Improving Maternal Healthcare Access and Neonatal Survival through a Birthing Home Model in Rural Haiti

Stan Shaffer, Denise Fryzelka, Cindy Obenhaus, Elizabeth Wickstrom


High neonatal mortality in Haiti is sustained by limited access to essential maternity services, particularly for Haiti’s rural population. We investigated the feasibility of a rural birthing home model to provide basic prenatal, delivery, and neonatal services for women with uncomplicated pregnancies while simultaneously providing triage and transport of women with pregnancy related complications. The model included consideration of the local context, including women’s perceptions of barriers to healthcare access and available resources to implement change. Evaluation methods included the performance of a baseline community census and collection of pregnancy histories from 791 women living in a defined area of rural Haiti. These retrospective data were compared with pregnancy outcome for 668 women subsequently receiving services at the birthing home. Of 764 reported most recent pregnancies in the baseline survey, 663(87%) occurred at home with no assistance from skilled health staff. Of 668 women followed after opening of the birthing home, 514 (77%) subsequently gave birth at the birthing home, 94 (14%) were referred to a regional hospital for delivery, and only 60 (9%) delivered at home or on the way to the birthing home. Other measures of clinical volume and patient satisfaction also indicated positive changes in health care seeking. After introduction of the birthing home, fewer neonates died than predicted by historical information or national statistics. The present experience points out the feasibility of a rural birthing home model to increase access to essential maternity services.


health care access; birthing clinic; maternal health care; neonatal health care; barriers to health care; community health; health census; electronic medical records; midwifery;

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Department of Family and Social Medicine
Albert Einstein College of Medicine/Montefiore Medical Center
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