Design and Sampling

From June to August 2017, a chain referral sampling study was conducted in Port-Au-Prince and the surrounding metropolitan area. Participants were community leaders, non-separated, and separated mothers. The research employed both quantitative and qualitative methods to allow mothers and community leaders to share their understandings of maternal-child separation and to understand the context in which such crucial decisions are made.

We conducted semi-structured interviews surrounding perceived factors contributing to maternal-child separation and maternal stress in order to capture the experiences of mothers (Table ​(Table1)1) and community leaders (Table ​(Table2)2) living in the Port-Au-Prince metropolitan area. Qualitative information was collected in face-to-face semi-structured interviews conducted via interpreter, Sarah Adolphe (Pan-American Health Organization). Additionally, in mother participants, quantitative methods utilized validated surveys including the PCL-C for PTSD screening, PHQ-9 for depression screening, maternal postpartum quality of life (MAPP-QOL) survey, and demographic information all captured using REDCap (Research Electronic Data Capture) database, hosted at Icahn School of Medicine at Mount Sinai, on a tablet provided to mothers [6]. All surveys were provided in Kreyol only after the option to complete the surveys verbally with the interpreter was offered.

Mother interview questions.

Community leader interview questions.

This study employed the “snowballing/chain referral” method for identifying participants which is particularly appropriate for studies that touch on sensitive and stigmatized topics such as maternal-child separation [7]. Each interview was concluded by asking the participant for recommendations of community leaders who had experience with or exposure to maternal-child separation, as well as mothers who had and had not separated from a child. Community leader sampling ceased when responses became saturated, i.e. the same individuals were being referred by each interviewee. We worked with local Haitian directors of HaitiChildren to aid our search and referral process.