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The extreme hardships of people living in post-earthquake Haiti are well-known: many who now live in the informal displacement camps that sprung up after the January 12, disaster go to bed hungry, live in wind-tattered tents that let in rain, face the same high levels of unemployment as other Haitians, and lack adequate access to clean water and sanitation. Many face eviction by both public and private actors, and children—sick from the bad living conditions and often not in school—live without basic levels of security. But women and girls in post-earthquake Haiti face additional hardships: lack of access to family planning, prenatal and obstetric care; a need to engage in survival sex to buy food for themselves and their children; and sexual violence. The situation is not entirely new: women and girls in Haiti died during pregnancy and childbirth at alarmingly high rates even before the earthquake. They also faced high levels of domestic and sexual violence, crushing poverty, and a stark disparity in access to education compared to men. However, the earthquake has exacerbated the vulnerabilities of this already vulnerable group. It examines the impact that food insecurity has on reproductive and maternal health; the reliance on transactional sex that some women and girls have developed in order to survive; and their vulnerability to, and the consequences of, gender-based violence GBV. Moreover, initial optimism felt by international aid agencies and donors that access to maternal health would improve in areas affected by the disaster has not been realized for all women and girls. This is despite an outpouring of international support and of new, free services run by international nongovernmental organizations NGOs that promised to remove the geographic and economic barriers that had historically prevented women and girls from accessing health care. For the women and girls interviewed by Human Rights Watch in the camps, their enjoyment human rights, such as the rights to life and health, remains poor not withstanding benefits accruing from the presence of free care and experts on the ground , and most of them lack basic information that would allow them to access available services.
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Women in Haiti have equal constitutional [2] rights as men in the economic , political , cultural and social fields, as well as in the family. However, the reality in Haiti is quite far from the law: "political, economic and social features of Haiti negatively affect most Haitians, but Haitian women experience additional barriers to the full enjoyment of their basic rights due to predominant social beliefs that they are inferior to men and a historical pattern of discrimination and violence against them based on their sex. Discrimination against women is a structural feature in Haitian society and culture that has subsisted throughout its history, both in times of peace and unrest. Some Haitian scholars argue that Haitian peasant women are often less restricted socially than women in Western societies or even in comparison to more westernized elite Haitian women. The sexual equality inherent to Haitian vodou translates into the inclusion of women in all aspects of society. The Haitian government contains a Ministry of Women's Affairs, but it also lacks the resources to address issues such as violence against women and harassment in the workplace. A number of political figures such as Michele Pierre-Louis , Haiti's second female Prime Minister, have adopted a determined agenda in order to fight inequalities and persecutions against women. Women have been involved in social movements in Haiti since the battle for independence even if History does not recall their names [10] [11]. A women's movement emerged in Haiti in the s during an economic crisis which is thought to have forced some middle-class Haitian women to work outside the home for the first time unlike peasant women who had always done so. In , writer and feminist Paulette Poujol-Oriol joined the league.

The extreme hardships of people living in post-earthquake Haiti are well-known: many who now live in the informal displacement camps that sprung up after the January 12, disaster go to bed hungry, live in wind-tattered tents that let in rain, face the same high levels of unemployment as other Haitians, and lack adequate access to clean water and sanitation. Many face eviction by both public and private actors, and children—sick from the bad living conditions and often not in school—live without basic levels of security.

But women and girls in post-earthquake Haiti face additional hardships: lack of access to family planning, prenatal and obstetric care; a need to engage in survival sex to buy food for themselves and their children; and sexual violence.

The situation is not entirely new: women and girls in Haiti died during pregnancy and childbirth at alarmingly high rates even before the earthquake. They also faced high levels of domestic and sexual violence, crushing poverty, and a stark disparity in access to education compared to men. However, the earthquake has exacerbated the vulnerabilities of this already vulnerable group. It examines the impact that food insecurity has on reproductive and maternal health; the reliance on transactional sex that some women and girls have developed in order to survive; and their vulnerability to, and the consequences of, gender-based violence GBV.

