39,000 girls under 18 will marry today.

Child marriage is defined by the United Nations as any child who marries before the age of18.  It is estimated that 39,000 girls under 18 will marry today.

Between 2011 and 2020, it is estimated that 140 million children will be married and of those 50 million will be under the age of 15.

One half of all the girls in South Asia will be married before they reach their 18th birthday.

These women walked several hours to wait for a government midwife to immunize their children and get prenatal care.  They wait at a small store and if she does not come, walk home again and try the following month.   There is no care in their villages.  Mostly they come for immunizations.

When I am there, in a small community, I offer prenatal care and work with the community health workers and Gigi, the newly graduated midwife.   I ask a young woman who is only 14 if this is her first pregnancy.  "No" she answers.  "I had one other who died."    "When?"  I ask. She looks at me and says, "The day he was born.  That day."   I wonder why.  "Did he cry at birth?"  "Yes, she says."

I ask who the midwife was and she answers that her husband delivered the baby.   

"Oh."  

She is fourteen, pregnant for the second time and has already lost one baby.  They tell me that the girls are frequently given in marriage for a dowry such as two horses or some other thing the family might need.  The  men are older and perhaps have other wives or children.   

The next day, I have a women's circle and we talk about birth and some things that might help in an emergency.   I suggest having a first baby after 18 but they laugh.  This is not possible.   They are married between 11 and 14.  

Mountains and Motherhood and Midwives

Childbirth in the mountains

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Twenty-seven percent of the earth' s surface is mountains and these mountains are home to over 720 million people.   They are also some of the poorest people on earth and the place where far more women and babies die in childbirth.

In many countries that I have visited, the mountains were the places that people fled to when escaping slavery, state making and colonization.   The people down below in the valley land see them as living ancestors; carrying with them the traditions and knowledge of the past.  Most people originally lived closer to the coast where  trading, better soil and more opportunities for growing and hunting for food existed.

In Haiti and as in the Philippines, when the Spanish came some died of disease and were enslaved and some escaped to the mountains.  They were sometimes known as maroons; people who escaped from slavery and went to live in the mountains.   Brave and resourceful they came to make the unwanted land of the mountains their home.  They learned to farm, hunt and build communities high in the crevices of these places.

There were and are still are few roads.  Paths connect communities and are often a long way from the road.

In the Philippines, they ask what is to be done about our poor maternal health rating?

"It is" I say,  "A matter of mountains."

"Mountains?"

"Yes, mountains.   The women can not get down when they need help and no one wants to bring care to them so far up in the mountains.  It is matter of roads and people."

The governments hope that the women will come down.  They plan for waiting homes and birth homes but they are far from the mountain communities and difficult to get to.  They must leave farm and family.

But it is not just roads, it is that the mountains are fragile ecosystems and things like mining and deforestation destroy their source of food and cause severe starvation and malnutrition.  Streams are filled in by landslides destroying a source of water.

There is also war.   I think of the sandy roads of Cambodia that offered many,well staffed rural health centers.   The roads were flat and easy to use.   People road bikes and walked and healthcare was greatly improved in this landscape.  But even there, high in the mountains, on the border of Thailand and Cambodia, soldiers camped with their families and in that place- that place of on-going conflict, the women had no access to care and were far from help, should it be needed.

In the Philippines, a people fearful of the army and foreign mining companies, have difficulty worrying about birth.  The government says, "Come down out of the mountains and give birth down here."

They threaten them with fines; fines for the mothers and fines for the traditional midwives.  A woman at a small store says, "They just more further into the mountains where no on will bother them."

When I teach a workshop, usually for the traditional midwives, all the women, children and some men of the village come.  I can see from their stories that there, everyone is the midwife.  Anyone could find them self beside a woman giving birth; on the road, in a field or by the water.  They tell me that there in the mountain they all need to know.

On my way down the mountain, the motorcycle weaves around many new landslides and through mud from hard rains.  It is a long, hard ride and even when we get to the main road, it is a long way still to the nearest birth center and even there the midwife is gone and would not be there, even if the woman had made that long journey or could have afforded the motorcycle ride on a day when the road was not washed out.

I too, live on a mountainside.   I am 67 and people sometimes say, "I am afraid to come up there on that road to see you" and sometimes friends say "maybe it is time to move off that mountain."

Other times, I sit on a rooftop in LaGonave or sit by the school in Mindanao or sit on my little mountain and look out.  Buried in the mountains, we can see lights in the distance and know there is a life  out there.

A doctor says , "And how is America?  " I consider and say., "It is big place so its hard to say but I live on a dirt road on a little mountain and look out at the dusk creeping over the valley.  I have chickens and sheep and the children run and do not want to stop playing. "   She can see it is much the same.  But it is not.   The army has never once come up my mountain and if they are mining this mountain range it is not on my land and mostly never could be.  I can get in my car easily, and drive to town.  When my grandchildren are born on the side of this mountain, I can easily get down in an emergency.

