Maintaining maternal health is crucial to the advancement of Haiti’s economy now, and for future generations. One social determinant of health would be health care access, before and after pregnancy.
As stated before, there are six primary factors that affect maternal and neonatal mortality rates, limited accessibility inadequate health care facilities, inadequate number of trained health care practitioners, low percentage of skilled attendants at deliveries, low percentage of prenatal and postnatal visits, high-risk deliveries in nonqualified health facilities. (Jacobs, Judd, & Bhutta, 2016). Alongside the increased material deprivation is inadequate health care, and who gets these resources is socially determined (Marmot, 2005).
According to the Pan American Health Organization (PAHO) “A total of 23,344 health professionals were registered in 2016. For every 10,000 inhabitants, there are 1.4 physicians and 1.8 nurses in the public sector, with 1 physician and 2.1 nurses in the private sector. The availability of these professionals is unequal across the departments.” Only trained health personnel attended 37.3% of births. In 2013, only 43% of health care institutions offered any maternity services, and 10% offered cesarean sections. Less than half is
There are also specific reasons why the high maternal mortality rate is so high. In a longitudinal cohort study conducted by Barnes-Josiah, Myntti & Augustin comprised of 12 Haitian women and they discovered a “Three Delays” model. This model proposes that pregnancy-related mortality is overwhelmingly due to delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached (1998). A major finding was that family and friend interviews suggested that a lack of confidence in available medical options was a crucial factor. A reason for the lack of confidence in Western traditional medicine could because of them calling on their trusted shamans , herbalists, traditional birth attendants, bonesetters, and injectionists (Barnes, et al., 1998). All are inexpensive and sometimes successful in treating illness. The birth attendants are typically called during labor so not as often as they should.
Often, when women do have regular contact with medical facilities, there is no structure in place to systematically accumulate and evaluate their records. Finally, women often die at home and their deaths may go ignored by medical or civil authorities, with surviving family members choosing not to report the event if there is a fee for doing so (Barnes, et al., 1998).
Early life is one of the messages the World Health Organization describes as a social determinant of health. Poor circumstances during pregnancy, like living in impoverished communities such as the 70% of the population that live in rural Haiti, can lead to less than optimal fetal development via a chain that may include deficiencies in nutrition during pregnancy, maternal stress, a greater likelihood of maternal smoking and misuse of drugs and alcohol, insufficient exercise and inadequate prenatal care (Wilkinson & Marmot, 2003).
Barnes-Josiah, D., Myntti, C., & Augustin, A. (1998). The “three delays” as a framework for examining maternal mortality in Haiti. Social Science & Medicine, 46(8), 981-993.
Jacobs, L. D., Judd, T. M., & Bhutta, Z. A. (2016). Addressing the child and maternal mortality crisis in Haiti through a central referral hospital providing countrywide care. The Permanente Journal, 20(2), 59
Marmot, M. (2005). Social determinants of health inequalities. The lancet, 365(9464), 1099-1104.
Pan American Health Organization. (2015). Country Report: Haiti. Retrieved from https://www.paho.org/salud-en-las-americas-2017/?page_id=131
Wilkinson, R. G., & Marmot, M. (Eds.). (2003). Social determinants of health: the solid facts. World Health Organization.