Moreover, initial optimism felt by international aid agencies and donors that access to maternal health would improve in areas affected by the disaster has not been realized for all women and girls. This is despite an outpouring of international support and of new, free services run by international nongovernmental organizations NGOs that promised to remove the geographic and economic barriers that had historically prevented women and girls from accessing health care.

For the women and girls interviewed by Human Rights Watch in the camps, their enjoyment human rights, such as the rights to life and health, remains poor not withstanding benefits accruing from the presence of free care and experts on the ground , and most of them lack basic information that would allow them to access available services.

Indeed, as is widely recognized, Human Rights Watch found evidence of three types of delay that contribute to pregnancy-related mortality: delay in deciding to seek appropriate medical care; delay in reaching an obstetric facility; and delay in receiving adequate care when reaching a facility. For the women and girls we interviewed, these delays occurred because women and girls did not recognize signs of early labor or were unfamiliar with a new neighborhood; because the places where they previously received care had been destroyed in the earthquake; because of distance, security concerns, or transportation costs; and because of inadequate care at facilities.

Most women and girls interviewed by Human Rights Watch did not know which organizations worked in and around their camps, when and where services were available, and to whom they should complain if there was a problem. They also face serious obstacles accessing or learning about prenatal and obstetric care and family planning—impeding their ability to control the number and spacing of their children, and compelling some to have illegal and unsafe abortions that threaten their health and safety.

Barriers accessing services are particularly worrying when it comes to adolescent girls, who may face additional risks in their pregnancy due to their age. Though prenatal care is often free, poor women and girls sometimes cannot pay for transportation to go to appointments and may stop seeking care if they cannot afford prescriptions for necessary tests, such as a sonogram.

Some women and girls we interviewed remain at home for delivery because they think wrongly they cannot return to the hospital without the sonogram. The women and girls interviewed by Human Rights Watch also experienced difficulties accessing care when delivering. Although most said they wanted to deliver in a hospital, over half of those who had given birth since the earthquake had done so somewhere other than a medical facility and without a skilled birth attendant: a significant number delivered in a camp tent or on the street en route to hospital.

Another problem is food insecurity in the camps, which leaves some pregnant women and girls, and lactating mothers interviewed by Human Rights Watch and their children without proper nutrition: one woman, Adeline, was forced to feed her three-month-old cornstarch mixed with water because she lacked sufficient breast milk for her child. Other women and girls said they felt weak due to insufficient food.

The extreme vulnerability and poverty in the camps—general food distribution stopped within two months of the earthquake and unemployment in the camps is very high—has led some women and girls interviewed by Human Rights Watch to form relationships with men for the sake of economic security, or to engage in transactional or survival sex. According to the women and girls we interviewed and recent surveys conducted by other human rights organizations, the exchange of sex for food is common.

Without adequate access to contraception, women and girls face increased vulnerability when they survive by trading sex for food. Moreover, many engage in these practices in secret, making them vulnerable to violence because they lack what little protection may be available to them from social networks or the community.

Women and girls in Haiti also face gender-based violence, a problem even before the earthquake. Human Rights Watch found that some survivors of sexual violence in the displacement camps had difficulty accessing post-rape care necessary to prevent pregnancy or transmission of sexually transmitted disease.

Social stigma and shame can create further obstacles to seeking care. Six of the pregnant women and girls who spoke with Human Rights Watch—3 of whom were 14 to 15 years old—said their pregnancies resulted from rape.

These numbers may be higher than those documented here since we undertook interviews to discuss access to health services, rather than violence in particular. The women and girls who reported rape to Human Rights Watch did so in the course of an interview about maternal and reproductive care.