I look at the group gathered to ask what I think about maternal health in the Philippines and I consider the question.  "Mountains.  You have to have a plan that considers the mountains and the people who live there; not one just for getting them down but one that respects their culture and their need to be near family and farm.  I think the midwives have to go to the mountains."

The Ladder System of Midwifery in the Philippines

The Ladder System in the Philippines - from Midwife to Doctor

This is my friend, Gigi, who lives and works and volunteers in the Philippines.  I spent my first week in Mindanao with her.  She has just finished her third year of midwifery school and was suppose to volunteer in the summer before she started a  year of nursing school in the fall.  

She and her other class mates are part of an amazing program, in which they complete three years of midwifery school and then can go on to complete a year of nursing school and then go on to medical school.  They can stop at any point in the program or just keep on going.   To qualify they must be chosen by their community or Baranga.   She was chosen for her obvious enthusiasm, intelligence and dedication.  

Her school is a large modern building. It is great, but what is amazing is the village of traditional houses across the field where all the students live, cook and study.   It is a remarkable model of improving healthcare in remote communities.   

Gigi and I had so much fun together.  We did prenatal care and taught classes and gave presentations as well as so much singing and riding motorcycles up to the communities and cooking and telling stories.  What was so impressive about her and the community health workers, was their true wish to help their communities and a sense of volunteerism.  She is becoming a doctor, via becoming a midwife and a nurse but her mission seemed so much larger.  It was to make her country a better place for everyone and most all of all those who have the least. She is eager to understand her country's history and the culture of the people she serves.  

There is much that can be said about maternal health in the Philippines but I want to start with this amazing woman and her path to becoming a doctor.   Her courage was as big as her heart and her smile.   

You may be surprised that it starts with 3 years of midwifery.  I think its inspiring  because its basically saying," let's start at the beginning of life and get that right."  A midwife also does many things including prenatal care, births, immunizations and family planning.  Each midwife there covers a large area that includes many remote villages.  There job is very hard, even with the help of community health workers from the World Health Organization.  There is no doubt that when Gigi graduates her community will be so happy to have her.  As part of the program, she made a commitment to stay in her country and return to her rural community.  

**** Just a note of caution, the Philippines did not meet the millennium goals in maternal and newborn health and the communities we visited had no prenatal care and no access for transport or even trained traditional birth attendants.  It is currently agains the law to have you baby at home with no ability to serve women in birth centers that they can have access to.   Gigi is part of the solution but in the mean time there ei much that can be done.

Prayers for Mary Jane Veloso

Mary Jane

Today we wait, with so much sadness as this young Filipino mother waits to be executed by firing squad.  She represents the many women and mothers, who each day, leave the Philippines to find work and support their families.  Although she was convicted of smuggling heroin into Indonesia, many supporters believe that she was a victim of human trafficking.  Like many mothers, poverty and a lack of education made domestic work in another country an inevitable solution for her and her children.  It is estimated that 100,000 women and children are part of the sex trade in the Philippines and that an estimated 4,000 people leave each day on temporary work visa's.  Still more, like Mary Jane, use any means they can to get a job and get caught in situations they could never have imagined as young girls in small villages.

I wait and pray, as so many are around the world with the hope that she will not be executed.  I do not believe in capitol punishment and support the United Nations efforts to make it an international human rights issue.  Only 21 out of 195 countries still have the death penalty and my country is one of them.

As midwives, we work hard to protect the life of mother and baby.  Nowhere is this more necessary than in the work to end human trafficking.  The impact, the violence, the fear are barriers to any move to healthy, sustainable societies.

I pray that they will not kill  her and she will get a fair trial.  I pray that we will one day have a world where a mother will never be forced to leave her children and risk her life to earn a living; that she will never have to leave her children so they can get an education and be safe.

I pray that there is work for everyone and a way for mothers to care for their children in  safe, secure way that causes no harm.  I pray for the end of the death penalty in my land and around the world.

Sometimes we know a person is convicted of a crime and when they are waiting for the firing squad, we know that society is to blame; poverty, war, greed, a lack of schools and a world that has too often turned their back on women.

I shut my eyes and wait and pray.  

Listening to the earth

I return from the Phillipines; from the southern most island of Mindanao.   I am here in Portland but my heart and mind are still there.  I know this is how it is.  I walk around and go through the motion of putting things away and getting settled back in but I am thinking of the people I met and loved in other places.

It is part of it.  When we go, we agree to get sick perhaps and to have our hearts ache.  The people I travel with there, call it an Exposure Trip.  They do not say it is necessarily a volunteer trip but an exposure trip.  Sure, I help as much as I can but mostly I am learning to see another part of the world in ways I had never thought of before.  I sit with mothers and midwives and community health workers and we teach each other.

Tomorrow I will begin to tell what I learned.  I have electricity and internet and an education.   I can put my laundry in the washer and walk away and sit here at the computer.   I can turn on a faucet.  I have the time and obligation to tell this story.

