Progress Amid Resistance

568 WOMEN’S RIGHTS IN THE MIDDLE EAST AND NORTH AFRICAmaternal mortality rate remains one of the highest in the MENA region.In rural areas especially, male relatives deny women what legal rights theyhave with respect to health care and maternity. NGOs and female journalistshave been active in promoting women’s social and cultural rights, butsome have consequently faced smear campaigns aimed at intimidating them.Articles 54 and 55 of the constitution state that all citizens have theright to health care and that the government has the responsibility toprovide free health services by establishing hospitals and other medicalin stitutions. Yemen’s 2007 country report to the UN CEDAW committeeplaces a special emphasis on women’s health, particularly with respectto pregnancy, childbirth, postnatal care, care for working mothers, andnutrition for the child and mother. 56 The objectives of the PopulationAction Plan of 2001–05 included providing health care to 60 percent ofpregnant women, increasing attended births to 40 percent, and providingpostnatal care to 15 percent of women. As of 2007, however, only35.7 percent of all births were attended by skilled health staff. There areno updated figures on the share of pregnant women receiving prenatalcare, which was 41.4 percent in 2003. 57 The government’s stated goals arequite difficult to achieve, especially if only a small portion of the budgetis allocated to the health sector. 58 In addition, the government announcedin 2008 that it would cut its budget allocations for ministries and institutionsby 50 percent, which is bound to make the health goals even harderto attain. 59Yemeni women generally lack the freedom to make independent decisionsabout their health and reproductive rights. On a social level, they areabsent from most such decision making within their families, and are oftenunaware of their rights to use contraception and determine the number ofchildren they wish to bear. On a legal and official level, women must getpermission from their husbands before they can undergo an operation onthe uterus—including a hysterectomy or a cesarean section—or obtaincontraceptives. 60The maternal mortality rate is one of the highest in the MENA region,at 430 per 100,000 live births. 61 Several factors contribute to this, includingearly marriage and teenage pregnancy, short birth intervals, high fertilityrates (5.5 births per woman as of 2007), malnutrition, and anemia. Thelack of access to and availability of skilled care during pregnancy is also aserious problem. Even where the medical infrastructure exists, the lack of