Structural violence in Haiti
Haiti is impacted by structural violence, a form of dysfunction where social structures prevent certain groups of people from having access to basic human rights, like education and healthcare. This has resulted from decades of political instability and social unrest. Additionally, Haitians are financially impoverished and within Haiti, there exist social inequalities. In 2012, 58.5% of its population was below its poverty line. Educational standards within the nation are low, where its literacy rate is about 60.7%, below the 84.1% global average. Haiti is also globally ranked lower than most other nations in various measurements of health outcomes. Such health outcomes include life expectancy, mortality rates, and disease levels. While there has been some international assistance, there are insufficient supportive infrastructures in place within the country to provide resources and opportunities for Haitians who are trying to attain a higher quality of life. Causes that have resulted in higher levels of structural violence within Haiti include political instability and corruption, as well as the impact of post-colonialism, which has established a caste-based class system within Haiti.
Definition of structural violence
As defined by Medical Anthropologist Dr. Paul Farmer, structural violence is the way by which social arrangements are constructed to put specific members of a population in harm's way. According to Dr. Farmer, social inequalities are at the heart of structural violence, where the prevailing societal framework imposes invisible barriers that perpetuate the suffering of certain groups of people. The term structural violence was first coined by Johan Galtung, the founder of peace and conflict studies, in 1969. The term further gained exposure when it was used by Latin American liberation theologians. These social arrangements are termed structural as they are embedded into the cultural, political and economic realms of society. The term violence highlights the fact that these structures cause injury or inequality to certain groups of peoples and constrain individual agency in the society in which they operate. While structural violence exists in other parts of the world, its effects are more readily identified within Haiti.Compounding factors
While the negative effects of structural violence affects almost everyone in the nation of Haiti, there are a number of social factors that render certain demographics of the population to experience a more severe form of human suffering. These include gender, ethnicity and socioeconomic status.Gender
While structural violence impacts Haiti as a whole, due to the presence of gender inequality, women within Haiti tend to be more heavily impacted by structural violence than men. In the 2004 United Nations Development Fund for Women report, Haitian women were found to remain as the target of oppression, independent of any political change within the nation. Among the 43% of households which are headed by women, more than 80% are reported to be living in poverty. Moreover, according to the 2000 UN Special Rapporteur on Violence against Women, a report on Haiti noted that structural gender disparities have made Haitian women disproportionately susceptible to physical violence, but also excluded from various forms of protection. For example, spousal rape is not regarded as a crime under Haiti's judicial system. Other forms of legal discrimination against women and girls include differentiated wage levels, as well as unequal penalties for both adultery and divorce.Race / ethnicity
Racial or ethnic differentiation has been well acknowledged as a means of depriving certain racial or ethnic groups of basic human rights, or from receiving the same quality of resources as others. In Haiti's context, such social discrimination exists predominantly from two areas: Antihaitianismo, which is the racial bias against Haitians and descendants of Haitians by Dominicans, and remnants of the Haitian colonial hierarchy via caste discrimination. While Haitian mulattoes make up 5% of the Haitian population, they are regarded as the upper class and control approximately 44% of the national income.Socioeconomic status
The Human Suffering Index, which examines measures of human welfare ranging from life expectancy to political freedom, listed Haiti to be one of the 27 of 141 countries characterized by "extreme human suffering".Coming from a lower socioeconomic background can render individuals and groups to be more vulnerable to "extreme human suffering". This is because economic and political structural barriers tend to have a greater impact on those who are lower down on the social order, or are affected by poverty. This stems from the fact that those who are of lower classes often have limited access to resources or do not share the quality of resources that those of higher socio-economic classes have access to. UNICEF statistics show that while less than 10% of births among the poorest 20% in Haiti had a skilled attendant present, 78.1% of all births had a skilled attendant present for the richest 20%. Underweight prevalence among the poorest 20% is 4.7 times greater than that of the richest 20%. Economically, the poorest 40% make up 8% of the nation's total household income, while the richest 20% make up 63%.
