Maternal Health Care in Haiti

HL 322 International Health Issues Winter 2014 Haiti Maternal Ladies: Carlie Kangas, Erin Carlson, Erin Ranta, & Temi Fadug ba

[Google Images]

DEFINITION OF THE PROBLEM:

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While pregnancy and motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death. The major direct causes of maternal morbidity and mortality include hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labor (Bring, 2010). Globally, over half a million women die each year from complications during pregnancy and childbirth. Haitian women and children, however, die from complications related to pregnancy and childbirth at rates vastly higher than those in any developed country. (Concern Worldwide, Inc. 2013.) Mothers often face catastrophic risks in Haiti, with 1 in 200 mothers dying during childbirth, the highest rate in the Western Hemisphere. (Concern Worldwide, Inc. 2013.) Haiti is one of the most dangerous places to be pregnant in the world, with the lifetime risk of dying in childbirth standing at 1 in 44 compared to 1 in 4,300 in most rich countries (WHO, 2010). Millennium Development Goal number 5 aims to improve maternal health. The target is to reduce the maternal mortality ratio by three quarters by 2015, and achieve universal access to reproductive health. Also, by striving for this goal, one can be sure that Millennium Development Goal number 4, the reduction of Haitian mother giving birth in the back of a van. child mortality, will also benefit. [Image taken by Katherine Porter/The Toronto Star] The implementation of various programs throughout Haiti and other surrounding countries has been reducing, and will continue to reduce, the number of maternal deaths brought about through various aspects of the country including its political, economic, environmental, and cultural aspects.

pg. 1

Maternal Health Care in Haiti

THE BACKGROUND:
In Haiti, the poorest Country in the Western Hemisphere, a history of civic strives, natural disaster, ecological devastation and economic chaos has created some formidable health care challenges. Basic infrastructure, clean water and sanitation are among the great needs facing the countrys nine million people, six million of which are children. (Saving Haiti's Mothers, 2010.)
A Haitian tent village [Photo by Jonathan M. Katz]

Critical health issues: More than one in three Haitians die from a preventable disease, illness, or health complication. An ongoing epidemic of cholera is exacerbated by lack of sanitation and clean, portable water. Infant mortality rates are over two-and-a-half times greater than in neighboring countries. Nearly one in ten children will likely die before they reach the age of five. Overall, Haiti has the worst health conditions in the Caribbean region including the highest rates of maternal mortality, malnutrition, and HIV/AIDS. (Maternal Health Issues In Haiti, 2014)

Haiti is the poorest country in the Western hemisphere. More than two thirds of its people live on less than two dollars per day. One result is that too many women are unable to afford basic maternity care - with fatal consequences for both mothers and children (Free, 2012). Most Haitians (75%) give birth at home with the assistance of a traditional birth attendant. These families are too poor to pay for proper health care, transportation, and hospital costs. Adding to these issues, hospitals in Haiti have been given a terrible reputation in the past. Women are scared of giving birth in hospitals after seeing and hearing about other women and infants dying (Saving, 2010). Compounding Haitis health problems is its vulnerability to destructive storms, mudslides and floods, and most recently, the devastating earthquake that struck in 2010. The earthquake killed over 200,000 people and damaged or destroyed many hospitals and healthcare facilities in the country. (Earth Talk, 2010.) The magnitude of the earthquake has added major burdens for a health care system that is already overwhelmed with high levels of communicable and chronic disease.

Haitis main midwife training school in Port-au-Prince after the earthquake. [Google Images]

pg. 2

Maternal Health Care in Haiti

INTERVENTIONS AND THEIR IMPACTS :
People are sometimes put off by the sense that they need to fix the entire health system in order to solve a problem. But there are interventions that can be implemented within a year or two that are really going to have a measurable impact at saving peoples lives. The first thing you need to do is look at education and education for girls and women. And help families and communities see that an educated girl, an educated woman is able to do a lot more for her family and community. --Ann Starrs, President of Family Care International, an organization that advocates for safer pregnancies around the world.

