The background:

“In Malawi, we say that women who are giving birth are in a space between life and death. No one knows if they will reach the other side alive.”

These were the words of Chief Kwataine, a Malawian tribal leader, during an interview with Mandolin Media for a short film commissioned by the Bill & Melinda Gates Foundation. 

His stark statement reflects the country’s acute maternal mortality ratio. According to UNICEF, one in 36 women die giving birth in Malawi, compared to one in 2,400 in the US. Women we spoke to said they feared becoming pregnant after witnessing the death of female friends and relatives. 

Mandolin Media was tasked with highlighting the work of the Safe Motherhood Initiative (SMI), a Malawian presidential campaign that aims to prevent fatalities during childbirth through education about safe conception. The initiative is supported by medical personnel from the University of North Carolina and through a Gates Foundation grant. 

SMI is addressing the main causes of maternal mortality in Malawi. 

It is using a Gates Foundation grant to build hundreds of maternity waiting homes in rural communities to ensure pregnant women no longer lack access to professional medical care.

Meanwhile, young women from rural villages are being enrolled in a nationwide midwifery training scheme, after which they are sent back to their communities to deliver babies, to address a countrywide shortage of professional midwives.  

SMI’s most important, and perhaps complex, task is to reverse long-standing cultural norms surrounding childbirth, many of which can have lethal consequences. 

Women, especially those in rural areas, traditionally conceive at home under the supervision of untrained ‘traditional birth attendants’.  These TBAs, as they are known, are unequipped to give the life-saving medical care to women facing birth complications that can be provided by trained midwives in health centres.

Large families are the norm in Malawi. Women tend to have five or more children during their lifetime, often from a young age when their bodies are not adequately developed for safe childbirth and without safe spacing between pregnancies.

Our aim was to display SMI’s commitment to inform communities of the dangers of using traditional birth attendants. Also that contraception and family planning are essential for women to become pregnant at a suitable age and to safely space their deliveries. 

Tribal chiefs are the gatekeepers of the communities they serve. Only by convincing these elders of the need for modern childbirth practices can the SMI’s message reach millions of women living in rural areas. 

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The shoot:

From its base in Malawi’s capital, Lilongwe, the Mandolin team travelled thousands of kilometres throughout the country to cover the tireless efforts of SMI staff in passing on their key message to chiefs, pregnant women, and new mothers. 

Of all our projects, this was by far the most musical. From a chief mobilisation workshop in Kusungu in northern Malawi to a post natal ward in Balaka in the south, the SMI team delivered messages relating to family planning, correct spacing of pregnancies, proper nutrition, and the benefits of professional medical care within the words of beautifully sung hymns. Many times we felt the urge to down our cameras and join in as entire hospital wards broke out into song and dance. 

We were privileged to gain access to some of the most remote parts of the country, where many people were seeing foreigners for the first time. Children soon overcame their wariness and happily swarmed in front of the camera to be filmed. On a more serious note, women living in these remote areas far from health centres said they once viewed pregnancy almost as a death sentence until SMI taught them that with the proper care, childbirth complications need not be fatal. 

At the heart of our storytelling was Chief Kwataine, who more than any other village chief has embraced the teachings of the SMI and ensured that women in his area of authority adhere to its principals. 

Chief Kwataine told us he is driven by the memory of a close female friend who lost her life from severe loss of blood during childbirth. He witnessed firsthand as she died making the long journey from her home in Ntcheu to the nearest hospital. Since becoming chief, he has pushed the use of contraceptives, set up family planning committees and banned traditional birth attendants from delivering babies. 

No woman has died during child birth in Ntcheu district for the past three years, a remarkable turnaround that we are sure can be replicated in communities throughout the country. 

The Team:

Paul James Driscoll: Cinematography - Photography - Post-production
Robert Ditcham: Photography - Interviews - Audio - Post-production

Our Equipment:

- Canon 5D MkIII camera x 2
- Manfrotto tripod and monopod
- Kessler slider
- Light reflector
- Sigma 85mm lens
- Canon 50mm lens
- Sigma 28mm lens
- Canon 70-200mm lens
- Zoom H6 voice recorder
- Sennheiser shotgun mic and wireless mic
- Rode Video Pro on-camera mic

Post Production

Adobe Premiere Pro CS6
Soundtrack Pro
Adobe Photoshop CC