Women need to be heard.  To be heard requires understanding and knowledge.  In this, women in America are very much like their sisters in Bangladesh, Tanzania and Guatemala.

All over the world, women are still dying in childbirth.  A woman dies every single minute.  In the majority of countries it is usually due to the absence of good medical support.  In the USA, a staggering number of women still deliver in the ER without having received any pre-natal care.  There is also a disturbing trend that too much technology and interference is leading to creeping maternal mortality rates in America.  Too much or too little?  Balance through this lens is something entirely different with life and death consequences.

In every instance, the cultural baggage of birth, how women are valued (or not) within their societies and the politics of the day play just as critical a role.

I attended a screening with UN Secretary-General Ban Ki-moon early last week of supermodel Christy Turlington-Burns' new documentary, No Woman, No Cry. The film is a moving examination of birth stories and cultural issues surrounding death in childbirth from Tanzania, Bangladesh, Guatemala and the USA.  Most of these maternal deaths are preventable through good pre-natal care and decent medical access. Introduced by Secretary-General Ban, there were multiple acknowledgements throughout the post film discussion of Ban's championship of this crisis, as the United Nations increases its focus on reducing maternal deaths.  Ms Turlington-Burns', as she presented her film and discussed her motivations and the story-telling experience, spoke determinedly about the work to be done.

Janet, a Tanzanian woman, 9 months pregnant with her third child, walked 5 miles to the nearest clinic, then 5 miles home because she wasn't progressing in her labor and had not brought any food with her.  Hours later, at nightfall, she trudged back again later when labor intensified.  When it became clear Janet needed additional help, the nearest hospital was a horrifically bumpy ride over several miles costing $30 - more than Janet's family earned in a month.  Having delivered four babies, that car ride to the hospital has always been the hardest part - clawing the back of the taxi cab and begging the Manhattan traffic to disappear.  I can only imagine how Janet's body felt as she was lunged from side to side.  She still hadn't eaten, because there was nothing to eat at home or at the clinic.  For a glimpse into the film and Janet's experience, take a minute to watch the No Woman No Cry trailer.

No Woman No Cry Trailer

The solution is vastly more complex than clean facilities and trained medical providers.  The tentacles of change reach out through decent transport, clean water, healthy food.  Janet's lack of food through the final days of her labor reminded me of the intense appetite I have only ever had during pregnancy.  Hunger that was at times insatiable, and shockingly primal.  However, access to trained care would indeed be a formidable start.  When a woman dies, it's not just the emotional heart of a family that is gone, or its primary nurturer.  It is also the end of the one who provides basic survival to a family unit.  Godfrey Mbaruku, MD discusses.

No Woman No Cry: When A Woman Dies

The United States ranks 41 on the list of global maternal morbidity rates.  Australia, where I come from, ranks number 14.  Essentially all of the developed countries have better outcomes, and yet the US spends more than anyone else, anywhere else, on as Ricky Lake put it, the business of being born.  The lack of pre-natal care for the uninsured is a critical factor.  Another important perspective that has shaped my thinking is from Debra Bingham, Doctor of Public Health, RN, and Executive Director of the California Maternal Quality Care Collaborative (CMQCC) as well as Chair of the Lamaze International Institute of Normal Birth.  Debra discusses the social and cultural barriers to women in America to give birth naturally when it is possible.  When viewed in contrast to developing world issues of giving birth with greater medical assistance, it was sadly not shocking to me that both results come from the same place.  The underlying prejudices about women, power and birth are staggeringly similar.

The details of how it plays out in the care versus no care spectrum are obviously vastly different.   As American maternal deaths in childbirth increase, over-stepping to control mother nature is possibly exacting an ever increasing price of women who bleed to death on the birthing bed.  I wouldn't be here without the gift of C-sections and am a grateful recipient of (mostly) stellar obstetrical and midwifery care.  The risk as we over use and perhaps more profoundly, teach women to disengage with their bodies and instincts, is that we leave women powerless and without understanding of their bodies and their power.  In one of my first blog posts, I explore this thought through the birth story of my third child.

There are others vastly more qualified and knowledgeable than I on these issues and I am not for one second suggesting we walk away from skilled midwife and obstetrical care; the absolute opposite.  I am suggesting that women need to be heard.  To be heard requires understanding and knowledge.  In this, women in America are very much like their sisters in Bangladesh, Tanzania and Guatemala.

Turlington embraces the loaded cultural issues and shows her viewers that the medical profession is not the sole solution provider.  At one point, as we watch a woman in Bangladesh live through an indescribably awful night in the hospital, Turlington realizes going to the doctor may not be seen as an improvement.  The magnitude of the problem can be heard in her voice.

I write about negotiation skills as a key tool in living a life that is rich and yes, balanced in the ways that honor and reflect what is important to you.  For too many women, the opportunity to have a crisis of balance is remote.  They want to live through bearing their children first.  I believe in the power of the individual to change their own lives and those around them.  I also firmly believe in the power of public outcry and its knock-on effect to public policy.  The two have to go hand in hand.  To change an individual, a family, a company, a country.  To change a culture.  To change the world.

Movements to raise awareness and improve access to maternal and child healthcare are changing the lives of mothers and the livelihoods of their communities.  Get imvolved:

The UN Foundation, who invited me to this event, is harnessing the power and reach of American girls to try and tackle this problem.  Their GirlUp Campaign www.girlup.org is altering the dialogue about who needs to be at the heart of this discussion and is inspiring and uniting girls around these issues.  Engaging girls to fight for the future of mothers is deeply powerful and I am inspired by their work.

You can learn more about Christy Turlington-Burns' film and work to end preventable maternal morbidity here at www.everymothercounts.org. Take some time on the site to really look around and understand what can be done and how you can help.

This post is cross-posted from WORK. LIFE. BALANCE.