These Women Are Saving Lives, One Pregnancy at a Time

Regions of sub-Saharan Africa have some of the highest maternal mortality rates in the world. Geographical obstacles, scarce financial resources and the terrors of political insurrection can transform what should be one of the happiest times of a woman’s life into a race for survival. While this issue has been covered extensively from a geopolitical vantage, photographer Valeria Scrilatti traveled to three African nations to explore its effects on individual woman and those who are fighting to help them.

Teaming up with journalist Emanuela Zuccalà and with a grant from the European Journalism Center, and carried out in collaboration with Doctors with Africa-Cuamm and Intersos, Ms. Scrilatti visited Sierra Leone, Uganda and Nigeria where she covered a group of medical professionals and health advocates who are significantly improving the outcomes of pregnant woman in those countries. Her project is called “Crossing the River.”

Ms. Scrilatti spent 10 days in each country working in rural communities and found that the factors affecting maternal mortality are different in each country. In Sierra Leone, where the maternal death rate is the highest in the world, Ms. Scrilatti met with and photographed Flaviour Nhawu, a public health advocate who is working with women living in the district of Bonthe to create better transportation options. Roads there are mostly unpaved. In one community, pregnant women who are sometimes already in labor must a cross a river to get to a medical facility that is on an island.

Hellen arrived at Matany Hospital in the Karamoja region of Uganda with her sister by bus, to give birth to her twins. She has two other children, who are 6 and 10. Credit: Valeria Scrilatti


A newborn under the heat lamp in the delivery room at Matany Hospital. Credit: Valeria Scrilatti


Betty Agan, 38, works as midwife for Doctors with Africa-Cuamm in the Karamoja region of Uganda. She assists in births, teaches new mothers about basic care for newborns, works with HIV-related health issues and conducts training for mothers. Credit: Valeria Scrilatti

“The women,” Ms. Scrilatti said “have to work hours during the days to reach the river and then cross the river to reach the hospital.”

Ms. Nhawu and her team have reduced the maternal mortality rate in the region by half, by cobbling together meager public health care resources to create a more efficient emergency transportation system.

Betty Agan is the chief midwife in the Lorengechora Health Centre in the Napak district of Uganda. Ms. Agan’s greatest challenge is helping women overcome the fear of being in a hospital.

“One of the main problems there is the traditional belief that women don’t see the hospital as a comfortable option,” Ms. Scrilatti said. Ms. Agan, she said, “talks with them, leads them inside their room and makes sure they really feel at home.”

Women learn about the risks of pregnancy at the primary health center in the I.D.P. camp at Bama in Borno State, Nigeria. Boko Haram seized control of the city in 2014. Credit: Valeria Scrilatti


Dr. Halima Haruna Yusuf, 29, examines a pregnant patient in Gamboru Ngala, Borno State. Credit: Valeria Scrilatti


Women and children in the Arabic Camp, which was once the Arabic-speaking college in Borno State. Credit: Valeria Scrilatti


A woman with her child in the general hospital next to Arabic Camp. Credit: Valeria Scrilatti

When a cesarean delivery is needed, Ms. Agan must refer the woman to a hospital 40 minutes away “on roads that are not really roads,” Ms. Scrilatti said.

While some doctors and nurses have fled to less dangerous areas of Nigeria, Dr. Halima Haruna Yusuf has not. The 29-year-old physician studied in Borno, an area particularly imperiled by the Boko Haram, before working at the clinic. Many of her patients are former captives of the terrorist group.

Dr. Yusuf refers obstetric emergencies to the Ngala refugee camp hospital. But a curfew, imposed because Boko Haram is in the region, prohibits any patient transports after 5 p.m.

“She’s a woman working alone in a high-risk place,” Ms. Scrilatti said.

“Crossing the River” is Ms. Scrilatti’s first project focused on woman’s issues and the first to bring her to Africa. Based in Rome, she admitted to being initially frightened but was soon intrigued by the complexity of the story she sought to tell. Africa is often seen through a unilateral lens as “the third world,” rather than as a diverse continent comprising vastly different countries with their own issues and concerns. Ms. Scrilatti said that she did not want to use “poverty as a filter.”

Women at a training course for midwives at the Bonthe Hospital in Sierra Leone. Credit: Valeria Scrilatti


A rescue operation to transport Kadi, center, who had complications in her pregnancy, from Bendu village to Bonthe Hospital in Sierra Leone. Credit: Valeria Scrilatti


The Bonthe Hospital in Sierra Leone. Credit: Valeria Scrilatti


Agnese Jimmy, left, a community health worker, visits a child in Moyowa village in Sierra Leone’s Bonthe District. Credit: Valeria Scrilatti

“We already have enough journalists who did Africa from this point of view,” she said.

One of her primary goals was to “destigmatize Africa, and African women in particular, which means trying to portray them not as victims but as real women.”

“I realized it was not all about maternal maternity,” she said. “It was about women fighting a problem, dealing with gender equality and dealing with a patriarchal legacy. What I see in all of these counties is the solidarity between the women.”

The intimacy of photographing labor and delivery, Ms. Scrilatti said, required a deft hand and the ability to disappear while still capturing the scene, especially in an operating room, where she recorded the candid moments of quiet and culmination of herculean tasks of compassion.

“It’s childbirth so there is blood, but this was not the point,” she said. “These women really make a difference. They are the makers of this change.”

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