The Yemeni government issued the Law of Free Delivery in 1998 to help reduce the high mortality rate in Yemen, but the benefits are not extended to Yemenis in rural areas and public clinics.

“I do not understand how such a decree can be carried out if there is no support for clinics and hospitals,” said Hana Al-Hubaishi, who participated in a USAID workshop on implementing the law and providing access to care.

Such decrees should be funded before issued, Al-Hubaishi said, adding that delivery requires tools and medications that the government does not provide.

In spite of the law providing free deliveries, only 14 percent of women giving birth knew the law existed, according to a study by Oxfam in 2007. The study also revealed that implementation of the decree was limited to main hospitals, and not carried out in rural areas and public clinics.

Yemen has among the highest maternal mortality rates, with 365 deaths for each 100,000 live births, according to local official statistics. This is because of the long delivery period where people travel long distances to reach hospitals and lack of emergency obstetric care policies. Out of 1,000 infants, 69 die due to a lack of health services.  Only 47 percent of women receive care during pregnancy.

Last week, as part of the Responsive Governance Project, USAID conducted an advocacy training workshop on “Free Delivery, Family Planning and Emergency Obstetric Care” for  90 representatives from the Ministry of Health, National Safe Motherhood Alliance (NSMA) and the Yemen Family Care Association (YFCA). The workshop consisted of discussions on how to advocate for the implementation of the free delivery law, as well as family planning and emergency obstetric care policies to promote maternal health in Yemen.

Rami Al-Maqtari of NSMA presented a survey conducted in 2003 on maternal and child mortality rates at the USAID workshop. At least 40 percent of newborn babies whose mother died during delivery lived for less than a year, 27 percent of the children died during birth. Furthermore, for each of seven deaths due to delivery, 210 women face dangerous complications. The survey showed that 93 percent of mortalities happened in rural areas. At least 65 percent of the 365 died while delivering their babies at home.

According to UNICEF, one of the main reasons behind the high mortality rate in Yemen is that there is only one doctor per 1,000 people in Yemen and that only 60 percent of the Yemeni population has access to medical care. At least 80 percent of women deliver their babies at home in Yemen.

At least 74 percent of the mortality rate in Yemen is in rural areas. The distance between home and hospitals and clinics, along with the expenses of medication, medical checkups, and transportation are the main reasons for the deaths of women delivering their babies at home, according to the World Health Organization.

Nearly 15 percent of women delivering their babies at home did not go to hospitals due to the expense of delivery services, 11 percent were turned from the hospital because they could not pay, and five percent did not have transportation from home to the nearest clinic or hospital.

According to YFCA, of 1,000 infants, 69 die during their first two years and 78 die in their first five years, and seven mothers die each day while giving birth or within a month due to the complications of delivery.

The recommendations from the workshop focused on shifting the law to a decree issued by the Prime Minister for Yemen to implement the laws more quickly.

Charles Swagman, Technical Director of USAID, said the implementation of free delivery and free contraceptive decrees, as well as the formulation of a policy of obstetric care are two crucial issues.

It was recommended that the Ministry of Health and other Civil Society Organizations form a committee to monitor implementation of the law, especially in remote areas. In addition, the workshop suggested campaigns to increase awareness and sending teams from the ministry to different parts of the country.