The Acquaintance: Esther Mbabazi’s Photo Essay of Birth in Rural Uganda

The Acquaintance is a photo-documentary of the life of Masa, an 81-year old Traditional Birth Assistant (TBA) in Uganda. It also looks at the changes that have happened in the East African nation since it outlawed the use of TBAs for expectant mothers in 2010.

“The Acquaintance” centers around photojournalist Esther Mbabazi’s chronicles in Bududa on the slopes of Mountain Elgon. Bududa has a hilly landscape that presents geographical challenges. Naturally, this complicates movement, especially for pregnant mothers. Walking long distances up and down hills to get to the hospital can prove to be a challenge–so pregnant women often opt for working with TBAs instead. As a documentary photographer, Esther uses storytelling and photojournalism to address issues in her society. Coming from a humble background, her work explores changing conditions on the African continent, with a focus on the social, economic, physical and emotional aspects of daily life, especially in rural areas and minority groups. Esther is driven to bring to light issues in society that are too often overlooked.

Editor’s Note: Visual Momentum refers to the flow of storytelling and its effect on the viewer’s thinking process. This series highlights creators who are successfully using their tools and minds to create an impact on the world through imagery with the intent of inciting action. With the support of Fujifilm, we share their stories. Also, be sure to check out This Week in Photo’s Video interview with Esther.

A portrait of 81-year-old Masa at her home in Bududa, Uganda. She began supporting mothers to give birth in the villages of Bududa District 40 years ago when her daughter in-law was forced to give birth in the middle of the night in the Elgon mountains in Eastern Uganda.

Esther documented Masa’s attempts to aid these women despite the steep terrain and the complications of her own old age. “She would pray for the women when they were in labor pains. She would stay at the hospital until the baby was born, and she would always offer encouraging words to help give strength to the mothers. When she had teenage girls having their first child, she would stay by their side and guide them through everything – only stepping out of the way so the midwives could deliver babies.” Masa became a TBA four decades earlier after seeing the experience of her daughter-in-law giving birth – the pain and lack of personal care. Her daughter-in-law was forced to give birth in the middle of the night in the Elgon mountains in Eastern Uganda.

Masa 81, shows the only tool she has available when assisting in deliveries – a plastic sheet that she lays down in her living room in Bududa to protect infants from the unsterilized ground, on November 4, 2016. This is a sharp contrast to the tools used in deliveries at the rural health center in Bududa, Uganda.

Masa saw her role as a mother and as an elder to care for the younger women and help them to have healthy babies and survive their births.

“I am inspired by different works from many photographers, writers, and other creatives. I find a lot of inspiration from photographers like Mary Ellen Mark, Eli Reed, my mentor at VII – Nichole Sobecki and I am always discovering more creative approaches to storytelling that inspire me to keep telling stories.”

Since that time, Masa has dedicated her life to helping women who otherwise don’t have access to the same types of amenities available in first-world countries. Esther observed that Masa’s typical day involves going to the garden, cooking for her and her husband, praying every evening at home or with her Jewish congregation, and checking in on her clients before calling it a day. “After her home chores, she visits her clients – new and old – expectant mothers, new mothers, and longtime mothers.”

Masa’s only tool for birthing is a plastic sheet that she lays down in her living room in Bududa to protect infants from the unsterilized ground. This is in sharp contrast to the tools used for deliveries at the rural health center in Bududa, Uganda.

“She mostly does not get paid by the women but in kind (with food, soap, sugar) when they can,” explains Esther. “Masa is contributing to reducing maternal and child mortality rates,…Families, in general, are more engaged in caring for expectant mothers and their partners are encouraged to support their women by different health centers, organizations, and programs.”

An expectant woman rests outside a rural health center in Bududa, Uganda, as she prepares to give birth, on November 11, 2016.

In 2010, Uganda banned the practice of TBAs–a controversial move that sparked debate in the media. Despite this, TBAs are still used. In the most remote villages of Uganda, many women have almost no access to modern healthcare. The World Bank shows that the fertility rate for women in Uganda has plummeted in the last 20 years. Often, the only hope these expecting women have rests on the older women in the community who, through years of experience, serve and help each other on different levels, including being the go-to midwives.

Although the government banned the practice of TBAs, it did little to improve modern maternal health services in rural areas of Uganda. While Uganda’s maternal mortality rate has declined in recent years, women in rural areas still suffer disproportionately from a lack of medical services. In northern Uganda, a woman has a 1-in-25 lifetime chance of dying in childbirth.

