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. 2018 Jun 20;18(1):254.
doi: 10.1186/s12884-018-1881-3.

The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study

Tonya MacDonald  1 , Suzanne Jackson  2 , Marie-Carmèle Charles  3 , Marius Periel  4 , Marie-Véna Jean-Baptiste  4 , Alex Salomon  4 , Éveillard Premilus  4
Affiliations

The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study

Tonya MacDonald et al. BMC Pregnancy Childbirth. .

Abstract

Background: In Haiti, the number of women dying in pregnancy, during childbirth and the weeks after giving birth remains unacceptably high. The objective of this research was to explore determinants of maternal mortality in rural Haiti through Community-Based Action Research (CBAR), guided by the delays that lead to maternal death. This paper focuses on socioecological determinants of maternal mortality from the perspectives of women of near-miss maternal experiences and community members, and their solutions to reduce maternal mortality in their community.

Methods: The study draws on five semi-structured Individual Interviews with women survivors of near-misses, and on four Focus Group Discussions with Community Leaders and with Traditional Birth Attendants. Data collection took place in July 2013. A Community Research Team within a resource-limited rural community in Haiti undertook the research. The methods and analysis process were guided by participatory research and CBAR.

Results: Participants identified three delays that lead to maternal death but also described a fourth delay with respect to community responsibility for maternal mortality. They included women being carried from the community to a healthcare facility as a special example of the fourth delay. Women survivors of near-miss maternal experiences and community leaders suggested solutions to reduce maternal death that centered on prevention and community infrastructure. Most of the strategies for action were related to the fourth delay and include: community mobilization by way of the formation of Neighbourhood Maternal Health/Well-being Committees, and community support through the provision/sharing of food for undernourished women, offering monetary support and establishment of a communication relay/transport system in times of crisis.

Conclusions: Finding sustainable ways to reduce maternal mortality requires a community-based/centred and community-driven comprehensive approach to maternal health/well-being. This includes engagement of community members that is dependent upon community knowledge, political will, mobilization, accountability and empowerment. An engaged/empowered community is one that is well placed to find ways that work in their community to reduce the fourth delay and in turn, maternal death. Potentially, community ownership of challenges and solutions can lead to more sustainable improvements in maternal health/well-being in Haiti.

Keywords: CBAR; Fourth delay; Maternal mortality; Near-miss maternal experiences.

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Conflict of interest statement

Authors’ information

TM is a Registered Midwife, Assistant Clinical Professor (McMaster University) and Master Lecturer (Laurentian University) of Midwifery. MC is a Haitian Nurse-Midwife currently completing a Registered Nurse bridging program in Montreal, Québec. MP continues to work for Hôpital Albert Schweitzer as Community Health Worker Coordinator. MJ-B is a homemaker and community member in which the research took place, as are, ÉP, a local farmer and AS, a community pastor. SJ is Associate Professor Emerita (University of Toronto).

Ethics approval and consent to participate

Ethics approval was obtained from the University of Toronto’s Office for Research Ethics (Protocol number 25561) and from Hôpital Albert Schweitzer Ethics Committee in Deschapelles, Haiti. Written informed consent was obtained from all participants before their participation.

Consent for publication

Written informed consent was obtained from the five women survivors of near-miss maternal experiences as well as the 31 community leader participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Maternal Mortality in a Community in Rural Haiti
See this image and copyright information in PMC

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