Women and girls pregnant from rape face the same obstacles in accessing reproductive and maternal care as others, with the added stigma and trauma of being a rape victim. Many NGOs, donors, and experts on maternal health have sought to address the needs of women and girls in post-earthquake Haiti. Yet a significant number of women and girls interviewed by Human Rights Watch still do not gain access to clinics or hospitals, give birth without assistance on muddy tent floors, in camps streets and alleys, and—desperate and hungry—trade sex for food to survive.

We found that sexual violence and the lack of post-rape care have left women and girls as young as 14 with unwanted pregnancies. The government, which should be exercising oversight in the provision of maternal health care, does not have current and comprehensive maternal health data for women and girls living in camps who do not reach one of its facilities for care. Nor does it have data on women and girls who discontinue care.

Without that information, it is not possible to identify and implement measures to develop redress mechanisms for mistakes or grievances, to correct systemic failures, or to replicate effective programs.

Human Rights Watch found that important information that is necessary for the Haitian government to monitor progress related to maternal health is not recorded in camps: for example, none of the five infant deaths recounted by women and girls interviewed by Human Rights Watch were reported or registered with any NGO or government body.

Camp residents told Human Rights Watch that deaths in the camp, regardless of cause, generally went unregistered. Thus, if women and girls die of maternal-related deaths in the camps, they would not be recorded.

This basic data on maternal and infant deaths is fundamental to determining whether the government is making progress on its obligations related to the right to health. The Haitian government is the primary guarantor of human rights in Haiti, and it retains its obligations to respect, protect, and fulfill the human rights of those in Haiti—even after an earthquake, and despite the fact that the measures it can take are limited in resources and capacity.

It is obligated to take necessary measures to prevent sexual violence and maternal mortality and morbidity; to help women and girls prevent unwanted pregnancy; and to address the needs of the more than , women and girls still languishing in displaced person camps.

The government should ensure women and girls have access to health-related information and advice, including regarding family planning, the means to decide the number and spacing of children, and prenatal, obstetric, and postnatal care. It has a special duty to ensure that adolescents can access adequate information and services appropriate to their particular needs, and to ensure that all women and girls have equal access to family planning and maternal care services. This may require that it make extra efforts to provide women and girls displaced by the earthquake with information on access to available care, and to design specific interventions to improve access to services for vulnerable women and girls engaged in informal transactional sex.

As it did with the cholera prevention informational campaigns, the government may require assistance by NGOs and donors to disseminate this information. The Haitian government also has treaty obligations to ensure appropriate prenatal care for mothers. It should ensure women and girls have access to skilled birth attendants and, when necessary, emergency obstetric care. Health facilities, goods, and services should be of good quality and physically accessible and affordable, without discrimination.

Even when care is free, the government may need to take steps to ensure it is economically feasible for the most vulnerable women and girls to reach the free care. Moreover, the Haitian government has an obligation under international law to prevent third parties from jeopardizing the sexual and reproductive health of others through sexual violence.

Should violence occur, it is obligated to investigate and sanction perpetrators, and should ensure that survivors have access to post-rape medical care. While the evidence that Human Rights Watch has collected for this report suggests the government is not fulfilling its obligations, the political and economic realities facing the country means that it would be unrealistic to demand that it alone address the obstacles to fulfilling these rights. Despite significant destruction of government infrastructure and breakdown of the civil service, Haiti published a post-disaster needs assessment and a plan for recovery less than two months after the quake.

The plan included efforts to address both maternal and reproductive health and to prevent gender-based violence. Yet, without enough funds of its own, the government is dependent upon donors, international organizations, and several thousand NGOs to fund and implement its plan and deliver a wide range of social services. The Haitian government does not have the capacity to go systematically into the field to check that NGOs provide the services they claim to be, to see if there are gaps in services, or assess if NGOs are duplicating their efforts.

Nor does it know if there is an impact on the fulfillment of rights from all of the aid. As a result, it must rely on NGOs to provide it with information about their activities in order to assess what progress has been made towards its recovery plan or the realization of rights. In the Paris Declaration on Aid Effectiveness, supplemented by the Accra Agenda for Action, donor and recipient countries have recognized that mutual accountability when it comes to the effectiveness and use of aid, and the ability to monitor progress, is a shared interest.

