Abstract
Background:The Haitian orphanage sector receives more than 70 million United States Dollars (USD) in foreign aid annually and continues grow; there are over 500 orphanages in Port-Au-Prince alone. An estimated 80% of the 30,000 children living in Haitian orphanages have at least one living parent.Objectives:This research seeks to identify factors contributing to maternal-child separation in Port-Au-Prince to understand motivations and attitudes surrounding maternal-child separation. We hypothesized that poverty, health status, and current state of the family unit are influential in the mother’s decision to separate from her child.Methods:From June to August 2017, a chain referral sampling study was conducted in Port-Au-Prince and the surrounding metropolitan area. Seventy interviews were conducted with (1) Mothers – separated (n = 8) and non-separated (n = 48) – and (2) Community leaders exposed to maternal-child separation (n = 18). The semi-structured interview consisted of questions about (1) exposure to maternal-child separation, (2) circumstances surrounding maternal-child separation, and (3) factors contributing to maternal-child separation. Additionally, all mothers completed a survey including demographic information and multiple validated surveys: Maternal Postpartum Quality of Life, Patient Health Questionnaire (PHQ-9), and PTSD Checklist (PCL) to address quality of life, depression, and PTSD, respectively.Findings:This study found separation to be associated with poor economic means compounded with other factors, most notably access to education, ability to care for disabled children, insufficient support, and poor maternal mental health. Additional themes identified include negative stigma towards maternal-child separation and sparse education surrounding family planning. Quantitative findings revealed separated mothers experienced significantly higher rates of PTSD compared to non-separated, small but statistically worse quality of life, and no difference in rates of major depression.Conclusion:This research finds economic means to be insufficient in predicting maternal-child separation, with access to education being the most salient contributing factor mentioned after economics. Findings from this study will inform development of programming focusing on education, family planning, and social support in Port-Au-Prince.
Highlights
The Haitian orphanage sector receives more than 70 million United States Dollars (USD) in foreign aid annually and continues grow; there are over 500 orphanages in Port-Au-Prince alone
We conducted semi-structured interviews surrounding perceived factors contributing to maternal-child separation and maternal stress in order to capture the experiences of mothers (Table 1) and community leaders (Table 2) living in the Port-Au-Prince metropolitan area
In mother participants, quantitative methods utilized validated surveys including the PTSD Checklist (PCL)-C for PTSD screening, PHQ-9 for depression screening, maternal postpartum quality of life (MAPP-QOL) survey, and demographic information all captured using REDCap (Research Electronic Data Capture) database, hosted at Icahn School of Medicine at Mount Sinai, on a tablet provided to mothers [6]
Summary
The Haitian orphanage sector receives more than 70 million United States Dollars (USD) in foreign aid annually and continues grow; there are over 500 orphanages in Port-Au-Prince alone. Findings: This study found separation to be associated with poor economic means compounded with other factors, most notably access to education, ability to care for disabled children, insufficient support, and poor maternal mental health. Conclusion: This research finds economic means to be insufficient in predicting maternal-child separation, with access to education being the most salient contributing factor mentioned after economics. In 1989, Medicine, US § Departments of Psychiatry and System Design and Global the United Nations Convention on the Rights of the Child established it is within a child’s rights to “grow up in a family environment [2, 3].” This conclusion concurs with research showing lifelong physical and psychological impairments in children raised in orphanage care. Children in orphanages suffer due to intolerable living conditions
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