Cervical cancer risk and access: Utilizing three statistical tools to assess Haitian women in South Florida

Although decreasing rates of cervical cancer in the U.S. are attributable to health policy, immigrant women, particularly Haitians, experience disproportionate disease burden related to delayed detection and treatment. However, risk prediction and dynamics of access remain largely underexplored and unresolved in this population. This study seeks to assess cervical cancer risk and access of unscreened Haitian women. Extracted and merged from two studies, this sample includes n = 346 at-risk Haitian women in South Florida, the largest U.S. enclave of Haitians (ages 30–65 and unscreened in the previous three years). Three approaches (logistic regression [LR]; classification and regression trees [CART]; and random forest [RF]) were employed to assess the association between screening history and sociodemographic variables. LR results indicated women who reported US citizenship (OR = 3.22, 95% CI = 1.52–6.84), access to routine care (OR = 2.11, 95%CI = 1.04–4.30), and spent more years in the US (OR = 1.01, 95%CI = 1.00–1.03) were significantly more likely to report previous screening. CART results returned an accuracy of 0.75 with a tree initially splitting on women who were not citizens, then on 43 or fewer years in the U.S., and without access to routine care. RF model identified U.S. years, citizenship, and access to routine care as variables of highest importance indicated by greatest mean decreases in Gini index. The model was .79 accurate (95% CI = 0.74–0.84). This multi-pronged analysis identifies previously undocumented barriers to health screening for Haitian women. Recent US immigrants without citizenship or perceived access to routine care may be at higher risk for disease due to barriers in accessing U.S. health-systems.

Infernal Journeys in Marie-Célie Agnant’s Femmes au temps des carnassiers

The emphasis on testimony in the oeuvre of Haitian-Québécois author Marie-Célie Agnant attests to her recognition of the vital task of bringing truth to light. Indeed, most of Agnant’s works take as their focal point the far-reaching consequences of the Duvalier regime, underscoring in particular the crucial importance of giving voice to the terrifying events that occurred throughout this period. In the richly layered Femmes au temps des carnassiers (2015), a number of Haitian women recount their experience of political violence and testify to the “unspeakable” atrocities that turned Haiti into a “terre gorgée de sang” (Agnant 2015, 21). While this text addresses the complex relationships between history, memory, silence, and voice, it does so by emphatically equating the Duvaliers with the demonic and women’s trauma with a form of hell. Agnant’s deployment of the trope of hell characterizes her female protagonists’ trajectories as a grueling journey into an infernal realm with no guarantee of return. At the same time, however, the narrative strongly suggests that bearing witness, especially through art, can potentially play a significant role in bringing about healing after an unwanted descent into the underworld. Le thème récurrent du témoignage dans l’œuvre de l’écrivaine haïtienne-québécoise Marie-Célie Agnant souligne l’importance qu’elle attache à la nécessité de mettre en lumière la vérité sur des événements historiques troublants. En effet, la plupart des textes d’Agnant ont comme sujet central les conséquences du régime des Duvalier et insiste en particulier sur les événements terrifiants qui ont eu lieu pendant cette période. Dans le roman Femmes au temps des carnassiers (2015), plusieurs générations de femmes haïtiennes victimes de la violence politique racontent les atrocités “indicibles” qui ont transformé Haïti en une “terre gorgée de sang” (Agnant 2015, 21). Bien que ce texte traite des thèmes de prédilection d’Agnant - les rapports complexes entre l’histoire, la mémoire, le silence et la voix - il le fait en créant un parallèle frappant entre l’enfer et les traumatismes subis par les femmes. L’emploi du trope de l’enfer sert ainsi à présenter les Duvalier comme une incarnation du diable et les trajectoires des personnages femmes comme un voyage douloureux sans fin dans un monde infernal. En même temps, cependant, le récit suggère fortement que l’acte de témoigner, surtout à travers l’art, peut potentiellement jouer un rôle significatif dans le processus de la guérison après une descente aux enfers.

