Haiti

Saj Fanm pou Fanm (SFF)

I remember that one day, a lady, who had already lost three stillborn babies, had found a smile and hope thanks to a good follow-up of the labour and delivery that I had done. I stayed at her bedside from the beginning of the active phase until the baby was born in very good health.

– Marie Eleine Alcidas, midwife

I have a very good relationship with my midwife. She is friendly and very attentive. When I am with her, I always feel well taken care of and respected. I have received quality care. They are always available and responsible. In addition, the midwives work from their hearts.

– Marvine Saintina, pregnant woman

Haiti has one of the most fragile contexts in the world following decades of oppression, corruption and natural disasters. Since the most recent earthquake, hospitals are reporting a lack of medication and necessary medical supplies, and health workers are targeted for kidnappings.

MATERNAL MORTALITY RATE

523 deaths for 100,000 live births

42% of births are attended by skilled health personnel

This expo describes the incredible challenges facing expectant mothers in Haiti, and the equally incredible efforts that midwives make to give them the care they require.

I remember being afraid. I felt that God was welcoming me. But then I thought, “No, you can’t leave your baby yet”. I remember waking up in the clinic. The midwife saved my life.

– Anonymous, birthing mother

The aim of the SFF project is to contribute to reducing maternal and infant mortality by improving the sexual and reproductive health of women and girls in four departments (North-West, South-East, Nippes and Grande Anse ) in Haiti, with emphasis on reducing gender inequalities and strengthening women and girls’ capacities to make choices based on their sexual and reproductive rights.

The SFF project is an initiative led by the United Nations Population Fund (UNFPA), with the participation of:

It is funded by the Government of Canada, through Global Affairs Canada.

The AISFH (Association of Nurse Midwives of Haiti) was founded in 2004. Their mission is to help promote midwifery in order to decrease the maternal and infant mortality rate in Haiti. They work in collaboration with other entities (such as the Ministry of Health, the Haitian Society of Obstetrics and Gynecology, etc.) to improve healthcare, and promote the health and well-being of women in Haiti. The mission of the AISFH is to work for the professional development of its members and to promote midwifery in Haiti.

Nurses and midwives account for nearly 50% of the global health workforce.

Gross national income per capita in Haiti:
1,665 USD per year

Midwife salary:
1,200 to 3,000 USD per year

Today in Haiti, 250 midwives serve more than
2.8 million women of childbearing age.

© UNFPA Haiti: Respectful Care and Violation of Women’s Rights: An Emerging Issue in Haiti, by Vavita Leblanc, Maternal Health Specialist, UNFPA Haiti CO

One day while doing my internship in a hospital as a student nurse, I assisted a midwife who was doing a perineal repair. In my eyes as a trainee nurse, the vagina of this young woman who had given birth two days earlier was beyond repair. But, this midwife came in with confidence, skill and knew how to repair it very well. It was extraordinary and miraculous. That day, I told myself that I had to acquire this skill, and here I am today as a midwife and perineal repairs have become routine for me.

– Virginie Pluviose, midwife

PUBLIC & COMMUNITY ENGAGEMENT

Haitian midwives advocate for the accessibility of information for Haitian women and families. To this end, they regularly participate in radio programs to share information on various topics related to sexual and reproductive health. Haitian midwives also fight against all forms of violence against women and girls.

My relationship with the community is positive. I regularly participate in mobile clinics, mothers’ clubs and awareness sessions. This helps us to detect pathologies and to get to know the community.

– Résia Pierre-Pierre, midwife

The women I come in contact with always ask for my assistance during their delivery, and when the midwives organize awareness activities in schools on March 8, I regularly take part. In addition to organizing cervical cancer screening clinics using the VIA/Pap Test method, I participate in radio programs related to the promotion of midwifery and family planning.

– Mona Metellus Milord, twelve years of experience

INTERNATIONAL DAY OF THE MIDWIFE

Despite the restrictions imposed by COVID, for the International Day of the Midwife, AISFH took the opportunity to conduct public awareness activities in the different departments, including the promotion of early cervical cancer screening, prenatal consultations and training sessions with midwives.

Kajo Keji midwifery students during practice at the Juba Teaching Hospital

TRAINING

16 instructor-midwives took an Emergency Skills Workshop (ESW) to strengthen their technical, clinical and teaching skills.

