Reproductive health characteristics among women living in severe poverty in urban Haiti

Data on women’s reproductive health in settings facing extreme poverty are limited. We describe the reproductive health characteristics across the life course of women living in urban Port-au-Prince, Haiti, and identify factors associated with adverse pregnancy outcomes (APO). Data were sourced from the Haiti Cardiovascular Disease Cohort Study, a population-based observational study in Port-au-Prince. This analysis includes all women who completed a reproductive health questionnaire, which included self-reported age of menarche, menopause, infertility, menstruation abnormalities, and APO, defined as a history of pregnancy loss, preterm births, and pregnancy complications. We performed univariable and multivariable log-binomial regression to identify factors associated with APO. Among 1746 women in the parent cohort, 1,163 (66.6%) women reported reproductive health data. The median age was 43 years (IQR 31–55). The median age at menarche was 14 years (IQR 12–16). A downward trend in the age of menarche was observed over time: women born from 1930 to 1970 reported a median age of 15 years, compared to 13 years among women born from 1990 to 2012 (p < 0.001). 11% (11.0%; n = 130) of the participants reported a history of infertility. The median age of reported menopause was 48 years (IQR, 44–50; n = 540), with approximately 37.4% (n = 203) experiencing menopause before the age of 45. Among 1007 women with ≥ one pregnancy, 61.7% (n = 623) experienced an APO, and 20.3% (n = 206) reported two or more APO. The most common APO was pregnancy loss (n = 515, 51.0%), pregnancy complications (n = 244, 24.0%), and preterm births (n = 132, 13.0%). Factors associated with a history of APO included hypertension, body mass index > 25 kg/m2, higher education, and a moderate perceived stress score. Among women living in extreme poverty in Haiti, we found a high prevalence of adverse reproductive health outcomes, namely APO, and a temporal trend of a decreasing age of menarche across time. Adverse reproductive health outcomes have been associated with increased chronic disease, and additional research is needed to establish if these factors are associated with increased cardiometabolic disease in extremely poor settings to identify targets for future prevention and treatment. Data on women’s reproductive healthcare are not readily available in settings of extreme poverty, including Haiti; yet they are essential for improving women’s health in these contexts. We report data from women participants in the population-based Haiti Cardiovascular Disease Cohort Study. We used regression analysis to identify factors associated with adverse pregnancy outcomes. Among 1163 women, the median age was 43 years. The majority (68%, n = 791) earned less than 1 USD, and 46% (n = 530) had only a primary-level education. We noted a statistically significant decline in the age at which women experience their first menstrual period, from 15 years for those born between 1930 and 1970 to 13 years among those born between 1990 and 2012. The median age at menopause was 48 years (n = 540). Among women who had one or more pregnancies, the vast majority, 61.7% (n = 623), reported experiencing adverse pregnancy outcomes. Factors associated with these outcomes included hypertension, obesity, and stress. Among women living in extreme poverty in urban Haiti, we found that two-thirds experienced one or more adverse pregnancy outcomes. Adverse pregnancy outcomes have been linked to chronic diseases like heart disease and may help identify women at high risk in low-resource settings, allowing for targeted prevention and treatment.