Maternal and Child Health in Haiti

Maternal and Child Health in Haiti

In Haiti, more women die from pregnancy-related complications than in any other country in the Americas. Out of every 100,000 live births, an estimated 380 die of pregnancy related complications.1 Because most deliveries do not occur in a health care facility and there is no systematic way to track deaths, the actual number of maternal deaths is believed to be much higher.

CDC’s Public Health Systems Recovery Team assists countries affected by emergencies to initiate and improve recovery of public health systems. Following the devastating 2010 earthquake in Haiti, CDC began working closely with the Haitian Ministry of Health (MSPP) and other international partners* to identify and address barriers to optimal maternal health in Haiti.

Specific goals and activities include:

Increasing access to institutional deliveries and quality emergency obstetric and neonatal care

Maternal deaths are preventable when timely, adequate and quality emergency obstetric and neonatal care (EmONC) services are available. For EmONC services to be effective, they must be linked to community services, and an efficient referral system must be in place so that women can access care in a timely manner. CDC provided direct support to refurbish and/or rehabilitate the infrastructure at five facilities, five referral ambulances, and equipment and supplies for eight facilities. Further, CDC provided technical assistance to develop EmONC clinical training curriculum for nurses and midwives, as well as in-service clinical training for 95 nurses and midwives at 19 facilities.

Increasing access to quality antenatal care and postnatal care

Many pregnancy-related health complications can be prevented, detected, or treated during antenatal (during pregnancy) or postnatal (after delivery) visits with trained health workers. To improve the quality of care during pregnancy and after delivery in Haiti, and to help revise Haitian national guidelines, CDC conducted a baseline study to assess the quality of antenatal and postnatal care delivered at large hospitals and health centers in three departments. Data were collected from more than 1400 antenatal charts, where only 38% indicated that the World Health Organization’s recommended four visits were completed. Interviews with pregnant women revealed that routine services, such as weight, blood pressure, and HIV testing were completed for most pregnant women; however, counseling messages regarding delivery danger signs, postpartum family planning and other pregnancy-related messages were infrequent. Overall satisfaction with care was high, but maternal knowledge of postpartum family planning and birth spacing was low. National guidelines, including locally adapted healthcare messages, were approved by MSPP and partners in early 2016.

Establishing a scalable maternal death surveillance and response system

The maternal death surveillance and response (MDSR) framework enables researchers to assess the true magnitude of maternal mortality and effectiveness of interventions to reduce these deaths. 2 To accurately assess maternal deaths in Haiti, CDC and its partners are supporting the Ministry of Health in developing a national framework for a MDSR system. A pilot system was implemented in 2015 at two facilities and their surrounding communities. Results from the pilot demonstrated the utility of the system to increase identification and notification of women of reproductive age (WRA) deaths from both the facilities and communities. Researchers documented a 44% increase in reported WRA deaths from 2014 to 2015. This increase is largely due to successful community surveillance. CDC is currently working to implement verbal autopsy interviews. Verbal autopsy is a method of gathering information to determine the cause of maternal deaths, particularly deaths at the community level, and it helps us to better understand the true magnitude of women who die from pregnancy complications in Haiti.

Haiti’s commitment to improving maternal care and wellbeing is evident by the ongoing work of the Haitian Ministry of Health to improve and align activities with recommended practices.

Strengthening data management and surveillance systems for maternal and newborn health

To improve data management and to provide information on pregnancy outcomes, a Pregnancy Outcomes Surveillance System (POSS) was implemented in 19 facilities and target communities beginning in 2012. POSS aims to monitor continuously pregnancy outcomes including information on maternal deaths, neonatal deaths, stillbirths, birth defects, birth complications, and live births. The POSS system offers tools for facilities to report reliable and timely data to inform and improve maternal and neonatal health. CDC and partners are currently collecting and analyzing the data collected from implementing facilities.
Besides facility based surveillance system, we also strengthen community-based surveillance (CBS). This type of surveillance aims to improve active monitoring of pregnant women during the pregnancy and postpartum periods to detect and minimize complications associated with pregnancy. Working with local partners, CDC has implemented CBS in the North East department of Haiti. CBS includes the use of two management tools -- micro-planning and local area monitoring. These tools are designed to enable the community health center and health workers to better track and monitor pregnant and postpartum women and their newborns. This system improves the ability of communities to:

• Register and monitor all pregnant women in the target area
• Increase awareness and active monitoring of danger signs during pregnancy
• Encourage women to attend all four antenatal care visits and to deliver in a facility
• Improve the facility surveillance system by detecting and reporting community data not captured at the facility
• Develop planning with the health center to improve coverage and the services

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1 World Health Organization, UNICEF, UNFPA, The World Bank, United Nations Population Division. Trends in Maternal Mortality: 1990 to 2013. Geneva: WHO; 2014.
2 World Health Organization. Maternal Death Surveillance and Response: Technical guidance. Information for action to prevent maternal death. Geneva: WHO; 2013. http://www.who.int/maternal_child_adolescent/documents/maternal_death_surveillance/en/.
*International partners include: United States Agency for International Development, Organisation mondiale de la Santé, United Nations Population Fund, and Jhpiego.