116 healthcare providers (midwives, nurses, doctors and OBGYNs) were trained by ESW instructors.

**The Safe Delivery App was introduced in the ESW, and was rolled out into healthcare facilities as a workplace resource to facilitate continued learning. Approximately 400 healthcare providers in Haiti are now using the app** to support their learning.

COVID-19

During the pandemic, the impact of COVID-19 on healthcare workers’ mental and physical well-being was severe. Nurses complained of a lack of equipment, emotional overload, and difficulties in getting patients to understand the need to wear masks and respect social distance. Confronted with the health crisis related to COVID-19, the nurses expressed their helplessness and psychological distress, because they have seen that wherever the health crisis rages, nurses are on the front line. They suffer the anxiety of seeing patients arriving en masse, as they are also faced with a lack of equipment.

Are we going to resist the fatigue when we were already understaffed? We also ask ourselves questions about our life outside the hospital. I am afraid of contracting COVID-19. Not so much for myself, but because I could be a carrier for my loved ones, my colleagues and my patients. The day my hospital received the first case of COVID, I was so scared that I spent the night with my mask over my face.

– Je, nurse

She mainly emphasized on caring for the baby, as well as exclusive breastfeeding. She gave me advice on how to protect myself from the coronavirus; the importance of vaccination and the benefits of good nutrition for the baby.

– Robencia Mathurin, pregnant woman

...And also I feel a little stressed, but I try to manage my stress because when we leave the hospital, when we arrive at home, our children tend to come and stick to us, and I, in fear of the spread of the virus, tell them “no”, and I stay away from them. As soon as I feel a sign of the virus, I quarantine myself. It’s really stressful for me. The worst thing is that I don’t know when we will have a solution to this pandemic.

– Katiana Mie Brunot, midwife and nurse

ALO SAJ FANM

The Alo Saj Fanm Telephone Hotline is a free telephone service offered 24 hours a day, seven days a week to people in Haiti. A collaboration between l’Association des infirmières sages-femmes d’Haïti (AISFH), UNFPA and CAM, and funded by Global Affairs Canada, the telephone line features the option of listening to pre-recorded information regarding maternal and child health, and Sexual and Reproductive Health and Rights (SRHR), or speaking with a midwife live. This telephone service is designed to fill in the gaps in Haiti’s vulnerable health system, where most mothers do not have access to any healthcare, especially in remote areas.

The hotline has received more than 12,000 calls since its launch in September 2020.

Over 750+ have registered for push notifications (SMS Messages) with information about maternal and child health.

THE FUTURE

From 2000 to today, midwifery in Haiti has been evolving. This profession, which decades ago hardly existed for some and for others was confused with traditional childbirth, is beginning to take its place timidly within the Haitian health system.

From a nurse midwifery specialization school with approximately 18 months of study to a midwifery training school with 3 years of study, midwifery is now on the verge of becoming a 4‑year program, and will thus be integrated into the Univerisité d’État d’Haïti (UEH).

Thanks to various strategies employed by the Association of Nurse Midwives of Haiti (AISFH), many people in the Haitian community are beginning to embrace this profession, which is committed to the well‑being of women.

However, there is still a long way to go. This profession, which is the third largest medical profession in the world, is still struggling to take its rightful place in the health hierarchy in Haiti. Its recognition and valorization still leaves much to be desired. A process of regulation of midwifery is needed, and the number of midwives spread throughout the country is far from sufficient to reduce the maternal mortality rate in Haiti.

But the best is yet to come. Thanks to the support of many AISFH partners, midwifery may be moving slowly but surely towards a bright future: where more than one midwifery school will be in charge of training the quantity of midwives needed to reduce the maternal and neonatal mortality rate in Haiti; where midwifery will be recognized and valued by the Haitian community; and finally, where their working conditions will be improved and the practice of midwifery regulated.

– Jeffthanie Mathurin, Communications and Public Relations Manager, AISFH

To future midwives ...

I would advise them to carefully consider their choice. I will show them the beauty of this profession, but which requires self-sacrifice and empathy to be able to practice it with love and passion. Also, I will remind them of the main objective for which the institute was founded, namely, to contribute to the reduction of the ratio of maternal and neonatal morbidity in Haiti.