National & International News

PHOTOS: Why Lynsey Addario Has Spent 10 Years Covering Maternal Mortality

By Emily Vaughn

Published October 19, 2019 at 7:00 AM EDT

Addario's coverage of maternal mortality took her to a remote village in Badakhshan province, Afghanistan in 2009, where she photographed a midwife giving a prenatal check in a private home. "In these areas someone will announce that a doctor and a midwife are coming, and any pregnant and lactating women within a certain radius come if they want prenatal or postnatal care," she says.

Editor's note: This story includes images that some readers may find disturbing.

When photojournalist Lynsey Addario was awarded the MacArthur Fellowship in 2009, she took it as a chance to work on a topic that many photographers and editors shied away from: maternal mortality. Her photos of overcrowded hospitals, bloody delivery room floors and midwives in training illustrate the challenges women face in childbirth and what the global health community is doing to overcome it. The series was featured at this year's Visa Pour L'image festival in Perpignan, France.

Addario has borne witness to some of the most intense global conflicts of her time. She has worked for publications like The New York Times, National Geographic and Time Magazine and has covered life under the Taliban in Afghanistan and the plight of Syrian refugees. She has been kidnapped twice while on assignment, most recently in Libya in 2011 while covering the civil war.

Every two minutes, a woman dies from childbirth or pregnancy-related causes, and many of these deaths are entirely preventable. While the global health community has made great strides bringing down the rate of these maternal mortalities since efforts intensified in the early 1990s, the reality for many mothers is still harrowing.

We spoke to Addario, author of the 2015 memoir It's What I Do: A Photographer's Life of Love and War, about what drives her work and what she's witnessed over a decade of reporting on this topic. The interview has been edited and condensed for clarity.

Addario recalls visiting Tezpur Civil Hospital in Assam, India, "where there's tea plantations all around. In that area I was looking at the conditions for women, and you can tell that [the hospital] is grossly overcrowded. There were women waiting to deliver, some had already delivered — there were even women sleeping in the hallways of this hospital on the stairs leading up to the main ward."

How did you get interested in the topic of maternal mortality?

In 2009 I was named a MacArthur Fellow. It was the first time in my career where I was given money to work on a project without an assignment, so I could choose something that I felt was important to cover. I started learning about the incredible number of women who were dying in childbirth every year. It wasn't a story that was easy to get published — I think most editors felt it wasn't a sexy topic. Most people just don't realize what a big deal this is.

[Early in the project,] in the very first hospital I walked into outside of Freetown, Sierra Leone, I literally watched a very young woman, Mamma Sessay, hemorrhage in front of me on camera and die. And I knew that it was a story I had to continue with.

You write in your book Of Love & War that what compels you to do photojournalism is "documenting injustice." How does that apply in this series?

If you're a poor woman living in a village where there are no medical professionals around, and you don't have enough money to get to a hospital, then you run the risk of dying in childbirth. That's injustice. I think everyone is entitled to a safe delivery. In 2019 there should be medical facilities within reach for anyone to be able to access them, or mobile clinics.

"This is a fistula repair in Kabul, Afghanistan, with two surgeries going on side by side," Addario says. "A fistula is a tear, often between the vagina and the anus. It's common in many countries with child marriage, or where women have birth very young. It's quite a shame — often women are shunned from their houses or don't get care — there's often a smell associated with fistula."

Were you a mother when you started the project?

No. In fact I always used to joke around on the delivery ward that I would never become a mother because I had photographed so many women delivering, and I knew it was such a painful and difficult experience. Then in 2011 I gave birth to my first son, so I ended up doing it anyway. Even though this project made me more scared to actually deliver because I know how many things can go wrong.

Ironically my own delivery in 2011 was not a great experience. I moved to London when I was 32 weeks pregnant and delivered at 37 weeks. I had no doctor, basically just showed up at the hospital nine centimeters dilated and delivered with whatever midwife was on duty. Now that I've been doing this project for 10 years, there are so many things I would suggest to first-time mothers — or second-time mothers.

Like what?

Like maybe have a doula or have someone with you who can be an advocate — who can explain to you what's going on with your body, who can help you navigate the pain. Someone who can understand if something's going wrong, like the symptoms of preeclampsia: headaches, sweating, swelling. There's so much that we just don't know, that we're not taught. People take childbirth for granted.

What is it like talking to your male colleagues about this project?

Most of them just haven't paid attention to this work. Colleagues have said things to me about some stories — like the woman giving birth on the side of the road in the Philippines and the Mamma Sessay story — because they're sensational, but no one really asked me about the work, which is interesting in and of itself. I think people sort of shy away from talking about birth, you know? Unless it's something happy and positive.

"This is part of Dr. Edna Ismail's team doing outreach in a remote village in Somaliland," Addario says. "They do a similar thing like in Afghanistan, where they make an announcement for any pregnant and lactating women to come for a prenatal check. That's essentially the only way women can get care unless they walk or are able to get transport to the nearest hospital or clinic."

What has surprised you while photographing this series?

How much access people give me. I've photographed — I can't even count how many — probably three or four dozen births. The women invite me into very intimate spaces. I obviously try to be very respectful of how I photograph something like this. It's one of the most beautiful things I've ever witnessed, watching a baby be born. It's something delicate to photograph because it's so incredible and at the same time it's very graphic. It's hard, and it's always surprising to me how many people have let me in.

That word "graphic" jumps out at me. I'm looking at one of your photos now, where there's blood on a delivery room floor, and it's uncomfortable in a way that's different than looking at blood from violence.

A mother receives postnatal care in a Somaliland hospital. "She was brought [there] in a wheelbarrow," Addario recalls. "She delivered her baby stillborn then started hemorrhaging. It was extraordinary for me to witness — it was very similar to what I'd seen a decade earlier when Mamma Sessay died but in this case the woman survived because there were trained midwives who knew exactly what to do."

It is different. It's different because no one thinks of childbirth like that. They think of childbirth as Hallmark pictures, but there's a lot that's not beautiful about it.

You've been working on this project for 10 years now. What has changed?

The statistics [for maternal mortality] have gone down, which is incredible, and there's a lot more awareness. There are so many organizations — like Every Mother Counts, which is Christy Turlington's organization, and UNFPA and UNICEF — working to fight maternal death. There's more information, but it's still too many — one woman a day is too many.