September 10, 2012
September 10, 2012
JÉRÉMIE, HAITI – Mirlene Jeudi is an expecting mother from Jérémie, a small town in southwestern Haiti. Her due date is only a month away, yet she has not been able to stop working. Her husband died after she became pregnant so she is now a single mother and must save enough to support her children.
“I am eight months pregnant, and I sell fruit in Port-au-Prince,” she says. “Despite the fact that I often feel weak, I have no choice to take the boat from Jérémie to Port-au-Prince to sell fruit and vegetables because that is the only hope I have to make a living.”
Jeudi has worked as a fruit and vegetables vendor for years, though the 2010 earthquake in Port-au-Prince, the capital, forced her to stop for a period. As the country recovered, she resumed her business because she says that it was the only way she knew how to make a living. She planned to stop working as her pregnancy advanced, but then her husband died after having stomach pains and a high fever.
The job requires frequent travel from Jérémie to Port-au-Prince, which is difficult when eight months pregnant. The bus leaves at 6 a.m. from Jérémie and on a good day gets to Port-au-Prince at 3 p.m.
But she says she has no other choice. She has two children and another on the way.
In Haiti, life is difficult for pregnant women. Many pregnant women say they maintain their physically strenuous jobs until their delivery date because they need to support their families. Shortcomings in maternal health care also mean many women don’t receive the medical attention they need during their pregnancies. Public and private initiatives strive to offer free maternal care, but many agree it’s not enough.
The maternal mortality ratio in Haiti dropped from 1,000 maternal deaths per 100,000 live births in 1990 to 670 maternal deaths per 100,000 live births in 2005, according to the Millennium Development Goals Monitor. Still, the country is off track to meet targets to improve maternal health – goal five of the Millennium Development Goals, a U.N. anti-poverty initiative that countries worldwide have agreed to achieve by 2015.
Pregnant women here say that despite carrying a child, they must continue to work as hard as they have always worked, especially in the rural areas of Grand’Anse, one of the 10 departments of Haiti.
Elsi, a pregnant woman who declined to give her last name, works as a vendor at the market in Jérémie, the capital of Grand’Anse. She brought the yams that she is selling here from Marfranc, a village 10 kilometers outside of Jérémie.
“I carry everything I sell in the market on my head, and I have a lot of pain in my abdomen,” she says. “When that happens, I tie a large piece of cloth around my abdomen so I can still come and sell at the market.”
She says her children won’t have food otherwise.
“It is with the little I make here that my other four children are able to eat,” she says.
And Elsi is not alone. It is common here to see pregnant women carrying heavy loads on their heads as they walk long distances to transport goods to sell at the market. But they say that walking is better than taking a bus or a truck because of the poor state of the roads and trucks that break down frequently.
Nurses and midwives say this is dangerous for the health of the mothers and their babies. It could even be fatal, says Marie Loudie Germain, who has been a nurse for 17 years.
“When women carry loads that are too heavy, especially in the eighth or ninth month of pregnancy, that could lead to them aborting the baby, or she could start bleeding,” Germain says. “This poses a dangerous situation for the woman. She can lose her life as well as the baby’s.”
Marie Elcie Calas, 48, has been a nurse for 24 years. She currently works at the Center of Hope, a maternity center founded and run by the Haitian Health Foundation, an organization dedicated to women’s health.
“A pregnant woman is not supposed to lift things that are too heavy,” she says. “But in Haiti, especially in the countryside, women cannot afford to stop working.”
She says that most women don’t have the privilege of working jobs that offer maternity leave.
“The state normally gives pregnant women one month off before delivery and two months after delivery,” she says. “Private institutions give one-month maternity leave. But the majority of pregnant women do not have a steady job, so they continue to work because their children need to eat. That’s the situation in Haiti.”
Rose Myrtha Louis, a nurse who works at St. Antoine Hospital, says that some women even give birth while they are working.
“Pregnant women in Haiti do not rest,” Louis says. “They even deliver the baby in the street or on the boat that comes from Port-au-Prince to Jérémie.”
In addition to performing physically demanding labor throughout their pregnancies, many women also lack access to maternal health care. For some, it is only after the fifth or sixth month of pregnancy when they begin to show that they realize they are pregnant.
"We need to encourage more women to come for prenatal care, so we can talk to them about these issues," Calas says.
Lelaine Marcelin, a pregnant woman who lives in Beaumont, a small village in Grand’Anse, says she didn’t seek prenatal care until she was five months pregnant and her feet began to swell.
“Women are the primary victims of the lack of health care,” she says.
In addition to seeking prenatal care, Louis encourages women to go to a medical facility to deliver as well.
“Pregnant women are supposed to come for regular checkups with a doctor,” she says. “They are not supposed to stay home and have the baby delivered by a midwife with minimal training. What if the mother is HIV-positive? Often the midwife does not know that.”
The Haitian government in 2008 declared that all women can deliver their babies at any state-run hospital free of charge. “Maternity care gratis!” was the initiative’s slogan.
The Haitian Health Foundation runs a maternal waiting home called Center of Hope for women with high-risk pregnancies. Women stay here until they are ready to deliver, says Anneau Joseph, the center’s administrator.
The home receives about 50 women daily for free prenatal care, she says. Marcelin is one woman who found prenatal care here.
But despite these public and private efforts, women and health professionals say there is still way too little prenatal and post-natal care available for women. The Haitian Health Foundation serves just three out of 10 communes in Grand’Anse. And Joseph says that it’s difficult to gauge the impact of the governmental initiative here in Jérémie because the state-run hospital has a bad reputation and women try to avoid seeking care there.
Editorial Note: Renate Schneider, country editor of GPI's Haiti News Desk, is the former director of the Center of Hope. She has not had ties with the center since 2009.