Haïti

OVERVIEW
In Haiti, women face significant challenges in accessing comprehensive sexual and reproductive health. The country struggles with having the reputation as the poorest country in Western hemisphere and its turmoils have been compounded by disastrous earthquakes and hurricanes in recent years. This has left the country in need of international aid and a devastating lack of resources. This has obviously had a dramatic effect on sexual, reproductive and women's health care needs throughout the country. Though Port-au-Prince has more civil resources available than many of the countries more rural areas, there is still undoubtedly a lot of improvement to be made in these areas. Some of the issues include the lack of availability of contraception, overpriced feminine hygiene products, lack of proper medical facilities, unaffordable and outdated hospitals, a high rate of HIV infection and an alarming rate of sexual abuse against women. Additionally, abortion is completely illegal and there is little help from government organizations to curb the STI infection rate and lack of education on family planning. Historically, women's rights are not a high priority for the Haitian government. As of 2016, not a single woman holds a seat in the senate of Haiti.

Contraception

Préservatifs en vente à Port-au-Prince

Remarque générale : Il existe de nombreux moyens de contraception, comme les DIU (dispositifs intra-utérins ou stérilets), les contraceptifs oraux (pilule), les patches, les progestatifs injectables, les préservatifs, etc. Pour une liste exhaustive, cliquez [1].

Lois et stigmatisation sociale

Si les contraceptifs oraux sont apparus très tôt en Haïti, leur utilisation ne s’est pas réellement démocratisée : seulement 37,8 % des femmes entre 15 et 49 ans déclarent utiliser un moyen de contraception, quel qu’il soit. C’est le taux le plus faible enregistré dans les Caraïbes. Parmi les femmes qui utilisent une contraception, une immense majorité opte pour les progestatifs injectables. Plusieurs campagnes de sensibilisation à l’utilisation des contraceptifs ont été menées, avec des résultats mitigés. Beaucoup de femmes sont élevées dans des familles chrétiennes conservatrices et n’osent pas admettre qu’elles ont eu des relations sexuelles avant le mariage. Le sujet de la contraception est donc rarement abordé, en particulier chez les jeunes.

Quoi et où

• Pour accéder à la liste complète des contraceptifs hormonaux disponible dans le pays, consultez la page IPPF d'Haïti.
• Les préservatifs peuvent être achetés en supermarché mais sont plus difficiles à trouver dans les petits commerces.
• D’après la Fédération internationale pour le planning familial (International Planned Parenthood Federation), il existe plus de 20 types de contraceptifs hormonaux oraux (pilules contraceptives) disponibles. On trouve majoritairement des pilules combines ou séquentielles, mais aussi un large choix d’implants hormonaux. En revanche, seul un DIU est disponible : il s’agit du Mirena. Les anneaux vaginaux (Nuva Ring) ne semble pas être autorisés à la vente en Haïti.
• Il est possible de trouver des progestatifs injectables, comme Depo-Provera SAS 150 mg/ml, Mesigyna, Mesigyna Instayect et Noristerat, d’après l’IPFF.
• Des implants hormonaux sont également disponibles, tels que Implanon et Jadelle, d’après l’IPFF.

Coût

KORE, qui signifie « je te couvre » en créole haïtien, est une marque de préservatifs disponible à Haïti depuis 2013. Elle a été lancée dans le but de pallier le manque de préservatifs disponibles et de faciliter leur accès en proposant un produit plus abordable pour les haïtiens. Une boîte de trois préservatifs de marque coûte généralement entre 200 et 300 gourdes (soit approximativement entre 2,90 € et 4,30 €) .

Contraception d'urgence (pilule du lendemain)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Lois et stigmatisation sociale

Il est très difficile de se procurer une pilule du lendemain sans ordonnance à Port-au-Prince et si elle est délivrée, elle est la plupart du temps importée d’un autre pays et accompagnée d’instructions rédigées dans une langue étrangère, la rendant inutilisable. Si vous avez besoin d’une contraception d’urgence, vous pouvez prendre un contraceptif oral standard dans des doses plus élevées pour remplacer la pilule du lendemain.

Quoi et où

Note : La contraception d’urgence efficace le plus longtemps à ce jour est ellaOne. Elle peut être prise jusqu’à 5 jours (120 heures) après le rapport sexuel non protégé. Si ellaOne n’est pas disponible dans votre pays, le stérilet en cuivre peut également être utilisé pour éviter la grossesse, s’il est posé dans les 5 jours qui suivent le rapport non protégé. Si aucune de ces options n’est disponible et que le rapport non protégé remonte à plus de trois jours, vous pouvez tout de même prendre une contraception d’urgence, qui peut être efficace jusqu’à 5 jours. Notez cependant que les CU ne sont pas efficaces à 100 % et qu’elles doivent être prises le plus tôt possible.

