A Wretched Journey Into Haiti's Clandestine Abortion Trade

Haiti has the highest maternal mortality rate in the Americas. Where female sexuality is taboo and abortions illegal, it all happens clandestinely, and in the worst possible health conditions.

A pharmacy in downtown Port-au-Prince
A pharmacy in downtown Port-au-Prince
Agathe Logeart

PORT-AU-PRINCE â€" She came alone this morning at the crack of dawn. She winces in pain when she sits, after Dr. Jean-Edouard Viala, chief of the obstetrics department in Haiti’s state university hospital, welcomes her in his office.

The doctor takes her hand, calls her "chérie," and speaks in Creole. Sandrine is 25 years old but has the voice of a frightened little girl. She's in shock. She doesn't know that upon her arrival she was categorized as an "IIA," for "interrupted induced abortion."

Dr. Viala is used to it by now.

In a given week, he typically sees 20 young women just like Sandrine. Though one in four have suffered from spontaneous recurrent miscarriages, most of them come after having an illegal abortion. Too often, they are forced upon the women, which is precisely what has happened to Sandrine.

She recounts her story in a whisper, tears rolling down her cheeks. She had been unemployed and had been in a relationship for a year with a 60-year-old man, probably married, who was financially supporting her family. When she realized she was pregnant, she was happy. One day, though, she felt feverish and the old man took her to the doctor's office. There, she was told the baby was not healthy, and she was sent to see another physician. This "colleague" injected something into her body, so that "the baby could feel better," and she passed out right away.

Hours later â€" she doesn't know how many â€" she woke up bathed in her own blood, and with her feet up in the stirrups. All she knows is that her lover is gone, and her baby too. Her file says she has iron deficiency, suffers from deep vein thrombosis and from a serious infection that needs medical attention.

A few days later, Sandrine is sitting in the obstetrics department common room, eating some sort of gruel her aunt brought her. The hospital doesn't have the financial means to feed its own patients. She's wearing a long loose T-shirt through which the IV stuck in her arm is visible. She's looking at other women around her, all with their newborn babies. Sandrine looks away through the window.

Old laws

The previous day, Dr. Viala received a mother and her 14-year-old daughter. The girl did not understand why she wasn't having her period anymore. He performed an ultrasound and let her listen to her baby's beating heart. The teenage girl was 20 weeks pregnant. When he asked who the father was, she said, "The father of what?"

An estimated one in seven women in the world has an abortion during her lifetime. In Haiti, abortion is strictly illegal under article No. 262 of the criminal code, an article passed in 1835! It specifies that abortion is punished with a lifetime jail sentence for the patient as well as for anyone (intermediaries, doctors, pharmacists) who helps abortion patients. In reality, that law is never enforced. From time to time, legal proceedings are launched, but most of them are dismissed.

Dr. Vladimir Larsen, president of the Haitian association for gynecology and obstetrics, is fed up with this hypocrisy. Haiti has the highest maternal mortality rate in the Western Hemisphere, with 530 maternal deaths per 100,000 children born, at least a fifth of them linked to abortions. Early pregnancies often happen one year after the first periods, as young as 12 or 13 years old.

Like other doctors and nurses whose job is to take care of the sick and suffering, Dr. Larsen fights every day against religious bigotry, evasion and male chauvinism â€" all in a country where extreme poverty doesn't leave much room for progress.

"Having this many maternal deaths is not something we can tolerate," he says. "The same goes for all the sexual assaults that are too frequently the cause of unwanted pregnancies. "We find ourselves in front of young girls or young women who are often badly distressed emotionally â€" and, when having gone through illegal abortions, are often physically in poor shape. This cannot go on anymore. We can't keep silent. We have to end this cruelty."

Hidden clinics

Around the Port-au-Prince hospital, dozens of white-and-green pop-up drugstores await customers. You go up a few steps and find yourself facing a barred counter from which there is no way of seeing the face of the man in front of you. Behind him, the dispensary looks dark. He can be suspicious and even aggressive when someone asks him if he has any Cytotec. This drug, produced by the pharmaceutical lab Pfizer, is the more common name for the Misoprostol drug, designed to treat ulcers.

But, in Haiti, as in many other countries where abortions are illegal, Cytotec is often used to terminate a pregnancy. On the Internet, many false prevention campaigns feature the drug as a way to help young women in distress. If the pharmacist is obliging, he will sell one pill of Cycotec for between 50 and 100 Haitian gourdes (around $2). Depending on the prescription, a patient must take between eight to 12 pills, a costly "cure" in a country where the median income is around $2.50 a day.

Rogue pharmacists will then send the patient to take the back alley that runs along the building, where there are chickens and stray dogs, until they reach a hidden door. There, in an air-conditioned room, people in nurse-looking outfits are waiting. They tell the patient the appropriate dosage of the drug and suggest they return for a $100 to $120 curettage in the illegal clinic. Any sudden movement causes panic, and jittery patients will be asked to promptly leave the clinic.

