“Pregnancy is a normal physiological event,” states Goitom Berhane, a health officer in residency at a rural hospital in Ethiopia. “This is not a disease. It is only that society is not organized enough to handle it, to appreciate its risks. It has risks whether it’s in Europe or Africa. Wherever you are, pregnancy is always a challenge.”
An unflinching look at the stark and bloody reality of infant and maternal mortality, the new documentary Sister follows maternal health care workers in Ethiopia, Haiti and Cambodia. Beautifully shot, Sister captures both agonizing and ecstatic moments in birth and delivery. from a woman whose fetus is dead inside of her, to a successful emergency Caesarian operation.
In the U.S., one in 4,800 women die from childbirth-related causes. The statistics in other parts of the world are staggering. In Haiti, one in 48 women will die of childbirth related causes. In Cambodia, one in 44 women will die of childbirth related causes. In Ethiopia, one in 27 women will die of childbirth related causes – that’s 55 every day. Sister is the story behind the statistics, putting a human face on the very real suffering and death of women and infants across the planet.
Madam Bwa, a 65 year old TBA (Traditional Birth Attendant), living in Haiti, started delivering babies when she was 12 years old.
“I have delivered about 12, 000 babies,” she boasts. While she has no formal medical training, she provides the the majority of primary maternal and prenatal health care and education in her community.
“God blessed me to serve the people in this community,” she says, “Mostly to prevent them from dying during delivery.”
“Shada is the most miserable part of the city,” Madam Bwa says as she navigates the narrow alleyways between rickety shelters, “It’s badly built. If you have to transport a sick or pregnant person there are no roads in Shada.”
Lack of access to transportation is one of the most significant hurdles faced by pregnant women.
“Obstructed labour is caused by obstructed roads,” Berhane says. In Ethiopia, 85% of population resides in rural areas, meaning transportation is one of the largest hurdles to tackling maternal mortality rates.
Pum Mach, a supervising midwife at the Tasanh Health Centre in Battambang Province, Cambodia, struggles to find emergency transportation to a hospital for a 19 year old patient who has a transverse pregnancy. The fetus is sideways inside the mother; without a Caesarean, the fetus will surely die and the mother will likely follow. Each week Mach leaves her house on Monday morning to travel to the Health Centre where she will stay all week, returning home on Friday night. Often she is called back to the Centre on weekends for emergencies. The area around her home and the health centre is heavily studded with land mines, making every day travel exceptionally treacherous.
Hirity Belay, one of 1200 Health Extension Workers in Ethiopia, travels from home to home, sometimes up to eight hours on foot to reach her patients. Administering vaccinations, birth control shots and information, Belay builds an intimate trust with her patients.
“We are creating a bond like sisters,” she says.
Without Health Extension Workers, many patients would not receive any prenatal care at all. Workers like Belay provide basic nutrition lessons, working to change the traditional belief that husbands require more and better food than women, even pregnant women. Health Extension Workers also impart basic hygiene information such as washing and air-drying in sunlight any bedding and clothes that will be used during delivery, keeping things clean to prevent bacteria from entering the womb, mean the difference between life and death during a delivery.
Of course the biggest obstacle to maternal health is poverty. Madam Bwa says: “Hunger is always fighting these women. They do not have treated water to drink. They cannot afford to pay for a bucket of water. Meanwhile, they are pregnant.”
In addition to caring for women during pregnancy and delivery, Madam Bwa also holds informational sessions about hygiene, nutrition and contraception. She also advises strongly against having pregnancies close together.
“Even when foreign aid comes to this country,” Madam Bwa asks during her information session, “have you ever received them?”
“They stay at the rich houses,” she says, meaning food, milk, medical supplies that are sent to Haiti by foreign donors, “They share them with their relatives, they never come to share them with you.”
“The sun shouldn’t set twice on a labouring mother, which means she has to get delivered within 24 hours maximum,” Berhane states. “90% of [maternal death] is completely preventable,” Berhane says of the statistics, “so it should be.”
A very difficult and emotional watch, Sister is a crucial documentary and paints a vivid portrait of the desperate need of global aid for maternal health and contraception. The daily courage of community health care workers who face almost insurmountable odds to treat their patients is both moving and motivating.
To learn more about supporting and donating to campaigns for maternal health around the world, visit http://www.sisterdocumentary.