At the first light of dawn in Douillette, a village nestled in Chardonnières commune of southwestern Haiti, market stalls open one by one as children rush to school. Manita, who is seven months pregnant, crosses this lively village on a two-hour journey for a prenatal consultation at Rendel Health Center, a facility supported by Doctors Without Borders/Médecins Sans Frontières (MSF).
The return journey is even more exhausting, with mountainous terrain that’s difficult to cross due to her pregnancy. “It takes me much longer to get home because I can’t walk quickly,” she said.
Douillette is located in Haiti’s South department, which was hit hard by the 2021 earthquake, leaving many health facilities damaged. “There is no health center in Douillette,” Manita explained. “The nearest one is in Rendel, then in Port-à-Piment, which takes several hours of walking or half an hour by motorcycle [to reach]. Chardonnières is even further away. Apart from that, there are no other health care facilities in the vicinity.”
A 2023 statistical report from Haiti’s Ministry of Public Health and Population revealed a concerning situation for maternal health in the country. The maternal mortality rate reached 201 deaths per 100,000 live births in 2023—an increase from 155 deaths per every 100,000 births in 2022. The South department is particularly affected, with an alarming rate of 344 deaths per 100,000 live births. This is one of the highest maternal mortality rates in the country.
Raising awareness on the importance of prenatal care
The Port-à-Piment maternity ward, which MSF rebuilt and expanded after the 2021 earthquake in collaboration with the Ministry of Public Health and Population, is one of the few facilities in the region offering comprehensive care. This includes safe deliveries, emergency obstetric interventions, neonatal care, and the only intensive care unit in the entire department. MSF teams at the facility perform about 120 deliveries per month, including about 20 complicated cases. In 2024, nearly 450 newborns were cared for at the facility.
“Due to the lack of functional health facilities, some women travel long distances to give birth in Port-à-Piment,” said Mackencia Beaubrun, MSF’s midwifery team supervisor. “In Haiti, especially in rural areas, home births remain common.”
From left: Doctors perform a cesarean section on a patient with severe pre-eclampsia in MSF's maternity ward in Port-à-Piment; anesthetist Valérie assists a patient with pre-eclampsia as nurse Esther prepares anesthesia. Haiti 2025 © Marx Stanley Léveillé/MSF
To reduce pregnancy-related risks, MSF’s health promotion teams organize daily community awareness sessions in surrounding villages about the importance of prenatal consultations. They also explain how giving birth in a health center means that medical staff can provide timely care for the pregnant women or their babies if complications arise during delivery.
Yvane, who is from Grand Chemin, gave birth alone to her first six children. After awareness sessions with MSF, she chose to give birth to her seventh child at the hospital. “Discussions with MSF convinced me to avoid the risks,” she said. “By chance, my previous deliveries had gone without complications.”
Because she lacked a means for transportation, her neighbors and son helped her walk for an hour to reach the maternity ward. “Despite the pain, I didn’t want to give birth at home," she said. "I received a lot of care and feel much more reassured.”
In addition to the maternity ward in Port-à-Piment, MSF supports three health centers in South department—in Rendel, Tiburon, and Chardonnières—to strengthen people’s access to care in the most isolated areas. Two MSF ambulances are also available for referrals to the Port-à-Piment maternity ward from other health centers or the community.
The rainy season will further block access to care
As the rainy season approaches, access to health care will deteriorate further. For women like Manita and Yvane, the obstacles are daunting: River floods can isolate villages, cutting off access to health care facilities.
“When it rains a lot, even if your child is sick, you can’t take them to the hospital because it’s impossible to cross the rivers,” said Manita.
Manita and Yvane have no choice but to risk their lives and their children’s by navigating a challenging route to access prenatal and postnatal consultations, and even to give birth. “If we had more functional health centers, pregnant women could give birth safely, and children and adults who fall ill would receive care on time,” added Manita.
Violence and US aid cuts further threaten access to care
Although South department is relatively safe from the insecurity that has raged for years in Port-au-Prince, it suffers heavily from the consequences: The growing grip of armed groups on key access roads isolates the region from the capital and severely disrupts the supply of medicines, blood, and other essential resources in health facilities.
At the same time, there is a shortage of medical staff in remote areas as many Haitian health care workers have left the country. The suspension of US funding, which covered 59 percent of Haiti’s humanitarian plan in 2024, could worsen the shortage of humanitarian actors, making maternal health even more difficult to access and potentially increasing maternal mortality.
