“This is my first child. I attended two prenatal consultations at the hospital. I did not have problems during pregnancy but I did have complications during the birth and am happy I delivered at the hospital. At home the baby could have died.”
19-year old Merise Merita is a single mother and lives in a poor neighborhood in Port-Salut, Haiti. She is one of thousands of women who benefited from a project that has offered free obstetric care to poor women since 2008. A first evaluation of the project involving 50 health facilities across Haiti shows a sharp rise in the use of maternal services and a significant decline in maternal mortality.
High risk of dying in childbirth
Haiti is the poorest country in the Western hemisphere. More than two thirds of its people live on less than US$ 2 per day. One result is that too many women are unable to afford maternity care - with fatal consequences for both mothers and children. Even before the devastating earthquake in January 2010 that killed over 200 000 people and damaged or destroyed many hospitals and healthcare facilities in the country, the statistics were alarming: Haiti was a dangerous place to be pregnant, with the lifetime risk of dying in childbirth standing at 1 in 44 compared to 1 in 4 300 in most rich countries (1). Of every 100 children born, more than six failed to survive their first year of life.
Most poor women were forced to give birth at home, assisted by unskilled helpers, as they could not pay for antenatal care and a safe birth at a health facility. Removing the cost seemed an obvious way to increase the use of essential maternal health services.
Free obstetric care
With the support of the Pan American Health Organization (WHO/PAHO), the Canadian International Development Agency (CIDA) and the European Commission, the Haitian Ministry of Health embarked upon a free obstetric care project which pays health facilities and hospitals to offer poor women free childbirth and care before and after birth, and refunds transport costs. Facilities are only reimbursed if they submit a standardized record of the care given to each woman. An electronic information system developed by the WHO/PAHO Latin American Centre for Perinatology and Women's Reproductive Health (CLAP) is used to monitor the performance of the different facilities.
Lamarre Anthonese, a nurse midwife in the Port-Salut referral hospital, is amazed at the positive response to the project. “We have seen a total change in women’s attitude to health services. They never used to come to the hospital, as they could not afford the fees. Now they are coming from all over the district - even from places as far as three to four hours away.”
An initial evaluation of the project was encouraging. According to country figures, 630 women per 100 000 births die in Haiti every year due to complications during pregnancy and childbirth. Data collected in the project area up to December 2009 showed that participating clinics were reporting fewer deaths and a six-fold increase in antenatal visits. Four out of five women using the free services said that they were satisfied with assistance and support received.
Expanding the project
Since the earthquake, the project has been integrated into a broader programme focusing on reproductive health supported by UNICEF and UNFPA. Between 2008 and 2012, 137 000 women benefited from free obstetric care for a total cost of US$ 10 million. CIDA has donated US$ 20 million to expand the project to cover children up to the age of five, and to continue it until June 2013.
Eight-months pregnant Paula Ferdinand is relieved that she no longer has to pay for childbirth care. “Money has always been a problem for me and coming to the hospital had meant spending a lot for the services, transportation and medicines.” Now she and many other women can be sure that they and their babies receive the necessary care before, during and after birth, whatever complications arise.
1 The adult lifetime risk of maternal death is defined as the probability that a 15-year-old female will die eventually from a maternal cause.
Photo credits: WHO