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Every year, 50,000 women, mostly from Latin America and the Caribbean countries, die from consequences of unsafe abortions.
Called the Poto Mitan in Haitian Creole, women account for 50.49% of the Haitian population and are the center pillar of most households. From commerce to education, their contributions to society are undeniable. As the prosperity of the nation relies on its citizens’ well-being, women’s health is a public health priority when it comes to the national health policies, especially regarding reproduction. Despite these efforts, unsafe abortion remain a prevalent and poorly addressed issue in the Haitian healthcare system.
I recall one of my night shifts at Chancerelles’ maternity ward three years ago, a 16 year-old pregnant girl came in with intense abdominal pain and vaginal bleeding. When I asked her questions during the exam, she did not admit to me to taking any medication prior to the onset of her symptoms. But as I know, there is often a lot of mystery around the practices pregnant Haitian women engage in when they consult a doctor for such symptoms. Oftentimes, they consume abortive products such as home-made potions of specific leaves or a high dose of pills mixed with alcoholic beverages. As a matter of fact, her 30-year-old boyfriend confessed that he had provided her with 4 pills of misoprostol (Cytotec®), an anti-ulcer drug known for its common use in inducing abortion. For the gynecology residents I was working with, it was a routine and common case. Yet openly discussing unsafe abortions in Haiti is still taboo.
According to the article 262 of the Haitian penal code, induced abortion no matter where or who performs it, is a criminal act and legally punished nationwide. Regardless of the law (or maybe because of it), complications of clandestine abortions are common motives of visit in general and obstetrical care facilities. The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating a pregnancy performed by persons lacking the necessary skills or in an environment not in conformity with minimal medical standards, or both. Hemorrhaging often occurs when pregnant women attempt to end their pregnancy by their own means or in clandestine abortion clinics, leading to many cases of maternal death. Every year, 50,000 women, mostly from Latin America and the Caribbean countries, die from consequences of unsafe abortions. In Haiti, 102 of the 530 maternal deaths for 100,000 inhabitants are due to consequences of unsafe abortion.
Carole told me that if she had had safe and legal options to end her pregnancy, she would not have had this near death experience.
Carole, a young woman I examined two months ago, was going through her second abortion experience. When she got pregnant, economic difficulties arose, pushing her to make the decision with her husband’s consent. The hospital she visited would not provide the desired services as forbidden by law. So she turned to a clandestine clinic, even though the fees were high. The clinic was not hard to find, her sister who also went through this experience referred her to a familiar practitioner. In a tiny room near General Hospital, Carole underwent a curettage, a procedure used for removing fetal tissue from the uterus. But the sanitary and sterilisation conditions were minimal, and the clinic had little equipment to take care of Carole. When she decided to consult a doctor 15 days later, she was pale and weak, with her hemoglobin reaching the level of severe anemia. As we spoke, Carole told me that if she had had safe and legal options to end her pregnancy, she would not have had this near death experience.
A few days later an obstetrician and HIV care specialist explained to me that to alter the perilous consequences of unsafe abortion in Haiti, it would be best to decriminalize it. Fortunately, in the last five years, the Ministry of Health has debated this subject with several social groups in order to allow abortion with the full consent of the women and appropriate medical care. This is one step forward in the modernization of women’s health in Haiti. In fact, on January 2016, a presidential commission presented a preliminary draft of the new Haitian penal code in which abortion is decriminalized, but there is still a long way to go before it is voted by both chambers of the parliament and adopted.
In Haiti, the main cause of induced abortion seems to be socio-economic status, so the future laws should absolutely include women who desire to arrest their pregnancy for reasons other than congenital malformations or rape, provided they have given their full consent. It would be better if every woman could openly discuss it with their doctors. It is the state’s duty to guarantee optimal healthcare to the population and health is not restricted to the body; health also includes mental and social well-being.
The case for abortion couples activism with effective health communication. Often, the barriers to improving women’s health in Haiti are due to erroneous traditional beliefs. An emphasis on the importance of conducting proper scientific studies on this public health issue and clearly communicate the best ways to prevent the consequences must be advocated. After all, prevention costs exponentially less than complication management, and as the recently published statistics show, the state’s funds have long been depleted.