Reducing Maternal Mortality in Haiti

By: Nadene Brunk, Midwives for Haiti is a winner of the Women Deliver 50

Midwives For Haiti began educating Haitian women, in the skills that save mother's lives, in 2006. We began by teaching under trees, in the laundry room of a hospital, in an outdoor restaurant; wherever we could find room to teach and learn. With no textbooks in Creole, the native language of the majority of women in Haiti, we improvised and created teaching materials with our students. We learned that Haitian women are hungry for knowledge and have seen enough maternal and infant death to know they want to be a part of ending the suffering and grief. 

Development of the curriculum and methods of teaching continue to be an evolving process. The main text used as a guide for curriculum, A Book For Midwives, was translated into Creole in partnership with Virginia Women's Center and New Haiti Institute. Frustrated with losing too much in translation, Haitian midwives were recruited and trained to be teachers. It became clear that the students we chose, who were already auxiliares and infirmieres, could be trained in the core abilities of the skilled birth attendant in less than one year if the clinical experiences and settings were in high-risk areas of Haiti. 

Rather than build a birth center of our own, we made the choice to partner with the government-owned hospital. It made many steps in the process more difficult but we believed if we worked within the existing healthcare system the project would ultimately be more sustainable. The supplies and resources a midwife needs to care for women safely were not always available and supplying them seemed like a journey against impossible odds. 

Today there are 42 graduates of the Midwives For Haiti program. They are delivering babies, giving prenatal care, testing for HIV and syphilis, treating malaria and intestinal parasites. They are educators, teaching about nutrition and warning signs of pre-eclampsia. Pre-eclampsia, the biggest killer of women in Haiti, is becoming a well-known word and the prevention and warning signs are becoming the heart of every educational session taught by graduates. Our mobile prenatal clinics travel to sixteen villages, some of which were previously only accessible by foot.  Women who are miles from the nearest hospital can now get prenatal vitamins, iron, and treatment for infections, or be transported to a hospital when they are ill. 

The barriers to skilled care in Haiti are socio-economic, cultural, and geographic. It has been proven that educating women empowers them to delay childbearing, become leaders in their communities, and to problem-solve to make themselves and their families healthier. Midwives For Haiti has proven this can be done on a shoe-string budget partnering with Haitian healthcare providers and other NGO's. We have learned that educating midwives is not enough. We also need to deploy them where women live and work and in places of referral that would otherwise not have enough skilled staff. 

Midwives For Haiti began as a volunteer organization and they remain at the heart of all we do. They have modeled compassionate care in some of the most difficult and uncomfortable settings in Haiti. They have problem-solved in hours of meetings with Haitian community leaders, hospital personnel, and midwives struggling to do their job well in a resource-poor country. But the goal remains to empower Haitians to be the healthcare workforce.

It is estimated that Haiti needs at least 1200 skilled birth attendants to provide care to every pregnant woman in Haiti. There are less than 200 university trained midwives in Haiti. We have added 42 skilled birth attendants to that number. With 5 more schools, Midwives For Haiti could supply the workforce of 1200 skilled birth attendants in ten years. Changing the picture of maternal mortality in Haiti is an attainable goal.

Photograph courtesy of Midwives for Haiti