— A motorbike kicked up dirt as its teenage driver rushed up to a clinic in this town just across the border from Haiti. His passenger, a pregnant woman wearing spandex pants and a pink scarf around her head, struggled to get off.

“I’m bleeding,” she said.

The woman has no immigration papers, like thousands of pregnant Haitian women who come to the Dominican Republic for medical care. But the armed Dominican soldiers guarding the gate dividing the two countries let most of them through.

Haitian women make up roughly half of the patients giving birth in Dominican hospitals, officials here say. They come because they don’t have access to health care in Haiti, especially since last year’s earthquake. They come because they can get free health care in the Dominican Republic each year, and so that they can have their babies in hospitals instead of on the floors of their homes.

In Haiti, 27 of every 1,000 newborns in 2009 died, according to the latest numbers from UNICEF, nearly seven times the U.S. rate. For the mothers, the situation is even worse. The lifetime odds of a woman dying while giving birth in Haiti are one in 93. The rate in the United States is 1 in 2,100.

And those were the numbers before the January 2010 earthquake, which killed more than 300,000 people, injured and displaced hundreds of thousands more and collapsed the impoverished country’s infrastructure.

Overwhelming the system

Across the country, on their half of Hispaniola island, Dominican hospitals and clinics are being overwhelmed by Haitian women.

“The border is imaginary. It’s just a door,” said Jose Delancer, director of the Dominican Ministry of Health with the Department of Women and Children. “It’s a problem of poverty; it’s a problem of education; it’s a problem of empowering of women.”

It is also a problem of access. In the Dominican Republic, health care is provided free of charge whether the individual has documentation or not.

Joaquin Recio, vice director of nursing at Hospital General Melenciano, the public hospital in Jimani, said doctors and hospital administrators widely support the policy.

“If God has given you this gift to give service to others — this special service, of health — then you have to give it with quality, warmly, with love to whomever, no matter their creed or race, their color, it does not matter,” he said. “You have to give service to the person. This is what is important.”

But that comes up against a harsh reality: The Dominican health-care system is designed to care for about 7 million people, Delancer said. The Dominican Republic has a population of nearly 10 million, and more than a million of them are Haitians, with more coming every day.

Delancer worries about those numbers: “How many of them are in reproductive age?” he asked. “How many of them need health care?”

A place for women

Camila Perozo treated patients for four years in Haiti before she and her husband spent their life savings building the health clinic in Jimani, a town of more than 14,000 about an hour’s drive east of Port-au-Prince, the Haitian capital.

“I picked this area because it is too poor,” the Dominican-educated doctor said. “There are other border crossings. But this is the one that takes people directly from the capital.”

Her patients are often in dire condition, the victims of malnourishment, anemia, septicemia and poverty. Few have had prenatal care before coming to the clinic.

Other women arrive on the backs of motorbikes at the Jimani public hospital, often in the throes of labor.

“Here we call them ‘time bombs,’ ” said hospital director Francis Moquete.

Of the 40 or so deliveries performed at his hospital each month, about 30 are Haitian births, Moquete said. At least four come without any previous medical care, he said.

“This is what most worries us when they come like this — suddenly, with nothing, absolutely nothing,” he said.

At the Jimani public hospital, which is a few minutes’ walk from Perozo’s clinic, two women wearing street clothes rested on small cots. A nurse injected a clear liquid into their IVs. Next to each woman lies a baby, both just hours old and neither named.

“They are illegal,” Moquete said of the women.

By that afternoon, the women are gone and their beds stripped clean.

“One wants to go where there is better service,” Moquete said. “So they come here, this is where they want to come.”

This story was produced as part of the Borderlands Initiative at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.