Then she walked us through her clinic, whose walls were covered with explicit posters promoting healthcare practices designed to mitigate massive public health risks such as malaria, COVID-19, and malnutrition. She did not mention the obvious limitations of the clinic: its erratic electricity, antiquated technologies, or minimal plumbing. Instead, she drew specific attention to the importance of a private, secure room, located in the rear of the facility, that was reserved for family planning counseling. The walls of the room were mustard yellow and in the center of the room was a chestnut-brown desk. Sitting on the desk was a wide notebook and a bowl of contraceptive pills.
“What do you want to know?” she asked.
We told her that we would like to learn about the importance of family planning.
Adama paused, then smiled.
“I can tell you about it,” she said.
We collaborated with Adama to make a short film in which she outlines the importance of her work within this room, where she provides specific contraceptive options, offers clinical support, and, perhaps most importantly, ensures confidentiality. She speaks plainly, delineating the public health benefits of family planning for the women of Sierra Leone, their families, and their communities.
Established in 2019 as part of Lehigh University’s Global Social Impact Fellowship, Mothers of Sierra Leone is a documentary film campaign that foregrounds the voices of Sierra Leonean women and the expertise of Sierra Leonean healthcare workers. We leverage stories of innovation and resilience, and we study the efficacy of these stories for improving maternal health outcomes.
Sierra Leone has massive healthcare challenges, including the world’s highest rate of maternal mortality. According to a recent UNICEF report, pregnant women in Sierra Leone suffer poor maternal health because of the legacies of imperialism, global inequities, and corruption that have marred the nation’s healthcare system, resulting in a shortage of skilled medical workers, insufficient medication, and a comprehensive lack of available infrastructure, including an unreliable energy grid.
While those in the West may not hear of the frequent accounts of maternal mortality in Sierra Leone, such discussions are neither new nor difficult to find. All too often, these narratives adopt dramatic, sensational, or sentimental storytelling techniques that engender a form of exploitative empathy, in which so-called experts negate the authentic experiences of Sierra Leonean women through benevolent attempts to raise awareness—attempts that often showcase women’s suffering.
“Storytelling is usually prompted by some crisis,” writes Michael D. Jackson in his 2002 book The Politics of Storytelling: Variations on a Theme by Hannah Arendt. Jackson highlights the exigencies, trials, or difficulties that initiate stories, insisting that “[s]torytelling is a coping strategy.” This theory of storytelling has driven dominant narratives of maternal mortality in both the United States and Sierra Leone, foregrounding pain, hardships, and even looming calamity. Such stories, rooted in crises, invite listeners to feel pity, concern, and compassion toward others condemned to “cope” with their lot.
Mothers of Sierra Leone brings together faculty and students from diverse disciplines to engage in an alternative mode of filmic storytelling that highlights pragmatic solutions rather than consciousness-raising, alarm-sounding, or blame-assignation, efforts that all too often sustain problems and prompt women to make do rather than make change.
The films of Mothers of Sierra Leone are short and direct, designed for Sierra Leonean viewers, but they are neither simplistic nor disingenuous. As storytellers, we do not dramatize the sufferings of individual Sierra Leonean women to advance political ends, raise money, or attempt to increase awareness among Western viewers. Our films tell stories that teach maternal health practices, explain and build trust in Sierra Leonean healthcare experts, and motivate more Sierra Leoneans to become maternal healthcare practitioners. We craft our documentaries for and with the people of Sierra Leone and evaluate the efficacy of our stories against our explicit goal of improving maternal health outcomes.
Our methods foreground the particular utility of filmic storytelling, drawing on the claims of Haidee Wasson, Charles R. Acland, and others that film and film technologies have “been useful, at times involved more with functionality than with beauty.” In Useful Cinema (2011), Acland and Wasson bring together a series of scholars who help us appreciate how “cameras, films, and projectors have been taken up and deployed variously—beyond questions of art and entertainment—in order to satisfy organizational demands and objectives, that is, to do something in particular.” Mothers of Sierra Leone deploys documentary film to do something about maternal mortality.
Mothers of Sierra Leone is not a panacea, and we do not erase or ignore the devastating effects of the nation’s civil war, the Ebola epidemic, or widespread poverty. Instead, we tell stories that treat women as competent, worthy, and vital, and we avoid narratives that sensationalize dangers to pregnant women. Our preliminary data from focus groups we have conducted in Sierra Leone suggests these stories educate women about maternal health services in the country, which will increase engagement with the healthcare system and ultimately improve maternal health outcomes.
