In her small house in Aden, Sahar Salem spoke of the war in Yemen, the closed shops and empty bakeries, the silent taps with no running water, the one hospital women sometimes fail to reach before it is too late for their babies, and the fear.

She spoke of her life. After a painful divorce, she lives with her only daughter, Sondos, a brother and her elderly mother. She is the sole breadwinner of the family. She had originally hoped to become a doctor. But, when she didn’t get the required scores for medical school, she trained to become a midwife. At the time, she didn’t realize midwives like her will be the difference between life and death for Yemeni women who were cut off from reproductive health services because of the war.

“Sometimes, women come to me to deliver without having the money to pay,” Sahar said, “I tell them it’s alright. They don’t have to.”

After all, she can relate to their suffering. Her own experience with childbirth was traumatizing. She developed the dreaded obstetric fistula- a hole between the birth canal and the bladder or rectum caused by prolonged obstructed labour without access to timely, high-quality medical treatment. It leaves women leaking urine, feces or both. Fistula often leads to chronic medical problems, depression, social isolation and deepening poverty.

“When my husband heard the news, he said I was no longer good enough as a wife and that he did not want me anymore,” Sahar recalled, “He divorced me.”

At first, Sahar was growing desperate when a doctor told her she might have to go abroad for the surgery she needed to repair the fistula. She couldn’t afford it. But then she learnt that UNFPA, the United Nations agency for sexual and reproductive health, supports patients of obstetric fistula to get the repair surgery inside Yemen for free. Her surgery was successful and her husband wanted her back.

“I swore I will never return to him. He abandoned me and didn’t support me, not even with a kind word,” Sahar said, “He added an additional scar to my wounds.”

After the surgery, Sahar decided to become more proactive so other women in her community don’t go through the same pain. She became one of 163 midwives supported by UNFPA across Yemen to provide reproductive health services from their homes to women in deprived communities. Two thirds of all reproductive health facilities in Yemen have stopped working since the war started which leaves millions of Yemeni women vulnerable to maternal mortality and morbidity. Many Yemeni women are unable to access the few remaining functioning facilities because of blocked road, or because they can’t afford transportation, or because they can’t afford the cost of the medical services they need. In this context, midwives like Sahar are crucial because trained midwives can avert two thirds of avoidable maternal deaths.

But, even with her services, Sahar believes that the war’s impact on the lives of women and girls is likely to continue for generations to come.

“There was this girl who came to deliver here. She was married at the age of 11 because of poverty. The poor girl got pregnant and delivered her first baby at the age of 12. She delivered her second baby at the age of 13,” Sahar recounted remembering that the girl hemorrhaged long and hard before she was finally able to go home with her baby.

Sahar dreams that her daughter’s future will be different, full of opportunities, and kinder to women. 

About UNFPA in Yemen:

In 2019, 24 million Yemenis need humanitarian assistance including 6 million women and girls of reproductive age and an estimated 960,000 pregnant women. An estimated 144,000 of those pregnant women are likely to develop pregnancy and childbirth medical complications that will require emergency medical intervention to prevent the death of the mother and/or the baby.

In 2018, UNFPA helped establish 382 maternity homes/tents, and supported 235 existing medical facilities to be able to provide emergency obstetric care. A total of 335,199 Yemeni were reached with reproductive health services.

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