© JONATHAN HANSON
Midwife in the Haregeweyn region, north of Mekele, checking the belly of a local woman during a scheduled checkup.
Last November 2010, travel and documentary photographer Jonathan Hanson (links to portfolio), headed to Ethiopia to begin a photo documentary project about midwives as a sustainable source of reproductive health care. Ethiopia has some of the highest maternal and infant death rates in the world. On average, 670 mothers will die from giving birth for every 100,000. Women often face serious birth injuries, including Obstetric fistula, which leaves women incontinent and in public shame. To promote a sustainable source of reproductive health care, The Hamlin Fistula hospital has combined forces with the Ethiopian government and has implemented a new school of midwifery called, The Hamlin College of Midwifery.
Due to a combination of culture and religious influences and lack of access to medical help, 95 percent of births are unassisted by a health professional and are done at home, often without running water and electricity. An unassisted birth is very dangerous, and often complications cause the average birth to last five days, greatly increasing the chance for birth injuries, defects and death to the infant, mother or both.
The Hamlin College of Midwifery recently graduated its first batch of midwives in October of 2010, sending them into the rural areas of Ethiopia. The focus is to prevent Obstetric fistula and death from birth. The program has built clinics and dormitories for the graduated midwives in remote areas to help make reproductive health care more accessible to the rural population. Once the clinics and dormitories are built, the midwives are able to make visits to the nearby villages to promote the clinics and services, including family planning.
It takes a student four years to graduate at the Hamlin College of Midwifery and all students graduate with a minimum of 40 live births. As graduation for high school students nears, representatives from the college head out to the schools to speak about the program and recruit new students. After an applicant’s grades are checked, they must pass an exam to be admitted into the college. Students attend the college from all over Ethiopia, living in dormitories on campus, then returning to the regions they are from to work as midwives. During Hanson’s time interviewing students and working with the midwives, all of the women he spoke with knew someone who died from birth, knew someone who had a baby die during birth or someone who had an obstetric fistula. The issue is something that is well known in Ethiopia. The people who choose to enter this line of work do it to help their communities, and that personal connection is where the power lies in this project.
During Hanson’s last visit to a village in the town of Gidget with NGO, Healing Hands of Joy, he went to the home of a woman who just a few months prior lost her baby due to birth complications and suffered an Obstetric fistula. “It did not take long for me to see the deep sadness and pain from her experience and it is something that has stuck with me,” says Hanson. Unfortunately, her experience is not unusual, as her birth was at home and she did not have running water or electricity.
For Hanson, the biggest challenges to shooting the project were logistics and communication. He shot most of the story in rural areas without paved roads and sometimes without roads all together. “In order to get to the villages, I had to secure vehicles that could handle the terrain, driver and fuel,” he says. Fuel was difficult to come by at times and caused delays before excursions. There is also a language barrier that adds to all the complications. The national language of Ethiopia is Amharic but it differs widely throughout the country’s regions. English is spoken in the larger cities but once venturing beyond the cities it becomes a rarity.
One of the program’s goals is to reduce and eventually abolish Obstetric fistula. With a follow up visit, Hanson would like to investigate the impact midwives have had on areas with high incidents of this injury and the ensuing results. “I think the relationships midwives can foster with their patients are very important and I would like to add moments between midwives and their patients, showing the personal relationships and bonds that form through out this process," he explains.
Hanson is currently seeking publication for this documentary. He was recently selected to be part of the Eddie Adams Workshop in 2010. His work has been recognized by The Magenta Foundation Flash Forward Award 2010, the National Press Photographers Association and The International Color Awards.
Clients include: The Atlantic Magazine, The Smithsonian Magazine, The Wall Street Journal, The London Times, The New York Times, Bloomberg News, NPR,American Lawyer Magazine, The Advocate, AARP Bulletin, USA Today, Financial Advisor Magazine, Dewalt, Baltimore Magazine, Forest City Enterprises, Patuxent Publishing, and The Santa Fe Workshops among others.