Every two minutes, a woman dies from complications of pregnancy and childbirth — 99% of them in the world’s poorest countries. Three photographers give those women a voice and capture the importance of the work of international aid projects that work hard to prevent these human tragedies.
In Malawi, the words for pregnancy in the local language — ‘pakati’ and ‘matenda’ — translate into ‘between life and death’ and ‘sick’. Every year in Sub-Saharan Africa, approximately 200,000 mothers die from complications of pregnancy and childbirth — a human tragedy affecting families and communities. Italian photographer and videographer Paolo Patruno documents maternal health in Sub-Saharan Africa in often very intimate photographs.
In his powerful black and white photographs, B.D. Colen, an American Pulitzer Prize-winning reporter and photographer, reports on the important work of the NGO Midwives For Haiti, working in the poorest country in the western hemisphere. Colen believes that by bringing health care to pregnant women and infants, Midwives For Haiti and similar groups are saving one life at a time, the most effective way to improve life in Haiti.
Somalia is not only one of the most dangerous countries in the world to live, but it is also rated the worst place globally to be an expectant mother. New Zealand photographer Nikki Denholm has spent over 20 years photographing in some of the world’s darkest corners to tell the stories of the voiceless. In her moving and confronting photographs, she documents the impact of the famine and maternal health conditions in some of northern Somalia’s IDP camps, clinics and hospitals.
A positively joyful experience is what comes to mind when we think of motherhood. However, for far too many women, motherhood is associated with ill-health, suffering, and even death. Every two minutes, a woman somewhere around the globe dies from pregnancy or childbirth-related complications. That’s 830 women every day. And, according to the World Health Organization (WHO), 99 percent of all maternal deaths occur in developing countries. The direct causes of maternal deaths include severe bleeding, infections such as sepsis and eclampsia (high blood pressure) and complications from delivery or unsafe abortions. The majority of these complications are preventable by offering adequate maternity care during pregnancy, while giving birth and during follow up visits after birth.
Women’s lives at high risk in developing countries
Women who live in remote rural areas and in poor communities have a higher risk of death, as they are least likely to receive adequate health care. According to the United Nations, while all women in developed countries are attended to by skilled health workers, only around 40 percent of pregnant women in developing countries have the recommended antenatal care, which means that millions of births are not assisted.
This not only reflects the gap between rich and poor, but also highlights the main problems that prevent women in developing countries from receiving proper care during pregnancy and childcare: poverty, inadequate access to health services, distance from medical services, lack of information and cultural factors. Additionally, women in developing countries have, on average, many more pregnancies than women in developed countries, and as a result, their lifetime risk of death due to pregnancy is higher.
In Sub-Saharan Africa, more than half of all births take place without the support of a skilled birth attendant. “In Ethiopia, for example, 90 percent of women deliver their babies without the help of any trained health professional,” UNICEF writes in an article on maternal and newborn health.
Every year, approximately 200,000 women die as the result of pregnancy and child birth-related complications in Sub-Saharan Africa and account for 66 percent of all maternal deaths worldwide according to the international organization Amref Health Africa. The UNICEF article concludes “[…] high fertility rates combined with inadequate access to quality antenatal care and skilled attendance at birth substantially elevate the risk of death in this region.” Additionally, HIV and AIDS epidemics are one of the greatest challenges to maternal and newborn health in Sub-Saharan Africa.
In the Western Hemisphere, Haiti is the most dangerous country to give birth. According to the United Nations Population Fund (UNFPA), a woman in Haiti has a 1 in 80 chance of death due to pregnancy or child birth, compared to the region-wide risk of 1 in 510.
“A lack of infrastructure, no waste removal, limited access to clean water and basic health care services, frequent natural disasters and cultural barriers make it very challenging to deliver proper care to women, especially in rural areas of Haiti,” explains Nadene Brunk, CEO and founder of Midwives For Haiti, a non-profit organization that trains skilled birth attendants and educates and empowers people to improve health in their communities. The organization offers a mobile clinic to provide prenatal care in remote areas and distributes clean birth kits to traditional birth attendants.
“In Haiti, only 25 percent of mothers have access to skilled birth attendants during childbirth and 75 percent deliver in rural areas, often with the help of traditional Haitian midwives that lack medical knowledge and equipment,” Brunk says. “Our mission is not only to increase access to skilled birth attendants, but also to increase access to care and skilled training. Training Haitian nurses to become skilled birth attendants is critical to reduce maternal and infant mortality.”
