Imagine being nine months pregnant, ready to give birth, when your life is turned upside down. You have nowhere to live, and your local hospital is in ruins. Even if you weren't planning to give birth in a hospital, you at least expected to have a bed, running water and electricity. This is the situation for thousands of women following the earthquake in Haiti.
As humanitarian agencies and governments scramble to provide shelter, food, water and medical services for the three million survivors of the earthquake, it is critical that they also provide lifesaving reproductive health services for women and girls. Based on Haiti's birthrate, an estimated 7,000 earthquake-affected women can be expected to give birth in the next month. Some 15 percent of all pregnant women are likely to need care for life-threatening complications, such as hemorrhage, sepsis or infection, during pregnancy or delivery. In crisis situations, access to emergency obstetric care is vitally important.
Even in the absence of fully functioning hospitals and clinics, there are proven ways to reduce the risks. Giving clean delivery kits--consisting of soap, a plastic sheet, a clean razor blade, tape or string to tie the umbilical cord, a cotton cloth to wrap the newborn and latex gloves--to all visibly pregnant women will help prevent infections in mothers and newborns. These kits could be distributed along with non-food distributions, such as blankets and water containers. Health care workers should establish emergency obstetric services to treat complications of pregnancy and childbirth, including emergency C-sections, in those hospitals that are still functioning and in emergency field hospitals that are being established, as well as transportation for women. And pregnant women must be made aware of these services.
With people sleeping in the streets or in tent encampments, and thousands fleeing the capital for the countryside, the risk of sexual violence and exploitation is rising. We know from our experiences in refugee settings worldwide that women and girls can be protected by ensuring that they have safe access to food, cooking fuel, water and other basic necessities, so they do not have to trade sex for these items. In cases of rape or unprotected sex, treatment with post-exposure prophylaxis within three days can prevent HIV infection. Emergency contraception, if taken within five days, can prevent pregnancy, but does not affect existing pregnancies.
With HIV prevalence in Haiti already high, the current crisis puts additional people at risk of infection through exposure to blood and body fluids, as well as through unprotected sex. It is important that in the midst of the emergency, health workers not take shortcuts and that they continue to practice standard precautions against the transmission of infections in all health facilities, including in field clinics and hospitals. Other key interventions can help, such as distributing condoms widely at no cost, screening all blood products for HIV and other blood-borne diseases and identifying people who were already taking antiretroviral medicines to enable them to continue their treatment.
Our experience in humanitarian crises and following natural disasters around the world has proven that ensuring priority services such as those outlined above saves lives and prevents illness, trauma and disability. Sexual and reproductive health problems are the leading cause of women's ill health and death worldwide; the international community must act to make sure they don't become a cause of preventable death in Haiti.