Haitian Women Cross Border to Give Birth

BY LAUREN GILGER
Cronkite Borderlands Initiative

JIMANI, Dominican Republic – A doctor sits on the porch of her clinic, the only one in Jimani, the Dominican city that serves as the busiest border crossing between Haiti and its neighbor.

SLIDESHOW: The porous Jimani border is the busiest of the eight official crossings between Haiti and the Dominican Republic.

Just beyond the quiet porch, everything is chaos: dust, smoke, heat and the angry roar of motorbikes.

Suddenly, one of the bikes kicks up dirt and heads directly for the clinic. It is driven by a teenage boy in shorts and on the back sits a woman wearing spandex pants, a pink scarf tied around her head.

The woman struggles to get off the bike.

“I’m bleeding,” she tells Dr. Camila Perozo.

SLIDESHOW: Despite its crowded conditions, this Dominican clinic is popular with pregnant women in two countries.

The woman, three months pregnant, has just crossed the border from Haiti to see the Dominican doctor. She has no immigration papers or money to pay a fee. The same is true for thousands of pregnant Haitian women, many of them ready to give birth, who cross the border each year.

Haitian women make up a large portion of the patients giving birth in Dominican hospitals. In the capital of Port-au-Prince, hospitals estimate that up to 35 percent of the patients in their maternity wards are Haitian. On the border, the numbers are higher still. One hospital director estimated that three out of four of his patients are Haitian women who come there to give birth.

They come because they don’t have access to hospitals and health care in Haiti, especially after last year’s earthquake. They come to have their babies in hospital beds instead of on the floors of their homes.

But many come too late. In the Dominican Republic, 17 of every 1,000 newborns died in 2009, according to the latest numbers available from UNICEF. And the lifetime risk of maternal death is one in 320.

Still, those odds are much better than what women face if they stay in Haiti, where 27 of every 1,000 newborns died in 2009 and the odds of a woman dying giving birth is one in 93.

So the women cross the border. Their children may have a better chance of survival, but they also end up in a legal no man’s land they may never escape.

In Arizona, these children might be called “anchor babies.” They might be born on U.S. soil to immigrants from Mexico or Guatemala who illegally came to this country. They might become the center of the emotional debate about immigration and the U.S. Constitution that’s being waged in 14 states, in the halls of Congress and on the streets of Phoenix.

But the children will be U.S. citizens.

In the Dominican Republic, these children have no “anchor.”

In a series of changes to its Constitution over the past decade, the Dominican government has done what some powerful conservative politicians are attempting in Arizona and around the country – revoke birthright citizenship for many. A child born to illegal immigrants in the Dominican Republic is no longer a citizen of that country. At the same time, without registration in their parents’ home country, they are not citizens there either. They are stateless.

But that doesn’t stop a pregnant Haitian woman from getting on the back of a motorbike and making the dusty crossing into the Dominican Republic. She knows the doctors there won’t turn her away: Although the Dominican Republic is a relatively poor country, it treats everyone needing medical assistance regardless of immigration status.

As a result, these women are overwhelming an already stressed Dominican health care system.

“We are poor,” said Jose Delancer, director of the Ministry of Health with the Department of Women and Children. From money to beds to doctors and nurses, “the Dominican Republic was not set up to handle this.”

Still, Delancer understands why they come – and why they will keep coming.

“If I were Haitian,” he said. “I would do the same thing as them.”

Refugee from an Earthquake

“Life in Haiti is hard,” said Ludia Baptiste. She sits upright on the side of her bed in a one-room shanty in Bateye San Isidro, a tight-knit, impoverished Haitian community outside of Santo Domingo.

SLIDESHOW: Ludia Baptiste, a Haitian immigrant, believes her unborn child will be born with Dominican citizenship.

The walls of her room are covered in newspaper and magazine clippings written in English; American celebrities smile out from the pages. Nothing is out of place: A small Bible sits on her pillow and a sheet serves as a curtain separating the kitchen from her bed.

Baptiste came to the Dominican Republic along with thousands of other refugees after the earthquake in early 2010 left Haiti – already the poorest country in the Western hemisphere – devastated.

“The house in Haiti collapsed,” she said in broken French. “The people who live in Haiti have a hard life. The house collapsed. And the food – everything people had in Haiti – they have no food anymore.”

The hospitals are gone, too, she says, which is why she crossed the border. Five months pregnant with no father in sight, she is waiting for her baby to be born. Then she will return home.

“I want to go back to Haiti because my family is there,” she said, nodding and adding an emphatic “Uh huh.”

Here, she lives alone in this small, tidy room. She cannot work because she has no papers, and hunger has followed her across the border.

Still, Baptiste smiles widely and laughs as she looks at the sonogram she’s just pulled out of her purse. She has been to Centro Materno Infantil San Lorenzo de Los Mina hospital five times since she found she was pregnant. “Each month,” she said with pride.

“You get free vitamins here, and you get free consultations here. You get a lot of things for free, which is better than in Haiti.”

This will be her first child and she laughs at the suggestion that she might have another in the future. But if that happens, she will come back to this country to give birth – if she can. “If I have papers,” she said.

