A study from Zanmi Lasante, a WKKF grantee in Haiti, explores barriers that prevent pregnant women in rural areas from giving birth in hospitals, and what might help.
Read the article, Barriers and facilitators influencing facility-based childbirth in rural Haiti: a mixed method study with a convergent design, published in BMJ Global Health.
- A team of medical researchers led by Haitian OB-GYN Dr. Maxi Raymondville of Zanmi Lasante (Partners in Health’s sister organization in Haiti) set out to assess the factors preventing women from giving birth at medical facilities. An estimated 63 percent of Haitian women still give birth at home in Haiti.
- Researchers looked at the cases of 1,105 pregnant women who sought antenatal care at Hôpital Universitaire de Mirebalais in Mirebalais, Haiti. They sought to understand how factors such as distance, access to transportation, traditional birth attendants (‘matrons’) and perceptions of in-facility quality of care serve as barriers to or facilitators (factors increasing the likelihood) of delivering in a facility in rural Haiti.
- Researchers found that 30 percent of the women in the study did not return to the facility to give birth, and that those women tended to be poorer and live farther from the facility.
- Interviews with women in the study revealed additional deterrents to facility-based births. Interviewees spoke positively about how matrons supported them physically and emotionally through home-based childbirths, and recalled discomfort with facility birthing practices and mistreatment by medical staff.
- Despite barriers, women in the study also expressed a belief that the hospital is the best place to handle birth complications. Facility-based childbirth is the standard of care for reducing maternal and neonatal mortality because skilled staff there can recognize emergency obstetrical complications and provide timely management and treatment, including C-sections.
Why This Matters
Haiti has the highest maternal mortality rate in the Western Hemisphere. At 359 maternal deaths per 100,000 live births, it is more than five times the 70 in 100,000 rate set as a target by the UN’s Sustainable Development Goals for 2030. A key aspect of WKKF’s health work in Haiti is supporting efforts to remove barriers to women accessing quality perinatal care regardless of where they live. It is clear that structural inequality and social inequity are determinant of health outcomes among mothers and children in rural Haiti. Therefore, minimizing barriers to receiving care in facilities and strengthening facilities’ capacity to provide that care are logical strategies for increasing healthy birth outcomes and improving early childhood development.
In addition to highlighting some well-known structural and geographical barriers to facility-based childbirth, this study drives home the importance of traditional birth attendants (‘matrons’) in rural Haiti. Interviews with pregnant women revealed negative experiences with practices and personnel at hospitals, as well as a high value placed on matrons for their physical and spiritual support during at-home birthing. The study’s authors therefore conclude that if matrons were trained and more present in the hospital delivery room, they might collaborate with nurse midwives to bring support and comfort to the women, widening the appeal of giving birth in facilities and ultimately improving maternal and neonatal outcomes in rural Haiti.