Final Post Week 7

Haiti has suffered many natural disasters, such as the earthquake in 2010, and hurricane Matthew in 2016 and still has a ways to go in order to rebuild. With a population a little over 10,000,000 Haiti remains the poorest country in the Western Hemisphere. In the United States, the rights of women compared to the rights of men didnt come as naturally. Its only years later that they were granted rights that were somewhat the same as men. But, this inequality still continues in other other forms and even in other countries  such as Haiti. The United States as well as Haiti has garnered amendments to protect the rights of women but  great obstacles still stand. Education, poverty and the environment have major effects on maternal mortality. Having a skilled worker at only 37% of live births increases the chances of Haitian mothers death . Per 100,000 births , 630 reported maternal deaths occurred between 2008-2012 (UNICEF).  To evaluate this crises in detail, one needs to look through the lens of a critical medical anthropologist. In order to reduce this massive number, the women need to be educated, poverty needs to cease, the environment needs to rebuild and access to quality health care is detrimental.

The greatest one of all is education. Education is knowledge and knowledge breathes freedom. Knowledge is power. Humans have this innate curiosity that drives them to learn and want to have the best lifestyle possible. When women lack this knowledge  they lack the know-how during pregnancy and birth. Very few skilled midwives exist and there needs to be more to assist in the birthing process. For most Haitians, education is the key strategy for alleviating poverty; it is also associated with the reduction of inequalities. Improvements in educational achievement indirectly mitigate the risks of crime and conflict by enhancing opportunities. Increasing investments in education will diminish crime over the longer term (Verner, 2006). Education has become more of a privilege than a right in Haiti (Richardson, 2014).The attempt at staying healthy includes, reading and writing. The average adult literacy rate is 83%, the more education the better chances of living independently and gaining necessary skills to survive (UNICEF).

Poverty has been developing over time due to many factors. Sometimes the women are unable to send their children to school, or are able to afford very few to attend. Verner and Heinemann from the World Bank Group says that there are three main components to conflict poverty traps:  demographic and socioeconomic factors at the individual and household levels, the capacity of the state to provide public goods, including security and the rule of law; and  the agendas and strategies of political actors in facing these challenges (2006). Being the poorest country in the Western Hemisphere, education is an indicator that poverty is extensive. As much as 62% of the population live on $1.25 a day which equals 66 gourdes in Haiti (UNICEF) From watching a 2011 video from the World Food Programme, $1=40 gourdes and got the basis for one meal but not a complete one ( a bit of rice, 2 tomatoes, peppers, some beans) (Shopping) . This is what a mother would be able to afford for an entire day. Prices of food items have clearly risen since 2011 and continues to fluctuate due to the vendors needing to make a living too. Its not easy to pay for a supplemental amount of food, let alone the privatized education. The women are supposed to take care of all household duties and care for herself and children. If women were able to get a proper job that pays well, they wouldn’t have to make certain sacrifices to survive.

Energy is another commodity thats hard to come by in Haiti. According to USAid, “Only about one-quarter of the population had access to electricity prior to the 2010 earthquake, and that remains the case today. Of these consumers, half were connected to the electrical grid illegally.” Even those who have access to electricity, it not reliable and very costly. Without electricity refrigeration isn’t possible to store food, or get on the internet. Impoverished communities struggle with getting energy but with it many achievements can happen. Take EarthSpark for example, this US based non-profit team spent five years developing their first microgrid in Haiti. It is serving 449 homes and businesses with affordable, reliable electricity. They acknowledge the gender aspect of energy by using the term feminist electrification which means streamlining gender concerns at every step of the process of electrification and recognizing the unique value of women and how it impacts them. Women can cook with electricity and use clean lighting and the organization has employed a few of them. Some women started their own business since the new grid and one in particular own ice cream business with the new electricity. Sanitation is key in the home of women and children in every aspect of living.

Environmentally, because of this lack of electricity and crops, Haitians are starting to rely more on charcoal and unconventional foods. The long history of overworking Haiti’s land, the many natural disasters, and the heavy rains and sometimes the lack of rain wiped out much of the land use to grow crops. Less and 2% of Haiti is forest. In order to make a living, chopping down trees to sell charcoal is the only way (Microgrid, 2016) . Another way women make a living is by growing what they call  bonbon terre or mud cookies all day, according to a video that Worldfocusonline published. The cookies has barely any nutritional value, are made from dirt, vegetable shortening, sugar and salt are mixed in. Older women would mix for days as the cookies would serve as their only source of income. In turn, they’d feel sick for a few days before their system gets used to it (Haitians) . Who knows what damage consuming the cookies does to women’s and children’s bodies. Interventions are needed to provide women with not only proper food, but jobs to reduce the maternal morality rate and keep the women healthy. Women are the backbone of Haitian families and by ensuring the health of them, it ensures the health of Haiti society.