Ci-dessous la liste des contraceptifs oraux pouvant être utilisés comme contraception d’urgence (progestérone uniquement)

	Prendre 40 comprimés dans les 120 heures suivant le rapport sexuel non protégé :
	Ovrette
	Prendre 50 comprimés dans les 120 heures suivant le rapport sexuel    non protégé :
	Microval

OContraceptifs oraux utilises comme CU / oestroprogestatif Remarque : dans les tablettes de 28 pilules, seules les 21 premières peuvent être utilisées

	Prendre 2 comprimés dans les 120 heures suivant le rapport sexuel non protégé puis prendre 2 autres comprimés dans les 12 heures qui suivent :
	Eugynon
	Neogynon
	Nordiol
	Ovral
	Prendre 4 comprimés dans les 120 heures suivant le rapport sexuel non protégé puis prendre 4 autres comprimés dans les 12 heures qui suivent :
	Lo-Femenal
	Minigynon 30
	Nordette

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

Haiti has a 1.8 percent prevalence rate of HIV/AIDS, among the highest percentage-wise in the Caribbean region (behind the Bahamas, and Belize). However, it has the most overall cases of HIV/AIDS in the Caribbean region with an estimated 120,000 HIV/AIDS-positive Haitians. One of the best ways to avoid contracting HIV and other STIs is to regularly using condoms. Contact the International Planned Parenthood Federation to inquire about making an appointment for an STI test if you are sexually active. Getting tested regularly is recommended to avoid unknowingly spreading disease further as well as diagnose anything you may have contracted so it can be cured or treated before irreversible damage is potentially done to your body.

What to Get & Where to Get It

Testing Facilities

• IPPF Association Pour la Promotion de la Famille Haitienne
  

8 Rue La Forest, Delmas 31
HT 6120
Port-au-Prince, Haiti
P: (509) 2811-0411
E: info@profamilhaiti.org

• AHF Haiti - Avenue Lamartiniere 1, Impasse Rigaud, Bois Verna Port-au-Prince Haiti

Support

If someone you know is incarcerated in Port-au-Prince or elsewhere in Haiti and has contracted or is at risk of contracting HIV, the Aids Healthcare Foundation can help. They provide testing and medicine for those in need. Visit their website for more information.

Costs

Many clinics run by NGOs offer free STI/STD screening.

Medications & Vaccines

What to Get & Where to Get It

"Fluconazole" is the name of the active ingredient in yeast infection medication. Make sure this is listed under active ingredients to ensure that you are buying an effective medication. PReP is not available to buy in Haiti. As far as HPV vaccinations go, Haiti has a "Pilot Program", which means it is available but not readily accessible to everyone. Click here to be redirected to a list of 11 pharmacies in Port-au-Prince and their Facebook pages.
Hôpital Immaculée Conception has a steady supply of antiretroviral HIV medication.

Costs

In 2004, initial antiretroviral therapy (ART) in Haiti cost approximately $US 1,000 per patient per year.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

Laws & Social Stigmas

The women of Haiti have little access to education on feminine hygiene and menstruation. In one poll, nearly 25% of women surveyed did not know why they had their period. Given the income of the women ranged from an estimated $1 – $3/day, disposable sanitary pads are often too expensive. Therefore, more than 80% of the women regularly used folded cloth sheets or old T-shirts to absorb menstrual blood. The women with no access to sanitary pads are often forced them to modify daily activities such as going to school or work.

What to Get & Where to Get It

"Kotex" is the most common brand of disposable pads available in Port-au-Prince.

Organizations working on menstrual issues in Haiti:

• Women's Hygiene Kits - Haiti: Visit the site for details.
• DivaCup Partnership in Haiti
• Helping Haiti Work: This nonprofit has expressed interest in providing disposable pads to Haitian women, but we're not sure about the current status of their work

Costs

A box of 32 Tampax OB tampons can cost around 600 Gourde (~$9 USD). This price is even higher than many western countries. Because of this, disposable menstruation products have not much popularity among many women in the country. A company called SOIL claims to provide reusable sanitary kits for free to all women in Haiti. Visit their website for more information.