Impacts of structural violence
Poverty
The impacts of structural violence are far reaching. They affect individuals, and overall social outcomes. Poverty is one of the biggest by-products of structural violence, as structural violence inhibits individuals and communities from achieving basic human rights. These basic rights include access to healthcare and education. As identified by the 2012 World Development Report, health and education are two key human capital endowments that can influence an individual's ability to reach his or her full potential in society. Due to the inability to receive proper education and maintain good health, individuals impacted by structural violence often are less well-positioned to attain better socio-economic opportunities or to be upwardly mobile. In 2012, Haiti was the poorest nation in the Western Hemisphere, with approximately 58.5% of its population lived below the nation's poverty line. The Gini coefficient for Haiti was 59.2 in 2001, making it the 7th highest nation in terms of its degree of inequality in the distribution of family income.Education
Structural violence impacts one's ability to receive education. Haiti's literacy rate is about 60.7%, below the 90% average literacy rate for Latin American and other Caribbean countries. Due to the oppressive political and economic structures that are plaguing the nation, the educational sector in Haiti has limited financial support. The quality of education is low due to the lack of organization, expertise, and resources. There is a shortage of school supplies and qualified teachers. This problem is more prevalent in rural areas. Schools may use either outdated curricula or a partially implemented framework from the 1997 National Plan of Education and Training curriculum. Due to the state's lack of institutional strength and capacity to provide basic education to the general Haitian population, the education sector is now predominantly privatized. A 2006 World Bank Study on the private education in Haiti found that 92% of all Haitian schools are privately owned, tuition-based institutions. Due to Haiti's widespread economic hardship, the majority of the nation's population is unable to meet the cost of education. 88% of children aged 6 to 12 are enrolled in school, and less than one-third of those enrolled reach fifth grade. Close to 60% of children drop out of school before receiving their primary education certificate. The 2006 World Bank report notes that "the high dropout rate is generally not reflective of a Haitian disregard for or disinterest in education; rather, it is an unfortunate consequence of limited family resources". In the poorest 20% of households in Haiti, school fees can represent up to 25% of a family's annual household income per child. Of those who were able to progress to secondary education, 75% go to private schools. Students who complete secondary schooling were not automatically eligible to enroll in a university. This is because approximately 90% of the higher education system consists of private universities with high tuition fees, making it unaffordable to the general population. While the average GDP per capita in Haiti is $673, tuition fees can exceed more than $2000 a year for Haitian private universities. There is also a lack of enrollment space among public Haitian universities, which comprise 5% of all institutions of higher learning.Access to healthcare
Serviced by a mixture of the public sector, the private sector, the non-profit sector, and religious institutions, the health system in Haiti faces the challenge of establishing efficient health coordination. This is further compounded by the presence of more than 250 additional implementing partners within the health sector. Coupled with a continuing series of political upheavals that have led to an unending social instability, Haiti's inefficient healthcare framework has crippled the nation's ability to provide good healthcare access to its people. The government has limited ability to provide services, where about 55% of health care is provided by missionaries or other non-governmental organizations. While there are a small number of physicians who operate for-profit clinics, most are found in the larger cities. Additionally, medical services, whether public or private are disproportionately located in the metropolitan Port-au-Prince area. Obstetric facilities also follow a similar trend. Hospitals outside the Port-au-Prince area provide limited obstetric services. In rural areas, prenatal care services are often delivered either by outreach teams or by small clinics that do not have formal maternity wards or delivery capabilities. This physical separation of adequate medical facilitates from parts of rural Haiti makes access to healthcare by those living away from the city difficult. While most medical infrastructures are concentrated within Port-au-Prince, these hospitals and clinical facilities are often in a dilapidated state as they are compromised by infrastructural deficiencies and electrical blackouts. This lack of medical infrastructure was further exacerbated by the 2010 Haiti earthquake. In 2007, 47% of the population lacked access to basic health care, with a majority of the population turning to traditional healers for various forms of treatment. A study on Haiti's prosthetic situation also revealed that less than 25% of all amputees obtain a prosthetic limb.Access to healthcare also includes issues like perceived quality of care. While well-known national maternity hospitals located in Port-au-Prince are either at full capacity or overcapacity, rural maternity beds outside of Port-au-Prince, are under utilized, with utilization rates of about 30 to 35%. However, evidence suggests that pregnant women want competent care. This under-utilization of existing rural services is directly tied to the perceived and actual quality of the facilities. A widespread tendency to avoid government-run public facilities is frequently credited to those institutions' low quality of care, such as a lack of equipment and services, and unfriendly attitude of the medical staff.