Situated in one of the largest Internally Displaced Persons camps in Northern Uganda, not only does the Earth Birth birthing clinic provide maternity care to local women, it's also become a safe space for those displaced by war to gather and work on projects. Founded in 2008 by Brooklynite Rachel Zaslow, the clinic is home to around five births a day and sees up to 50 women daily for pre-natal care. A large part of Earth Birth's staffing consists of traditional birth attendants, women who practice midwifery as it has been handed down to them from generation to generation; the World Health Organization (WHO) estimates that 80 percent of Uganda's population has passed through the hands of a traditional midwife.
How did someone from Oregon by way of Brooklyn end up delivering babies in Uganda?
It's a long and twisty narrative, but the short version is that I was invited to come to Uganda by a fellow New York birth worker in 2007 to volunteer in a government-funded hospital. What I witnessed there was devastating. The hospital was functioning at what the WHO estimated to be over ten times its capacity. Women were turned away in labor or sent to walk home minutes after giving birth, often bleeding to death on the road home. Women who were admitted to the hospital were often treated violently by the hospital staff for not pushing fast enough or failing to bring their own piece of plastic to give birth on. These conditions made for a traumatic and dangerous place to give birth in an area that has been ravaged by war. I founded Earth Birth with my partner, midwife Olivia Kimball, the next year.
What kind of services does Earth Birth provide?
We provide prenatal care, labor and delivery; post partum, family planning and HIV/STD treatment. Women do not need to pay to receive services, but rather, they must involve themselves in a project that sustains the clinic. For example, they can choose to work in our community garden. The food that is grown there goes back to the women and the excess is sold in the market to pay for supplies at the clinic. We also have the only ambulance in the region so we are able to transport women to the closest hospital (50km away!) when a situation occurs that we cannot handle in-house.
Uganda, particularly in the north, has been devastated by civil war over the last two decades. Would you say war is exponentially harder on women?
Yes. Absolutely yes. Women are often used as tools of war. In Northern Uganda for two generations women have been used either as sex slaves for the rebel army or as reproductive machines, abducted and forced to give birth to as many babies as possible to build up the army with child soldiers. Women giving birth in captivity are faced with lack of prenatal and obstetrical care, severe starvation, untreated STDs, physical mutilation and extreme emotional trauma, among other issues. Not surprisingly, Northern Uganda has one of the highest birth rates in the world, and also one of the highest maternal and perinatal mortality rates.
How is the most basic human act—giving birth—also a political act?
Well, it has to do with vaginas, and I find that almost anything related to the vagina tends to become politicized. But on a serious level, childbirth is completely embedded in issues of class, race, education and privilege. Women without money or education or community support networks don't tend to have a lot of options and as such, have higher rates of complications and mortality. That's true in Uganda and it's true in New York.
Have you ever felt in danger as you worked?
Sometimes I am in the middle of a situation and I think “I really shouldn't tell my mother about this”— like the time I had to transport a woman with a stuck second twin to the hospital in the middle of the night. We were driving down the road that was the pathway for the rebel army to abduct people—and had to pull over because the feet of the baby started coming out. My partner midwife Olivia and I had to stick our butts out the window of the car so that we could reach the woman, catch and resuscitate the baby, and the thought did cross my mind, “this is really dangerous.” For the most part though, our clinic site is really peaceful and safe. My daughter runs around naked and chases chickens.
What lessons from Uganda have you been able to apply to your midwifery back here in New York?
My focus in NY right now is academic. I am finishing a PhD in Women's and Gender Studies. I am writing about childbirth, displacement and the problem of humanitarian aid. I don't think enough midwives write about the importance of what we do in a way that the academic community can hear. This ultimately affects the way we work together with the medical community, which ultimately affects the options that women have— so it's all just one big political act.