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In the documentary, called SISTER, first-time director Brenda Davis turns the camera on women giving birth in dire conditions and on the health workers who stand by them
Under the bright lights of an operating table, 19-year-old Peum lies still as a gloved hand reaches through a long, wide and bloody cut in her belly and pulls a child from her womb.
I had to look away at first – I’d never witnessed a caesarean section before and although I’m only watching it on a computer screen, it’s still gruesome.
Films depicting this sort of scene usually show busy doctors handling instruments, nurses assisting them and the constant 'beep' of a heart rate monitor.
But in this documentary, called SISTER, first-time director Brenda Davis exposes the health risks faced by many pregnant women in developing countries. She turns the camera on women as they give birth and on the devoted health workers who deal with the blood and pain of childbirth in places where healthcare facilities are poor or non-existent.
The “operating theatre” where young Peum has her baby is little more than a room with a bed, a sink and a few instruments. It’s nothing like a clinic in the West.
Peum was rushed to this hospital in rural Cambodia to avoid a breech delivery. Midwife Pum Mach took her there from a local health centre in Battambang province, which was ill-equipped for a C-section.
Mach struggled for days to find a car to transport the girl to the nearest hospital, because Peum had no money to pay for transport and she would have died had she not made it to the delivery room.
"The reason why I'm motivated to fulfil my duties (as a midwife) is because I am emotionally attached," Mach says in the film. "I see the plight of these poor people, I see that their troubles are even harder than my own."
In the United States, one in 4,800 women dies from childbirth-related causes. In Cambodia, the rate is one in 48, according to the film.
In Haiti, another country Davis focuses on in the documentary, one in 44 women dies in childbirth.
"I wanted people to ask why this is happening," Davis told Thomson Reuters Foundation by phone. "I wanted some critical thinking to come out (of the film)."
Poverty, culture and tradition, no means of transport, a lack of education and poor family planning – these are all factors that need to be addressed in order to improve maternal health in developing countries, so that women, their children and their whole families can survive.
"The death of a mother is the death of a family," says Ethiopian health officer Goitom Berhane elsewhere in the documentary. "Pregnancy is a normal physiological event, it's not a disease. It is just that society isn't organised enough ... to appreciate its risks. We are not prepared."
One in 27 Ethiopian women dies from causes related to childbirth.
At Adigrat hospital, a rusted-gate compound in Ethiopia's Tigray region where Berhane works, patients queue at the registration desk, swarms of flies buzzing in the heat.
The film opens with Berhane treating a rural woman who was taken to the clinic after being in labour for more than 24 hours. Her unborn baby had died by the time she reached medical care and she was in excruciating pain. "I'm dying, I'm dying," she says to the camera. She had waited too long before seeking medical help because it's a cultural tradition for women to give birth at home.
More than 90 percent of maternal deaths are preventable, Berhane says. "These are our mothers, these are our sisters (who are dying)."
Berhane is part of a "task force" of trained health workers who are trying to consign maternal mortality to the history books in Ethiopia, where there is a serious shortage of maternity services.
Berhane says the world needs to sit up and pay attention to the issue of maternal health and mortality and that all preventable deaths should be stopped.
Berhane and Davis met in Stockholm at a medical training course.
"He’s pretty incredible," Davis said. "This is like his obsession, learning more about surgery and saving lives....He thinks mostly about this and a little bit about football.”
Davis said the subject of maternal health feels personal to her.
"My parents grew up in rural Nova Scotia (Canada) and as a child I would hear these stories about my mother’s mother who had 16 babies – the first one at 19 – and they all grew up in poverty and she lost 5 (of them) altogether."
"(And then) I'd go like ‘wait a minute ... people are drinking tea and eating biscuits and talking about losing babies at birth ... it was just kind of always around me."
She decided to make SISTER while she was filming a course on maternal mortality in Sweden. She spent weeks with health workers from Asia and Africa and became fascinated by their lives.
Every year, more than 4 million women and children die from causes related to pregnancy and childbirth, according to statistics in the film. Ninety-nine percent of these deaths occur in the developing world.
Davis said that to help end preventable maternal deaths, it was essential to create “a local health force” by training health workers “who look like them (the patients) and respect what works with their local strategies."
Empowering women and young girls is also crucial. "If we can educate our girls then they’ll know their rights, I heard a midwife say," Davis said. "We have to enable them to make their own decisions, to make choices about when they’re going to be married, whether they want to continue with school."
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