In this first phase of our three-part project, we highlight stories of antenatal care and spotlight individuals who speak to Sierra Leonean women about government-funded and private healthcare options: routine clinical visits, community support, and programs for family planning, nutrition, hygiene, and obstetric scans. We also feature specific training programs for men and women to become maternal healthcare professionals. And we use data from our focus groups to assess the effectiveness of our films, modifying them as needed.
In our first film, we worked with Ramatu Barrie, a midwife at the Kalangba Community Health Centre (CHC), about 27 kilometers from Makeni, whom we met in August 2019, during our initial trip to the Bombali District of Sierra Leone. We watched as Ramatu and her staff administered care to dozens of patients on antenatal care (ANC) day, a designated day each week on which pregnant women attend the local clinic. We returned the following week to make a five-minute film documenting the benefits of ANC day, a vital component of Sierra Leone’s 2010 Free Health Care Initiative that provides care for pregnant women, lactating mothers, and children under five years of age.
The COVID-19 pandemic interrupted our filmmaking, but in August 2022, we returned to Bombali to reunite with Ramatu. We were finally able to show her the film we made about her clinic, her patients, and the expert care provided by Ramatu and her staff. Our film features numerous healthcare professionals from Kalangba CHC and details the availability, specific benefits, and safety of antenatal care visits for both pregnant women and their unborn children. Upon viewing the film, Ramatu emphasized the film’s accuracy, explaining how faithful depictions of patients and the clinic will increase women’s confidence in the safety and accessibility of antenatal care days. Our focus group data on this film suggests that women in the local community responded favorably to the aesthetics and content of our film.
We make our filmic stories readily available to Ramatu, Adama, and all of our collaborators in Sierra Leone. At Makama Community Health Centre (CHC), just a few kilometers from Makeni, Agnes N. Fullah, the maternal and child health nursing aide (pictured above), recently used our family planning film to teach women about the benefits of deliberately spacing their births. As over a dozen women gathered for their regular checkups, Agnes employed our story to communicate the family planning options made available by the clinic, and our focus group data confirm that women and families are listening.
Sierra Leone, no doubt, needs more qualified maternal healthcare experts like Ramatu, Agnes, and Adama, and several of our films document important healthcare training programs, including the Makeni Midwifery School and the schools of Nursing and Public Health at Ernest Bai Koroma University (EBK). Our stories provide media platforms for Sierra Leonean experts to detail the ways that these institutions professionally prepare men and women to care for the nation’s mothers and children.
We also invite students to express their personal ambitions for entering the maternal healthcare profession. Their stories function as recruiting tools for the training programs, and they increase women’s confidence in the healthcare system and its educated personnel. Preliminary focus group data on such films suggests that our stories have reinvigorated student workers’ passion for their work and will likely motivate others in the country to join the healthcare profession to improve the lives of women and families.
We are already collaborating with our stakeholders in Sierra Leone on phase two of our documentary project on perinatal care. This August, we will develop stories of maternal healthcare focused on the weeks immediately before and after delivery.
Our films will not miraculously increase the number of qualified medical professionals in Sierra Leone, transform the electrical grid, provide abundant clean water, or improve the availability of vital drugs. All these problems remain, and they are immense.
Over the past 20 years, academics, activists, and international aid organizations have all drawn attention to the challenges surrounding maternal mortality in Sierra Leone. In 2021, Purple Field Productions, a UK charitable company, released Di Kombra Di Krai (Cry of a Mother), which it describes as a “hard hitting full length drama” that “rais[es] awareness around current day superstitions and taboos, tackling loss and tragedy.” Likewise, Amnesty International previously produced the impressive documentary No Woman Should Die Giving Birth: Maternal Mortality in Sierra Leone (2009) and instructed viewers to “take action.”
Danielle Paquette, former West Africa bureau chief for The Washington Post, produced “Where Pregnancy Is a Deadly Gamble,” a multimedia essay that instrumentalizes the story of Susan Lebbie, a 17-year-old pregnant woman. Paquette writes, “To be pregnant in Sierra Leone is to be at the mercy of resource-strapped institutions and the global trends shaping them,” adding: “Survival is too often up to luck. Luck that a nurse or physician is nearby. Luck that the government is paying them. Luck that personnel aren’t charging for care that should be free. Luck that medicine is stocked. Luck that the blood bank has reserves.”
