No Woman No Cry

College of Western Idaho

“No Woman No Cry”

At Risk Pregnancy Outcomes

Simon Skovgard

English 102- 012W

Jewkes

15 April 2013

The film addresses the risk factors that can reduce fetal mortality and morbidity in the world. Identifying the risk and eliminating them will improve maternal health care and promote greater pregnancy outcomes. Statistical data from around the world and research in four countries was utilized in the film making. The plot, setting and characters lend credibility and gain support for this cause. The statement of this film is that at least ninety percent of maternal deaths are preventable through proper prenatal care and assisted deliveries.

Reducing maternal and infant morbidity and mortality and improving pregnancy outcomes throughout the world is a concern of physicians, patients and humanitarians globally.  The incidence of maternal disease and fetal and maternal death has increased to alarming numbers.

I continued to think about those women I had met—young mothers who had so much to fear. As a result, I was inspired to learn more about maternal health in other impoverished parts of the world and was horrified by the tragic statistics I found. So I decided to begin a film to highlight what is being done and what more could be taken on, giving viewers an informative and powerful look at this compelling global issue without having to leave their ZIP code. (No Woman No Cry)

 For many at risk women, pregnancy is a death sentence. One thousand women die each day from complications during pregnancy or childbirth and nearly all maternal deaths and disabilities can be prevented by identifying and eliminating risk factors and providing prenatal care. Christy Turlington Burns shares the stories of four at risk women in different parts of the world through her film No Woman No Cry. This film depicts the struggle of four women, one from a slum of Bangladesh, one from a remote tribe in Tanzania, one from a post-abortion care ward in Guatemala, and a the final woman from a prenatal clinic in the United States.  Through the lives and heartaches of these characters, the film tells a gripping story of the number of preventable deaths across the globe due to insufficient prenatal care and assisted delivery.

Through the main characters in these four regions Burna draws the viewer in and offers a compassionate but realistic world view of the alarming number of preventable deaths.  The main characters are three at risk women including Janet Loboy Tadel in Tanzania, Rachel Masikawa in a slum of Bangladesh, Monica Begum in post-abortion care ward in Guatemala and Edward Burns whose wife died in the United States. Through the film techniques Burns develops these characters by giving separate accounts of their experiences with pregnancy without really connecting with the character together. The other characters are experts through whose eyes the main characters experiences come to life.  Linda Valencia, MD, is an Obstetrician and is also eight months pregnant during the filming. She provides reproductive health care to women in Guatemala. Godfrey Mbaruku, MD, is Director of the only health facility in Tanzania serving more than two million women.. In many rural places portrayed in the film, infrastructure, electricity, equipment, supplies, emergency transport and more skilled health workers are needed to meet the growing demands of the population. Jennie Joseph is a Midwife who discusses the extreme challenges uninsured and low income pregnant women face when trying to pay for their prenatal care. Sabina Faiz Rashid, PhD is a Professor in Bangladesh whose main concern is women giving birth at home without a skilled attendant. His project is aimed at bringing skilled providers, who are equipped to handle complications, into the slums and underprivileged parts of the region.

Filming on location lends credibility to the film by allowing the viewers to place themselves in an unsterile environment with makeshift labor and delivery areas. The harsh terrain and remote setting as well as the culture of the people involved is very important to the final outcome of the film. The movie is filmed in four different locations with each focusing on a different aspect of the film. In Bangladesh the film’s focus was cultural barriers. In Tanzania the focus was physical and geographical limitations. In Guatemala the primary focus was on the legal barriers. In the United States the focus was on bureaucratic barriers women are facing in regards to insurance and access to health care. 

I knew from the start that I wanted to convey the global urgency of this issue at a critical time and to illustrate that I needed to highlight more than one or two countries. We chose four countries to be representatives of the larger regions around them. This was a challenging task because of the enormity of the situation in so many countries. I also wanted to highlight locations that could successfully achieve Millennium Development Goal 5—to reduce maternal mortality by three-fourths percent by 2015—despite the fact that very little progress has yet to be made. (No Woman No Cry)

The film techniques and camera and lighting angles used really assisted the theme of the movie be understood by viewers. These techniques helped the audience visualize the importance of the film. Placing the viewer in a makeshift hospital with a dirt floor brought the urgency of the problem to the forefront. The lack of transition was important in this film. It is difficult to transition from a home in Bangladesh focusing on cultural barriers to the United States focusing on bureaucratic issues. There are no connections between the main characters other than they are all at risk and are telling the same story of the magnitude of this problem. Producers shot almost 200 hours and faced many challenges. One of the biggest challenges was deciding if the stories could be interwoven or whether they would remain separate, in sections. Each character’s story was relatively complicated and because the international stories required subtitles, interweaving was not a viable option. The final transition that binds the stories comes from the shooting in the US and the incorporation of that into this film. Burns interweaves local interviews with those in other countries to stress the importance of morbidity and mortality in America.

