Despite revolutions, earthquakes, and a devastated economy, Haiti has reduced maternal health risks by nearly 50% since 1990.
Maternal health in Haiti has been steadily improving for over two decades, despite numerous challenges and setbacks. In 1990 the maternal mortality rate was 620 deaths per 100,000 live births, which meant that over 1,600 women died each year. Since then, increased access to better sanitation, water, health care providers, preventative care, and family planning have led to a 43% drop in the maternal mortality rate. Less than 1,000 women died in 2010 for the first time in decades. (Unless otherwise noted, data and information was obtained from WHO and Human Rights Watch, “Nobody Remembers Us: Failure to Protect Women’s and Girls’ Right to Health and Security in Post-Earthquake Haiti”, Amanda M. Klasing, 29 August 2012, 5, 20, 21, 25, 45, 46).
Yet despite all the progress, circumstances are still dire for the majority of mothers in Haiti. Skilled personnel only attend 26% of all births. Just over half of all women received at least four antenatal visits, while the single visit rate is now up to 85%. Total fertility is still relatively high with nearly four children born per woman. Only 40% of women in recent surveys indicate that their family planning needs are met. Other surveys show that the ideal number of children for most women is three (Bureau of Democracy, Human Rights and Labor, Country Reports on Human Rights Practices for Haiti, U.S. Department of State, 2011).
One of the key impediments to adequate care is poverty. The difference in care between the rich and poor is staggering, though even the most well-off struggle somewhat. For instance, for the poorest 20%, fewer than 10% of women have a skilled practitioner to assist at birth. For the wealthiest 20% the figure rises to about 70%. The number of births which take place in temporary camps is tragically high. While care is technically available to women in these camps, accessing such care is difficult. Women report that they must engage in paid sex work to obtain food. Rape and sexual violence are rampant. Without birth control options, many become pregnant. Women do not know the camp layout, and often must move to avoid violence. When the time for birth comes, they often are unable to make the journey due to safety or monetary issues.
However, since the earthquake, government officials, international organizations and practitioners have attempted to explicitly address maternal health risks in current recovery plans. Rather than put off maternal health as something to solve after other crises have been dealt with, maternal health is one of the current priorities. In 2008, a pilot program to provide free childbirth care was implemented in 49 institutions. Maternal death dropped sharply in areas serviced by these facilities (five times lower than other facilities). Since 2001, a midwifery school has graduated 35 new trained professionals each year. Though this number is far from meeting overall demand, it is an improvement. Concurrently, there is some distrust of midwives’ skills and some mothers actively avoid them, even when hospital care is unavailable.