May 28, 2015


Source: Chime Original

BY Paolo Patruno

I first measured the catastrophic state of maternal health in Sub Saharan Africa when I was working as a social documentary filmmaker in Malawi. It is an English midwife who talked me through the many layers of maternal health issues in Africa from Bwaila Hospital where she worked. The complexity of the matter became more and more familiar to me as we spoke and I decided to document pregnancy and childbirth in sub-Saharan Africa in the long-term. Documenting maternal health in Africa may be one of the most challenging assignment for a male photographer: I’m a man, a white man, a white man with a camera hoping to document this most intimate and private moment in a woman’s life: birth.

But I went to Cameroon, the Democratic Republic of Congo, Ethiopia, Malawi, Mozambique, Uganda and Zimbabwe. I visited hospitals and health centers in rural areas, checking on the facilities or lack thereof. I saw the nurses and midwives working around the clock to save the lives of mothers and children alike. I also visited women in remote villages who had chosen to deliver at home with a birth attendant. I spent hours talking to them. And sometimes when women didn’t speak English, I was able to establish an intimate friendly relationship just through a smile, just sitting close to them and letting them feel how much I cared.

Every day, about 800 women die due to complications in pregnancy and childbirth. Almost 60% of the daily maternal deaths occur in sub-Saharan Africa. I tried to put this in perspective:
After nearly four years of civil war in Syria the casualties have risen to 210,060, according to the Syrian Observatory for Human Rights.
Meanwhile, every year, almost 300,000 women die in childbirth in Sub-Saharan Africa.
Sadly, very few media, both print and broadcast, talk about this tragedy.
But silence is another killer, as most of us remain oblivious to the maternal mortality issue.

The lack of equipment or the shortage of skilled professionals are only the tip of the iceberg leading to birth complications and deaths. Cultural and traditional behaviors have a great influence in the decision-making process when it comes to women. The community may impose home birth in the villages because hospitals are far and women can stay away from home for up to 3 weeks when they often have other children to attend.
Another major factor, yet a paradoxical one, is that women may fear the way they expect to be treated at hospitals. They know not to expect privacy as mothers give birth in overcrowded labor wards. Women may find themselves stark naked attended by male staff, while nurses shout at them for being too loud.

Home birth, on the opposite, provides an intimate atmosphere appealing to young mothers despite the risks involved.
In Uganda, among the patients of a traditional birth attendant, I even met a professional midwife who preferred to deliver at home, rather than in the hospital, albeit with the support of her colleagues’ midwives and doctors.

In total, I have been travelling through Africa for more than ten years, I have had the time to measure how crucial women are to the well being of each family, every community and for African society as a whole. They are the feeders, the providers of education and homecare. Women are the hidden pillars of the continent on which rest entire communities. They are the micro fabric of Africa displaying the emotional wisdom that holds these societies together.

When in DRC I asked an NGO focused on women’s issues the reason why they didn’t have projects to support maternal health? “Because women give birth everyday” she said. Too complicated, too expensive.
But the death of a single mother severely affects families and communities and makes it harder for a family to meet their needs and escape the crush of poverty.

I’ve been quite shocked when I learned that in Malawi, where I started my project, the words for pregnancy are – ‘pakati’ and ‘matenda’ – translating into “between life and death” and “sick”.
In Uganda, I met a woman, Elisabeth, who told me: “There isn’t any pregnancy that could be the same as the other, but is only God who is upon us. It’s only God who helps us to deliver”.
I think these words explain best how most African women experience their pregnancies: with a deep fatalism, as after all, chances are great that you may experience unsafe delivery which can possibly kill you and your baby. I have been stricken by the lack of joy, happiness and hope for these mothers to be.

And this year, I’ve decided to expand my project outside Africa, to document and bring more attention to the maternal health crisis in the United States: America has the highest maternal mortality rate of any industrialized country in the world.
While other countries, both developed and developing, have reduced their maternal mortality ratios, for the past 25 years the US is experiencing an unprecedented rise in the numbers of women lost during pregnancy, birth or postpartum. To connect with my work in Africa, I’ve decided to start documenting stories from African-American women in the USA; they are nearly 4 times more likely to die of pregnancy-related complications than white women.

I found a strong connection between Africa and the US for women of color: they are less likely to go into pregnancy in good health because of a lack of access to primary health care services; they are also less likely to have access to adequate maternal health care services. And there are considerable racial disparities: the maternal death rate is 42.8 per 100,000 live births for black women, compared with 12.5 for white women and 17.3 rate for women of all other races.

While media attention is now directed to the violence that surrounds black males lives in the US, it is crucial to remember that black women are by far the largest demographic to suffer these outcomes, it has been this way for decades and yet they are seldom able to make their voices heard. Through my documentary “The AMERICAN dream” I wish to give women the opportunity to tell their own stories: they know what is wrong, they share their hopes, they share their fears, and they share what American dream means to them.
(Paolo’s work has been entirely self-financed he is looking for partners and funders to help him pursue his important awareness raising work)