Haitian Health Foundation (HHF):

[Google Images]

The HHF works tirelessly to improve the health and well-being of the poor, sick, and the infirm of the greater Haitian area, with a focus on women and children. Reducing the number of deaths of mothers and children in childbirth, and improving the care of mothers and children before and after birth are just a few of their goals (Haitian). HHF team provides high tech service in very low tech areas. They give prenatal checkups to mothers, many of whom [Picture taken from Google Images] have never had any type of prenatal care for any of their births. HHF created the Center of Hope: A residential treatment facility for two of the most vulnerable and fragile populations in rural Haiti: at-risk pregnant women and severely malnourished children. It is near the hospital thereby making it easy for at-risk women from remote areas to

pg. 3

Maternal Health Care in Haiti

stay towards the end of their pregnancy, before they become emergency cases (Center, 2010). HHF Mortality Review: gathering of medical or related personnel to discuss and review maternal or infant mortality cases that could have been prevented with proper care, better timing, etc. Through these meetings, the HHF is able to discuss what went wrong, why, and what can be done in the future to provide these women with better care (Saving, 2010). Midwives and Traditional Birth Attendants: The HHF, along with the Haitian government, has discovered that trained midwives are a key answer to the problem of maternal health in Haiti. They are less expensive to train and less expensive to maintain. The government is currently expanding a program that trains and graduates midwives in proper maternal health, childbirth, and postchildbirth care, and with the help of the United Nations Population Fund, the midwives are being sent across the country to developing and rural areas for internships (A New, 2013). Many organizations are now working with and educating Traditional Birth Attendants, which can be seen as a large cultural problem, in order to get them educated

Midwife teaching her training to a traditional birth attendant. [Google Images]

and linked in to the health facilities. Traditional birth attendants are generally older Haitian women in the local community who assist in the birthing process. The Haitian Health Foundation and the United Nations Population Fund have been working to bridge the gap between the traditional health care practices of these attendants and those offered at the nearby maternity hospital in Petite Riviere. The midwives teach the traditional birth attendants life-saving birth techniques, including delivery techniques, proper hygiene, what to do with afterbirth and placenta, and proper care of the mother and child after birth (Saving, 2010).

Free Obstetric Care Removing the cost of maternal health care seemed to be an obvious way to increase the use of essential maternal health services. With the support of the Pan American Health Organization (WHO/PAHO), the Canadian International Development Agency (CIDA) and the European Commission, the Haitian Ministry of Health embarked upon a free obstetric care project which pays health facilities and hospitals to offer poor women free childbirth and care before and after birth, and refunds transport costs. Between 2008 and 2012, 137,000 women benefited from free obstetric care for a total cost of $10 million US dollars. CIDA has donated $20 million US dollars to expand the project to cover children up to the age of five (Free, 2012).

pg. 4

Maternal Health Care in Haiti

Community Evacuation Teams: In many cases, pregnant women are not easily accessible. Rough terrain, rivers, and hills make it difficult for women to get the proper care they need. Community Evacuation Teams have proved to be an ingenious strategy in remote rural villages. When a woman needs help, a whistle is blown to signal the evacuation team to gather. The assigned member in charge calls the HHF ambulance or vehicle to meet them at a designated area that is easily accessible for both parties. The Community Evacuation Team gets the woman on to a stretcher and brings the woman to meet the ambulance (Center, 2010).

A community evacuation team takes a laboring Haitian mother to meet the ambulance. [Google Images]

Hpital Albert Schweitzer (HAS): Hpital Albert Schweitzer Haiti is an integrated health care organization that provides hospital and community based services that promise exceptional care. Through community-based programs that provide prenatal screening and counseling and by making high-risk obstetric and neonatal care available 24/7, HAS is significantly improving maternal and child healthcare outcomes. HAS is the only healthcare provider in its service area that can offer advanced, life-saving care to mothers and babies who need it most (Hpital, 2014) (Maternal). Project Concern The Concern Child Survival Program was established in October 2005 with the goal of reducing the staggering rates of death by improving the quality of health care available within five slum areas of Port-au-Prince and encouraging timely care seeking and health care practices. The following are brief descriptions of some of the specific interventions being implemented by this program: Communication campaigns delivering key messages on maternal health and rights awareness to target populations through Community Based Organizations (CBOs), health clinic staff, matrons (traditional birth attendants), health agents, youth volunteers and other channels. Provision of iron/folate (to protect against anemia) and clean birth kits to mothers visiting health clinics. Training of matrons in clean deliveries and recognizing danger signs requiring immediate referral.
Haitian nurse providing care at HAS. [Google Images]

pg. 5

Maternal Health Care in Haiti

Using youth volunteers to track pregnancies and refer pregnant women for antenatal care services. Conducting assessments and providing of technical support to tertiary hospitals and health clinics to improve obstetric and neonatal quality of care (Haiti Child, 2013).