Cytotec is applied both vaginally and orally, with Toro (energy drink), or with wine, beer or pineapple juice. Every doctor has seen the consequences of these cocktails: a destroyed uterus, perforations, significant bleeding and, sometimes, even infertility.

Despite these risks, street vendors still sell this drug without ever being investigated. Sometimes, everything "works out."

A secret with God

Questions about abortions have multiplied, particularly regarding the use of Cytotec. Dr. Myrna Eustache, head of the POZ association, an NGO working with AIDS patients, talks about one of her patients, Emily. She is unemployed and divorced, a mother of two girls aged 20 and 18.

Emily herself is 38, and when she found out that she was pregnant again, with a new boyfriend, she feared he would beat her. So one morning, without having eaten anything, she swallowed two tablets of Cytotec, and at night, put another two into her vagina. Three hours later, she was bleeding. Her OB told her the "egg had gone away." Emily then went to church and asked for forgiveness. "It was my secret with God," she says. "Now I know he's forgiven me and everything is fine."

Dr. Eustache says Emily got lucky. "Most often, I see 13-year-old girls whose abortions were performed by complete quacks," she says. "That is a crime. Abortion shouldn't be a taboo in Haiti anymore."

According to the sociologist and women's right activist Danièle Magloire, who has long been fighting violence against women, abortion and birth control are among the central paradoxes of Haitian life. "You have to take into account social background and tradition of a patriarchal society," she says. "When you have the financial means, then you can have an abortion, and no one will ever find out."

An IUD can be purchased abroad and inserted for more than $300 in a secret practice. Hospitals can also insert IUDs previously purchased, for a lower price, though people may find out. Indeed, in Haïti, female sexuality itself is still taboo. "Below the waist, a woman's body belongs to her husband," locals are fond of saying.

A variety of relationship statuses exist in the country, marriage not being very popular. Magloire says one of them is called the "placage," or common-law marriage not formally registered with the state but widely accepted by society. Another is the "viv avek," or living together, which doesn't require permanent cohabitation.

"In reality, Haitian women live according to serial monogamy principles while men are openly polygamous," Magloire explains.

Arcane beliefs

A high number of abortions is easy to understand in a country where women rarely use contraception, except when men ask them to (only 36% of Haitian women use birth control compared to 68% and 95% for Dominican and Colombian women). Religious and obscure beliefs prevent society from widely embracing the use of birth control.

What about condoms? Again, people in the country spread the idea that condoms were the cause of HIV. And priests claim they even promote sex. Meanwhile, birth control pills are regarded as a vile sin by many members of the religious community, according to which, only God can decide upon the number of children a woman can bear.

"To many young people, abortion has become a method of birth control," Magloire says.

The sociologist also says that women in Haiti don't have control over their own sexuality: "Men take control over everything, whether it's birth control, pregnancy, or even sexual intercourse. Women don't have the right to say "No," and face financial blackmail," she explains. "Men refuse to lose control of their partner's sexual activity."

So, women have to look out for themselves â€" as they have done since slavery, when women didn't want to bring future slaves into this world. Outside of the city, people don't always have access to medical facilities, and they use traditional medicine to avoid giving birth to "a fatherless baby." Everything is done based on beverages with banana tree roots, logwood bark, lemongrass leaves.

After the apocalypse

Jan. 12, 2010, 4:53 pm. Haïti barely survived the apocalypse. The earthquake left more than 200,000 dead and 300,000 injured. Around 1.5 million people were left homeless. About 40% of the population of Port-au-Prince wound up in camp sites. A few months later, a cholera epidemic hit the country, infecting some 700,000 and killing 8,000.

In this country of 10 million, many international and humanitarian organizations come to help. In temporary camp sites, the lack of privacy is startling. Children, teenagers â€" orphans sometimes â€" are left unattended. To feed their family, women, widows, depend on the good will of the men handing out food aid.

Some have reported that this situation has caused a rise in sexual assaults. Doctors certainly see too many young pregnant girls coming their way.

Four years have passed since the earthquake, and even now, 150,000 people are still living in camp sites. In the maternity ward of Isaïe-Jeanty, in Port-au-Prince, facility heady Raymond Fleurimont recounts that a 19-year-old girl, who had just given birth, simply got up and walked out of the building a few days ago, leaving her newborn baby behind on the delivery table.

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How China Flipped From Tech Copycat To Tech Leader

Long perceived as a country chasing Western tech, China's business and technological innovations are now influencing the rest of the world. Still lagging on some fronts, the future is now up for grabs.