Beside the importance of ensuring that all pregnant women receive proper care in order to avoid maternal deaths, women need to have access to contraception, safe abortion services and post-abortion care, so they don’t find unsafe methods to prevent and terminate their pregnancies. However, since taking office in January, U.S. President Donald Trump has reinstated the global gag rule which prohibits the use of U.S. aid money for abortions, prevents NGOs that receive U.S. funding from using private funds for abortion services or even referring women to groups that provide abortions or even offering information on abortion services. As a result, regular access to contraceptives will become more difficult and many organizations now fear that the number of unwanted pregnancies will increase and lead to more unsafe abortions and women dying from unsafe practices and complications.
A global issue calls for global initiatives
Unsafe maternal health is not only an issue limited to the countries of Haiti and Sub-Saharan Africa — it is a global issue in developing countries. Although the maternal mortality rate worldwide has fallen by nearly 50 percent between 1990 and 2015, and more than 71 percent of births were assisted by skilled health professionals globally in 2014 (compared to 59 percent in 1990), there is still a long journey ahead for many countries.
As a follow-up to the UN’s Millennium Development Goals’ agenda — that had maternal health as one of its top priorities — the 2030 Agenda for Sustainable Development was launched. It calls on countries to begin efforts to achieve 17 sustainable development goals by 2030, among them reducing the global maternal mortality rate to less than 70 per 100,000 live births. Furthermore, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) was launched by former UN Secretary-General Ban Ki-moon. This initiative is a roadmap for the post-2015 agenda with the aim to end all preventable deaths of women, children and adolescents, as described by the Sustainable Development Goals. It is also a call to action for all countries and all people to help end the tragedy of mothers dying during what should be the most joyful experience in their lives.
For more information
Amref Health Africa
Midwives For Haiti
United Nations Children’s Fund
United Nations Population Fund
World Health Organization
ZEKE is published by Social Documentary Network (SDN), an organization promoting visual storytelling about global themes. Started as a website in 2008, today SDN works with more than 1,500 photographers from around around the world to tell important stories through the visual medium of photography and multimedia. Since 2008, SDN has featured more than 2,000 exhibits on its website and has had gallery exhibitions in major cities around the world. All the work featured in ZEKE first appeared on the SDN website, www.socialdocumentary.net.
Spring 2017 Vol. 3/No. 1
Executive Editor: Glenn Ruga
Editor: Barbara Ayotte
Interns: Kelly Kollias, Laney Ruckstuhl
Social Documentary Network Advisory Committee
Barbara Ayotte, Medford, MA
Senior Director of Strategic Communications
Management Sciences for Health
Lori Grinker, New York, NY
Independent Photographer and Educator
Steve Horn, Lopez Island, WA
Ed Kashi, Montclair, NJ
Member of VII photo agency
Photographer, Filmmaker, Educator
Reza, Paris, France
Photographer and Humanist
Jeffrey D. Smith, New York NY
Contact Press Images
Molly Roberts, Washington, DC
Senior Photography Editor
Steve Walker, New York, NY
Consultant and educator
Frank Ward, Williamsburg, MA
Photographer and Educator
ZEKE is published twice a year by Social Documentary Network
Copyright © 2017
Social Documentary Network
Print ISSN 2381-1390
Digital ISSN: Forthcoming
ZEKE does not accept unsolicited submissions. To be considered for publication in ZEKE, submit your work to the SDN website either as a standard exhibit or a submission to a Call for Entries. Contributing photographers can choose to pay a fee for their work to be exhibited on SDN for a year or they can choose a free trial. Free trials have the same opportunity to be published in ZEKE as paid exhibits.
Photographers and writers featured in this issue of ZEKE
Anna Akage-Kyslytska, Ukraine
Azad Amin, Iran
Sarah Blesener, United States
Emma Brown, United States
Caterina Clerici, United States and Italy
B.D. Colen, Canada
Nikki Denholm, New Zealand
Ariz Ghaderi, Iran
Saeed Kiaee, Iran
Kelly Kollias, United States
Mehdi Nazeri, Iran
Paolo Patruno, Italy
Laney Ruckstuhl, United States
Anne Sahler, Germany and Japan
Sadegh Souri, Iran
Frank Ward, United States
Cover photo by Mehdi Nazeri from Poverty in Wealth. Bandar Abbas, Iran.