Giving Birth in Haiti

Giving birth is dangerous business for Haiti's poor, who suffer the highest maternal mortality rate in the Western Hemisphere. Some 630 of every 100,000 women died of pregnancy-related causes in 2006 -- more than five times the Latin American and Caribbean average, according to the United Nations.

The problem is heartbreakingly simple: Millions of women either cannot access health care, or cannot afford it.

Haitian health officials made significant strides last year with a program to waive entrance fees -- the equivalent of 25 to 64 cents a day -- for pregnant mothers at public hospitals. But the women must pay for almost everything else, from doctors' gloves and syringes to medicine, food and transportation, said Jacqueline Ramon, a maternity ward nurse at Port-au-Prince's General Hospital.

So many like Aristide still give birth at home, often with untrained midwives who administer traditional care using leaves made into tea, oil, smoke or steams.

"It's never, ever going to work unless we say some things are not meant to be sold, and safe motherhood is one of them," said Dr. Paul Farmer, a Harvard physician. In rural towns where his nonprofit Partners in Health provides free health care, Farmer said the maternal mortality rate is less than one-tenth the national average.

Maternal health is one of the issues the Clinton Global Initiative and U.N. agencies are emphasizing, part of a wider call for increased aid and investment that Bill Clinton and U.N. Secretary-General Ban Ki-moon made in a visit to Haiti last week.

For $40 million a year, and likely even less, Farmer said, comprehensive care could be given to all pregnant Haitian women.

The issue is likely to be discussed at a long-delayed international donors conference on Haiti scheduled for April 13-14 in Washington. Haiti faces as much as a $100 million budget shortfall after large-scale emergency spending following four destructive storms in 2008.

Other steps are also needed in this country of nearly 10 million, including preventing unwanted pregnancies and lowering the highest birthrate in the Western Hemisphere -- almost 36 births per 1,000 people.

The situation turned critical last fall when Port-au-Prince's public hospitals went on strike during the fall peak birthing season -- nine months after Carnival.

With mothers forced to turn to a handful of not-for-profits, the cramped, 66-bed Jude Anne maternity hospital run by Doctors Without Borders Holland in central Port-au-Prince became, in the words of obstetrician Dr. Wendy Lai, a "war zone."

Women were giving birth on the floor, in the waiting room, on staircases and in bathrooms. One died before doctors, caught up with other life-threatening emergencies, could attend to her.

"They had nowhere to go," said Lai, a Canadian who previously worked in the Democratic Republic of Congo. "This has been described as a baby factory. On a normal day, we line them up and catch the babies."

Some things are improving. Doctors Without Borders recently moved to a larger facility after 21/2 years in a building so cramped, doctors could not walk around some patients' beds.

At the old facility in January, women lay in rows, legs open and knees in the air, as professionally trained midwives chatted quietly and watched for signs that birth was imminent. Some of the mothers sang to get through the pain.

Haitian mothers are disproportionately threatened by the disorders of eclampsia and pre-eclampsia, which bring high blood pressure, excess protein and swelling, and can cause seizures, heart failure, brain hemorrhages and death.

Though seen all over the world, the incidents are much higher in Haiti -- 14 in every 2,000 pregnancies compared to a rate of 1 in 2,000 to 3,000 pregnancies in the U.S., according to the National Institutes of Health.

Because they are caused by pregnancy, the only cure for the disorders is to deliver the baby.