In her directorial debut, Christy Turlington Burns—fashion model, mother of two, and maternal health advocate—explores women’s reproductive health in No Woman No Cry. Screened this week to rave reviews at the Tribeca Film Festival, No Woman No Cry captures the plight of pregnant women in four parts of the world—a Maasai tribe in Tanzania, a slum in Bangladesh, a post-abortion care ward in Guatemala, and a prenatal clinic in the United States—as they strive to give birth to healthy babies.

In Bangladesh, only 1 in 10 births occur in a clean environment and with the aid of a skilled healthcare provider. The result: a maternal mortality rate of 1 in 51.

In sub-Saharan Africa, where the maternal mortality rate is 1 in 22, less than one-third of women have contact with a healthcare worker during or after birth.

In Tanzania, a woman in labor walks five miles to a clinic because she has no money to pay for care at the hospital. Staffed by one nurse and one midwife, the clinic offers limited care and resources. Workers at the clinic tell the woman her only chance for survival is a hospital birth. Turlington Burns’ film crew intervenes and arranges to transport the woman to the hospital—a ride that typically costs $30, more than this woman’s family earns in an entire month. With proper care, she safely gives birth in the hospital to a healthy baby boy—a happy ending that is, far too often, a rarity in many parts of the world.

Every minute, a woman dies from complications related to pregnancy or childbirth—resulting in the death of more than half a million women each year (the vast majority in Asia and sub-Saharan Africa), making reproductive health issues the leading cause of death among women of childbearing age.

The United States ranks 41^st in maternal health and spends more money on healthcare than any other country in the world—as much as $86 billion annually on pregnancy and childbirth related hospital costs. Still, the risk of maternal death is greater in the U.S. than in 40 other countries, including virtually all industrialized nations. In the last 20 years, maternal mortality rates in the U.S. have doubled from 6.6 deaths per 100,000 births in 1987 to 13.3 deaths in 2006. Given that there are no federal requirements for reporting maternal deaths, this number may actually be higher.

Prevention
Experts estimate that 90 percent of maternal deaths are preventable. According to the world’s leading non-governmental organizations, most maternal deaths could be prevented if there were adequate equipment and supplies, transportation in rural areas, money to pay for proper care, and skilled health workers. Half of all women in the world give birth at home without a skilled attendant.

According to the United Nations Population Fund, family planning is also a key component. Annually there are over 200 million pregnancies worldwide—and nearly one-third are unintended, resulting in 50 million induced abortions, 20 million unsafe abortions, and close to 70,000 maternal deaths. An estimated one in three lives could be saved if women had access to birth control measures. In countries such as China, Cuba, Egypt, Jamaica, Malaysia, Sri Lanka, Thailand, and Tunisia, significant declines in maternal mortality have been achieved through a combination of simple yet critical interventions that include access to: family planning, skilled birth attendants, and backup emergency obstetric care.

Access to health insurance is another strategy for reducing maternal mortality. In the U.S., one in five women of reproductive age is uninsured. Without affordable health insurance, access to care is limited and maternal mortality rates remain unacceptably high. In an effort to highlight the urgent steps needed to reduce maternal mortality in this country, Amnesty International offers 10 key recommendations in their report, “Deadly Delivery: The Maternal Health Care Crisis in the USA.” Among the recommendations:

• The U.S. government must ensure that all women have equal access to timely and quality maternal healthcare services—including family planning services—and that no one is denied access to healthcare services by policies or practices that have the purpose of discriminating on grounds such as gender, race, ethnicity, age, indigenous status, immigration status, or ability to pay.

• Federal, state, and local governments should ensure that an adequate number of health service facilities and health professionals—including nurses, midwives, and physicians—are available in all areas. Particular emphasis should be given to medically underserved areas.

• The Department of Health and Human Services should, in collaboration with affected communities and the medical community, develop and implement comprehensive, standardized, evidence-based guidelines and protocols for maternal healthcare services.

• Washington, D.C., and each of the 29 states that do not currently have a maternal mortality review committee should establish one. Committees should receive ongoing funding to collect, analyze, and review data on all pregnancy-related deaths and address disparities.

Solutions
The Millennium Development Goals–5 (MGD–5) set a target of reducing maternal mortality by 75 percent by 2015. Unfortunately, MGD–5 has made little progress to date. The objectives of No Woman No Cry is to increase awareness of maternal mortality, encourage women to become active participants in their fundamental human right to give birth safely, and urge lawmakers to fund these efforts. No Woman No Cry will be screened for an audience of leaders and representatives from 20 countries at the G8 in Canada—the premier forum for international economic development—in hopes of encouraging a dialogue on preventable maternal deaths.

The film ends by reminding viewers that during its 60-minute running time, 60 women died from pregnancy or birth-related complications. If you are among those who, like Turlington Burns, believe that maternal health is a human right, let your voice be heard.