A mother breast-feeds her newborn child in the recovery room of a rural health center in Bududa, Uganda, where mothers and babies are monitored before being sent home, on November 11, 2017.

Uganda cites stories from mothers as its reasons for banning TBAs. Horrifying accounts of women who have enlisted the help of a TBA give us an idea precisely why this practice needed to be addressed. Take the story of 40-year-old Salome Nakitanda, as told to The Guardian in a 2010 feature:

“I was bleeding a lot, and the baby could not come out regardless of how much I pushed,” she said. “I kept trying for hours, and the TBA kept giving me herbs all through the night. The next morning, the TBA asked my husband to take a walk around the neighborhood. He looked nervous. The second he left the room, I felt a sharp pain all over my body and fainted.”

The story continued with the TBA taking drastic action, performing a cesarean section on Salome using a kitchen knife while she was unconscious, then stitching her up using a tailoring thread. Salome’s baby died. In the context of the new law, Masa now refers her patients to the health facility in Bushiika town, Bududa District, Uganda. Masa is much different though due to her engagement with the health facilities–which is how she became “official.” Masa acknowledges the importance of hospitals and that having access to improved health services is very beneficial to her clients. It was this change in the role of TBAs, longtime midwives like Masa, that so fascinated Esther and prompted her to point her camera at Masa and document her life.

“I get the feeling that either someone takes you to be an amateur for shooting on a small sized camera, or they take you to be a pro for shooting with a camera and brand that is still not very common here.”

Inside a Rural Health Center

The recovery room at a rural health center in Bududa, Uganda, where women rest after giving birth, on November 11, 2016.

 

“(Masa) started preaching the word to (expecting mothers) and took them to the hospital by herself.”

 

An expectant woman in labor pains lies in bed in the recovery room at the rural health center in Bududa, Uganda, as she prepares to give birth, on November 11, 2016.

 

“Masa mostly does it out of pure love–and she takes great satisfaction when she sees a mother give birth to her child in a healthy way,” Mbabazi said.

 

An expectant woman in labor pains at the rural health center in Bududa, Uganda, as she prepares to give birth, on November 11, 2016.

 

The tools used in deliveries at the rural health center in Bududa, Uganda, are a sharp contrast to the plastic sheet, which in most cases is the Traditional Birth Attendandants’ only tool of trade, seen here in the Health Center in Bushiika, on November 11, 2016.

The Evolution of a Photo-Documentarian

Esther’s Camera

Esther is a 2018-2020 VII Photo Agency Mentee and recently became a National Geographic Explorer, a program that supports the work of storytellers who are committed to a better understanding of our planet. She was a 2017 Magnum Foundation Photography & Social Justice Fellow.

In 2016, Esther was selected to participate in the World Press Photo Masterclass, East Africa, and also won the inaugural Young Photographer Award presented by the Uganda Press Photo Award. In 2015, she won third place at the Uganda Press Photo award for her story on rural education in Uganda.

Esther’s works have been published in The New York Times, TIME Magazine, The Washington Post, Wall Street Journal, Slate, El Pais, and has been commissioned by a variety of NGOs and international organizations.

“I knew I wanted to be a storyteller of some sort, I thought I would be a writer – but in 2012 I came across a public photography exhibition in Kampala with many amazing works,” said Mbabazi in an interview with the Phoblographer. “I was blown away by the power of photography – the ability to capture an emotion, a feeling, and share it with a large audience. I started taking lessons from photographers and attend photography and storytelling workshops.”

Esther’s work grew rapidly during the Magnum Foundation Photography and Social Justice Fellowship in New York. At that time, she dipped her toes into using a Fujifilm. The system accompanied her DSLR on a long-term project documenting youth in the country. ”I am inspired by different works from many photographers, writers, and other creatives. I find a lot of inspiration from photographers like Mary Ellen Mark, Eli Reed, my mentor at VII – Nichole Sobecki and I am always discovering more creative approaches to storytelling that inspire me to keep telling stories,” Mbabazi said. “This project, like some of the other stories I get interested in, was out of a need to know more about the TBAs of rural Uganda. What kept these women taking care of other women even when they were not paid? Who are they?” she asked. “I started out photographing different TBAs, but when I felt more drawn towards Masa for her humility, patience, and the love she involved in taking care of the women in her area.

