The “Dominican Paradox”

Project HOPE assesses reasons for the rising maternal mortality rate in the Dominican Republic

By Rachel Brodrick

High Maternal Mortality Rates (MMR) in developing countries gained attention from the international community in 2000 when the issue ranked number 5 on the UN list of Millennium Development Goals. Project HOPE staff members recently traveled to the Dominican Republic, where the MMR is alarmingly high, to do an assessment of the reasons behind the issue. Research shows that 98% of mothers in the DR deliver in hospitals and over 96% receive prenatal care. Naturally, the assumption would be that since these mothers are taking the necessary steps to ensure safe delivery that they would in fact be safe, but to the contrary they are dying, thus the nickname given by health officials in the DR, “The Dominican Paradox”.

While the World Health Organization reports that 1,500 women die every day from pregnancy or childbirth-related complications, HOPE staff members found the issue to be a somewhat silent one in the DR. Today there are 159 mothers dying for every 100,000 births in the DR, which, by comparison to other countries is high. By contrast, in the United States this ratio drops to just 7 maternal deaths out of every 100,000 births.

What the HOPE team discovered during their weeklong assessment was that there is no silver bullet for this problem. Maternal mortality is caused by a number of things, most often hemorrhaging (number one cause in the DR), infection (rooted in poor hygienic practices in hospitals), eclampsia (onset by stress of the mother), obstructed labor and unsafe abortion practices, all of which vary on a case-by-case basis. In the DR the most prevalent causes of maternal mortality were a lack of high quality health care in hospitals, inaccurate patient information resulting in lower quality care, or a personal reaction to the stress of delivery, resulting in eclampsia. Not to mention the shocking reality that up to 20 women must deliver in one room without a companion at most DR facilities, creating a chaotic and overcrowded environment for delivery that often results in neglect of mothers.

Though the challenge is great, there are numerous opportunities for intervention in the DR, which taps directly into one of HOPE’s greatest strengths: assessing the need of complex health systems and integrating sustainable solutions at any level. Today the HOPE team moves forward with more insight and motivation to help these brave women continue to bring forth life without losing their own.