The use of sound effects and sub titles was very profound it getting the story to global markets. In the film music and sound very used to grip the viewer. The film included a Lullaby from the foreign country and although the viewer may not understand the words, there was a calming effect in the music and it had a great effect on the scene. Early prenatal care can prevent many risk factors and ensure healthy outcomes. Patients who do not seek the advice of a physician are more likely to have problems during labor and are at a greater risk for birth defects. Prenatal testing can be very useful in diagnosis and treatment of fetuses as Harms says, “still, in some instances you may wish to know specific information about your baby’s health before his or her birth” (Harms 305). Due to cultural and economic barriers in other parts of the world testing and prenatal care is not available. 

This is a film for all viewers. Pregnancy not only affects the mother but the entire family. “Everyone should see this” said a reviewer of the film Jadorelamour. This film is not only educational but it gives viewers an idea about what pregnancy is like. Portraying expectant mothers compounded with all the knowledge presented, triggers a sense of responsibility in the viewers and sheds light on the severity of the issue of maternal mortality. More than half a million women die from pregnancy related causes each year and 90 percent of these deaths are preventable. Turlington said, “I knew that more could be done to elevate awareness around this issue and felt that through the medium of film, I would be able to share women’s stories from around the world that could rally some activism” (No Woman No Cry). Through further research and support the instances of death can be greatly reduced.

This film a good introduction on the subject; however, it only addresses a few of the main challenges facing pregnant and birthing women around the world. Although the filmmakers discuss how inadequate or lack of health insurance in the US affects women's health care, they barely scratch the surface. They do make note of how low  the US ranks compared to other developed and even developing countries when it comes to maternal health outcomes but don't really go into why. They mainly wanted to focus on other countries besides the US. There is a lot of research being done on the health of the mother and the availability of healthcare in other countries. A healthy diet is critical to ensure a healthy baby. According to the Epidemiology Resource Center,  “research has accumulated, showing associations between birthweight and the risk of developing obesity, cardiovascular disease, type 2 diabetes and other health outcomes in later life” (Newnham 29). This research shows the importance of fetal nutrition for lifelong health and has spurred an interest with policy makers in improving maternal nutrition. Many impoverished women have a very limited diet which greatly increases the chance of complications.

This movie is incredibly informative. It's scary the realities many women still face and the undesirable consequences they experience due to the type of care they receive during pregnancy and childbirth. The filmmakers do a beautiful job explaining how “the loss of one mother reverberates through a family, the community and consequently the world. Mother's rights are human rights” (No Woman No Cry). Physicians are concerned with low birth weight (LBW) and reducing risk factors to increase pregnancy outcomes.  As discussed in Newnham’s text, “It has long been understood that poor birth outcomes across the whole population, particularly rates of LBW, are associated with greater rates of morbidity throughout life from infancy to adulthood” (21).  In order to reduce the rate of infant mortality and morbidity, we must increase maternal health outcomes by identifying and eliminating risk factors, requiring prenatal screening tests, and diagnosing and treating fetal anomalies.

Infant mortality and morbidity can be reduced with proper prenatal care. “The United States has one of the highest overall infant mortality rates of the thirty developed nations… The infant mortality rate represents the number of infants, per 1,000 live births, who die before their first birthday” (Albrecht 377). This film discusses a profound subject of women’s reproductive health which has been considered “taboo” in many countries. People are not sympathetic because they think maternal death is a natural process, but the death of a woman impacts the entire family.  There is overwhelming evidence that supports the idea that early intervention, preventable pregnancy and proper prenatal care can reduce the instances of fetal morbidity and mortality globally.

Work Cited

Albrecht, T, D Eaton, G Quinn, C Mahan, and SZ Kabir. "Development, Ethics, and Prenatal Health Outcomes." Journal of Social Philosophy. 31.4 (2000): 376-81. Print.

Harms, Roger W. Mayo Clinic Guide to a Healthy Pregnancy. 1st ed. New York: Harper Resource, 2004. Print.

Murkoff, Heidi Eisenberg., and Sharon Mazel. What to Expect When You're Expecting. 4th ed. New York: Workman Pub., 2008. Print.

Newnham, John P., and Michael G. Ross. Early Life Origins of Human Health and Disease. Basel: Karger, 2009. Print.

No Woman No Cry. Prod. Christy Turlington Burns. 2012. DVD.

Shelov, Steven P. Caring for Your Baby and Young Child: Birth to Age 5. 4th ed. New York: Bantam, 2003. Print.

"The Film."  Ed. Christy Turlington Burns. Every Mother Counts., n.d. Web. 20 Mar. 2013.