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Syria- Damascus, 31 August 2022


“My husband will be angry when I tell him I’m expecting another girl. He did not want a third child and the only thing that would make him accept this baby is if it were a boy. I am anxious about how he will react.” Marwa is 23 years old and is a beneficiary of one of the United Nations Population Fund (UNFPA) -supported primary health care clinic’s in rural Tartous governorate. She told her story to Karen, the Sexual and Reproductive Health Technical Specialist of UNFPA Syria.

At the age of 15, Marwa married; early marriage is common phenomenon in rural areas and is increasing in Syria as a harmful coping mechanism to the deteriorating economic situations and limited access to meaningful educational opportunities. Marwa’s husband is a day laborer and his income depends on the available construction work in the area.


“I have two children, a 5-year-old boy, and a 2-year-old girl. After my first child, I returned to the clinic for an intrauterine device (IUD) to ensure spacing between my pregnancies, and after two years I returned and had the IUD removed”, Marwa elaborated.

Now, Marwa is five months pregnant and visiting the doctor for a routine antenatal care visit. The clinic has the only free laboratory in the area, and Marwa was waiting for the results of her tests. She spoke softly, explaining how much the free services meant for her as life in the past few years had become incredibly difficult with the costs of food and transportation rising exponentially.



Her children were born at Tartous National Hospital, both by cesarean section. She explained that her third birth would be another C-section because of the myth in her village: once you have a cesarean, you will always have caesareans. The cesarean section rate in Tartous is estimated at 50%[1] which is incredibly high compared to the 10-15% WHO recommendation. This is due to several factors including doctors’ preference due to profit, the convenience of scheduling, as well as shifting social norms which emphasize a preference for cesareans for aesthetic purposes.  There is no existing evidence of the benefits of cesarean sections for women or infants when it is not medically required[2].

UNFPA encourages safe delivery and avoiding unnecessary cesarean sections which can lead to complications and affect future pregnancies.

After her second child, she did not have another IUD inserted and instead she relied on the calendar method for contraception. However, this method is not as effective as modern contraception, and Marwa became pregnant for the third time. She spoke of how she would get another IUD after this birth to better safeguard against another intended pregnancy.

“The services I received were vital for my health and wellbeing; without them I would not be able to maintain routine prenatal care or receive post-natal care because of the high costs of transportation”, Marwa explained.

UNFPA's goal is to contribute to the reduction of maternal and newborn morbidity and mortality as well as the provision of Gender Based Violence (GBV) prevention and response services by ensuring availability, access to, and utilization of integrated Sexual Reproductive Health (SRH) and GBV services and information.

Integrated SRH services include antenatal, postnatal, and neonatal care; referral to maternal and emergency services; and psychosocial support (PSS). UNFPA partners also refer to advanced case management services through static facilities and the outreach services of integrated mobile teams.


UNFPA believes that every Syrian woman and girl has the right to have access to affordable reproductive health care and be effectively protected from gender-based violence.


*Marwa: The name has been changed to protect confidentiality.