JÉRÉMIE, HAITI – Mirlene Jeudi is an expecting mother from Jérémie, a small town in southwestern Haiti. Her due date is only a month away, yet she has not been able to stop working. Her husband died after she became pregnant so she is now a single mother and must save enough to support her children.

“I am eight months pregnant, and I sell fruit in Port-au-Prince,” she says. “Despite the fact that I often feel weak, I have no choice to take the boat from Jérémie to Port-au-Prince to sell fruit and vegetables because that is the only hope I have to make a living.”

Jeudi has worked as a fruit and vegetables vendor for years, though the 2010 earthquake in Port-au-Prince, the capital, forced her to stop for a period. As the country recovered, she resumed her business because she says that it was the only way she knew how to make a living. She planned to stop working as her pregnancy advanced, but then her husband died after having stomach pains and a high fever.

The job requires frequent travel from Jérémie to Port-au-Prince, which is difficult when eight months pregnant. The bus leaves at 6 a.m. from Jérémie and on a good day gets to Port-au-Prince at 3 p.m.

But she says she has no other choice. She has two children and another on the way.

In Haiti, life is difficult for pregnant women. Many pregnant women say they maintain their physically strenuous jobs until their delivery date because they need to support their families. Shortcomings in maternal health care also mean many women don’t receive the medical attention they need during their pregnancies. Public and private initiatives strive to offer free maternal care, but many agree it’s not enough.

The maternal mortality ratio in Haiti dropped from 1,000 maternal deaths per 100,000 live births in 1990 to 670 maternal deaths per 100,000 live births in 2005, according to the Millennium Development Goals Monitor. Still, the country is off track to meet targets to improve maternal health – goal five of the Millennium Development Goals, a U.N. anti-poverty initiative that countries worldwide have agreed to achieve by 2015.

Pregnant women here say that despite carrying a child, they must continue to work as hard as they have always worked, especially in the rural areas of Grand’Anse, one of the 10 departments of Haiti.

Elsi, a pregnant woman who declined to give her last name, works as a vendor at the market in Jérémie, the capital of Grand’Anse. She brought the yams that she is selling here from Marfranc, a village 10 kilometers outside of Jérémie.

“I carry everything I sell in the market on my head, and I have a lot of pain in my abdomen,” she says. “When that happens, I tie a large piece of cloth around my abdomen so I can still come and sell at the market.”

She says her children won’t have food otherwise.

“It is with the little I make here