For Day 5 of the 16 Days of Activism Against Gender-Based Violence, guest blogger Jeanne Chauffour recaps Chicago filmmaker Dawn Shapiro’s documentary The Edge of Joy, a chronicle of maternal health in Nigeria.
On November 16th, GlobeMed at The University of Chicago hosted its first Global Health Film Festival, which featured five documentaries. “The Edge of Joy”, Dawn Shapiro’s touching and compelling account of maternal health in Nigeria, was followed by a conversation with the director. The film alternates between documentary footage, interviews, and animation, and splits it focus between Kano, a Muslim city in the northern dry desert, and Oyo, a luscious metropolis in the Christian south.
Nigeria, the most populous country in Africa, has 140 million people equally distributed between these two areas of the country. But in both North and South, health professionals face daily struggles related to maternal mortality and newborn morbidity. Indeed, Nigeria faces the second highest number of maternal deaths in the world, with 36,000 Nigerian women dying in labor every year (2010).
Shapiro lays her first scene at the Murtala Mohammed Specialist Hospital, where thirty babies are delivered every twenty-four hours. Sakina is in her twenties, and in labor with twins. Already the mother of two, she, like fifty percent of Nigerian women, has never given birth in a hospital. While her first twin is born strong and healthy, the second twin is small and sickly-looking. Yet her newborn is not the only one with his life on the line. His mother is suffering from the leading cause of maternal mortality: post-partum hemorrhage. Sakina needs blood transfusion, but the hospital has no stock of her rare blood type. Fortunately, Sakina’s husband owns a car, but although he visits many hospitals and private blood suppliers across the city, he faces a barrier common to many Nigerians in his situation: one pint of blood costs $68, and the average Nigerian monthly salary is $94. These access and financial barriers cause thousands of preventable deaths every year.
Image courtesy of ‘The Edge of Joy’
In the same ward, we meet Aicha and Kabiru who are expecting their eighth child. Aicha bled a lot when her two previous children were born, so she asked her husband to take her to the clinic. In the North, women’s chances of dying during childbirth are increased because Islam prevents them from traveling without a male escort. When Kabiru’s car breaks down on their way to the hospital, Aicha must wait for her father-in-law’s permission to have another male relative accompany her. When she finally reaches the hospital, she has lost a significant amount of blood. Immediately, doctors strap her into an anti-shock garment. This innovative full-body suit is strapped tightly around the limbs and the stomach, and shoots blood back to vital organs, preventing hemorrhaging women from losing large amounts of blood. A couple minutes later, Aicha’s situation stabilizes and the garment allows her to survive the next five hours it takes Kabiru (who lost his first wife during her seventh delivery, and is the father of thirteen) to find two pints of blood.
The sharia, or Islamic law, dictates the way of life in most conservative Muslim communities. The interplay between Islam and modern medicine is a delicate balance that reproductive health professionals must navigate. Many families perceive the West as imposing ideas on them. Speaking of northern Nigerian men in general, a nurse explains that they have a difficult time understanding that doctors are not asking couples to stop having children, but to space out the births. According to sharia, women should not “take a break” from having children, because Allah disapproves of breaks. Yet, when husbands realize that birth spacing prevents their wives from dying, many consent to the beneficial aspect of contraception and family planning. Preventative community education has been successful as more and more women come to the clinic alone, and depend less on their husbands’ permission to leave home if they get contractions in the middle of the day.
The north of Nigeria is a dangerous and difficult to place to be a woman. If a woman has given birth five times, any birth beyond the fifth is disproportionally dangerous. Moreover, to further decrease maternal mortality, couples are recommended to wait at least two years between pregnancies. Especially for rural families, access to health facilities and emergency care is limited, and the lack of sexual and reproductive health education leads one in five pregnancies to be unplanned in Nigeria every year.
For many rural women like Rachel, who describes herself as “very fertile”, preventing pregnancies has been unsuccessful. After realizing she was pregnant with her fifth child, she tried to give herself an abortion by using local herbs and remedies, but after severe diarrhea and drastic weight loss that put her life in danger, she “accepted her fate” and started the prenatal care recommended by her local midwife.
In many parts of Nigeria, men perceive contraception as encouraging women’s promiscuity. While most men are eager to improve the reproductive lives of their families, contraception is a man-only dialogue that has not yet expanded to encompass how family income and wealth depends on maternal health. Strategies have been adopted to creating safe forums for discussions, where religious leaders and health professionals conduct pre-natal classes, and provide outlets for women and men to separately express their feelings, concerns, and ask questions. Especially in the southern city of Oyo, where the premier physician for maternal health lost his own mother at age three, nurses and leaders stress the social consequences of poor health and the multitude of challenges that families and children face without a mother.
To remedy this situation, Nigerian doctors have lobbied for separate maternity blood banks. With these new blood refrigerators in place, the wait time for blood has been reduced by 75%, and maternal mortality rates have significantly decreased. Other free maternal services have been deployed to allow women to travel without male escorts to nearby hospitals. The anti-shock garment has also contributed to 50% less blood loss and 64% fewer deaths in the maternity wards that use them.
After the screening of her inspiring documentary, director Dawn Shapiro spoke about the idea that sparked her interested in maternal health –specifically, the anti-shock garment led her to focus on Nigeria, where it is presently the most widely tested. She mentions how Nigerian hospitals are now very focused on training professional staff and local birth attendants, increasing access to transportation, making technologies like the anti-shock garment or the Odón device (engineered by an Argentinian car mechanic, and pictured below) more accessible, and blood donations more widespread.
The lesson that Shapiro encourages young global health-oriented students to keep in mind when working abroad is that the best way to understand women’s challenges is by getting community buy-in from health professionals and local leaders. Only in this way can one really come to understand the underlying moral values and ancestral traditions that shape attitudes, decisions, and priorities. And the messages Shapiro wants us to take home with us? “Saving one mother’s life saves a family’s life.”
Jeanne Chauffour is a third-year in the College studying History, Philosophy, and Social Studies of Science and Medicine (HIPSS) and Human Rights. Jeanne is Director of Campaigns for GlobeMed at The University of Chicago, and a Volunteer at Ci3 and the Center for Global Health at The University of Chicago.