Paquette, an award-winning journalist at one of the world’s most acclaimed newspapers, no doubt raised awareness in the West, but her treatment did little to make material—or even discursive—change. Like many prominent writers who have told stories about African American maternal mortality in the United States, Paquette deployed the pain of women to dramatize an already established problem and incite sympathy. When Western storytellers and journalists treat these issues as crises to raise global awareness, the result is more exploitative than inspiring, and the work does little to improve maternal health conditions.
Still, storytelling matters, and despite the resiliencies of Sierra Leonean women and the innovations of Sierra Leonean healthcare workers, we still hear dramatic, sensational stories that depict their experiences of maternal mortality as regrettable but distant.
Maternal mortality is not distant to us; Roni Caryn Rabin’s recent reporting makes clear that the topic should not feel far away to anyone living in the United States.
In her brilliant 2019 essay “Dying to Be Competent,” Tressie McMillan Cottom writes that “in the wealthiest nation in the world, Black women are dying in childbirth at rates comparable to those in poorer, colonized nations.” She cites a terrifying statistic from the Centers for Disease Control and Prevention: Black women “are 243 percent more likely to die from pregnancy or childbirth-related causes than are white women.” This data, like data on Sierra Leone’s maternal mortality rate, is neither new nor difficult to find. Media attention from major outlets, including ongoing features from The New York Times, has raised awareness but failed to remedy the problem that has only escalated following the overturn of Roe v. Wade, the persistence of COVID-19, and subsequent staffing shortages in medical facilities.
In her personal account, McMillan Cottom tersely explains that “the healthcare machine could not imagine me as competent and so it neglected and ignored me until I was incompetent.” We rarely listen to people deemed incompetent, and we rarely address them with dignity, respect, or care. The presumed “incompetence” of Black women has entrenched the structural racism that perpetuates the crisis of African American maternal mortality within both the US healthcare system and our popular consciousness.
Black women continue to develop new communities, technologies, and strategies to prioritize their healthcare stories and options. In Data Feminism (2020), Catherine D’Ignazio and Lauren F. Klein detail the work of Kimberly Seals Allers, a birth justice advocate and the creator of the mobile app and web platform Irth (“as in Birth, but we dropped the B for bias”). Irth supports an alternative mode of maternal healthcare storytelling, one that, according to D’Ignazio and Klein, “operates like an intersectional Yelp for birth experiences.” It allows women to share experiences, recommendations, and advice with other women, including accounts of racial bias, information on practitioners, and feedback on supportive communities. Irth, in short, privileges women as “competent” to make healthcare decisions, navigate resources, and advise other women. Seals Allers fully recognizes the widespread racism and pervasive inequities that imperil Black women in the United States and provides a mechanism for them to improve their maternal health experiences.
Our efforts are local, but our thinking is global. For Mothers of Sierra Leone, our guiding principle from the start has been to highlight how Sierra Leoneans are helping Sierra Leoneans. Our films are not intended for mainstream Western audiences and will not attract interest from major political organizations, nor will they make money. And while our films do not deny the immense challenges facing the mothers of Sierra Leone, we, like Irth, seek to privilege voices, experiences, and communities that provide pragmatic solutions for improving maternal health.
As part of Lehigh University’s Global Social Impact Fellowship, Mothers of Sierra Leone is an interdisciplinary documentary film campaign that highlights stories of women’s resilience and maternal healthcare innovation in Sierra Leone.
Michael Kramp is a professor of English and film and documentary studies at Lehigh University.
Fathima Wakeel is an associate professor in the Department of Community and Population Health at Lehigh University.
Jordyn Pykon is a Lehigh University senior majoring in science journalism and minoring in environmental studies and documentary studies.
Nahjiah Miller is a Lehigh University junior majoring in journalism and minoring in women, gender, and sexuality studies.
Featured image: Joseph Stella. Spring (The Procession), 1914–16. Yale University Art Gallery, Gift of Collection Société Anonyme. Photo: Yale University Art Gallery, CC0. artgallery.yale.edu. Accessed February 13, 2023.