issues have raised the price of medicines dramatically." The situation has also been affected by the lack of salaries and prices, which in turn affected health and medical centers in general, leading to abortions or obstructed births.
The High Cost of Imported Medicines
According to the medical website “connect.springerpub”, the most important medications given to stabilize pregnancy are: progesterone and hydrocortisone, in addition to beta-methadone.
Referring to the data of the Supreme Board of Drugs regarding the imported quantities of the three medications during the period (2010–2019), the analysis of “Khuyut” showed an increase in the cost of their import, especially Hydrocortisone; from 124 million and 177 thousand and 969 riyals to 306 million and 860 thousand and 20 riyals. That is, three times more expensive compared to the price at which these items were imported in the past.
Medications for Obstetrics
In addition, the report of the National List of Essential Medicines, issued in 2019 by the Ministry of Health and Population in Sana'a, indicates that magnesium sulfate is an essential medication. The authority's data, which was analyzed, reveals an increase in the value of its importing costs, especially since 2017.
Likewise, medications that help in placental expulsion and the management of postpartum hemorrhage have also increased in their import costs. In addition, oxytocin is also on the list of the Ministry of Health, but the analysis of the data of the Supreme Board of Drugs showed a decrease in the value of its importing cost.
Deterioration of Health Services
According to UNICEF, one woman and six newborns die every two hours from complications during pregnancy or childbirth. “Decades of underdevelopment and years of intense fighting have left essential public services, including crucial healthcare for mothers and babies, on the brink of total collapse,” the organization said.
Moreover, the report on motherhood and fatherhood in light of the ongoing conflict in Yemen indicates that the maternal mortality rate has risen sharply since the escalation of the conflict, from five maternal deaths per day in 2013 to 12 maternal deaths per day in 2018. In addition, one out of every 260 dies in pregnancy or childbirth, with only three out of 10 births taking place in regular health facilities.
Likewise, 1 in 37 new-born babies die in the first month of life; in addition, 1 in 15 adolescent girls between the ages of 15 and 19 have given birth.
On the other hand, the World Bank describes the current situation in Yemen's health sector as suffering from the consequences and repercussions of conflict, economic deterioration, and institutional collapse, all of which have been going on for a long time. The availability of functioning health infrastructure facilities, such as hospitals and primary care centers, has become difficult to provide. Besides, a large proportion of the population faces challenges in accessing health care.
Currently, only 50% of all health facilities are fully functional. More than 80% of the population faces significant challenges in accessing food, drinking water and health care services. The lack of human resources, equipment and supplies is also an obstacle to the provision of health care services. Moreover, the conflict has exacerbated health challenges and led to poor management of the healthcare sector.
In addition, the conflict has directly affected the health of the population and is now estimated to be the third leading cause of death in Yemen, after ischemic heart disease (the heart is not getting enough blood and oxygen) and neonatal diseases.
