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Haiti: midwives bring solace to women in Haiti’s slums

04-03-2009 Feature

Midwives Marie Joseph and Françoise understand the suffering of women in Cité Soleil. Marie Joseph’s daughter and Françoise’s niece have been victims of the rampant sexual violence in Haiti’s sprawling waterside slum. Trained by the Red Cross, the two midwives help evacuate pregnant and sexually abused women to hospital.

A large-boned woman with a booming voice, Marie Joseph does not mince her words as she goes on her daily rounds in Cité Soleil. The teeming slum is home to 300,000 people, most of them living on less than a dollar a day.

“These women have nothing,” she says, pointing to the young mothers and pregnant girls who crowd around her. She wends her way through the narrow dirt paths that separate the rows of back to back shacks, held together with metal and cardboard. “We’re all victims here, but these women suffer more than most.”

Marie Joseph and her colleague Françoise know all about suffering. They have spent most of their 55 years in the waterside slum, where between them they have brought up 18 children and buried 5 more. Their faces are hard from the stress of daily life but their hearts are open and giving.

“I saw a woman give birth in the street in the rain,” relates Marie Joseph, when asked why she became a midwife. “I asked the owner of a nearby house if I could cut the umbilical cord on his balcony but he refused. I pleaded with a taxi driver to take them to hospital but he drove off. In the end I cut the cord myself.”

The women have been midwives since 2001 and have updated their skills on ICRC-funded refresher courses. Since then they have helped countless women give birth, either at home or in hospital.

Most women give birth at home in Haiti, unable to afford a taxi to the hospital, the hospital fees or even the clothes and shoes they need to make the trip. So when complications arise, such as pregnancy-induced high blood pressure or pre-eclampsia, they often lose the child and risk their own lives. And t he incidence of pre-eclampsia is particularly high among Haitian women. More women die here before, during and after childbirth than anywhere else in the western hemisphere.

The Red Cross courses emphasize the importance of medical care, stressing that the expectant mothers should be encouraged to go to hospital, rather than deliver at home. Sometimes, the midwives hail a “tap tap,” a brightly decorated converted pickup truck that acts as a taxi, and take the woman to Choscal Hospital, the only public hospital in the shanty town. On other occasions, they call the Haitian Red Cross post in Cité Soleil. The Red Cross then evacuates the woman in a tap tap kitted out as an ambulance and protected temporarily by the Red Cross emblem.

“Many women are still reluctant to go to hospital,” says Françoise, “because treatment costs 40 gourdes (just over 1 US dollar). But even if we deliver at home, we make sure they go to hospital for postnatal checkups and vaccinations.”

Much of the midwives’ time is spent counselling women about unwanted pregnancies. 23-year-old Darline Leon was already bringing up her two-and-a-half-year-old daughter Judeline alone when she found she was expecting again.

“I sold everything I could to pay for an abortion,” she says, “but then I became anaemic and the doctor told me I could die if I aborted so I decided to keep the baby.”

Many women take poison to get rid of the baby, unable to face the prospect of another mouth to feed. But Françoise and Marie Joseph encourage them to go through with the pregnancy. If life becomes too difficult, they suggest the mother may want to put the child up for adoption in one of the many orphanages scattered across the capital.

Some of the children are born as a result of rape or prostitution. Both are rife in the shanty town where the men have little to do and the women, desperate to fee d and clothe themselves and their families, sell their bodies for as little as 100 gourdes (2.5 US dollars).

Rape is common in Cité Soleil. Marie Joseph and Françoise make sure women who have been raped get treatment and HIV/AIDS counselling. But they have their own experience of sexual violence; Marie Joseph’s 13-year-old daughter was raped by a 68-year-old man, who is now serving time in prison, while Françoise’s 19-year-old niece was raped by a gang of hooded men. Both girls are now living outside Cité Soleil, both for their own safety and on account of the stigma that rape carries in this deeply religious country.

Both midwives say it is now much easier for women to report rape and sexual abuse to the police or Haitian authorities, and that they take women’s accounts more seriously than before.

The biggest challenge facing women in the slums is birth control. Haiti has the highest birthrate in the western hemisphere, with families of 10 or 12 children not uncommon. But contraceptives are too expensive for some. A condom costs 3 gourdes, which will buy enough drinking water for five hours, or one of the ubiquitous mud cakes mixed with butter and salt that the slum dwellers sometimes eat to fill their empty stomachs.

“It’s a vicious circle,” says Marie Joseph, as she surveys the women blocking her path in the slums of Cité Soleil. “They need to use contraception and have fewer children, but they don’t because they can’t afford it.”