At the World Semiconductor Conference in Nanjing, China, on June 9

Emmanuel Grasland

BEIJING — China's tech tycoons have fallen out of favor: Jack Ma (Alibaba), Colin Huang (Pinduoduo), Richard Liu (Tencent) and Zhang Yiming (ByteDance) have all been pressured by Beijing to leave their jobs or step back from a public role. Their time may be coming to an end, but the legacy remains exceptional. Under their reign, China has become a veritable window to the global future of technology.

TikTok is the perfect example. Launched in 2016, the video messaging app has been downloaded over two billion times worldwide. It has passed the 100-million active user mark in the United States. Thanks to TikTok's success, ByteDance, its parent company, has reached an exceptional level of influence on the internet.

For a long time, the West viewed China's digital ecosystem as a cheap imitation of Silicon Valley. The European and American media described the giants of the Asian superpower as the "Chinese Google" or "Chinese Amazon." But the tables have turned.

No Western equivalent to WeChat

The Asian superpower has forged cutting-edge business models that do not exist elsewhere. It is impossible to find a Western equivalent to the WeChat super-app (1.2 billion users), which is used for shopping as much as for making a medical appointment or obtaining credit.

The flow of innovation is now changing direction.

The roles have actually reversed: In a recent article, Les Echos describes the California-based social network IRL, as a "WeChat of the Western world."

Grégory Boutté, digital and customer relations director at the multinational luxury group Kering, explains, "The Chinese digital ecosystem is incredibly different, and its speed of evolution is impressive. Above all, the flow of innovation is now changing direction."

This is illustrated by the recent creation of "live shopping" events in France, which are hosted by celebrities and taken from a concept already popular in China.

10,000 new startups per day

There is an explosion of this phenomenon in the digital sphere. Rachel Daydou, Partner & China General Manager of the consulting firm Fabernovel in Shanghai, says, "With Libra, Facebook is trying to create a financial entity based on social media, just as WeChat did with WeChat Pay. Facebook Shop looks suspiciously like WeChat's mini-programs. Amazon Live is inspired by Taobao Live and YouTube Shopping by Douyin, the Chinese equivalent of TikTok."

In China, it is possible to go to fully robotized restaurants or to give a panhandler some change via mobile payment. Your wallet is destined to be obsolete because your phone can read restaurant menus and pay for your meal via a QR Code.

The country uses shared mobile chargers the way Europeans use bicycles, and is already testing electric car battery swap stations to avoid 30 minutes of recharging time.

Michael David, chief omnichannel director at LVMH, says, "The Chinese ecosystem is permanently bubbling with innovation. About 10,000 start-ups are created every day in the country."

China is also the most advanced country in the electric car market. With 370 models at the end of 2020, it had an offering that was almost twice as large as Europe's, according to the International Energy Agency.

Photo of a phone's screen displaying the logo of \u200bChina's super-app WeChat

China's super-app WeChat

Omar Marques/SOPA Images/ZUMA

The whole market runs on tech

Luca de Meo, CEO of French automaker Renault, said in June that China is "ahead of Europe in many areas, whether it's electric cars, connectivity or autonomous driving. You have to be there to know what's going on."

As a market, China is also a source of technological inspiration for Western companies, a world leader in e-commerce, solar, mobile payments, digital currency and facial recognition. It has the largest 5G network, with more than one million antennas up and running, compared to 400,000 in Europe.

Self-driving cars offer an interesting point of divergence between China and the West.

Just take the number of connected devices (1.1 billion), the time spent on mobile (six hours per day) and, above all, the magnitude of data collected to deploy and improve artificial intelligence algorithms faster than in Europe or the United States.

The groundbreaking field of self-driving cars offers an interesting point of divergence between China and the West. Artificial intelligence guru Kai-Fu Lee explains that China believes that we should teach the highway to speak to the car, imagining new services and rethinking cities to avoid cars crossing pedestrians, while the West does not intend to go that far.

Still lagging in some key sectors

There are areas where China is still struggling, such as semiconductors. Despite a production increase of nearly 50% per year, the country produces less than 40% of the chips it consumes, according to official data. This dependence threatens its ambitions in artificial intelligence, telecoms and autonomous vehicles. Chinese manufacturers work with an engraving fineness of 28 nm or more, far from those of Intel, Samsung or TSMC. They are unable to produce processors for high-performance PCs.

China's aerospace industry is also lagging behind the West. There are also no Chinese players among the top 20 life science companies on the stock market and there are doubts surrounding the efficacy of Sinovac and Sinopharm's COVID-19 vaccines. As of 2019, the country files more patents per year than the U.S., but far fewer are converted into marketable products.

Beijing knows its weaknesses and is working to eliminate them. Adopted in March, the nation's 14th five-year plan calls for a 7% annual increase in R&D spending between now and 2025, compared with 12% under the previous plan. Big data aside, that is basic math anyone can understand.
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