“Every documentary photographer wants is to be a fly on the wall. The documentary process is particular in observing and visually recording what happens without any interference from the photographer…”

“Since I had the camera, I started shooting with it at first with the aim of easily getting into situations and staying involved while photographing without making the people so aware of my presence – which I felt would have been the case if I were shooting with a bigger DSLR,” explains Mbabazi. Mbabazi feels that a shutter’s sound can be interruptive during the documentary process. She valued the silent observer aesthetic when following Masa into the private lives of many women giving birth. When Mbabazi does projects like this, she appreciates a tool with a low-profile and quiet shutter. “The lightness and compact nature of the Fujis kept me interested in the connection and reactions that some people have towards me when I’m taking photos of them,” she said. “I get the feeling that either someone takes you to be an amateur for shooting on a small sized camera, or they take you to be a pro for shooting with a camera and brand that is still not very common here.

“I work with the Fujifilm Instax Mini 9, especially when I go to rural areas to photograph, where in most cases I know I won’t be able to bring prints to the people I’ve photographed. I make an instant photo print that I leave with them – you can’t imagine how happy this makes many people – to have a print of themselves – even if it’s small.”=

When it came to editing the series down to a final selection of images, Esther ensured that each photo had unifying elements to them. “I found her (Masa’s) character and passion outstanding, and when editing down the series, I wanted to keep the images few to communicate enough about Masa, the landscape she works in, the issue of limited access to health care in rural Uganda and so, I was aiming for each image in the final selection to communicate something to the audience,” explained Mbabazi, about some of the things she witnessed during the documentary process.

Esther mostly works with natural light and doesn’t use a flash, but she brings a reflector with her on shoots. Lately, she’s been very much about long-form documentary storytelling. She feels it lets her engage more in a story than shorter projects. For a long-term project involving youth culture, Esther goes to youth parties, photographs them in their homes, etc. “For my personal projects, I always want to spend a good amount of time with the people I am photographing,” she said. “This way, when I make photographs, I don’t feel like I walked into someone’s life and stole a picture of them. I like connecting with the people that let me into their lives, and I’d like to create images that are true to the people photographed.”

Since finishing this project, Esther has begun studying photography in low light using the Fujifilm camera system. She often encountered low light situations when working on “The Acquaintance.”

 

More About Esther Ruth Mbabazi

As a documentary photographer, Esther uses storytelling and photojournalism to address issues in her society. Coming from a humble background, her work explores changing conditions on the African continent, with a focus on the social, economic, physical and emotional aspects of daily life, especially in rural areas and minority groups. Esther is driven to bring to light issues in society that are too often overlooked.

She is a 2018-2020 VII Photo Agency Mentee and recently became a National Geographic Explorer, a program that supports the work of storytellers who are committed to a better understanding of our planet. She is a 2017 Magnum Foundation Photography & Social Justice Fellow. In 2016 Esther was selected to participate in the World Press Photo Masterclass East Africa, and also won the inaugural Young Photographer Award presented by the Uganda Press Photo Award. In 2015 she won third place at the Uganda Press Photo award for her story on rural education in Uganda.

Esther’s works have been published in The New York Times, TIME Magazine, The Washington Post, Wall Street Journal, Slate, El Pais, and her work has been commissioned by a variety of NGOs and international organizations.

 

More Information

Editor’s Note: This is a sponsored blog post from Fujifilm

 

About FUJIFILM North America Corporation (Fujifilm)

FUJIFILM North America Corporation (Fujifilm) is empowering photographers and filmmakers everywhere to build their legacies through sharing their stories. Grounded in its 85-year history of manufacturing photographic and cinema film, pioneering technologies in lenses and coatings, and driving innovation in developing mirrorless digital camera technologies, Fujifilm continues to be at the center of every storyteller’s creative vision.

Pushing boundaries in digital photography and filmmaking innovations, Fujifilm’s X Series and GFX family of mirrorless digital cameras and FUJINON lenses yield exceptional image quality for creators of all levels. Offering image clarity, advanced color reproduction technologies and a wide range of film simulations, Fujifilm’s family of mirrorless digital cameras delivers on fulfilling their intrinsic mission of capturing and preserving moments for generations to come.

With a Fujifilm digital camera at your fingertips, you can seize the moment, share your story and build your legacy. Learn more on our website.

Like us on Facebook, follow us on Instagram, subscribe on YouTube and join the conversation on Twitter.