Marie Stopes International Yemen (MSIY) explains that access to primary health care is insufficient both for Yemenis and the 67,693 registered and the increasingly large number of unregistered refugees - most of them Somali, Ethiopians, and Eritreans. Key findings from MSIY research into refugee reproductive health (RH) and general health needs showed that:

• Women without a formal refugee registration card are not entitled to subsidised services.
• Refugees' economic constraints make accessibility to health services difficult for most women.
• Social and traditional beliefs, along with a lack of health and family planning (FP) awareness within refugee families, make it difficult for them to plan or decide on their desired family size.
• Many refugees do not use any FP method and have high fertility rates.
• High levels of maternal mortality are compounded by a lack of awareness of the dangers of early pregnancy, frequent childbirth, and the prevalence of unsafe abortions.
• Refugee women say that they do not feel comfortable in Yemeni health centres.
• Younger refugees are poorly served by existing health facilities.

The above is unpublished programme data collated routinely by MSIY to monitor and evaluate project activities.

MSI management information system shows that the number of Somali clients accessing services at MSIY centres in Sana'a, Seiyun, Aden, and Ta'iz has risen steadily since the outset of the project (2001). During 2005, the MSIY Sana'a centre alone saw an average of 2,250 refugee clients a month.

Twenty community leaders were trained to conduct health education sessions at the centres; as of January 2004, more than 6,000 male and female refugees had attended these sessions. Due to funding constraints these activities had to be curtailed, but have resumed in 2006.

The increasing client numbers at the Sana’a centre suggests that health education sessions have resulted in increased knowledge about FP and demand for services.

Feedback from clients and the community to MSIY has suggested that health education sessions have resulted in more positive attitudes towards discussing sexual and RH matters.

The Sana'a centre has seen a 342% increase in sexually transmitted infection (STI) treatments and a 319% increase in FP services from 2001 when the health education began to January 2005. MSIY observes that, while refugees are increasingly accessing FP and STI services, they tend to access more general health care services than Yemeni clients.

The following case study, provided by MSI, illustrates some of the outcomes of the project: Amina Farah Warsame came to Yemen 5 years ago from northern Somalia to escape the civil war. She brings her children to the MSIY centre and also has health checks herself. She is pregnant with her 4th child and, while like most Somalis she would like to have as many children as possible, she had her last child 3 years ago. She is spacing her pregnancies using oral contraceptives after learning of the benefits to her children and her own health of spacing her births from the counsellors at the MSIY centre. She says that she likes the centre and is treated with respect by the welcoming staff.