The best theory to use for women in Haiti would be the critical medical anthropology theory. Women ore on the low end of the totem pole when it comes to rights and access to human needs, especially when pregnant. It encopasses all epidemics, social sciences and biological perspectives that would have anything to do with Haitian women and their health as women and mothers (Joralemon, 2010). Haiti has suffered a sort of structural violence; medical anthropologist  and co-founder of “Partners in Health”Paul Farmer (who did fieldwork in Haiti) stated it is “a host of offenses against human dignity [including]: extreme and relative poverty, social inequalities ranging from racism to gender inequality, and the more spectacular forms of violence that are uncontested human rights abuses…” (Singer & Erikson, 2013). Poverty is a major  issue in Haiti and 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).

In addition to the environmental problems and cultural and structural issues with maternal mortality, women that are impoverished lack the upward mobility into leadership positions politically because of cultural beliefs. Danielle St. Lot has worked for decades to promote women’s rights and opportunities in Haiti. She also served as Haiti’s first female minister of commerce, industry and tourism. Her advice to women is to earn seats for Congress, thought rebuilding the country around education and business. Women vote, but they along with other men, vote for men (Cox, 2010).

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. According to the Pan American Health Organization (PAHO) ” 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. Moreover, maternal mortality takes one in 74 women each year away from their families according to the World Health Organization. Syndemic infection during pregnancy adds another level of risk to what is already a risky situation for most women in the Third World (Singer & Erikson 2013). Women live in a resource poor nations that dont have the access to health care that is need to stay healthy. Almost half of Haitians live in rural areas, constituting them being a part of geographical isolation. Rural residents have limited access to basic health care and to qualified medical facilities.And even the few that had access to obstetric care, couldn’t get seen because of the high cost. If a pregnant woman cannot pay for a midwife or a physician, she will most likely be delivering the baby at home without any skilled assistance, resulting in the large number of births without a skilled attendant present (Jacobs, et al., 2016).

There are also specific reasons why the high maternal mortality rate is so high. A longitudinal cohort  study conducted by Barnes-Josiah, Myntti & Augustin, comprised 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 it’s not as often as they should. 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 through 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).

There is about a 1 to 1 ratio for people living in urban and rural areas. At the time birth, it would make sense for a skilled attendant to be more present in city areas because of more resources. It’ll take time to develop the rural areas but it isn’t impossible.  99% of all complications are due not seeing a doctor (Shah, 2018). However, there are nonprofit interventions to aide in training for better maternal care. The Modification In Mother-Baby Mortality Statistics Initiative or Mimsi, is an example of a program started by a former NYC physician Winfred Tovar. The goal is to train young women to set up mobile clinics, so that community volunteers can enter the home of the expectant mother with the materials needed to transform the patient’s home into a clinic. The volunteers are trained to measure vitals, height and weight, perform ultrasounds etc, and input all the information on a mobile device for diagnosis (Shah, 2018).

All in all, efforts are being done to help alleviate premature maternal and infancy death and complications.Distinctions between the biomedical and the social, or disease and illness cannot be allowed in the practice of critical medical anthropology, the connections will always be there (Donahue, 1998). It is important to address these problems of education, poverty, the environment and health care,  through the lens of a critical medical anthropologist in order for positive social, and health changes to occur to reduce maternal mortality and increase the vitality of Haitian women.

 

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.

Cox, T (Host) (2010, July 26).  The Role of Women In Rebuilding Haiti [Radio broadcast episode]. https://www.npr.org/templates/story/story.php?storyId=128776196

Donahue, J. (1998). Medical Anthropology Quarterly, 12(2), 257-258. Retrieved from http://www.jstor.org.proxy1.cl.msu.edu/stable/649550

Haitians eat dirt cookies to survive [Video file]. Retrieved from https://www.youtube.com/watch?v=s3337cj4sJQ

Joralemon, D. (2010). Exploring Medical Anthropology. New York: Routledge

Marmot, M. (2005). Social determinants of health inequalities. The lancet, 365(9464), 1099-1104.

Microgrid Knowledge. (2016, June 21). First Microgrid in Haiti: The Road to Feminist Electrification. Retrieved from https://poweringag.org/news-events/news/first-microgrid-haiti-road-feminist-electrification

Pan American Health Organization. (2015). Country Report: Haiti. Retrieved from https://www.paho.org/salud-en-las-americas-2017/?page_id=131

Richardson, J. (2014). Making education a right: in Haiti, the poorest nation in our hemisphere, work is under way to make education available to more of its children living in abject poverty. Phi Delta Kappan, (8),

Shah, P. (2018, March 03). Haiti’s Maternal Health Crisis. Retrieved from https://intpolicydigest.org/2018/03/03/haiti-s-maternal-health-crisis/

Shopping with a dollar in Haiti [Video file]. Retrieved from https://www.youtube.com/watch?v=c_uWMO11_lI

Singer, M., & Erickson, P. I. (2013). A companion to medical anthropology. Chichester [England: Wiley-Blackwell.

Unicef. (2010). At a glance: Haiti. Statistics

USAid Haiti. (2018, January). Retrieved from https://www.usaid.gov/haiti/energy

Verner, D., & Heinemann, A. (2006). Social resilience and state fragility in Haiti: Breaking the conflict-poverty trap.

Wilkinson, R. G., & Marmot, M. (Eds.). (2003). Social determinants of health: the solid facts. World Health Organization.

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