Gynecological Exams

What to Get & Where to Get It

• Dr. Serge Guichard
  

Address: 13 Rue Faubert, Port-au-Prince , Haiti.
Tel: +509 257 1109
Specialism: Obstetrics & Gynaecology

• Marco Percque
  

Phone: 2257-4711 / 2257-3646
Address: Unite Chirurgical

1. 75 Rue Lambert, Petion Ville
   

• Ronald Fouche
  Phone: 2245-6301/ 2244-2970/ 2968
  Email: Email: rfouche@obgyn.net
  Address: 42, Chemin des Dalles, entre rues
  

St-Cyr & Magny- La Maison Medicale, P-au-P

[http://www.shog.org/

• Société Haïtienne d'Obstétrique et de Gynécologie]
  

Address : 27 Ruelle Berne, Port-au-Prince, HAITI
Email: shog@hainet.net

Pregnancy

Laws & Social Stigmas

All women in Haiti are legally entitled to 6 weeks of maternity leave with 100% of their average pay to be compensated by their employer. However, the reality of the situation can be much different and many women find that they are not in a position to receive this aid. In Haiti, there are only 201 nurse-midwives for a population of 10 million. NGO Midwives for Haiti are trying to fill this gap with much needed help to improve mother and child survival. As of 2013, For every 100,000 babies born in Haiti, 630 women die of pregnancy-related causes.

What to Get & Where to Get It

• An option available for women in need of medical care regarding their pregnancy is provided by the organization Médecins Sans Frontièreshas at least one location in Port-au-Prince that offers prenatal care for women with pressing health complications regarding their pregnancy. Unfortunately, their facilities are often overwhelmed with too many patients seeking aid and only have room for very few of them. However, these facilities do their best not to reject any woman in labor, regardless of their health status.
  
• Pran Men’m - Located in the Delmas 33 neighbourhood of Port-au-Prince, MSF’s 148-bed Centre de Référence des Urgences en Obstétrique (CRUO)
  
• Many women, if they can afford it, choose to fly to Jimani in the Dominican Republic to give birth where healthcare is more widely accessible.
• UNFPA: Address: LOCAL MINUSTAH, Log Base - Zone 5, Boulevard Toussaint Louverture and Clercine 18, Port-au-Prince, Haiti, Email address: Office@unfpahaiti.org, Work timetable: Monday - Thursday 7:30 AM - 4:30 PM, Friday 7:30 AM - 1:30 PM
  Telephones: 509 2815-6000, 509 2813-0415.

Costs

The cost for a stay in a Public hospital in Port-au-Prince can cost less than 1 USD a day. However, the patient is accountable to pay for all other expenses, such as syringes, medicine, transportation etc. Because of this, the price of giving birth in a public hospital is out of the question for most people since about 60% of Haiti lives beneath the poverty line.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

Haiti has some of the strictest laws regarding abortion in the world. There are no grounds in which abortions are legally permitted. with the rare exception that it be necessary to save the mother's life, but even that is not guaranteed by law. Women often turn to highly unsafe and illegal underground abortion options. In large part, this is also due to the fact the contraception itself is not widely accepted, available or properly used. Despite the fact that it is illegal, abortion is common in Haiti. The number of post-abortion deaths in Haiti is unknown, but physicians say post-abortion complications are a leading cause of maternal death, with the health ministry estimating it could possibly account for as many as 30 percent of them.

What to Get & Where to Get It

It is considered extremely dangerous by almost all health professionals to seek an unlicensed abortion illegally. The most affordable and safest alternative to this is to travel to the Dominican Republic or other neighboring nations and get the procedure done there. Additionally, you may be able to order the "abortion pill" by mail. Check out this link for details

Costs

N/A

Advocacy & Counseling

Laws & Social Stigmas

Line outside the Doctor Without Borders Clinic in Port-au-Prince

Rape and all other sexual assault goes largely unreported throughout Haiti due to the fact that many victims are subject to victim blaming by their communities. Many women also don't report such incidents due to fear of potential reprisals from their attackers. Haiti has a long history of of enforcing minor penalties for those convicted of rape and sexual assault, but this trend has been slowly changing since new legislation was passed in 2005. The new law now holds the attackers more accountable for their crime as well as guaranteeing free health coverage for sexual assault victims. The legal procedure for reporting a sexual assault to police is convoluted and difficult, further diminishing the number of reports made. Critics of Haitian police have called their response to reported rapes inadequate.

What to Get & Where to Get It

The Pran Men’m clinic (Creole for “Take My Hand”) is a facility offering the emergency medical assistance required during the 72 hours following an assault, along with longer-term medical care and psychological support. They are open 24 hours a day, 7 days a week.

Costs

The Pran Men’m clinic offers most of its services free of charge.

List of Additional Resources

Haiti HPV Vaccine Status
Hands Up For Haiti
International Planned Parenthood Federation
Doctors Without Borders - Haiti
GANM Blogs
Expat Pharmacy List
MSF
SCMS (Global Access to HIV/AIDS Medication
International Women's Health Program (Haiti)