INTRODUCTION
Around 1.2 billion of the world’s population live in fragile and
conflict-affected states (FCAS). These states contribute with more than
60% of the global burden of maternal mortality. The Sustainable
Development Goals call for specific attention to address maternal health
in the realities of armed conflict.1,2
In war-affected Yemen, a country that has historically received scarce
attention in the health literature, the challenges in providing
maternity care are evident. In 2014, Yemen remained with maternal death
estimates between 148 and 270 per 100,000 live births, and neonatal
deaths between 22 and 26 per 1000 live births.3-5Since 2015, Yemen has been in a state of armed conflict with subsequent
breakdown of the health services. In 2016, 17% of the public health
facilities were out of function and 38% only partly functional, due to
either damage of facilities or lack of supplies or human
resources.6 The United Nations have repeatedly issued
warnings as demand for humanitarian assistance exceeds available
capacity.7,8
While there is an urgent need for data to inform the emergency response
and prepare for resurrection of the health system, health information
systems in Yemen have been unreliable since the beginning of the
conflict.9 Moreover, a systematic review found no
studies from Asia and the Middle-East reporting exclusively on maternal
health during acute conflict,10 and there is an
alarming need for research exploring maternal health service access,
quality and adaptive responses during acute crises.11
Taiz Houbane Maternal and Child Health (MCH) Hospital in Yemen is an
example of an adaptive response to mitigate the consequences of armed
conflict. The hospital was established by Médecins Sans Frontières (MSF)
in November 2015 and pre-dimensioned to serve 650 women in childbirth
per month. Since 2015, the hospital experienced a steady increase in
demand for services. In August 2017, 1014 births took place, and the
facility had provided care 50% above admission capacity for several
months. To mitigate the growing demand for care, a policy was introduced
to restrict admissions; it was decided that no new hospital admittances
were allowed when bed occupancy reached 100%. Following, as here
presented, a research evaluation assessed the restriction’s effects on
the quality of intrapartum care and birth outcomes, to provide
information for future provision of care and adaptive responses.