Monday, March 14, 2011

No woman, no cry.

Last night I went with a girlfriend to watch Christy Turlington-Burns' debut movie "No woman, No cry".

Turlington Burns, an ex US supermodel, has turned her hand to directing and researching this docu-film about the risks of women in four countries around the world that herald the titles of one of the most likely places to die during pregnancy, labour or postnatally.

The film, understandably, is shocking as Turlington Burns takes us to Bangladesh to meet with Monica who lives in the slums and is pregnant with her second child, Tanzania, to meet with Janet, a Masaai mother of two, expecting her third who has to walk five miles in labour to her nearest clinic. We also meet with David, a US father, who lost his beloved wife to a rare amniotic fluid embolism after the birth of their second child and finally we meet with Linda, a pregnant doctor in Guatemala working with women who are post abortion (a procedure that is illegal and outlawed in Guatemala).

We are greeted with statistics and raw and blunt conditions in which these women live and give birth. Janet, lives in a country with a maternal mortality rate of 1 in 24. As I've already said, she walks five miles in labour to attempt to give birth at the clinic. She is met there by a trained midwife, which, for many women in Tanzania is already a luxury that they are not going to get, but needs transferring to Mt. Meru Hospital which is a 30 minute car ride away. And there's the rub. We, in the UK, would get a tranfer in an ambulance to our hospital, paid for by the NHS, Janet however, doesn't have the money and cannot get the money. In fact, Turlington Burns and her crew step in and pay the $30USD that is required to get Janet to the hospital where she is induced and finally gives birth to her son. What Turlington Burns omits to tell us is how Janet then paid the hospital fees, the fees for the drugs and the fee for the doctor who would have delivered her child.

Having recently watched The toughest place to be a midwife I had already witnessed one woman's desperation at finding a way of paying for her maternity care by trying to trade a couple of her children in exchange. Whereas we may sit on our comfy sofas and think - "I could never do that", in this mother's situation, there was no other solution but to reduce the size of her family in order to enable the others to continue to eat and be educated - oh, did I mention that too? Education - the free stuff we gripe about here - you have to pay for that too!

Moving across the continents to Bangladesh now. We are in a Bangladeshi slum with Monica and her son. Her husband works in the country so he is not with them. What Turlington Burns conveyed here, whether intentionally or not, was just how little worth women have in Bangladesh, moreso if you are uneducated, even more so if you are poor. There is a caste system as well as a gender system and socio economic system. Monica was the lowest of the low. She was not only spurned by those in authoritarian positions, but also by her own people until she managed to fall pregnant a second time. Even then, because home birth is seen as the norm, there is a massive cultural boundary that would need to be crossed should Monica need to go to the hospital to have her child.
Monica didn't know the date of her last period and was questioned about this by the government funded health worker that came to the slum to occasionally assess how she was doing. The health worker, a female herself, would talk down to Monica, berating her for not wanting to go to the clinic or hospital to have her baby. You were left wanting to slap this woman for her condescending attitude, however, when finally, Monica consents to going to the hospital for an ultrasound to date her pregnancy, the immediate reason as to the health worker's disdain is crystal. The radiologist/doctor (wasn't made clear), spent several minutes hounding the health worker and patronising her for not knowing Monica's due date. "Who has worked out this woman's last period?" "When was her last period?" "It is up to you to find out her due date" - or words to that effect!
Of course - monkey see, monkey do - the hierachy of power is in full swing. All this while, we see Monica lying silent, passive on the bed whilst decisions and conversations about her are going on without anyone asking her input at all. She is a woman, she is poor, she is worthless.
On Monica's birth-day, she eventually does end up going back to the hospital as she is having some bleeding, but she initially does call an untrained birth attendant. They have to go under the cover of night so that she can be back in the morning with no one knowing that she went to the hospital. For this, she is scolded by the health worker who seems to lack the understanding that had she been more open about where she birthed, she risked isolation from all of her family and friends.

In the US we meet David, a father of two. Yes, David lives in the Western world, in the United States where the maternal mortality is 1 in 4,800! That's still a terribly high statistic for a country that prides itself on obstetric care, in a country where c-sections are at around 35 - 40% and the majority of births take place under the auspicious of an OB/GYN and midwives are few and far between. David's wife died a few days after childbirth from an amniotic fluid embolism. This is a rare pregnancy related complication that is not understood fully at all. On my own research it appears that it could be caused by fetal cells, debris, hair entering the mother's blood stream and causing a severe allergic reaction. In the film, Turlington Burns talks about there being just one man in the US who is researching into this and his funding is running out.
On my own research, however, I have found out that this particular complication is one of the leading causes of maternal mortality. There is no specific research that seems to have been done on this, but estimates range from deaths in 86% of cases dropping to around 36% of cases. However, what I am struggling to get my head around is that the money for funding research for this just doesn't seem to be there. In fact, the deeper you delve, the more you realise that reseach into pregnancy complications struggles to get funding at all. Why? Because, sceptically (and this was reiterated to me by a midwife I once chatted to) why spend the money reseaching a condition that women, hypothetically, only run the risk of getting during such a short span of their lives ie: 9 months. If your jaw has hit the ground now, then you might want to pick it up.