But this child, she’s not worried about. “The baby will be Dominican,” she said.

“Your baby will be Dominican?”

“Yes.” She nods her head and frowns. “Uh huh.”

Here’s the truth:

Children born to illegal parents in the Dominican Republic are not citizens of that country.

Nor are they citizens of Haiti.

They are stateless.

A Place for Women

“I picked this area because it is too poor.”

Camila Perozo’s voice is drowned out by a motorbike that is circling her clinic for the third or fourth time, the engine screaming.

Perozo worked for four years as a doctor in Haiti before she and her husband spent their life savings building a clinic on a dirt road one block from the public hospital in Jimani. They painted it clean white and baby blue with the words “Centro Clinico Diagnostico, Dra. Perozo” painted in gold lettering on the front. Her name is in cursive.

“There are other border crossings. But this is the one that takes people directly from the capital,” Perozo said in Spanish. “This is why we have so much movement.”

Jimani is just an hour’s drive from Port-au-Prince. Food, trucks, cars, goods and workers move across the border between these two countries at a frenzied pace. And then there are the women who walk to the dusty border crossing and pay a man with a motorbike to drive them into the Dominican Republic when their babies are about to come.

They arrive in the throes of labor and with a myriad of other health problems: malnourishment, anemia, septicemia and poverty. Few have had any prenatal care.

“Here we call them ‘time bombs,’” said Francis Moquete, director of Hospital General Melenciano, Jimani’s public hospital. He’s watched for years as countless Haitian women come to the hospital and leave with newborns.

“They come here; this is where they want to come. One wants to go where there is better service,” he said. “This is how it is.”

Of the 40 or so deliveries performed at his hospital each month, about 30 are Haitian births, Moquete said. “And of those 30, at least four come without any type of (medical) check,” he said.

“This is what most worries us when they come like this – suddenly, with nothing, absolutely nothing.”

Overwhelming the System

Across the country, on their half of this small island, Dominican hospitals and clinics are being overwhelmed by Haitian women.

“The border is imaginary. It’s just a door,” said Delancer of the national Ministry of Health, sitting at his desk in a crowded office with bright blue walls in Santo Domingo. “There are clinics and hospitals that are 100 meters away from the border line, and 50 to 60 percent of the births that occur here are Haitian.

“It’s a problem of poverty; it’s a problem of education; it’s a problem of empowering of women.”

And it’s a problem of access. In the Dominican Republic, medical treatment is provided free of charge whether the individual has documentation or not, Delancer said.

More than 150 miles away on the border, Moquete nods his head in agreement. “In this we are clear – no matter a person’s poverty, religion, race, they have to be given medical attention,” he said.

He spins his cell phone between his two hands on top of a spotless desk and frowns. “This is a right of all human beings.”

Joaquin Recio, vice director of nursing at the public hospital in Jimani, was born inside these walls. He has worked here for nearly a quarter-century and brings a religious fervor to the care he provides to Haitians. “If God has given you this gift to give service to others – this special service, of health – then you have to give it with quality, warmly, with love, to whomever – no matter their creed or race, their color – it does not matter,” he said as he sat inside the hospital, a fan buzzing behind him to stave off the Caribbean heat.

“You have to give service to the person,” he added with conviction. “This is what is important.”

But what is important comes up against a harsh reality: The Dominican health care system is designed to care for about 7 million people, according to Delancer. There are nearly 10 million living in the Dominican Republic, and more than a million of them are Haitians – with more coming every day.

Delancer worries about those numbers: “How many of them are in reproductive age? How many of them need health care?”

How can the system support so many?

“There isn’t a system that counts the total number of Haitian citizens who live in this country,” Delancer said. “Everyone knows that.”

“How do you count an illegal population, a population that is registered nowhere?”

Clinging to Citizenship

At the Jimani public hospital an hour from Port-au-Prince, two women, still in their street clothes, lie on small cots.

A nurse in a tight, white uniform uses a needle to inject a clear liquid into their IVs. A baby lies next to each woman on her bed. They are hours old. Neither yet has a name.

“Where are you from?”

SLIDESHOW: Many Haitian women cross the border to give birth at the public hospital in Jimani.

“Here,” they both say.

“My husband is Dominican,” one woman offers without being asked. This is an important detail: If it is true, her child is legal. The new Dominican law says that if one parent has Dominican citizenship, the child is Dominican.

The nurse doesn’t blink; she hears such claims every day. But she clarifies that the women are of Haitian descent. The two women agree.

The nurse files birth certificates for every child born in the hospital.

“She fills out a record – a card,” Recio said. “And she puts her name, what she is called, her last name. And with this, nothing more, the baby is registered.”

The nurse writes down whatever name the mothers give her on the certificate – Spanish or French. She’s not an immigration officer.

She doesn’t tell them that their children won’t be citizens until they are officially registered with the Dominican government and that they can be officially registered only if they can prove that they or their husbands are legal residents of the country. It’s a complicated process, fraught with challenges and delays that can be triggered simply by a surname that sounds more French than Spanish.

By that afternoon, the women are gone, taking their new babies with them. The beds are stripped and the hallways quiet. The babies have their birth certificates, but they are not citizens – not yet.

They are stateless.