Constructing Race and Ethnicity: “It Has to Do with Where You Are”

Drawing from the lived experiences of Haitian women in Boston and Montreal, this study illustrates how ethnography can augment understandings of race and place in demography by complementing quantitative analyses, showing how race is constructed across place through daily micro-interactions. Building on the work of demographers who examine how race shifts over time and place, this article challenges the practice of engaging with race as a fixed or static category to consider how race is constructed across place, highlighting the nuances of race that are sometimes lost in quantitative studies. The multi-sited ethnographic methodology employed in this study is uniquely suited to uncovering the specificities of race and place. The findings reveal that Haitian women experience race differently in Montreal and in Boston, based largely on the historical context of each place. Haitians in Boston experienced intraracial tensions with African Americans, particularly during the 1960s and 1970s, that shaped their experiences of race and place, while Haitians in Montreal at the same time experienced Blackness that was closely tied with xenophobia in the French Canadian context. The Haitian women in this study experienced race, place, gender, ethnicity, and class simultaneously, necessitating an intersectional approach to understanding the effects of race in and on their daily lives.

Desired formality

Formal work is essential to gain legal residence in Chile and the reason why Latin American and Caribbean migrants purchase fake contracts on the black market. Drawing on ethnographic fieldwork with migrant Haitian women applying for work visas in Santiago, this article explores the effects of desired formality and its promises of a good life on contemporary statehood in Chile. The analysis shows how Haitian women’s efforts to become formal workers transform their experiences as racialized and gendered migrants in Chile, and impact how state institutions manage and control migration. Desired formality reveals the paradoxical character of state policies that help create a racialized and precarious labor force within its legal frameworks and explain why migrants attach themselves to fragile good-life projects in new countries.

Bayo Lapawol (Let Their Voices Be Heard): Haitian Women’s Barriers to and Facilitators of Cervical Cancer Prevention and Control

This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women ( n = 25) who were on average 42 years ( SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education, evaluation, and empowerment, respectively, across individual, interpersonal, and institutional systems. Study results call for more extensive examination of the diversity present in the groups of African origin to unearth transnational, multifaceted determinants of health by biology, beliefs, and behaviors including sociocultural and socioenvironmental access. Future interventions must include development of proactive policies, which deliberately pressure the government and global community to prioritize health infrastructure while simultaneously educating women about and dispelling fear of cervical cancer, thus empowering Haitian women to live their healthiest lives. Accordingly, this study may contribute to understanding global health equity advances and improving public health infrastructure in underresourced settings in low- and middle-income countries in the Caribbean.

Gender and Transport in Haiti: Gender Diagnostic and Gender Action Plan

This technical note encompasses Haiti's gender assessment, evaluates the success of gender specific actions implemented between 2011-2017, and presents a Gender and Transport Action Plan (GAP). The GAPs main aim is to guide investments in Haiti's transport sector in conceptualizing and designing gender-sensitive transport projects. By proposing specific gender actions and outcomes, the GAP establishes a clear path to integrate a gender dimension into operations design, implementation and, monitoring and evaluation. The GAP presents an overall plan to support the development of Haitian women. However, it focuses in the needs of women as transport services users and devotes specific attention to two female sub-groups, comprised by Haitian women engaged in informal trade of local and regional products. These women are known as Madan Sara (MS), and local female mango producers and traders (MPT). The decision of focusing on MS is related to their vital role in the Haitian local labor market and the peculiarity of their work, which has specific transport needs. Understanding and addressing these female groups transport constrains could strategically improve the outcomes of upcoming transport investments and bring more benefits to its beneficiaries.

Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal

Background The province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs. Purpose of the study The main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program. Methods The study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community. Results A mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources. Conclusion Barriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.

Age Moderates the Association Between Microfinance Membership and Physical Abuse, Relationship Power, and Transactional Sex in Haitian Women

Microfinance interventions may have differential effects on relationship dynamics among subpopulations of women. We estimated the association between microfinance participation duration and physical abuse, relationship power, and transactional sex in a sample of Haitian women ( n = 304). Furthermore, we tested for moderation by age. In older women, microfinance tended to be associated with reduced risk of violence, low relationship power, and transactional sex. These associations were not observed for younger women. Thus, older Haitian women may benefit from microfinance in ways that younger women do not. Future studies should examine whether additional training and resources could improve outcomes in younger women.