Today Haiti is Pan American and one of the world leaders in maternal mortality rates. The causes of this phenomenon are complex and include poverty, poor infrastructure, and the prevalence of HDP diseases. The high mortality rate is due to the high percentage of births and abortions outside medical institutions. Many women decide to give birth at home because of the sense of isolation they get from nurses’ neglect in hospitals. Besides, most Haitian women cannot receive medical services due to the lack of transport infrastructure – most pregnant women live in remote mountain villages that do not have road links to the settlements where the hospitals are located. Five initiatives have been proposed to protect women’s rights and reduce maternal mortality. Among others, initiatives include building roads, educating nurses on ethical behavior, and enforcing stricter policies for abortion outside of health facilities. Responsibility for implementing these initiatives will rest with the UNDP and UNPF, the Haitian Ministry of Health and Ministry of Transportation, and all participants who wish to participate in the implementation of the initiatives.
Population and Statistics
Pregnant women in Haiti are a population group that requires the immediate attention of nurses and midwives. Women need education, medical advice during pregnancy, and medical assistance during childbirth. Unfortunately, according to the WHO report, Haiti’s maternal mortality rate has increased over the past 20 years from 435 to 480 cases per 100 thousand people from 2000-2017. For comparison, in the United States, this indicator is only 12 cases per 100 thousand people (Maternal mortality: levels and trends, 2019). On the other hand, maternal mortality decreased slightly compared to 2010 and 2015, when 506 and 488 women died.
Today there are four large hospitals in Haiti – Hôpital Albert Schweitzer (HAS) in Artibonite, Hôpital de Fort Liberté in Nord-Est, Hôpital Sacré Coeur de Milot (HSC) in Nord, and Hôpital Immaculée Conception des Cayes (HIC) in Sud (Bridwell et al., 2019). In 2012, the US Centers for Disease Control and Prevention (CDC) partnered with the Haiti Department of Health and Population (MSPP) to create an Enhanced Routine Pregnancy Surveillance System (ePOSS). The system has been implemented at 19 sites in the administrative departments of Artibonite, Nord, Nord-Est, Sud, Sud-Est, and Nippes, including in the listed hospitals (Bridwell, 2019). Notably, ePOSS allows collecting and analyzing standard epidemiological indicators that are used to measure pregnancy outcomes.
In hospitals, pregnant women receive pregnancy counseling and medical services, including childbirth. The most common diseases that threaten the lives of pregnant women in Haiti are HDP – hypertension, preeclampsia, and eclampsia (Bridwell, 2019). There is a link between HDP and low birth weight, premature birth and stillbirth, placental abruption, and maternal death. Specifically, HDP five times increases the chances of maternal mortality (Bridwell, 2019). The most likely predictor is eclampsia, a seizure that is accompanied by profuse bleeding.
Unfortunately, there is a catastrophic shortage of nurses and midwives in the country, with only 26% of mothers giving birth under health professionals’ supervision. Scientists note that an additional 563 midwives are required today to fill the gap (Breakey et al., 2015). Until 2010, there was a public nurse and midwifery school in Port-au-Prince, but after the earthquake killed 150 of its students and destroyed the building 2010, the remaining student nurses left the area. In 2013, Partners in Health (PIH) Boston-based organization established an 18,000 square feet, 300-bed tertiary-care academic medical center in Mirebalais and opened an Hôpital Universitaire de Mirebalais (HUM) in partnership with the Haitian Ministry of Health (Breakey et al., 2015). Later in 2013, the Haitian Ministry of Health and United Nations Population Fund (UNFPA) reopened the National Midwifery School.
One pressing problem in healthcare access is transportation since the vast majority of Haiti’s population lives in remote villages in the highlands. The road to the nearest town can be made on foot and takes several hours (MacDonald et al., 2018). Residents cannot use vehicles to transport pregnant women, as there are no roads. Typically, women seek help from their neighbors, who put the pregnant woman on the door and carry her to the hospital along mountain trails (Bridwell, 2019). Such a trip can be hazardous in the dark, as the paths are too narrow, and porters can trip and drop a woman, causing her serious injury. Therefore, as a rule, even in the case of profuse bleeding, the villagers wait for the morning, and often a woman can die during the night. The overwhelming majority of women do not receive medical care because of transportation problems.
