Bassam, a poor Syrian citizen and resident of the Quneitra countryside—who vowed to name his newborn Ihsan, a namesake of his martyred nephew—never expected death to overpower him. Layla, Bassam's wife, was unable to give birth thus losing her child. The local village midwife was incapable of anything expect offering her effete prayers. Layla's situation is identical to that of many other women driven to home births.
Giving Birth at Home—Safe... Yet!!
Giving birth at home is relatively safe for women in good health, and may even have positive features for both mother and child; yet remains an alarming choice, in case of complications for both. Decades ago, births were predominantly conducted at home under inappropriate health conditions, leading to an increased rate of mother and neonatal mortality.
Some doctors even point to the fact that the decision to give birth at home is still preferred by many pregnant women who seek to enjoy privacy and psychological comfort, under the supervision of their private doctor or midwife. Such is, however, quite far removed from the reality of the Syrian situation; especially that the number of doctors who migrated during this crisis has risen to circa 30% of the total number of doctors—circa 30 thousand doctors. This means that the country has lost, solely during the crisis years, almost 9 thousand doctors in these difficult health conditions.
Income: A Key Factor in the Preference of Home Births
Dr. Afaf Al-Shabb, a gynecologist, says: "Some women resort to giving birth at home due to its lower cost. Some even believe it to be safer; as women do not feel they are sick or required to resort to the hospital."
Dr. Al-Shabb warned of the risks of home births. She asserts that "the hospital is the safest place for any birth; especially since even low-risk births may face certain complications that may become dangerous in case of an unsuitably trained midwife." She is highly critical of the choice of some women to resort to giving birth at home; as moving to the hospital after birth—in case of complications—may have further deeply negative repercussions on both mother and child. She exclusively informs Rozana of a study showing that 16% of women giving birth at home end up eventually transferred to a hospital.
The Geography of War Has Imposed Itself
Public sector hospitals are an acceptable solution in terms of healthcare for those with low-incomes. The circumstances of war have, however, imposed a new map in Syria, thereby blocking access to those living outside the capital to its center, particularly from hot areas. Such is the situation for women in the areas of the Damascus countryside that lies outside regime control for example; who find themselves unable to reach hospitals at all. The same applies to the women of Aleppo under the control of the opposition, and other cities and rural areas. The majority of hospitals in opposition areas are not in functioning condition; if they are operating at all, they are closer to doing so as clinics; thus forcing midwives or GPs to perform dangerous operations that mostly lead to serious complications.
The cost for hospital birth in Damascus, for example, ranges between 40-50 thousand [Syrian] pounds for a natural birth; and 100 to 150 thousand pounds for a caesarean delivery—the equivalent of the entire annual income of a poor Syrian family.
Leila was, initially, not in danger. Yet the primary care she received reduced her survival rate from a birth-related complication that affects many women during giving birth.
Childbirth at home may become worrisome in case a Caesarean section might become necessary. Lujain, a Damascus resident who is eight months pregnant, says: "It is possible that I may suddenly require a Caesarean [section]. I will not risk giving birth at home—even if will have to pay a very large sum to the hospital."
Local surgeons' or gynecologists' clinics offer an acceptable, and more economical, solution to the problem of high-cost hospital births; as well as the problem of the quality of health preparations at home. Such clinics can be equipped so as to secure relatively advanced procedures, and at at a low cost.
Statistics and Figures
According to the World Bank figures, Syria has spent 3.6% of its Gross Domestic Product [GDP] on healthcare; whereas neighboring Jordan spends up to 9%, according to the Economic and Social Commission for Western Asia of the United Nations [ESCWA] report.
In the General [World Bank] Index, it may be noted that the number of states that spent less than 4% of their GDP on healthcare, does not exceed 26 out of 210 world countries studied by the World Bank. Syria, at best, ranks 190th in terms of health and healthcare spending world-wide—preceded by many other African and Arab countries, as well as the majority of Asian countries.