Haiti Health Partners Receive National Recognition for Research about Postpartum Family Planning Practices and Needs among Women in Cap-Haitien, Haiti.

 

	(Left to right) Dr. Youseline Telemaque with a healthy baby, traditional birth attendant and community organizer Mme. Bois, Konbit Sante agent sante Odile César, and Dr. Eva Lathrop talk outside Mme. Bois’ house in the Shada neighborhood of Cap-Haitien.

(Cap-Haitien, Haiti) Haiti is the poorest country in the Western Hemisphere where women are often the sole providers in families that survive on less than a dollar a day. Just 600 miles from our own borders, one in five Haitian children does not survive to the age of five and the rate of maternal mortality is fifty times greater than in the U.S - with a ratio of 680 maternal deaths for every 100,000 live births.

At the recent national conference of the American College of Obstetricians and Gynecologists, colleagues Eva Lathrop, MD, MPH, a U.S. OB/GYN and head of Maine-based Konbit Sante Cap-Haitien Health Partnership's women's health team, and Youseline Telemaque, MD, a Haitian OB/GYN and employee of Konbit Sante in Haiti, were recognized for their research evaluating family planning practices and needs in northern Haiti. Lathrop and Telemaque's research involved extensive interviews with both medical providers and postpartum patients at the Justinian University Hospital, a large public teaching hospital in northern Haiti which houses one of Haiti's three OB/GYN residency programs.

"We surveyed hundreds of postpartum women to garner further information regarding their experiences with contraception, their desired family size, barriers to achieving this, desired spacing intervals, as well as barriers to using contraception at all," says Lathrop. The survey also queried women about their desire for contraception in the immediate and extended postpartum period, and the response was overwhelmingly in favor of having access to more family planning information prior to leaving the hospital. This is all information that will be used in program design and implementation.

	Healthy baby and mom in the densely-populated Shada neighborhood of Cap-Haitien.

Census data from Haiti shows that only 25 percent of sexually active women use contraception, and 60 percent of those not using contraception would like to do so. Not unexpectedly, the majority of women interviewed by Lathrop and Telemaque also expressed a desire to either space or limit their pregnancies, citing profound economic hardship as a primary reason. They also shared misconceptions and fears - passed on through informal networks of family and friends - related to the safety and efficacy of various contraceptive options.

"From interviews with health care providers we learned that none had any experience initiating family practice discussions with patients immediately postpartum," says Lathrop, who did her OB/GYN residency at Maine Medical Center in Portland and is currently a Family Planning Fellow at Emory University in Atlanta. "At the same time, they expressed great concerns about the incidence of unsafe abortions and maternal mortalities and felt these could be reduced by improving postpartum family planning services." Prevention of unplanned pregnancies is one of the most effective approaches to decreasing maternal mortality, and thus family planning strategies are proposed as a method of primary maternal mortality prevention. Focusing on the postpartum population allows women to space and limit their pregnancies during a high risk period for unintended repeat pregnancy.

	Dr. Telemaque meets with traditional birth attendants and Konbit Sante agents sante to provide education and collect data about birth outcomes.

According to Lathrop, "Family planning programs have been successfully integrated into other services in Haiti, specifically voluntary programs testing clients for HIV/AIDS, so there is every reason to believe that a family planning program can successfully become part of the postpartum services offered at the hospital and other centers providing maternity care."

Lathrop and Telemaque have already begun using the findings of their research to implement family planning training for health care providers at the Justinian University Hospital in both the maternity and pediatric services. To reach out into the community, Telemaque has initiated ongoing reproductive health training for traditional birth attendants, who deliver the vast majority of the babies in the area.

	Street vendors sell food and water outside the busy Fort St. Michel Hospital in Cap-Haitien where Dr. Telemaque delivers babies and provide pre- and post-natal care.

"It was clear to us that the door was open for education efforts at all levels of our system and that this training has the potential to make an extraordinary impact from a public health perspective," says Telemaque. "It will take time and careful, culturally-appropriate interventions, but it is well within our capacity to help my Haitian colleagues become comfortable with reproductive and sexual health education. Obviously, in a country long suffering with high rates of HIV infection, the impact here will extend far beyond family planning."