INTRODUCTION
Yemen’s continuing conflict has had devastating consequences on the country’s severely underfunded, overstretched, and damaged healthcare system. The conflict has disrupted healthcare services, causing limited access, with women bearing a disproportionate share of the burden (ICRC 07/07/2022).
Across the country, healthcare needs are rising, primarily as a result of difficulties accessing medical services and medications (ACAPS 30/08/2023). Needs are especially rising among women and girls of childbearing age, who face a plethora of barriers impeding their access to timely sexual and reproductive health (SRH) services. At least 5.5 million women and girls of childbearing age require SRH services across the country, their lives at risk from pregnancy, childbirth, and postpartum-related complications (UNFPA 27/02/2023). Maternal mortality rates in Yemen remain alarmingly high, at 43.3 per 1,000 lives births in 2021, with a woman dying in childbirth every two hours, predominantly from entirely preventable causes (UNFPA 26/03/2024; WHO 26/04/2024).
As Yemen is one of the poorest countries in the world, accessing basic needs – such as medicine – is increasingly out of reach for many, further aggravating health risks for women and girls in need of essential SRH services (WB 01/03/2024 and 25/10/2024; KII 13/11/2024; UNHCR 28/08/2024). This situation is worsened by cultural and logistical barriers, which further impede access to SRH services.
This report explores the availability of SRH services in Yemen and the multidimensional challenges faced by women and girls in accessing available services, highlighting the intersection of cultural, economic, and structural barriers. This report also explores the availability of and access to three key areas of SRH services: gender-based violence (GBV) health responses, family planning services, and maternal healthcare.
METHODOLOGY
This report employs a mixed method methodology, integrating and building on existing data on women and girls’ access to SRH services in Yemen and triangulating with primary data from key informant interviews (KIIs). Seven KIIs were conducted with humanitarian responders, health practitioners, and key responders providing and coordinating SRH services in Yemen: two with experts responsible for coordinating services across Yemen, including in areas controlled by the Internationally Recognized Government of Yemen (IRG) and the de-facto authority (DFA) in the north of Yemen (also known as the Houthis); four with experts covering IRG-controlled areas; and one with an expert working in DFA-controlled areas.
Scope
This report covers the whole of Yemen, including areas under either IRG or DFA control, taking into account data availability, control area differences, data biases, and other relevant challenges.
Limitations
Certain SRH topics are more culturally sensitive than others in Yemen, including but not limited to safe abortion care, sexual relations outside marriage, sexually transmitted diseases, and sexual violence, including marital rape. These topics are less frequently mentioned in the secondary data and, although discussed in KIIs, information is more limited, likely as a result of cultural taboos. The sensitive nature of these more culturally sensitive SRH topics meant that we also could not directly consult with women and girls, instead relying on KIIs for such information.
This report is also limited by the lack of publicly available, up-to-date statistics on some key SRH indicators in Yemen. In some cases, key informants also provided conflicting information on the restriction of contraceptives in DFA-controlled areas, highlighting that policies on accessing contraception are fluid and vary depending on the governing authority in each area.
Although SRH response covers a very wide range of services, this report focuses on a handful of key services for which information was available.