Reproductive and maternal health is not ancillary to the larger reconstruction progress. Rather, for women and girls, the fulfillment of their rights—including the right to exercise control over the number and spacing of children, and to safer motherhood, and to live free of violence— is fundamental to any effort to rebuild their lives after the devastation and disruption caused by the earthquake.

This is true for all women and girls in Haiti, and not only those living in the camps who are the focus of this report. This report is based on research conducted by two Human Rights Watch researchers in the metropolitan area of Port-au-Prince in November and January, February, and June Human Rights Watch interviewed women and girls living in displacement settlements who were pregnant or had given birth since the January 12, earthquake.

Human Rights Watch also conducted 16 female-only group interviews and 11 mixed-gendered group interviews. In most instances, these interviews were conducted in person. In a small number of cases they were conducted telephonically. Female interviewers and, when possible, female interpreters conducted all interviews. Researchers attempted to create private spaces within individual tents or elsewhere in the camp environment for interviews. Most interviews were conducted individually, except in a few instances where interviewees preferred to speak in small groups.

Human Rights Watch used a multi-step sample strategy. First, camps were selected to ensure representation of a range of types including: managed, unmanaged, small, large, easily accessible to main roads, and those less accessible. Additional criteria for camp selection included safety and the availability of interlocutors to provide an introduction to camp residents. Second, women and girls who met the inclusion criteria of being currently pregnant or having given birth since the earthquake were identified in each camp either through interlocutors in the camp or by visiting individual households tents and asking whether women and girls who met the criteria were available to speak.

A total of women and girls in 15 camps were initially identified by Human Rights Watch. After initial interviews, 92 women and 11 girls were found to meet inclusion criteria. The most common disqualifier was giving birth prior to the earthquake. Of the women and girls meeting inclusion criteria, 28 were currently pregnant and 75 had given birth since the earthquake.

Eleven of the interviewees were girls ages , and three were year-olds whose pregnancies began when they were All participants provided oral informed consent to participate and were assured anonymity. As a result, pseudonyms or first names only have been used for each individual interviewed. Individuals were assured that they could end the interview at any time or decline to answer any questions, without any negative consequences. All participants were informed of the purpose of the interview, its voluntary nature, and the ways data would be collected and used.

No interviewee received compensation for providing information. Four women and girls interviewed by Human Rights Watch asked to be interviewed outside the camp for added security and received compensation for expenses they incurred while traveling to the interviews.

Where appropriate, Human Rights Watch provided contact information for organizations offering legal, counseling, or social services. Pregnancy is not a disease, yet globally, hundreds of thousands of preventable maternal deaths occur every year. Haiti was struggling to reduce one of the highest maternal mortality rates outside of sub-Saharan Africa when the January earthquake wrought unprecedented damage on its capital and surrounding areas. For women and girls giving birth in the minutes, weeks, months and now years after the earthquake, the risks associated with pregnancy remain, with the added challenges created by the post-earthquake destruction.

The earthquake put additional strain on a population already suffering from chronic poverty and extreme vulnerability to disease, environmental disasters, and political insecurity. Indeed, many women and girls already suffered from a myriad of societal and economic vulnerabilities. In the displacement settlements that Human Rights Watch visited these factors remain obstacles for women and girls seeking access to health services and improved health status. There is no law that prohibits sexual harassment in the workplace.

Prior to the elections, only 6 of the legislators in the Senate and Chamber of Deputies were women and there were only 3 women in a cabinet of 18 ministers, despite the fact women and girls comprise over 50 percent of the population. No woman served on the Cour de Cassation Supreme Court. The electoral code provides incentives for the inclusion of women: it mandates that political parties that nominate at least 30 percent of female candidates and elect 20 percent of those nominated will receive double the amount of public financing for the same positions in the next elections.



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