Another challenge is reported isolation and neglect by nurses during women’s hospital stay. Most of the study participants noted that the attitude of health care workers, which made them feel lonely, vulnerable, and stigmatized, was the reason why they would prefer to give birth at home (Dev et al., 2019). Therefore, nurses’ neglect is a decisive factor, which dramatically reduces the number of women who give birth under health workers’ supervision.
Issues of Concern
Today many international organizations provide health protection around the world. The United Nations Development Program (UNDP) focuses its initiatives on healthcare, education, and employment, including the issue of excessive maternal mortality. There are also local health organizations such as Haiti Plunge that run health, education, and environment programs. The United Nations Population Fund (UNPF) protects the sexual and reproductive health of women globally. These organizations can be involved in priority initiatives that will help tackle the problem of maternal mortality in Haiti.
In particular, it is necessary to focus on nurses’ and midwives’ education and create conditions for their retention within the country, since today, most nurses leave Haiti for higher compensations (Breakey et al., 2015). Further, the construction of roads to remote villages should be organized, which could become a large-scale government project. Motivating nurses and educating them to behave ethically towards patients requires special attention.
The first initiative will be road construction in partnership with UNDP and Haiti’s Ministry of Transport. UNDP can allocate money, hire local contractors and start building the roads with the permission of the Ministry. Efficiency will be assessed upon completion of construction according to the increase in the number of women who choose to give birth in the hospital. In doing so, UNDP will also need to finance the purchase of ambulances and provide the villages with the means of communication to call doctors when needed.
The second initiative will focus on nurses’ and midwives’ ethical education to improve their attitudes towards pregnant women. Nurses can be particularly influenced by statistics that represent the percentage of women who choose to give birth at home because of neglect. Educational training will be conducted on the basis of hospitals and will be funded by the hospitals, which will also provide reports on the effectiveness of the initiative. The effectiveness will be determined according to the number of women who chose to give birth in the hospital.
The third initiative will focus on educating women about the dangers of childbirth or abortion at home and the consequences of HDP disease. The education will be delivered by the health practitioners, who will want to participate in the initiative. Hospitals will finance the initiative and evaluate its effectiveness through research on the raised awareness. Further, the fourth initiative will focus on protecting women’s rights and reducing the incidence of rape and forced abortion. UNDP will carry out the initiative in collaboration with government agencies, including the police. The fifth initiative will focus on reducing the number of visits to illegal healers and voodoo sorcerers. The initiative will be implemented by one of the educational institutions with the support of the state and police.
Thus, the issue of maternal mortality prevention and maternal care in Haiti was analyzed. There are at least four hospitals in the country where women receive medical assistance. Formally, the population can go to hospitals to get help. But in practice, there are many obstacles, including transportation problems and the neglect of nurses toward women in labor. Another problem is the shortage of nurses and midwives who, after completing their education, leave the country in search of higher compensation. Five initiatives have been developed to increase hospital birth rates and reduce maternal mortality to a minimum.
Breakey, S., Corless, I. B., Meedzan, N. L., & Nicholas, P. K. (Eds.). (2015). Global health nursing in the 21st century. Springer Publishing Company.
Bridwell, M., Handzel, E., Hynes, M., Jean-Louis, R., Fitter, D., Hogue, C., & Pearce, B. (2019). Hypertensive disorders in pregnancy and maternal and neonatal outcomes in Haiti: the importance of surveillance and data collection. BMC Pregnancy and Childbirth, 19(1), 1-11.
Dev, A., Kivland, C., Faustin, M., Turnier, O., Bell, T., & Leger, M. D. (2019). Perceptions of isolation during facility births in Haiti-a qualitative study. Reproductive Health, 16(1), 1-14.
MacDonald, T., Jackson, S., Charles, M. C., Periel, M., Jean-Baptiste, M. V., Salomon, A., & Premilus, É. (2018). The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study. BMC Pregnancy and Childbirth, 18(1), 1-12.
Maternal mortality: levels and trends 2000 to 2017. (2019). Web.