Haiti's Maternal Health Crisis: An Overview

By Jiwhang Yoo, We Kids Chronicles

A UNFPA-supported clinic in Port-au-Prince, Haiti, provides antenatal care, safe delivery, emergency obstetric and neonatal care, and many other life-saving services for women and their newborns. © Jared Chambers

It is not rare to find Haiti in the news today; in recent years the country has fallen on hard times, most notably due to crippling natural disasters such as the 2010 earthquake. Yet obscured behind the high-profile earthquakes, storms, and floods is an insidious public health crisis that has plagued Haiti for decades: maternal health. Haiti’s infant mortality is the highest in the Western Hemisphere, with 46.869 deaths for every 1,000 live births in 2023[1]. Maternal mortality shows a similarly worrying trend, with a whopping one out of every 80 Haitian women dying from childbirth-related causes[2]. Hypertension, or high blood pressure during labor, accounts for 26% of childbirth-related deaths[2]. Other significant causes include postpartum hemorrhage (23%) and infection or obstructed labor (11%)[2]. 

Causes of maternal health deficiencies

A variety of factors contribute to Haiti’s maternal health deficiencies, one of which is poor healthcare infrastructure. Only 54% of pregnant women in Haiti attend at least four parental visits, which is the minimum amount recommended by the World Health Organization (WHO)[2]. 70% of mothers give birth at home, without the aid of birth attendants or emergency medical care; they instead rely on traditional “matwons,” who lack the necessary medical training[2]. According to the WHO, a paltry 39% of births occur at healthcare facilities, exemplifying the dire state of Haiti’s childbirth infrastructure. At least 23 health workers per 1,000 people are required to support the needs of Haiti’s population; the actual number, 0.5 health workers per 1,000 people, falls well short of that requirement[3]. Compounding the dearth of infrastructure is inadequate government support. The quality of healthcare is low, with this declining even further in rural areas. Insufficient opportunities for education mean that medical personnel are inadequately trained. Qualified medical personnel migrate to other countries in search of better pay and living conditions; the root cause of such “brain drain” is the Haitian government’s meager support for healthcare workers. 

This year’s cholera outbreak further strained health facilities still struggling to recover from a devastating earthquake in 2021. As part of Project HOPE’s response, our team in Haiti has provided three doctors, two nurses, a pharmacist, four cleaners, and 180 Community Health Agents to help meet the rise in need.

Haiti’s maternal health issues have been exacerbated by lasting impacts of natural disasters and emerging public health issues. The 2010 earthquake destroyed the National School of Nurse Midwives (ENISF), which was Haiti’s sole midwifery school. This created a significant shortage of qualified midwives. Although a new midwifery school was established in 2011, it has been unable to generate qualified midwives at an adequate rate. Furthermore, the reemergence of Cholera in 2022 has yielded over 30,000 suspected cases, a fifth of which are of children under 5; this has further strained the already-deficient medical system, spreading its resources thin[4]. 

Gang violence is yet another driver of Haiti’s low maternal health. The political and economic instability in the wake of the 2010 earthquake has given birth to increasingly radical gangs, which rape women and girls at an alarming rate. Because abortions are illegal in Haiti, such rape often leads to miscarriages and death. 80% of Port au-Prince’s neighborhoods are ruled by gangs, with civilians often being caught in the crossfires of gang wars[5]. The risks posed by gang violence have led to the closure of many hospitals and clinics, limiting women’s access to healthcare; the ones that do remain open are overloaded with Cholera patients. Law enforcement is powerless to defend the victims, due to underfunding and lack of equipment. 

BINUH/Boulet-Groulx

Gang violence in Haiti’s capital, Port-au-Prince, forced nearly 8,500 women and children to flee their homes in just two weeks.

Potential Solutions

First, there must be efforts to cultivate a workforce dedicated to maternity care. Education should be expanded, with programs optimized for different people depending on current level of competency. Priority training should be provided for existing matwons, to ensure the smoothest possible transition for rural mothers who are used to their care. Stronger incentives for healthcare workers must be implemented, so that skilled medical professionals remain in Haiti and contribute to the local maternity care workforce. The development of quality human resources does not occur overnight, and professionals cannot be everywhere at the same time. Thus, it is also imperative to raise public awareness through advertisements and the school curriculum on pregnancy-related risks, risk-mitigating behavior, and available care.

Even the best healthcare workers cannot maximize their skills without the proper equipment. Consequently, enhancing Haiti’s healthcare infrastructure is another important objective. More health centers must be erected, with an even regional distribution to reduce transport costs and overcrowding at urban facilities. Adequate equipment should be procured for such facilities, both through new purchases and refurbishment of existing ones. Cheap, simple maternity care packets for individuals and households could be useful in emergency situations, while freeing up hospitals for more severe cases. Moreover, hardening new and existing infrastructure against Haiti’s frequently-occurring natural disasters is essential for the stability of the country’s healthcare system.

Finally, law enforcement must be bolstered to defend mothers and children from gang violence. Training by experienced foreign law enforcement and counterterrorism units would rapidly level up local police forces. Modern equipment, such as weapons, sensors, and vehicles, would have to be procured to enhance lethality. Last but not least, more stringent screening of applicants would have to be put in place to prevent the infiltration of law enforcement by gangs. 

A multitude of organizations are working to alleviate Haiti’s maternal health crisis. The US Agency for International Development (USAID) has collaborated with the Haitian Ministry of Health to provide healthcare packages to 170 health facilities around the country[1]. The United Nations Population Fund (UNFPA) operated the Joint Programme to Support the Fight against Maternal Mortality in Haiti, which provided technical assistance for healthcare personnel and better access to emergency care[6]. NGOs, such as Every Mother Counts, Midwives for Haiti, and the Foundation for Advancement of Haitian Midwives, have also made significant contributions. Their training programs for midwives have nurtured 30% of Haiti's maternal healthcare professionals, while great progress in spreading awareness on maternity health issues has been made thanks to the networking opportunities they provide[2]. In addition, NGOs have pushed for government support on the training and regulation of midwifery and expanded maternity care services at existing medical facilities. 

[1] USAID

[2] Every Mother Counts

[3] WHO

[4] Reliefweb

[5] Health Policy

[6] UNFPA