Family Planning in Haiti: The 50th Anniversary of the Birth Control Pill
May 9th 2010 marked the 50th anniversary of the birth control pill, an event that Haiti helped to launch by being one of the two principal places where the pill was studied before its release in the U.S. in 19601. Yet, Haiti has benefited little from this major tool in family planning. Too often, poor countries bear the brunt of research but not the benefits of research outcome. Today, we need to make the pill widely available in Haiti in its current safer low dose form so that the children of the people on whom the high dose estrogen tablets were tested can now make use of the finished product.
The Haitian Ginen Heritage appears to have played a role in the development of the pill as well. At first, progesterone, a hormone in the pill, could not be synthesized in the laboratory. Rather, it was extracted from yams. Yam is a word from Senegal, Africa2. Yams have been cultivated in Africa for 8000 years and are a source of the precursors used to make hormones like progesterone. The Mexican Dioscorea, popularly called cabeza de negro is the yam from which the progesterone in the pill was made3.
The birth control pill is in many ways a Haitian birthright but abject poverty limits our access to the finished product.Today, it is unlikely that Haiti will ever be able to ensure a better life for its inhabitants without giving its citizens access to family planning services. Every day, 715 infants are born in Haiti, raising the countries population by 261,000 annually4. If current trends hold, 25% of these newborns will eventually live with someone other than their parents. A few will work the streets for a living4.
Haitian women have repeatedly indicated in surveys that at least 50% of their pregnancies were unplanned or unwanted.From the annual 261,000 births, about 1800 will be orphaned at delivery because of the catastrophically high maternal mortality rate of600/100,0004 . This situation is aggravated by the nation’s poverty which numerous groups exploit to take children from their parents, separate them from their siblings and divorce them of their culture, traditions, and land rights which they often lose through adoption4. The excessive birth rate in Haiti puts tremendous stress on Haitian families and on Haitian society. It allows for abuse and predatory practices like restavèk and the missionary practice of divorcing Haitian children from their parents' culture.
It is more sensible and humane to give poor children assistance in their home environment rather than to institutionalize them in orphanages. This is particularly true in a country lacking resources for government agencies to regulate the operations of orphanages. Moreover, children feel a greater sense of security when aid is delivered directly to them in their homes4. Money spent building, operating, and guarding orphanages consumes resources that could be spent on supporting and stabilizing families.
In the absence of widely available birth control, the Haitian population has grown from 1.2 million in 1901 to about 9 million today5. Meanwhile, the Haitian territory has not expanded, forcing each succeeding generation to live on less and less land with fewer and fewer resources. Poverty is linked to over-population and is the biggest threat to Haitian national security and to the dignity of Haitian cultural and religious heritage.
The birth control pill holds the promise of helping to make every delivery a wanted birth. This promise has not yet been achieved in the U.S. partly because despite the pills safety, the FDA, under political pressure, failed to make it available over-the-counter.In many European countries, the birth control pill is available over-the-counter.
Making the birth control pill easily accessible in Haiti would bring many benefits. It would prolong life by avoiding the high mortality associated with childbirth. It would also reduce the overall cost of health care by reducing the cost for unwanted deliveries as well as that for the treatment of ectopic pregnancies, miscarriages, and abortions6.
Today, 50 years after the introduction of the birth control pill, we must find ways of making it available over-the-counter.This would avoid imposing the cost of a doctor’s visit to obtain the pill, a medication that is better understood and much safer than current over-the-counter drugs. Facilitating access to the pill and to other forms of birth control will bring us closer to making every Haitian delivery a wanted birth. This alone will dramatically increase the chances that every Haitian child will grow in the loving embrace of his or her parents.
May 12, 2010
1Gardiner Harris. It Started More than one Revolution. The New York Times. May 3, 2010
2Judith A Carney. Black Rice: The African origins of rice cultivation in the Americas.Harvard University Press, 2001.
3The pill. http://www.pbs.org/wgbh/amex/pill/timeline/index.html (accessed in May 2010)
4Family Health International and USAID. The situation of orphans in Haiti... University of North Carolina at Chapel Hill. 2002
5Historical demographical data of the whole country. http://www.populstat.info/Americas/haitic.htm (accessed in May 2010)
6Droegemueller and others.Comprehensive Gynecology, Fourth Edition. Mosby, St Louis USA, 2001