"I just gave birth on the ground... I had no drugs for pain during delivery," one Haitian mother tells Human Rights Watch (HRW) in a report released this week that says a year and a half after the country's devastating earthquake, women and girls are still facing gaps in access to healthcare services necessary to stop preventable maternal and infant deaths.

"Some women and girls in Haiti don't have basic information about where to get free medical services. Others lack the less than $1 needed to transport them to a hospital to give birth. And some are even afraid to leave their belongings unattended in the camps to seek care," Amanda Klasing, an expert on Haiti for HRW, told IPS.

The 78-page report, Nobody Remembers Us: Failure to Protect Women's and Girls' Right to Health and Security in Post-Earthquake Haiti, documents the lack of access to reproductive and maternal care in the aftermath of the catastrophe.

"They give birth unattended on the muddy floors of tents, or trade sex for food without any protection from unwanted pregnancy," said Kenneth Roth, executive director of HRW.

Donors pledged $5.3bn in short-term recovery aid, with $258m dedicated to healthcare. Although only $118.4m of the health funding has been disbursed, $130.6m more is committed and nearing disbursement.

"Some of this money is for reconstructing hospitals and the health system, which can take some time. There are many levels of planning required. But even with over half the money waiting to be disbursed, there are free services available. It's a matter of making sure vulnerable women and girls benefit from what is already available," Klasing said.

Even though aid agencies are working hard to provide care, many women and girls have not benefited due to lack of information, poor transportation infrastructure, and unaffordable charges for services not covered by free care.

Extreme vulnerability and poverty in the camps has led some women and girls to form relationships with men for the sake of economic security, or to engage in transactional or survival sex, which is the exchange of sex for food, HRW reported.

This "exchange" sometimes happens without adequate access to contraception and other reproductive health services, increasing the chances of unplanned pregnancies and sexually transmitted infections.

The exposure of women and girls to being raped has dangerously increased after the earthquake. It is an even greater concern in the displaced persons' camps, where there is a high incidence of sexual violence.

Emergency contraception and other post-rape care is available in some health facilities, but many women and girls are unaware of it. Others are too scared, ashamed, or traumatised by rape to seek care in the necessary time frame for emergency contraception to be effective, the report states.

What is more, lack of co-ordination and data sharing on the part of donors and NGOs working to provide health services has made it extremely hard to keep track of progress.

"Accountability for women's rights, including accountability in efforts to reduce maternal mortality, require good data on whether programmes are having an impact and what changes need to be made to increase benefits," Klasing said. "This doesn't currently exist. This is one important area for collaboration."

At the same time, according to Klasing, to ensure that women and girls have the information they need to access services, the government, donors and NGOs need to have a global picture of what is available.

According to the report, the government should do more when it comes to protecting women and girls from violence, and ensure that they receive all the information they need. "Attention to human rights should be an essential part of Haiti's recovery plan," Roth said.

Roth called on the government, donors and NGOs to work together to provide women and girls the services, protection, and respect that they need, and establish the oversight needed to ensure that it happens.

According to Klasing, the government should adopt a strong gender policy across ministries and programmes to ensure women's rights are considered in all matters. "It also should take steps to make sure women and girls at public facilities understand what programmes and services are available for free and necessary to continue treatment," she said.

"With almost $260m earmarked for healthcare, no woman should have to give birth on the street," Roth said. "Women and girls have a right to life-saving care, including in adverse circumstances."