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Conversation topic for 13/09. Maternal health

T S, Sweden. PHOTOGRAPH BY MOA KARLBERG

See the images here: http://www.newyorker.com/culture/photo-booth/giving-birth-in-different-worlds

The photographs in the series “Hundred Times the Difference,” by the photographer Moa Karlberg, capture, in closeup, the faces of women in the final stages of giving birth. Across the images, there is a range of expressions: grit and sensuality, trepidation and expectation, pain and elation. But in their intimate perspective the photographs emphasize the women’s shared experience—the inward focus and physical determination in their final, transformative moments of becoming mothers.

 If you look closely, though, you’ll see signs—the sterile white backgrounds in some photos and patterned fabric in others; a single acupuncture pin in the center of a forehead—that the women in Karlberg’s photographs are having drastically different experiences of giving birth. Half of the pictures were taken in Sweden and half in Tanzania.In the former country, almost all births take place in hospitals, where women have access to supportive midwives who are backed by sophisticated medical technology when needed.In Tanzania, by contrast, only half of births take place in medical facilities, and those that do often occur in places that lack even the most basic amenities.

In a statement about the project, Karlberg, a native of Sweden who travelled to Tanzania in June, with support from the International Women’s Media Foundation, describes the disparity between the scenes she witnessed in the two places.In her home country,“The woman about to give birth is lying on the public hospital’s white sheets. . . . Next to her is her husband, stroking her back, talking to her supportively, helping her to focus on her breathing. Low music comes from the speakers.Water and VIEW FULL SCREEN helping her to focus on her breathing. Low music comes from the speakers.Water and juice is on the table next to the height-adjustable bed.The woman has her own room and her own bathroom with a tub. Painkillers are available upon request.”In Tanzania, “the woman about to give birth is lying on a bare, rusty bunk, covered in fabrics she brought with her.The water tap is not working, and even if it was, the water would not be drinkable.If she has to urinate there is a bucket on the floor.There is no family member by her side, but three other women, on similar bunks and in various stages of labor, share the room. As they moan, the nurses tell them to be quiet. Since there are no painkillers, the women need to save their strength for the pushing in the end.” As a result of these extreme disparities, and the corresponding difference in the ability to deal with medical complications, the risk of dying during childbirth in Tanzania is a hundred times higher than it is in Sweden.

But despite this cross-national chasm in maternal health, simple explanations of the West-as-best and modernization-as-cure are insufficient. As Karlberg hints in the photo shown in the final slide above—a woman originally from Uganda, giving birth in Sweden—Sweden has experienced a wave of immigrants over the past four decades, many of them refugees from conflict-torn places like Iraq, Eritrea, Somalia, and now Syria.Though Sweden has proved more welcoming than other European nations (http://www.pbs.org/newshour/bb/sweden-offers-shelter-denmark-tries-discouragerefugees/) in the current refugee crisis, the country’s government—influenced by the far-right Swedish Democrats, who received support from one out of every eight voters in the 2014 parliamentary elections—has grown more nativist and stingy about its welfare state.In Tanzania, meanwhile, maternal-mortality rates have improved slightly in recent years as the country has experienced impressive economic growth and extensive foreign aid, but the rates today are the same as they were sixty years ago.In both countries, birth attendants, who are almost all women, are underpaid and overworked.

In Karlberg’s stark photographs, these many inequities seem simultaneously highlighted and erased. Her stunning, unembellished mothers-to-be seem to triumph in ways independent of their immediate surroundings, and notwithstanding the obstacles to empowerment that extend across racial, ethnic, and national lines. Yet the obstacles remain.