25 Weeks: No Woman No Cry

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Continuing on the documentary tour!

The Business of Being Born

Pregnant In America

My friend Hillary brought over No Woman No Cry this week as a very ironic and extreme contrast to Pregnant In America. Unlike the latter, No Woman No Cry follows the stories of four high-risk pregnancies in four parts of the world and how women’s lack of access to healthcare puts them in danger – including death.

The film was directed by supermodel Christy Turlington Burns who herself experienced hemorrhaging shortly after giving birth to her daughter. Burns shares that she was lucky to be surrounded by a medical team at the time, but wondered what would have happened if she had been somewhere remote.

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Janet

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For me, the most moving story was the first one told of Janet, who lives in Tanzania where 1 in 22 women die in childbirth (many from preventable causes). Janet lives in a remote village where the closest midwife clinic is 5 miles away. At 40 weeks pregnant, she walks 5 miles to the clinic and is told that although she is experiencing contractions, she must return home because she is not dilating yet and the clinic needs beds for other patients. Janet then walks all.the.way.back. That’s 10 miles in 2 days. A few days later, she does the walk again – this time in more active labor. While at the clinic, it is determined that because her labor isn’t progressing, she needs to go to the hospital, which is an hour (bumpy bus ride) away. It also costs $30 – a monthly salary for Janet’s family. Her husband doesn’t get involved in the story until she leaves for the hospital, and it is mentioned several times that she doesn’t have any food or money.

Janet’s story just breaks my heart. I can’t even imagine the fear she must have experienced as she makes the trek through the wilderness, much less in pain, worrying about her baby and perhaps her own health and life. It frustrated me that I couldn’t just reach into the screen and share with her some of the things that I have – food, a bike, a car, a comfortable bed. I also can’t imagine how she managed without food or water on her journey. She may have had snacks that we didn’t see, but it didn’t seem likely. For Janet, survival was all that mattered. She was one brave woman. It surely makes me feel a bit different towards birthing in a cozy hospital room surrounded by healthcare professionals. And health insurance. And Pandora playing spa sounds. What luxury.

Even less major parts of pregnancy – like morning sickness – could be a huge complication for someone so isolated from medical care. I am so thankful there was a medicine that could help me take the edge off of my nausea, but what if there hadn’t been? I probably would not have eaten for a month and a half. When severe morning sickness hits these women and there isn’t much food around in the first place, they are really in danger of starvation.

Guatemala + The United States

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In Guatemala, abortion is illegal, even for rape and incest. The film follows the story of one woman who had been hemorrhaging for THREE DAYS before going to the hospital. Once there, the doctors discovered perforations to her fallopian tubes (that would be plural) that were likely caused by a home abortion. Even on the verge of death, the woman was reluctant to admit how this happened.

I can’t even imagine sticking something inside of me to do that kind of damage. But if you think about how horrible the pain must be, remember the women are choosing this option instead of having the child – which – in their eyes, in the context of their lives – must be worse. In these impoverished situations, women don’t necessarily have birth control pills that fail or perhaps even the power to say no to their husbands. Either choice has life-changing consequences.

One of the issues brought up in the movie is what would happen in any country if abortion was illegalized. Last year, 92 anti-choice measures were passed into law across the United States. [Source] If our country turns away from a pro-choice climate, would women will start making dangerous medical decisions to take matters into their own hands like the Guatemalan woman did? It’s easy to suggest they just have the baby and give it up for adoption, but that choice is much more complicated than it sounds. Every situation has unique circumstances. A sticky debate, for sure.

The film also interviewed a clinic that assists women who don’t have health insurance. The cost of a doctor (hospital not included) is $2-4,000, and hospital births can run upwards of $20,000. Sure some of these women could have midwife homebirths in their houses, but what about the ones with complications? Where do they turn? The film states that one in five women in this country has no health insurance. I remember a few years ago when I first got private insurance when I went back to school and I realized it did not include a lick of maternity care (which was sold a la carte). While we didn’t have plans to get pregnant, unplanned pregnancies do happen with all forms of birth control. Imagine if you did get pregnant without insurance and then had a very high risk birth – like triplets that required a c-section. The cost to those who already have little is more than overwhelming. Unfortunately, when faced with the high medical bills, women without insurance are often just not getting the prenatal care they need, which puts both their babies and themselves at risk for serious health situations.

Bangladesh

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The final story was that of Monica, a woman living in a slum in Bangladesh. She shared sentiments that she was embarrassed to go to a hospital and that most women hid in their homes to hopefully have a quick and quiet labor. She also had experienced three years of infertility that was an embarrassment to both her and her husband in their culture. Shame is put on the woman if conception doesn’t happen, and she said her husband might have left her to pursue a more fertile woman (even though it could have been a problem on his end!) When Monica does go into labor, she chooses not to call the midwife support team that is there to assist women who don’t have any medical help. After some scary bleeding, she ends up going to the hospital, at 2am, after hailing down some kind of taxi in the middle of the night. Like Janet’s story, it’s easy to forget that if you live in a slum you probably don’t have a phone to call 911, a car to drive you there or money for a cab. All major barriers to simply get from one place to another. Monica does have a healthy baby and the next day she is back at home carrying on. I couldn’t help but wonder about post-partum practices – was she wearing a “pad” of sorts? Did she tear and have stitches or was the tear expected to heal on its own? Did she have the means to properly treat herself to heal? My guess… probably not.

Missing Pieces

While I understand that the purpose of this film was to show high-risk pregnancies, I wish there had been some attention given to normal births and how they are handled within each culture. I was surprised that Janet’s village didn’t have a woman experienced in childbirth to help her. Maybe it did and Janet just knew her complications went beyond that of the woman’s capabilities. Maybe the village was just too small. My impression of how womankind has handled childbirth throughout the ages is that sisters, mothers and midwives all came to help a woman in labor, but it seemed that Janet was all alone. I had lots of questions about her circumstances that went unanswered – and about births that weren’t in medical trouble.

At the end of the film, they touched on a clinic (I think in Peru) that had a very high maternal mortality rate that had been cut in half thanks to some new practices and education. I would have liked to hear more in the end of the film about education and change and what has worked to help reduce complications and mortality. The film does shadow a doctor, Linda Valencia, MD, who works for Planned Parenthood Guatemala and is working hard to make changes in her country.

I really enjoyed this film as a contrasting perspective to the home birth movement in the US. While I don’t think there’s anything wrong with homebirths, nor do I think our hospital system is anywhere near ideal, it’s still an ironic situation. Childbirth is very normal and natural – except when it’s not.

Read more at Everymothercounts.org.

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