UNFPA representative to Yemen talk to the Yemen Times
Although last year’s turmoil forced many international organizations to close down, the UNFPA continued its programs and activities without suspension. In March, Vandenberghe signed the UNFPA’s Country Program Action Plan (2012-2015) with the Ministry of Planning and International Cooperation.
Yemen Times interviewed Marc Vandenberghe about the action plan and several issues relating to population in Yemen.
Tell us first about your 2012-2015 action plan for Yemen. Is the budget for this plan enough to tackle the population problem in Yemen?
The main goal of UNFPA’s Country Program Action Plan (2012-215), which has been signed with the Ministry of Planning and International Cooperation in March, is to improve sexual and reproductive health, in particular of women and youth, and to contribute to the reduction of maternal mortality. Therefore, our programme promotes reproductive rights, and aims at increasing access to sexual and reproductive health services.
To achieve this, we work at two levels. First, we aim at increasing the coverage of reproductive health services, and improving their quality, in particular to provide safe delivery services to women. Too many women in Yemen die while giving birth to a child, and we want to make sure that they have access to a well equipped health facility where a trained midwife helps them to deliver their baby, without a risk for their lives. This means that we will contribute to train health professionals and provide equipment to health facilities. But we also want to inform communities and women in particular, that these facilities are available for them and encourage them to use them.
This brings us to the second level of our plan, increasing awareness on the right of women to access safe delivery services and engage in communication with women to create the demand for sexual and reproductive health services.
We communicate not only with women, but also with men and with young people, because it is in the interest of the whole community that women have proper health care while they are pregnant and have a safe delivery. A special part of our programme is to provide treatment and care to women who suffer of obstetric fistula. This is a condition that is mainly caused by obstructed labour. Women who have a difficult delivery, often because in fact they are too young to deliver a baby and their body is not fully developed to give birth, may suffer serious internal injuries leading to incontinence or sterility. This is a major tragedy in the lives of these women, but also in the lives of their husbands, children and families. Therefore, we have set up two centers, one in Sana’a and one in Aden, where women suffering of obstetric fistula can receive surgical treatment and post surgical care. At the same time we communicate with women, men, and youth to encourage those young women to avoid giving birth at a young age, to remove the main causes of this condition.
We also support the Ministry of Public Health and Population with improving the logistics system to distribute contraceptives to health facilities in the governorates to assist couples who want to space or limit the births of their children. Couples have the right to decide how many children they want and we want to help them realize their wish, by providing access to health facilities that can provide information, advice, and contraceptives. If couples realize the number of children they want, they will most likely have less children, or opt for spacing their births, which will reduce the number of children families have. This will improve the health of women, and reduce the risk that they die while giving birth. Besides, in the long term it will contribute to stabilizing the population growth.
Our budget of USD 25 million is limited, but we will focus on supporting the Ministry of Health with improving the logistics system for the purchase and distribution of reproductive health commodities (in particular contraceptives), at a national level, and furthermore focus on providing support to health facilities and communicating with communities to promote the reproductive health services in a limited number of governorates.
UNFPA will also assist people who are affected by the crisis in the country. Not only those who have to flee their homes, but also populations who remain in an area of conflict. Women living in a situation of crisis, especially if they are displaced, are very vulnerable. They may be pregnant and in need of antenatal health services, or a safe delivery, or protection against violence. Our main purpose is to make sure that even in those difficult circumstances women have access to reproductive health services and are protected against violence. For this we cooperate with public and private health services to provide the minimum services needed, or to help them detect and help women victims of violence.
While in the past a lot of progress has been made to bring the issue of reproductive health to the national agenda, and to improve the services, it is clear that still a lot of work should be done. Fortunately, many partners are involved in this process in the whole country, supporting reproductive health services either in the public or in the private sector, and all contribute to the implementation of the National Reproductive Health Strategy.
Despite your noticeable contribution in the UNFPA to stabilizing the population growth, Yemen still has one of the highest population growth rates in the world. Why?
Stabilizing the population growth contributes to a balance between the needs of the population and the capacity of government, private institutions, and families to cover these needs. It is the mandate of the UNFPA to raise awareness of the importance of the issue of population growth, and to advise the government and private organizations on ways to tackle this problem. Stabilization is a long term process.
In fact, one can say that stabilization of population growth is the responsibility of everybody. It starts with the perceptions of individuals about the life they want to lead and how many children they would like to have, and continues with the commitment of government and civil society organizations to provide appropriate services and care. It is obvious that access to and information on the correct use of contraceptives will help couples realize the number of children they want, but services in other sectors are important as well. For example, if girls receive a good education, preferable up to secondary school level, then they will most likely marry and have their first child at a later age. They tend also to have less children than women who did not have the same educational opportunities. Furthermore, if families have access to good adequate health services for their children and their living conditions make it that their children have higher chance to survive, couples may decide to have less children.
The government depends totally on international organizations to control the population explosion. How do you evaluate the performance of the government regarding population control? Have they dealt with the problem seriously?