To me, this is where the point is totally missed. Birth is a factor of Life. Without birth, we would not be able to continue as a race. Of course, no one is saying that the money shouldn't be put into Cancer research or HIV research, but surely there should be more emphasis on researching these rare, but real conditions that cost 1 in 4800 women their lives in the US, or 1 in 8200 in the UK?
Interestingly, it is made very clear in the documentary about the importance of women like Janet in her tribe. Were she to die, all the family would struggle. The women are the birthers, they bring up the children, they run the home, they work the land. To lose a woman in a Masaai tribe, would be a huge tragedy. Maybe we should value all women then same?

Ina May Gaskin works hard to campaign for this in the USA if you are interested in finding out more.

Finally we are taken to Guatemala, the country of the four with the highest Maternal mortality rate standing at 1 in 71 (not the highest I found, however, that can be found back in Africa, where, in Niger, a woman runs a 1 in 7 chance of dying in childbirth...I have no words!)

Returning to Guatemala, we are told how abortion is illegal even if it is as a cause of rape or incest etc. So, I am eager to find out if the figures we're quoted actually include the cases of girls and women who die as a cause of botched backstreet abortions?

In Guatemala we meet Linda. Linda is an educated woman, she is a doctor. The divide is immediately obvious as we chat with Linda in her lovely home. However, Linda has worked hard for this with the opportunities she has been fortunate enough to have been given and she now gives back to her country by providing a service of care to women who are post abortion and also by supplying contraceptives and advice to other mothers.

We are introduced to a woman who has been very sick and has obviously tried to induce abortion at home, she is suffering from sceptacemia. The word "abortion" is not used however and all the while it is classified as a miscarriage as otherwise, the woman would be in serious trouble. What is briefly skirted over however, is the fact the woman was there due to being raped and no one seemed to bat an eyelid. Of course, Turlington Burns only has 60 minutes in which to fit all these issues into her film, but we are left wondering how much maternal death could also be reduced if women were respected, loved, nurtured and, more practically, if contraception were available to them; if there was not the high incidences of domestic violence, if women weren't raped or abused, if women were allowed to have a say as to how many children they want or how they want to have their children.

All in all, this film left me with a huge amount of questions and emotions that I'm slowly processing. 

Coincedentally, a wonderful, wise friend of mine, recommended "Half the Sky" to me last week after I was corresponding with her as to my elective placement in my third year. She advised me to read this book before I made any decisions as to where to go.

Not that being a student midwife will change the world in any shape or form, particularly a fortunate, middle class, Western student midwife, but being a woman and a mother might.

As Turlington Burns states on her website, of the 15% of births that become complicated by a potentially fatal condition, nearly all are treatable if there is a skilled birth attendant who recognises this and can act accordingly.

If I have one thing I need to do in the next 10 years alongside becoming a midwife, it's to ensure that my children know that this stuff goes on in the world and that they are a part of the circle of life and despite their privileges, they are able to spread the word in some shape or form that woman are amazing, women are strong and birth is the foundation of life, so we need to protect women from dying in childbirth unecessarily.

How you can help:

Support the cause here

Instead of giving your friend who has everything, another dust catcher for their birthday/Christmas present, why not send them the gift of goodwill and fund the training of a midwife: here in the US

Watch the film, read the book, spread the word.

Educate your own children.

Write to Andrew Lansley, encourage him to keep up the money for training our own midwives and preserving the NHS so we maintain our access to free healthcare.

Write to Bill Gates - he supports health and education around the world. he has injected money into various projects via the Bill and Melinda Gates Foundation. By heck, if the world's richest man was on board - I think there'd be many others who would follow suite. Just send him a copy of the movie ;-)

Finally, download this fact sheet, read it, watch the movie and feel empowered to do something, donate, raise funds, write a letter, have a movie screening, become a midwife, train a TBA, work with or for Oxfam, the list goes on. We may all be insignificant little dots, but together, we are an almighty roar!

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