But just for today, I want to lie in the tall grass and let the wildflowers crawl over me.  I want to watch the bees on the thimble berry and the snakes lying beside me on a sun baked rock.  I let the sheep nibble my hair and toes and I listen to the earth; the layer that wraps itself around the world like skin to one living, breathing  planet.  If I lie there long enough I can feel the roots that grow and connect me to the places in the Philipines where I so recently walked and slept and enjoyed my morning tea.  I feel those roots spread out and climb the mountains of Haiti and the rice fields of Vietnam and Cambodia. I know this layer of dirt; the one I am sinking into; the one I am trying to be a part of, does not know the name of  the country or who has claimed its soil as their own.   I feel the feet dancing and the men walking from the fields and the mothers giving birth and holding their babies to their breast.  I put my ear to the ground, buried there, in the tall grasses and listen.

At the bottom of the small mountain where I am lying in the grasses, I can hear the boats and trains and the factories.  I can hear how they too stretch out and try to reach all around the world.  They move chemicals and oil and coal and propane.  They want to dig up the land of the first people of Canada and move it through the First Nations Land of North America and across the world to the first people; the ones I lived and sang and world with in the mountains of Mendanao.  There are other lines.  There was the slave triangle and the path of colonial ships and imperialist armies and political deals we did not learn of until it was to late.  Paths.

Inside each mother the veins of the placenta reach deep within her and connect her unborn baby to nutrients necessary to growth.  If the placenta is not strong or is disrupted, the baby can not survive. The mother and baby depend on this connection.  They depend on the earth.

We are connected by cycles of sun and moon and tides and seasons.  But we, in this modern age, are connected by mines and the minerals we take from the earth.  I am connected to all the minerals taken from the earth to offer me a life style so different from the people whose land it is taken from.  The typhoons and earth quakes are made worst by this disturbance, these large extractions, the coal trains that benefit the very rich and leave mothers walking on roads blocked by landslides, by soil destroyed by de-forestation.

Every minute a mother will die a pregnancy related death.  Most people will  never take notice.

Today, if you were to ask me, why mothers died,  I would look up and say "perhaps mining."  And you might say,"Mines,  you mean the mothers  are in the mines and they collapse."  I can see the shock in  your face. But I  reply, "No. Its  that the mines and deforestation took away her food source and her roads and her child's education and the riches made possible  from the mining took away her human rights.  That is why she died."  I would squint in the afternoon sun.  "It might look like something medical but in the end it was mining or plantations or de-forestation."

But I am alone just now.  I let the grass cover me and listen for the mothers' footsteps beneath the dirt.   I put my ear on the ground and listen for the music and the prayers. This is how it is when I return. Its best to be alone for a little while; to do the simple tasks of home and garden as I feel my heart so connected to another place and time; to stories that cannot seem possible and solutions too far from reach.
 

FOLLOW ME ON MY JOURNEY TO THE PHILIPPINES

For the next three weeks, I will be documenting my work with mothers and babies in the southern island of the Philippines, Mindanao. I'm going in collaboration with Portland Committee for Human Rights in the Philippines. Follow me on my journey as I help women and children with their birthing needs. New journey, new place.

Mothers, study groups and being called

I meet an old friend and midwife in the store.   Our midwifery careers began in much the same way.  We were young moms who had births that in our heart of hearts did not feel "right."   We went on, after these births, to be moms and work and go to school but inside we knew we could birth differently.  We did not have the right words to say this or even had anyone much to say it to.  This feeling lived within us.  Perhaps we tried to shrug it off.   To say that's jus how birth is but inside we knew that wasn't true. We knew we had a strength, an inner voice and a power that was not allowed to   be heard.   We knew we had been silenced.  We had, of course, been silence many times before and had learned to still that voice; to not be who we were meant to be, to compromise our truest selves. We had watched our mothers and the women in our communities.   That we breastfed and fought for a natural childbirth against all odds- wasn't that enough.

But when we got pregnant again we knew that the voice would not be quiet.  Perhaps because it was in the hearts of own all over the country and because there were generations of women all over the world there minor hearts to encourage and protect us.  And so we began to look- quietly and alone and found a book and had a conversation and had our first home births and then joined study groups and took correspondence courses and dared to listen to that voice that called upon us to sing a song for women and mothers; the one inside of us that was waiting to be heard.

When we were young, with breastfeeding toddlers at home, we took a week long workshop on midwifery and slept in a tent in a backyard.  We laughed all night long.  We had no idea where this would take us or who we would be but we followed a small,still voice and tried to learn as best we could.  There were no schools in Portland.  We had study groups  and read what we could and began to attend births.  It was an avocation.   I don't think we thought of it as a profession.  It was our life as we saw and felt and dreamed it.  It was us waiting to be born, even as we held the hands of women giving birth.

This is how many, many woman became a midwife.   There was a river.  We put our toes in the water and then could not turn back.