The fourth Five Year Plan for Development and Poverty Alleviation 2011-2015, mentions reducing population growth as a major priority and as a condition for social and economic development, and it aims at increasing the utilization of family planning methods from 19 percent to 40 percent. We hope that the government’s two year plan for the transition period will continue working towards this objective. A lot of progress would be made if the two year plan would include measures to encourage the political participation of women in Yemeni society, to empower women economically, to include measures to improve access of women to reproductive health services, or access of girls to formal education. Such measures, if implemented, would have a positive effect on reducing population growth.
Nobody expects that the government should do all the work alone. It can count on many partners, including UNFPA, to help with policy development, and to provide technical support.
You always stress the importance of the role of youth in tackling the population explosion. What's their exact role in this matter?
Young people constitute the majority of the Yemeni population. They are literally the future of the country and the political developments in 2011 have shown that they are willing to assume their responsibilities.
It is important that youth are aware of the consequences of unabated population growth in terms of human development. They should be informed and educated and this includes raising awareness about what they can do at an individual level, as future young married couples.
If high fertility continues amongst the huge segment of the population that youth are, population growth will continue unabated and the population of Yemen will double in the coming 17 years! This will put a considerable strain on the country's limited basic resources, such as health infrastructure, water and schools. Therefore, we have to carefully focus on investing in young people, because they can contribute to reducing population growth.
Most of your activities are held in cities while about 70 percent of the population live in rural areas. Do you find it difficult to reach these areas?
In fact, we always work in the districts of our target governorates, as the majority of the population lives in these areas and access to health services is often difficult, in particular for women. For instance, during our previous programme cycle we implemented activities in Al-Mahabisha in Hajja, Sabra and Reef districts in Ibb, Al-Zayadia and Bait Al-Faqih in Hodeida, Al-Rujum and Al-Khabt in Al-Mahwit, etc. During the current programme cycle we will also implement activities in the districts of Hadramout and Ibb.
How can we empower Yemeni women to decide how many children they want to have?
Education is a major force in empowering women. Education has a big impact, not only on the capacity of women to participate socially and economically in society, but also on their health and as a consequence, on the health of their children and of other members of the family. Girls who go to school, preferably at least up to secondary level, are better equipped to share the burden of managing the household with their husbands and other family members. They can more easily express their views and contribute to solutions. Women who have benefitted from a good formal education tend to have less children than women who did not have this opportunity.
The ability of women to control their own fertility further strengthens their empowerment and contributes to greater well-being of the family.
How does the UNFPA deal with the problem of young girls in Yemeni being denied their education and being married off?
UNFPA is amongst the actors that work to enable girls and women to live with dignity and respect. Early marriage deprives girls from appropriate education. Even worse, it is a major factor of maternal mortality. Teenage girls are not physically fit for a pregnancy or to deliver a baby. Complications of pregnancy and/or delivery can be harmful and even fatal in many cases.
Therefore, UNFPA works with national and international partners on empowering women (including the most vulnerable) by helping them to acquire basic living skills, advocating for full access to formal education, and by supporting organizations who review and propose amendments to discriminatory laws, such as laws related to the age of marriage. Moreover, UNFPA works with men and boys, religious and community leaders to raise awareness of women’s rights.
How does population growth rate negatively affect Yemen's economy and development?
High population growth is a serious obstacle in the fight against poverty and malnutrition. It stretches existing resources, such as the provision of adequate and good quality health services for mothers and newborns, education for children, or access to safe drinking water. Therefore, high population growth will continue to affect the whole development process in Yemen.
Are you satisfied with the level of reproductive health services in Yemen?
In the last few years, Yemen has made a lot of progress with regard to improving their capacity to provide reproductive health services. The adoption and revision, last year, of the National Reproductive Health Strategy, under the leadership of the Ministry of Public Health and Population, is definitely a major step forward. Unfortunately, the crisis has affected the implementation of the strategy, and has had a negative effect on the capacity of health providers to provide services to the population.
There are many actors in the field of reproductive health, who all contribute to increasing the coverage and improving the quality of the services. However, they face many challenges due to insecurity and instability.
We cannot be satisfied as long as Yemen has one of the highest maternal mortality ratios in the region. Every day six Yemeni women die during childbirth. There are women who cannot have access to health services and information. There are women who deliver without the help of skilled birth attendants. There are women who have unintended pregnancies. More lives of mothers could be saved if easy access to quality health services during pregnancy and childbirth are secured.
All women should have access to contraception to avoid unintended pregnancies; all pregnant women should have access to skilled care at the time of birth; all those with complications should have timely access to quality emergency obstetric care. If this happens, we all would be satisfied with the level of reproductive health services in Yemen.
If we want to build a healthy society, we have to pay much care to women. Healthy women mean a healthy society.
HIV and AIDS poses a threat to Yemenis and there are no exact statistics about the number of cases in Yemen. How do you assess the danger of the disease in Yemen? What should we do to fight it?
While the prevalence rate in the general population is still low (about 0.2 percent), prevalence is increasing amongst groups at risk, such as sex workers. Fighting the spread of HIV is the responsibility of all actors in society and everybody has a role to play. UNFPA works with peer educators to increase youth awareness on the dangers of the spread of HIV so that they can protect themselves. In general, one should adopt a human rights approach, which means that everybody, whatever social or HIV status, has the right to information, health services, and care. It is important to talk openly about HIV and AIDS to avoid people living with HIV being stigmatized and refraining from seeking assistance, as this would only make the situation worse.