1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

An outstanding publication of the global advocacy organization, Women Deliver (2014), is titled Invest in Girls and Women: Everybody Wins-the Path to Sustainable Development. What a significant statement! Although progress has been made since 1990 in reduction of maternal/infant mortality, each death is a tragedy. When global health initiatives invest in girls and women, families, communities, and countries win. The new Sustainable Development (SDG) agenda from the United Nations includes Goal Three: Good health and well-being The focus of the SDGs on maternal/child health highlights the need to continue reduction of infant and maternal mortality.


The Lancet Series on maternal health supports the premise that "Every woman, every newborn, everywhere has the right to good quality care"(McDougall, Campbell, & Graham, 2016, p. 1). The executive summary identifies factors associated with the category of "too little, too late including the lack of evidence-based guidelines; lack of equipment/supplies/medicines; inadequate numbers of skilled providers; women [giving birth] alone; lack of emergency medical services, and delayed inter-facility referrals" (McDougall et al., p. 4).


Haiti has 1 midwife for every 50,000 people with the highest infant mortality rate in the Western Hemisphere (52.2 per 1,000 live births) (Galietta, 2017). The maternal mortality rate is 359 per 100,000 live births with only 67% of women accessing prenatal care, and only 37% having a skilled birth attendant while giving birth (Galietta). One Haitian nurse spoke of her clinical experience that motivated her to become a midwife, "I saw a lot of women who died [while giving birth], but I did not know how to help them" (Galietta).


Midwives for Haiti (, a nonprofit initiative, was organized in 2006 in collaboration with the Ministry of Health and Partners in Health by American nurse midwives and physicians. Over the past 10 years, dedicated volunteer faculty from the United States have trained Haitian nurses to become skilled birth attendants. The curriculum is based on international midwifery care standards with educational materials translated into Haitian Creole. Graduates of this 12-month program constitute 17% of the total skilled birth attendants providing care to Haitian women during pregnancy and birth. Eight classes of midwives have completed the course since 2006. Twenty-four hour, 7-days-a-week services are provided at St. Therese Hospital in Hinche, Haiti, by student midwives and graduates of the program with a yearly birth census of 2,200 births. Postpartum healthcare is also provided. The program has added a Mobile Prenatal Clinic, with midwives who work in 22 villages across the Central Plateau of Haiti, providing care for 500 to 800 women each month. Each year this mobile clinic provides over 6,000 patient care visits to rural women and emergency transports when needed in a custom-built Jeep.


Midwives for Haiti is an example of "task shifting" to improve access to maternal and infant healthcare (Floyd & Brunk, 2016). It is also an example of gender empowerment of women as providers by increasing their clinical skills as midwives. This contributes to meeting SDG 5 that relates to gender empowerment (Krubiner, Salmon, Synowiec, & Lagomarsino, 2016). This exemplary initiative in a small but significant way emphasizes the five-point action plan proposed by The Lancet Maternal Health Series, including quality, equity, health systems, financing, and better evidence. Everybody wins by investing in girls and women, when there is a focus on providing such innovative care for those who are bearing children around the world.




Floyd B. O., Brunk N. (2016). Utilizing task shifting to increase access to maternal and infant health interventions: A case study of midwives for Haiti. Journal of Midwifery and Women's Health, 61(1), 103-111. doi:10.1111/jmwh.12396 [Context Link]


Galietta W. (2017, July 24). I saw a lot of women who died during delivery, but I did not know how to help them. Washington Post. Retrieved from [Context Link]


Krubiner C. B., Salmon M., Synowiec C., Lagomarsino G. (2016). Investing in nursing and midwifery enterprise: Empowering women and strengthening health systems. Nursing Outlook, 64(1), 37-48. doi:10.1016/j.outlook.2015.10.007 [Context Link]


McDougall L., Campbell O. M. R., Graham W. (2016). Maternal health: An executive summary. The Lancet's Series, 388(10056). 1-8. Retrieved from [Context Link]


Women Deliver. (2014). Invest in girls and women: Everybody wins-The path ahead to sustainable development. Retrieved from[Context Link]