LESSONS LEARNED:
Maternal health in Haiti is a complex and interwoven subject. There is no black-or-white, simple fix to this problem. The fix will come when the various governments and organizations realize that women wont stop getting pregnant; they wont stop having complications or illnesses related to pregnancy and childbirth just because there is not enough funding to help them. What needs to come out of this issue is education: education of the people of Haiti, including women, men, children, and traditional birth attendants; education of midwives and nurses who devote their time to helping these women; education of the heads of government to show them just how big of a problem this is. Only when this matter is truly known for what it is, will funding and support come in.

REFERENCES:
"A New Midwifery School Brings Hope to Haitian Mothers." United Nations Population Fund. 06 November 2013. Web. 02 April 2014. <http://www.unfpa.org/public/home/news/pid/15524> "AmeriCares: Haiti." AmeriCaresorg News and Press. Americares, n.d. Web. 01 Apr. 2014. <http://www.americares.org/where-we-work/latin-america-caribbean/haiti.html>. Bring, M. (2010). Retrieved from <http://www.who.int/topics/maternal_health/en/> "Center of Hope." Health Care. Haitian Health Foundation. 2010. Web. 29 April 2014. <http://www.haitianhealthfoundation.org/index.php/programs/healthcare/> Earth Talk. 2010. Environmental impacts of the Haiti earthquake. [Internet]. November 8th, 2010. Available from: http://www.boulderweekly.com/article-1360-environmental-impacts-of-the-haiti-earthquake.html2010. "Family Care International-Homepage." Family Care International. Family Care International, n.d. Web. 01 Apr. 2014. <http://www.familycareintl.org/en/home>. "Free Obstetric Care in Haiti." WHO. World Health Organization, Apr. 2012. Web. 01 Apr. 2014. <http://www.who.int/features/2012/haiti_obstetric_care/en/>. "Haiti." Wikipedia. Wikimedia Foundation, 30 Mar. 2014. Web. 31 Mar. 2014. <http://en.wikipedia.org/wiki/Haiti>. "Hait Child Survival Program: Strengthening Maternal & Child Health." Concern Worldwide, Inc. 2013. Web. 2 April 2014. <http://www.concernusa.org/what-we-do/haiti-child-survival-program-strengthening-maternal-and-child-health> "Haitian Health Foundation." Haitian Health Foundation. Haitian Health Foundation, n.d. Web. 01 Apr. 2014. <http://www.haitianhealthfoundation.org/>. "Hpital Albert Schweitzer Haiti." Maternal and Child Health. HAS, 28 Mar. 2014. Web. 01 Apr. 2014. <http://www.hashaiti.org/maternal-and-child-health>. "Latest Publications." Improving Reproductive Health: UNFPA. United Populations, n.d. Web. 01 Apr. 2014. <http://www.unfpa.org/rh/index.htm>. "Maternal and Child Health." Hpital Albert Schweitzer Haiti. n.d. Web. 01 April 2014. <http://www.hashaiti.org/maternaland-child-health> "Maternal Health Issues in Haiti." Maternal Health Issues in Haiti. Midwives for Haiti, n.d. Web. 07 Apr. 2014. <https://midwivesforhaiti.org/volunteer/volunteer-resources/33-volunteer/resources/24-maternal-health-issues.html>. Porter, Catherine. "One Baby's Story Shows Why Haiti Is No Place to Give Birth." Thestar.com. Toronto Star Newspaper, 29 Oct. 2011. Web. 01 Apr. 2014. <http://www.thestar.com/news/world/2011/10/29/one_babys_story_shows_why_haiti_is_no_place_to_give_birth.html>. "Saving Haiti's Mothers." PBS. PBS, 29 Jan. 2010. Web. 01 Apr. 2014. <http://www.pbs.org/now/shows/605>.

pg. 6