PORT-AU-PRINCE — A year after the devastating earthquake in Haiti, recovery is occurring in fits and starts as the country continues to struggle against adversity. A million people are still living in accomodation sites for the displaced or in makeshift communities without basic services.
The lack of sewage collection and treatment, coupled with heavy rains, set the stage for a cholera epidemic that has killed more than 2,760 people and infected over 130,000 others. Social unrest following the contested November elections has complicated matters, as has the loss of many health workers.
Conditions have exacerbated many sexual and reproductive health care challenges, from the delivery of care and supplies, to managing sexually transmitted infectons and addressing complex issues such as delivery complications for cholera-infected women and care for their newborns, who may be premature. In response, UNFPA and its partners, including the Ministry of Health, is working on strategies to meet the needs of particularly vulnerable groups, including pregnant women, people living with HIV and youth.
An increase in post-earthquake pregnancies
“UNFPA data from a study in the camps suggests a spike in pregancies after the earthquake,” says Igor Bosc, the UNFPA Representative in Haiti. In the study, conducted in July 2010 of 2391 women in 120 camps, almost 12 per cent reported being pregnant. A peak in deliveries that began in November and is expected to continue through April is overwhelming hosptials and maternity wards, Bosc reported. In response, temporary and mobile clinics have been set up to provide obstetric care, along with other primary health services.
“Unfortunately, according to the data, two thirds of these were unwanted pregnancies,” Mr. Bosc continued. “And we also know that, when it comes to contraception, people are mostly resorting to injections or the pill. Very few people use condoms. We need to ensure that more condoms are available and to raise awareness of the importance of this method of contraception, because it obviously has a direct impact on the transmission of HIV,” he added.
More than 70,000 people were living with HIV in earthquake-affected areas of Haiti before the disaster, according to UNAIDS data. The country’s epidemic is mostly driven by heterosexual sex, and more than half of the people living with HIV are women.
Supplies and education to slow the spread of cholera
Condoms are among the items provided by UNFPA in ‘bokits’ – plastic buckets that provide hygiene supplies, and that were recently adjusted to include bleach to treat water – to vulnerable groups such as pregnant women and people living with HIV. Before each distribution, beneficiaries receive training in basic measures to prevent the spread of cholera.
Incidences of gender-based violence were reported by fewer than 1 per cent of women. International agencies are working to improve security conditions for women and girls in camps, including by improving patrolling. UNFPA has installed 109 solar streetlights to offer a degree of security when darkness falls. UNFPA also has worked with the Government and non-governmental organizations to establish a reporting and response system to address gender-based violence. The Fund is working with the Ministry of Health to build ten reproductive health centres, which provide comprehensive obstetric and neonatal care, as well as separate spaces for women to socialize and to receive family planning services and supplies.
Strengthen support to young people and health care workers
Life in crisis zones can be deeply troubling to anyone. The personal traumas, disruption of school, breakdown in routines, and boredom can be especially hard on young people and result in high-risk behaviour. In Haiti, more than 7 per cent of the reported pregnancies are among girls ages 15 to 17.
UNFPA youth leaders travel around camps, distributing condoms and teaching young people how to protect themselves from unintended pregnancy and HIV and other sexually transmitted diseases."It's very important that youth have access to counselling on family planning and have access to condoms," said Mr. Bosc. UNFPA is also working with the Ministry for Youth to create safe spaces for sports, arts, music and discussions among youth.
To address the lack of health-care workers, UNFPA is supporting the rebuilding of the National School of Midwives, which was destroyed in ‘goudou-goudou’, as the earthquake is called in Haiti, a reference to the terrifying sound of the earth moving, and providing incentives to keep them in school or in practice. The Fund will work with the Ministry of Health to strengthen maternal obstetric and neonatal care at community level.
Laying the groundwork for the longer term
As part of its Special Initiative on the Census, UNFPA is providing technical support to the government to prepare for its next population and housing census, which is scheduled to take place in 2013. UNFPA is also advocating for improved access to adequate shelter, food and basic services, for professional training and self employment initiatives for women and youth. Over the longer term it plans working closely with government ministries and other agencies to ‘build back better’ in the areas of community health services, safe socialization spaces for women and youth, schools, and redistributive fiscal policies that favour marginalized groups -- in particular poor women and youth.
Thanks to UNFPA Haiti for reportage