In November, a 21-year-old woman showed up at a midwifery clinic in the north of Haiti, seven months pregnant. Violently abused by her boyfriend after she refused an abortion, she had received no prenatal care at all.

“She got away and got to our clinic,” explained Jane Drichta, executive director of the nonprofit Midwives for Haiti, which cares for pregnant women at seven community clinics and a maternity home in the country’s north.

Midwives transported the now-homeless woman to Kay Manman Yo, the organization’s maternal waiting home, for the remainder of her pregnancy.

As violent instability continues to rage in Haiti, pregnant women are severely affected. Malnutrition, preeclampsia, severe iron deficiencies, and other maternal health issues caused by insufficient access to care, food, and medicine are rife. Many women travel on foot, pregnant and with children, out of gang-controlled areas in the south at horrific risk.

But even in more stable areas, where midwives often risk their lives to care for patients and even treat patients at their own expense in their off-hours, a lack of nutrition and available medicine have created a dangerous situation for Haiti’s pregnant women.

To counter the lack of necessary maternal health medications and supplies, Direct Relief supports maternal health providers across Haiti with Midwife Kits – specialized caches of the equipment, supplies, and medications needed for safe delivery. The organization provided 113 full kits and 228 replenishment kits to partners in 2024, and is providing an additional 132 full kits and 150 replenishment kits during this season’s cycle. Each of these kits, endorsed by the International Confederation of Midwives, contains the medical items needed to carry out 50 facility-based safe births.

In addition, Direct Relief will provide Haitian partners with 20 Perinatal Health Kits this season, enough to treat up to 4,000 cases of pregnancy complications: pre-eclampsia and eclampsia, preterm labor, neonatal infection or sepsis, and neonatal respiratory distress. 

The midwife kits “are used absolutely everywhere,” by about 40 midwives and other maternal health clinicians at Midwives for Haiti, Drichta said.

“Worse and worse and worse”

The organization has an 18-month training program, taught entirely by Haitian professionals, that produces 30% of the country’s total skilled birth attendants.

“Midwifery is not as complicated as, say, cardiothoracic surgery,” Drichta explained. Many women feel called to midwifery by the need they see in their own community, and Drichta constantly frets that midwives ignore the safety protocols she’s placed on travel and working hours because they know how urgently they are needed.

But Drichta, who has worked in public health for 23 years, amid startling violence – such as caring for Yazidi women and children in Iraq – says the situation in Haiti is the worst she’s ever seen.

“As it’s gotten worse and worse and worse, I’ve found myself relying on a lot of the things I learned in Iraq and elsewhere,” she said. “It was all apparently preparing me for Haiti.”

Many of the women who flee north have experienced severe trauma and unthinkable violence. For the young woman who came to a Midwives for Haiti clinic in November with nowhere to stay, this wasn’t her first pregnancy. In 2024, gangs had broken into her home in Port-au-Prince and shot her nine-month-old baby in the head before her eyes.

“In a country where women do not traditionally get tattoos, she has her first baby’s name inked right over her heart,” Drichta noted.

This winter, the ongoing violence was compounded by Hurricane Melissa, a Category 5 storm that killed 43 people in Haiti alone and displaced many thousands, although precise numbers are unavailable because of the country’s unrest. Women from the south, as well as Haitian women deported from the Dominican Republic, fled north, many of them in urgent need of maternal health care.

Tezita Negussie, the Haiti country director at the Haitian healthcare NGO Konbit Sante, explained that the lack of medication and supplies places an ongoing burden on physicians and midwives.

“One of the most needed sets of materials is what you offer,” she told Direct Relief. “It’s critical.”

Konbit Sante has placed Direct Relief midwife kits at four partner facilities, including Hôpital Universitaire Justinien, a teaching hospital in the northern city of Cap-Haïtien.

Jenn Schenk, executive director at Second Mile Haiti, said a lack of nutrition and available treatment have led to more pregnant women with severe iron deficiencies or preclampsia. Because magnesium sulfate – used to prevent the onset of eclampsia and available in the Direct Relief midwife kits – is hard to come by, midwives at Second Mile Haiti have noted that providers sometimes wait until after a woman has started having seizures to treat her with the medication.

“This results in serious complications,” Schenk noted.

Second Mile Haiti has begun to treat higher-risk pregnancies at its two facilities, which see about 700 deliveries per year. Low iron levels and malnutrition are widespread: “Probably 25% of our patients are malnourished,” she said.

Malnourished patients are treated with therapeutic food, and women with low iron levels begin receiving injections straightaway to prevent complications.

In a country where travel is dangerous and difficult, even in relatively safe areas like Cap-Haïtien, where one of Second Mile Haiti’s facilities is located, Schenk said it’s essential to have everything pregnant patients need on hand, to prevent women from going without care.

“As it becomes increasingly difficult for both providers and patients to find medications elsewhere, the ability to receive comprehensive care in a single visit matters more than ever,” she explained.

Hope amid danger

Despite the urgent needs, Schenk said she’s determined to provide more than basic services. It’s essential that Second Mile Haiti facilities feel safe and restful – a place where women living in dangerous circumstances, often caring for multiple children already, can find respite.

At the Cap-Haïtien facility, which sits on half an acre of land and provides ample places for women to sleep and eat, “I walk around the facility and I see women full-on snoring,” Schenk said. She’s delighted to see it.

“I always think, ‘When does this woman ever get to take a nap during the day?’” she observed.

For Drichta, the hardship and tragedy she observes every day are tempered by the tremendous impact of skilled midwifery care, and by the sense of safety and new beginning many pregnant women find at Midwives for Haiti.

She recalled the day a woman sought shelter at the maternal waiting home in the middle of a staff meeting with dozens of midwives: “She walks in, completely flat affect,” with three-week-old twins in her arms and a seven-year-old walking alongside.

“She had fled Port-au-Prince on foot…her husband was shot dead and they left him by the side of the road,” Drichta remembered. The midwives “just surrounded her” with care.

Today, that woman is the house mother at the maternal waiting home, a pivotal staff member.

The challenges the midwives and their patients face are numerous. Many babies are born too early to survive, and many can’t receive medical oxygen in time to save their lives. Women are dying of hemorrhage in higher numbers, despite skilled care. The head midwife at Midwives for Haiti was kidnapped two years ago, a period that Drichta called “the worst three months of my life.”

For clinicians at Midwives for Haiti, medical donations are a continual source of hope. When the midwives receive the medicines and supplies they need, the care they provide is extraordinary, Drichta said.

She also noted that the communities where Midwives for Haiti offers care keep growing in number – often because midwives notice urgent needs in their own villages and quietly provide care in their off-hours, only to find their patient numbers growing greater than they can handle. What was once informal care, offered on a Saturday, becomes a full-fledged community clinic.

“Sometimes, in Haiti,” Drichta mused, “it’s easy to lose sight of what is possible.”