(Port-au-Prince) – Women and girls in Haiti are facing gaps in access to available healthcare services necessary to stop preventable maternal and infant deaths, Human Rights Watch said in a report released today. Serious gaps in access to healthcare services are harming vulnerable women and girls still displaced after the January 12, 2010 earthquake. Aid efforts that lack effective mechanisms for monitoring and reporting shortcomings compound the problem.

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 post-earthquake Haiti, even with unprecedented availability of free healthcare services. The report also describes how hunger has led women to trade sex for food and how poor camp conditions exacerbate the impact of sexual violence because of difficulties accessing post-rape care. It looks at how recovery efforts have failed to adequately address the needs and rights of women and girls, particularly their rights to health and security. Haitian authorities and donors should take concrete steps to improve access to services and to protect the human rights of these women and girls, Human Rights Watch said.

“More than a year and half after the earthquake, some women and girls 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 Human Rights Watch. “Despite gains made due to free healthcare services, the government and international donors have not addressed critical gaps in access to health services or addressed conditions that may give rise to maternal and infant deaths.”

More than 300,000 women and girls currently live in camps for displaced persons. Human Rights Watch interviewed more than 100 women and girls ages 14 to 42 in 15 displacement camps who were pregnant or had given birth since the earthquake.

Some described delivering their babies in tents, in the street, or alleys on the way to the hospital, or, in one case, on the street corner after a hospital turned her away for not being able to pay for a Caesarean section. Haiti had the highest maternal mortality rate in the Western Hemisphere before the earthquake, at 630 per 100,000 live births. The rate after the earthquake is unknown, and there is a lack of effective tracking of maternal or infant deaths in the camps.

“I just gave birth on the ground…I had no drugs for pain during delivery,” one woman told Human Rights Watch.

The January 2010 earthquake caused an estimated 222,000 deaths, injured 300,000 people, and displaced between 1.3 and 1.6 million people. Approximately 300,000 homes and much of the country’s infrastructure were damaged or destroyed, including 60 percent of hospitals in the affected areas.

Donors pledged $5.3 billion in recovery aid in line with a government-drafted post-earthquake recovery plan, with $258 million dedicated to health care. Although only $118.4 million of the health money has been disbursed, $130.6 million more is committed and nearing disbursement.

Aid agencies have worked hard to provide care, but many women and girls have not benefited, due to lack of information, poor transportation infrastructure, and unaffordable charges on services not covered by free care. As a result, women’s basic rights to health and security are being jeopardized, Human Rights Watch found.

Moreover, lack of coordination and data sharing on the part of donors and nongovernmental organizations (NGOs) working to provide health services has made it difficult for human rights monitors, and the government itself, to assess progress.

Many poor women and girls cannot pay for transportation to facilities providing free care, Human Rights Watch found. Some stop seeking care if they cannot afford tests they are told to obtain, such as a sonogram, or because they think, wrongly, that they cannot return to the hospital without the sonogram.

“With almost $260 million earmarked for health care, 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.”

The 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, such as the exchange of sex for food, Human Rights Watch found. This transactional sex takes place without adequate access to contraception and other reproductive health services, increasing the long-term vulnerability of the women and girls to unplanned pregnancies and sexually transmitted infections.

The vulnerability of Haitian women and girls to rape was a concern even before the earthquake. It is an even greater concern in the displacement camps, where some women’s groups have reported an especially high incidence of rape and sexual violence.

Emergency contraception and other post-rape care is available in some health facilities, but many rape victims don’t have access to this care for the same reasons that women and girls have difficulty accessing other health services: they lack basic information about what is available and where, or they have difficulty paying for transportation to reach the services. Some women and girls told Human Rights Watch they were too scared, ashamed, or traumatized by rape to seek care in the timeframe necessary for emergency contraception to be effective.

The government should do a better job of protecting women and girls from violence, and ensure that they have information on and access to post-rape care, Human Rights Watch said.

“Attention to human rights should be an essential part of Haiti’s recovery plan,” Roth said. “The government, donors, and nongovernmental groups should work together to provide women and girls the services, protection, and respect that they need, and establish the oversight needed to ensure that this happens.”

SELECTED TESTIMONY

Mona

Mona moved to a camp in Delmas 33, a suburb of Port-au-Prince, with her husband and children after the quake destroyed her home. “I just gave birth on the ground…I had no drugs for pain during delivery,” she said. She finally saw a doctor three days later: he gave her three tablets for pain relief.

Gheslaine

Gheslaine is a single mother of three who lost everything in the earthquake. She recently gave birth, but has no way to feed her two children and young infant:

People will try to survive by the way they can. Women have relationships with men so they can feed their children. That happens a lot. My daughter is 12 and does not have friends in the camps, because it happens that even girls are pressured to have sex for things. I don't work. I don't have parents to help. Many times women get pregnant, and they don’t have anyone to take care of them. So, for US$0.60 or $1.25, you have sex just for that. Unfortunately, women sometimes get pregnant, but if we had access to planning, we’d protect ourselves.... It's not good to make prostitution, but what can you do? You have to eat.

Florence

Florence is barely 15 years old, is five months pregnant, and has no parents. She lived with a family and did domestic chores for them. After the earthquake, she and the family moved to a camp in Mais Gaté. Her employer raped her, then threatened her and told her not to tell anyone. She became pregnant, and someone in the camp took her to one prenatal appointment. Florence discontinued prenatal care because she could not afford ancillary tests.

I went one time to the doctor who gave me a prescription. I don't have money to get the blood test and stool sample. The doctor said to come back, but he advised me to come back with the test results…. I don't have a mother or father, I live with an “aunt (her employer),” but she doesn't take care of me now. Now I live in the camp with someone else, since I was raped.

Yvonne

Yvonne, 30, from a camp in Croix-des-Bouquets, thought she could not give birth at the same place she visited for prenatal care. She received a prescription for a sonogram, but could not afford it, so she was scared to go back for additional check-ups or for delivery.

I went to several different hospitals before I gave birth for check-ups [because] ... when they asked me to do a sonogram, and I didn't have money to the sonogram, I changed hospitals…. No one told me that I would have a difficult birth … [but] I had pain when I went into labor. I arrived at the hospital at 9, at 10 I had not given birth, and by 11 I had the C-section.