Like many women, I was excited to become a mother and enjoyed being pregnant. But just after delivering my first child, I suffered a serious complication. While I had a birth team that worked quickly to manage the situation, I was shocked to learn that more than 500,000 women die each year during childbirth—and that 90 percent of these deaths are preventable. This left me needing to learn more about maternal health.

I have since become the Maternal Health Advocate for the Cooperative for Assistance and Relief Everywhere (CARE) and enrolled in the Masters of Public Health program at Columbia University's Mailman School. But I still felt helpless, frustrated by the reports that maternal mortality numbers were not dropping. I was inspired to make a documentary film that would share the stories of women at risk of becoming a mortality statistic. I hope that by bringing people together through the universal experience of birth, we can help create a mainstream maternal health movement that ensures the lives and well-being of mothers worldwide, for generations to come.

In 2005, while pregnant with my second child, I traveled with the organization CARE to El Salvador—my mother's birth country. Of the many CARE projects I visited on that trip, there has been one in particular that has stayed with me and has inspired me to focus on maternal health. As part of CARE's water project, I visited a remote village where pregnant women and mothers of newborns had walked for miles to access clean water. For some, this was also their only opportunity to receive some form of antenatal and postnatal care. I returned home to New York City and gave birth to a healthy baby boy—a beautiful, uncomplicated delivery in the birthing center at St. Luke's-Roosevelt Hospital. But I continued to think about those women I had met—young mothers who had so much to fear. As a result, I was inspired to learn more about maternal health in other impoverished parts of the world and was horrified by the tragic statistics I found.

In 2007, I traveled to Peru to visit a project that focused on reducing maternal mortality in the Ayacucho region. This project, The FEMME Project, is a partnership between CARE, Columbia University's Averting Maternal Death and Disability (AMDD) program, and the United States Agency for International Development (USAID). Together, with the support of the local Peruvian government, The FEMME Project has reduced maternal mortality by almost 50 percent in less than five years.

I met some of the people on the frontlines, working together in response to an enormous unmet need, and I was given hope that projects such as this could be the solution. I set out to learn what other measures were being taken to reduce maternal mortality throughout the world. While I was disheartened to discover that the numbers were still abysmal, there had recently been a lot of attention and new momentum generated around this issue. So I decided to begin a documentary film to highlight what is being done and what more could be taken on, giving viewers an informative and powerful look at this compelling global issue without having to leave their ZIP code.

What was the genesis of this film? What attracted you to maternal health issues?

I had a complication after delivering my first child and learned that hundreds of thousands of women in developing countries die each year from the same complication. That following year I began working with the humanitarian organization CARE and traveled to Central America where my mother was born. I was pregnant with my second child at the time.

Being in that state (pregnant) compounded with all that I later learned, triggered in me a sense of responsibility to shed light on the severity of the issue of maternal mortality. More than half a million women die from pregnancy related causes each year and 90 percent of these deaths are preventable. I knew that more could be done to elevate awareness around this issue and felt that through the medium of film, I would be able to share women’s stories from around the world that could rally some activism.

This is your first time directing.  What did you find most rewarding about the experience?

The entire process of making this film has been an incredible journey. I loved collaborating with our talented crew who taught and continue to teach me so much, even beyond filmmaking. I can truthfully say that we positively impacted the outcomes of more than a few lives during this process. There is not much I could do that would parallel that.

How did you choose which countries to visit and include in the film?

I knew from the start that I wanted to convey the global urgency of this issue at a critical time and to illustrate that I needed to highlight more than one or two countries. We chose four countries to be representatives of the larger regions the around them. This was a challenging task because of the enormity of the situation in so many countries. I also wanted to highlight locations that could successfully achieve Millennium Development Goal 5—to reduce maternal mortality by three-fourths percent by 2015—despite the fact that very little progress has yet to be made.

We chose each country to highlight various barriers to accessing quality reproductive health care. In Bangladesh we focused on cultural barriers; in Tanzania physical and geographical limitations; in Guatemala the legal barriers; and in the U.S. we looked at some of the more bureaucratic barriers women are facing.

How many hours did you shoot? What was the challenge of editing?

We shot almost 200 hours and began editing as soon as we returned from Tanzania in early July. One of our biggest challenges was figuring out whether the stories could be interwoven or should whether they would remain separate, in sections. Each character’s story was relatively complicated and because the international stories required subtitles, we found that interweaving was not a viable option. We then had to find a through-line to string all of the stories together which didn’t come together until the end after our final US shoot early this year.

How much time did you spend filming in each of the different countries?

We filmed for about two weeks in Tanzania, Bangladesh and Guatemala. The U.S. was more broken up over the course of a year. Prior to filming, each country required months of research and some advance scouting. We worked with some local producers to help us narrow down our options in advance so that we could dive in when we arrived to shoot.

What surprised you the most about the women you spoke with?

I was prepared to see much of what we saw because I had read so many accounts from women and their loved ones, but I continued to be genuinely awestruck by the strength of the women we encountered.

In Bangladesh we watched women go through long labors with hardly a wince. In Tanzania, we watched women in the same state walk for miles to get closer to a safe place to give birth and in some cases be turned away if they weren’t ready to deliver. In Guatemala, we met a woman close to death due to an infection caused by an unsafe abortion in a maternity ward. She was one of the lucky survivors in a ward full of other women suffering from similar medical problems. In the U.S., I met women who could not afford insurance and were forced to take unnecessary risks to save money by not seeking prenatal care at a critical time in their pregnancy. The strength these women possess is not an option but more a means of survival as they’ve yet to be empowered by their societies to claim their basic human reproductive rights of safe pregnancy.

What was your most memorable moment while making this film?

With so many memorable moments, it is hard to highlight just one. I remember thinking a number of times while filming that I might be delivering a baby with my own hands. We had extra birth kits with us at all times and went to bed each night as if we were on call, like doctors knowing that the phone could ring at any moment. We were running on little more than adrenalin during most of our shoots and when a baby was born and the mother and child were in stable condition, being overcome with emotion was common.

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