A perilous journey: The obstacle to safe delivery for vulnerable women in Port-au-Prince, Haiti

For a pregnant woman living in the slum communities of Port-au- Prince in Haiti, each step she takes in her journey to give birth is fraught with life-threatening perils. In Haiti, life expectancy of women is estimated at 58.8 years (whereas in its neighbour country the Dominican Republic, life expectancy is 68 years), while the maternal mortality rate is estimated at 630 deaths per 100,000 live births (in Dominican Republic, the maternal mortality rate is 92 per 100,000 live births) - the worst in the western hemisphere. In the capital city of Portau- Prince, less than half of the pregnant women deliver their baby in a health care institution, while the rest of them deliver at home without skilled assistance, usually with the help of a traditional birth attendant. Over 1.5 million people are living in the poor and violent slums of Port-au-Prince, and this number is ever growing. Life is harsh for the overwhelming majority and it is even more difficult for women, especially pregnant women. Most pregnant women stay at home when it comes time to deliver. For many, there are no complications and they are able to deliver relatively safely. But when and if there are complications, women are forced to make a difficult decision. The lack of adequate health facilities in their neighbourhoods - partly as a consequence of violence - and the limited skills of traditional birth attendants, force women to seek assistance elsewhere. Leaving their homes after dark is dangerous: Many women are reluctant to risk encountering gangs or other violence on their way. They experience similar risks with hiring a taxi or a tap-tap (local means of transportation), as this form of transportation is hard to find in the slums after dark. There are also financial barriers and other security risks. They must spend money on transportation, hospital fees and drugs which imply that a family must live without other essential things (such as food, or paying for shelter). If a pregnant woman does manage to arrive at a hospital in time, there is no guarantee there will be room for her or quality healthcare for her and her baby. She might also be discouraged from going to a clinic outside her community due to derogatory comments made by health care professionals, hospital workers and other community members. Given the alarming maternal mortality indicators and pervasive violence, Médecins Sans Frontières opened Jude Anne Hospital in March 2006 to provide free emergency obstetric care to this most marginalized population of Port-au-Prince. Since the opening of the hospital, the monthly number of deliveries has been growing steadily. In 22 months, MSF has provided free and quality obstetric care for over 21,000 births, almost 60% of which were with complications that had potentially life-threatening consequences for the mother and the child. After two years of experience in such a demanding context, MSF feels compelled to share its experience and to raise awareness about the desperate situation of vulnerable pregnant women in Port-au Prince. MSF calls for an urgent and concerted action to reduce the unreasonably high maternal mortality in Haiti.