An Evaluation of Midwives for Haiti Programs: Can they Reduce Infant and Maternal Mortality in Haiti?

Monday, 9 November 2015: 3:15 PM

Jacquelyne L. Brooks, DNP, MSN, BSN, ADN, RN, CNM, WHNP
Frontier Nursing University, Hyden, KY, USA

The United Nations was commissioned to develop a plan to eliminate poverty and hunger and improve health around the globe, which was announced in 2005 as the Millennium Development Goals (United Nations Development Project, 2005). The use of skilled birth attendants (SBAs) in underserved areas was identified by the Millennium Development Goals as a necessary service to reduce maternal and infant mortality (United Nations Development Project, 2005; WHO, 2004). Because of the importance of providing skilled care during pregnancy and childbirth, many international organizations are working to close the competency gap among SBAs (Harvey et al., 2007; Kreyberg & Helsingen, 2010).

Haiti has the highest maternal mortality rate in the Western hemisphere and ranks 34th amongst all nations for maternal deaths (Central Intelligence Agency, 2014; Ministry of Public Health and Population [MPHP], 2013). In 2010, the neonatal mortality rate was 31 per 1,000 live births in Haiti, compared with 6 per 1,000 live births in the United States (MPHP, 2013; You, Bastian, Wu, & Wardlaw, 2013). In 2012, the infant mortality rate was 59 per 1,000 live births, also the highest in the Western hemisphere (MPHP, 2013).

In response to the alarming maternal and infant mortality rates in Haiti, American certified nurse-midwife, Nadene Brunk, established Midwives for Haiti (MFH, 2014) in 2006. Midwives for Haiti is a non-profit organization with a home base in Richmond, VA and primary teaching site in Hinche, Haiti (MFH, 2014). The mission of MFH (2014) is to reduce maternal and infant mortality rates in Haiti by training Haitian nurses to be SBAs. From 2006-2013, MFH trained 73 SBAs who worked in 11 birth centers or clinics and three hospitals throughout Haiti (N. Brunk, personal communication, March 21, 2014). In 2013, the MFH SBAs attended approximately 10,000 births and provided more than 60,000 prenatal visits (N. Brunk, personal communication, March 21, 2014).  

A systems evaluation was conducted using a Logic model to assess the ability of MFH to successfully achieve its mission. The direct investment of human, organizational, Haitian, financial, and teaching resources helps to sustain the activities necessary to train SBAs, support salaries of the Ste. Therese Hospital midwives, and provide free prenatal and postnatal care.  The output of the investments and activities is intended to fortify the fragile maternal health infrastructure in Haiti by increasing the number of SBAs and access to perinatal care. In addition, the intent of the Matron Outreach Program is to increase the knowledge and skills of the traditional birth attendants, known as Matrons, and increase referrals to skilled care when needed.

The logic model considers assumptions and external factors that may affect the outcomes of a program (W.K. Kellogg Foundation, 2004). Midwives for Haiti encounters barriers due to various assumptions among global and national agencies, policy makers, and healthcare providers about how the program will work and the people involved. In addition, external factors that are part of the Haitian society, culture, and healthcare system exist in the environment in which MFH must interact. Working with and within the assumptions and external factors, MFH (2014) has created a network of support and positive relationships to facilitate its programs and increase access to maternity care in several areas of Haiti. The systems evaluation showed that MFH programs have the potential to positively impact the health of infants and childbearing women and reduce infant and mortality rates in Haiti.


AbouZahr, C., & Wardlaw, T. (Millennium Project. (2005). Investing in development: A practical plan to achieve the Millennium Development Goals.  New York: United Nations Development Program. Retrieved from

Central Intelligence Agency. (2014, February 26). The World Factbook: Haiti. Retrieved from

Harvey, S. A., Blandon, Y. C. W., McCaw-Binns, A., Sandino, I., Urbina, L., Rodriguez, C., …Djibrina, S. (2007). Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward. Bulletin of the World Health Organization, 85(10), 783-790.

Kreyberg, I., & Helsingen, L. M. (2010). Skilled attendance at delivery: How skilled are institutional birth attendants? An explorative study on birth attendants at Bansang Hospital, The Gambia. Oslo, Norway: University of Oslo, Institute of Public Health, Faculty of Medicine.

Midwives for Haiti. (2014). Providing training for quality maternity health care. Retrieved from

Ministry of Public Health and Population, Haitian Childhood Institute, ICF International. (2013). 2012 Haiti mortality, morbidity and service utilization survey: Key findings. Calverton, MD: Author.

United Nations Children’s Fund. (2014). Every child counts: The state of the world’s children 2014 in numbers. Revealing disparities, advancing children’s rights. New York, NY: Author. Retrieved from

United Nations Development Programme. (2005). The Millennium Development Goals Report 2005. New York, NY: United Nations Department of Public Information.

W.K. Kellogg Foundation. (2004). Using logic models to bring together planning, evaluation, and action: Logic model development guide. Battle Creek, MI: Author. (Original work published 1998)

World Health Organization. (2004). Making pregnancy safer: The critical role of the skilled birth attendant. Geneva, Switzerland: Author. Retrieved from

World Health Organization. (2012). Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and World Bank Estimates. Geneva, Switzerland: WHO Document Production.

World Health Organization. (2013). World health statistics, 2013. Geneva, Switzerland: Author. Retrieved from

Yampolskaya, S., Nesman, T. M., Hernandez, M., & Koch, D. (2004). Using concept mapping to develop a logic model and articulate a program theory: A case example. American Journal of Evaluation, 25(2), 197-2007.

You, D., Bastian, P., Wu, J., & Wardlaw, T. (2013). Levels & trends in child mortality-Report 2013. New York, NY: United Nations Inter-Agency Group for Child Mortality.