By Christoph Lubczyk | Project Leader
The Reproductive Health Officer (RHO)
and the Project Manager (PM), have
many years of expertise in the field
of reproductive health. For many years,
they have been working for the partner
organization of Aktion Deutschland Hilft
ADRA Yemen, helping women and their
newborns—and saving lives.
In this interview, they discuss challenges,
solutions, the importance of local structures,
and why they still can't always help.
Aktion Deutschland Hilft: What is the
situation for expectant mothers in Yemen?Reproductive Health Officer (RHO): A major
problem is that many women cannot afford to
visit healthcare facilities during their
pregnancies. Transportation costs are also a
barrier: A large part of the population lives
in rural or mountainous regions where
infrastructure is limited.
Project Manager (PM): We repeatedly hear that
women travel very long distances to the nearest
healthcare facility—sometimes even on animals
like donkeys or camels. These journeys are often
dangerous, especially during floods or when roads
are in poor condition.
Even non-pregnant individuals suffer significant
physical strain during such journeys; for pregnant
women, the risk is even higher. Psychological stress
also plays a role.
RHO: Cultural aspects are another factor: often, men
make the decisions about whether or not women seek
medical help. And even if women overcome all the
aforementioned barriers, they often encounter further
problems in healthcare facilities. There is a lack of
equipment, medication, and staff.
PM: That's right, the healthcare system is weakened,
and the ongoing conflict exacerbates this situation.
For example, one of our hospitals in Lahj currently
has a critical funding gap. It urgently needs to be
closed in order to maintain basic reproductive
healthcare services.
And what risk factors at the individual level
contribute to the high maternal and infant
mortality rates?
PM: The structural problems we've described mean
that decisions are only made when it's already
too late. We repeatedly see cases where women
experience premature rupture of membranes and lose
amniotic fluid. This can lead to serious or even
fatal complications for both mother and child.
In some situations, any help is then too
late – for the women affected or their children.
It's also difficult for us as medical professionals
to witness that there's nothing more we can do.
How often do women typically visit a doctor
during pregnancy?
PM: During pregnancy, most women don't visit a
medical facility at all, or at most once or twice.
Many only seek help when complications have already
arisen.
As part of our humanitarian work, we therefore
provide information and guidance in the communities.
We want to encourage women to attend at least four
prenatal appointments as early as possible in their
pregnancy.
RHO: Many women also prefer to be at home
during childbirth.
From a woman's perspective, what are the advantages
of giving birth at home?
PM: Many women desire privacy and want to be
accompanied by trusted family members. Bleeding
or the loss of amniotic fluid is often associated
with shame and stigma.
However, home births can pose health risks, for
example, due to a lack of sterile instruments.
Sometimes the umbilical cord is cut with tools
like fabric scissors. Hygiene kits and birthing
supplies help minimize these risks. We regularly
distribute such kits.
RHO: If no trained midwives are nearby, trusted
family members, so-called traditional midwives,
provide valuable support. Expectant mothers feel
comfortable with them because they are part of
the same community. They are present during births
and maintain close contact with the pregnant women.
Sometimes they even temporarily take the women
into their homes to ensure a safe birth. However,
they are not always prepared for serious
complications.
Strengthening local capacities
Do you also work directly with local communities?
RHO: In the communities, we offer training for
midwives and equip them with essential
tools – including measuring devices, medications,
and delivery kits.
They monitor vital signs, provide advice on
medications and folic acid, organize transportation
when needed, and ensure that everything proceeds
as safely as possible. Our experience shows that
training and involving local midwives significantly
improves care and reduces complications.
And what does postnatal care entail –
under ideal conditions?
RHO: Under ideal conditions, postnatal care includes
several visits in the first few weeks after birth.
We check mother and child for complications, provide
breastfeeding advice, and offer support for problems
such as breast tenderness or jaundice. The midwives
also receive training in this area.
Have you had to adapt your programs in recent
years due to the security situation?
PM: The conflict has become somewhat less intense
in recent years. However, incidents still occur.
RHO: Yes, the situation was largely stable, although
there were occasional incidents, for example in Abyan.
Activities there were not suspended, as all healthcare
professionals are from the region and were able to
continue working. We monitored the situation remotely
and coordinated with the human resources department
as needed.
What would need to change in the long term to improve
the situation for expectant mothers and their children
in Yemen?
PM: It is particularly important to strengthen the
training of midwives. We want to support them in
obtaining diplomas and developing their skills
through targeted programs.
In general, any investment in midwives and healthcare
personnel has a direct positive impact on the local
community. Psychosocial support is also crucial. And
we need to reduce stigma so that women actually access
healthcare services.
RHO: Midwives stabilize the healthcare system and
make reproductive health accessible to all pregnant
women. Strengthening local structures by providing
midwives with birthing kits and the necessary
materials is also of central importance.
Thank you for your kind donation!
By Christoph Lubczyk | Project Leader
By Christoph Lubczyk | Project Leader
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