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About Yemen

Situation analysis 
Yemen ranked 133 out of 169 countries on the Human Development Index in 20101 . In 2010, 42,7% of the population lived below the national poverty line . Most of the people (73%) live in rural areas .

More than 45%of the population is below the age of 15, and another 23.17% is youth (between 15 and 24 years old), a majority of which are unemployed due to limited availability of job opportunities and the economic crisis .This puts a considerable strain on the country's limited basic resources such as health infrastructure, water and schools. At the same time, during the last decade, the ability of the Government to finance essential services and investments has been decreasing, mainly due to the impact of the global financial crisis and the decline in oil revenue. Since the beginning of 2011 a protracted political crisis has led to a collapse of the economy leading to soaring prices for commodities (on average 40% price increase for food and more than 100% for fuel between January and September). More than 5 million people are food insecure, while 60% of children are chronically malnourished . 

The population is estimated at 23 million in 2010, which at the current growth rate of 3% per annum, is expected to double by the year 2033. Unfortunately, inconsistencies, a lack of periodicity and a lack of national capacity limit the availability of reliable data on population trends. Improving consistency and quality of data collection and utilization for policy development, is one of the challenges policy makers face. 

The population growth is an underlying cause of many of the problems the country faces, such as the depletion of water resources, malnutrition, slow economic growth, insufficient education and insufficient health-care capacity. With this rapid population growth rate, poverty in the country is expected to aggravate, hindering prospects for sustainable development. The Government considers population growth as a key development challenge the country faces. 

Population growth is related to a number of factors. Early marriage, limited girls education, high female illiteracy, high adolescent fertility rate and the low use of contraceptives, all contribute to the relatively high total fertility rate (TFR) (6.2 births per woman). The unmet need for family planning is high and the latest estimates that it is 37% ), and cultural taboos and misconceptions impede access to existing services. Nevertheless, the contraceptive prevalence rate (CPR) for modern methods increased from 13.4 per cent to 19 per cent between 2003 and 2009, indicating a growing demand for FP services. However, the RHCS system is still very weak. In the absence of a functioning Logistics Management Information System (LMIS) and trained staff to use it, reporting is irregular and data for decision making are not reliable. Therefore, forecasting is unlikely to reflect the national needs. 

Yemen has one of the highest maternal mortality ratios in the region. Maternal mortality is related to poverty, inadequate access to health care services including maternal health services and family planning and low awareness and knowledge about Reproductive Rights. 

The latest reliable estimate for maternal mortality ratio is 365 maternal deaths per 100,000 live births . While the figures suggest a reduction of the MMR (by 61% since 1990) , progress is still too slow. It is highly unlikely that Yemen will be able to achieve Millennium Development Goal 5 by 2015.Although Yemen is part of the Secretary General’s initiative to accelerate progress towards achieving MDG 4 and 5, the MoPHP is still prioritizing and allocating more resources to MDG4 and less attention is given to MDG 5 both politically and financially. Additionally, maternal mortality is expected to rise in the near future as a result of the latest political and economic transformations that the country is going through that are affecting mobility and resources and may therefore, affect access to health care particularly for women. Health services, in general, and primary health care, in particular, are inefficient and of low quality. Yemenis pay more than 50% of their expenditures out of pocket, in spite of the MoPHP policy of free access to health care. This adds burden on the poor and affects poor women needing maternal health services. Additionally, only 43% of the population has access to a public health facility. 

All the major factors leading to the high maternal mortality rate exist in Yemen, particularly, as mentioned, the limited access to maternal health care, including access to skilled birth attendants and EmONC services. The organizational structure of the Ministry of Public Health and Population (MoPHP) separates human resources and planning from the reproductive and maternal health services with negative consequences on coverage by qualified midwives. Additionally, the links between the community, the primary health care and the comprehensive EmONC services are weak. 

The low utilization of skilled birth attendants (SBAs) is a major issue. Eighty-four per cent of all births take place at home, and skilled birth attendants (SBAs) are present at only 27per cent of them. This is generally due to limited availability of midwives in the districts, long distances, and lack of awareness of the importance of the role of midwives. In most cases, complicated deliveries cannot be managed on time, nor is a referral organized. 

The Ministry of Public Health and Population has developed a National Midwifery Strategy to improve training of midwives, deployment and retention, and supervision. This strategy has not been activated yet through a Ministerial Decree. The employment issue is critical to motivate more high school graduates to enroll in midwifery schools and increase midwifery coverage in the country. A number of complementary interventions are now being studied to increase coverage by midwives such as the support of private midwifery practice. Mobile clinics with midwives have been pioneered over the last few years, with some degree of success. In addition, there is a need to focus on recruitment of midwives for the public system through district and governorate councils. 

Fistula is one of the most serious and important complications of deliveries without skilled birth attendants (SBAs) particularly prolonged labour. Although exact figures of the magnitude of the problem are not available, it is expected to be highly prevalent, especially in rural areas, with high fertility and poor maternal health services. However, the provision of services for repair or social rehabilitation are only being set up now. The capacity to manage fistula cases including repair, follow-up and social readjustment is still limited in Yemen. 

HIV/AIDS prevalence is low, about 0.1%, mainly in high risk populations like commercial sex workers. 

The National Reproductive Health Strategy, 2011-2015, recognizes rapid population growth, poor access to maternal health and family planning as major challenges to development in Yemen. However, the institutional capacity to implement pro-poor policies and to address societal and geographical disparities needs to be strengthened. Such policies will have an impact on maternal health. 

Reproductive Health Commodity Security remains an issue. Yemen is still dependent on multilateral and bilateral donors to fulfill its contraceptive needs. The system of logistics management and distribution of commodities such as contraceptives and medications for emergency obstetric care is inadequate. The system is not fully linked with the essential drugs logistic system. The RHCS technical group has not met in the past year. In order to secure the country’s needs and ensure a sustainable system there is a need to strengthen the RHCS system. 

Gender inequality is considered to be a major obstacle to reducing population growth and the maternal mortality ratio. The illiteracy rate among women is 65 per cent, compared to 27 per cent among men. Although Yemen has endorsed the Convention on the Elimination of All Forms of Discrimination against Women and has adopted the national women’s development strategy, there has only been limited improvement in the socio-economic status of women. Gender-based violence remains prevalent. More than one in every three women in the coastal areas has undergone female genital mutilation/cutting (FGM/C). Parliament has suspended the adoption of a law establishing a minimum age for marriage. Raising awareness amongst women about RR, in particular in rural areas, is considered a pre-requisite to encouraging their demand to access RH services. 

 The prominent representation of youth in the population structure will require efforts to empower youth as well as develop youth-oriented policies. Within the context of high adolescent fertility, high maternal mortality and a high prevalence of gender-based violence, the needs of young women require special attention. The youth revolution that started in January 2011 gives an indication of the frustrations of the youth and their cry for change. For the programme this is an opportunity to engage the youth.