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On the Horizon: Interview with “Birth Wars” filmmaker Janet Jarman

“On the Horizon: Outspoken Women Making Documentaries” is a Skylight series of interviews with emerging filmmakers, artists, documentarians focused on collaborative, ethical storytelling with historically disenfranchised communities around the world. Read more in the series here.

My colleague Janet Jarman is a long-time photojournalist who is marking her directorial debut with a documentary I admire “Birth Wars” about the tensions emerging between medical doctors and midwives in Mexico about whose vision of childbirth should prevail.  The film is part of the SR Socially Relevant Film Festival NY which is taking place this week and the festival is hosting a filmmaker Q&A on Wednesday, June 24th at 5:30pm on their YouTube channelThe film is also part of these film festivals (all happening online) DOXA Documentary Film Festival, June 16-26, 2020 and Rastro Festival on June 26, 2020.  And it was recently featured in the Ambulante en Casa Festival.  

Lee este blog en español aquí.

featured image: Janet Jarman. In the Highlands of Chiapas, Mexico, traditional midwife María López Gonzalez (known as “Doña Mari”), checks on her patient Rosita Gonzalez López, 22, to see if her baby is in the right position. Pregnant with her third child, Gonzalez had never been to a hospital. Throughout Mexico, most indigenous women rely on traditional midwives when they give birth. They distrust government hospitals where medics may dismiss their traditions, discriminate against them or force them to undergo unnecessary operations. During the Covid-19 crisis traditional midwives are often the only frontline healthcare providers in the region. They and the families they serve lack personal protective equipment such as gloves and face protection, putting them at high risk.

Pamela: You’re a well-known photojournalist, so what was it that made you want to make your debut documentary “Birth Wars”?

Janet: First, I want to say thank you, Pamela. Thank you so much for your interest in “Birth Wars.” Your support really means a lot.

 Yes, I have been a photojournalist for many years, but more than that, I consider myself a social issue storyteller who should use all the tools available to tell the fullest story possible, and the rapid technological development over the past few decades has given me access to the type of equipment that I could never have dreamed of earlier.

The transition has been a natural process that started around 15 years ago, when I began adding audio to still photo slideshows while working with writers for editorial clients like The New York Times. Sound is deeply moving, and I believe it is an important storytelling element, and this belief expedited my evolution into film. I slowly began making short films that would be packaged with an article and slideshow. I felt that adding motion really allowed for more comprehensive storytelling. I also loved conducting interviews and listening to people tell their own stories. 

One of those short films attracted the attention of the MacArthur Foundation and led to my being awarded a grant to make a feature documentary and a book. It was an incredible opportunity that challenged me to use every aspect of my journalistic and artistic skill set, and I am so grateful that I was given the opportunity to live this experience. I’m definitely eager to continue on this path.

“Birth Wars” is such a provocative title. Why “wars”?

Ultimately, most of my work is about unmasking systems of power, and this story is no different. In health systems, not just in Mexico, but throughout the world, women are being denied respect and dignity and the right to choose, and this is an abuse of power.

The title “Birth Wars” warns viewers that they will be entering a world of conflict, in this case a conflict about who has the decision power, who gets the jobs and who controls the funding. It’s an unequal fight where the medical establishment has a lot of power, and many women, midwives and maternal health advocates see their efforts as a true fight for justice and equality.

For me, “Birth Wars” also depicts a philosophical war between opposing approaches to childbirth, one that is often driven by efficiency and profit and another that honors natural processes with fewer interventions. We know very well by now the tragic consequences of destroying natural processes, and birth is no exception. 

Finally, “Birth Wars” is not a story about just birth and maternity. Instead, it is a film about human rights, dignity and respect, and about the possibilities for bringing humanity back to medicine. The film depicts a silent war that lacks graphic photos of guns and soldiers. For this, it remains under-covered in the news but still plays out in the lives of thousands of women and their families on a daily basis.

I wanted to express this conflict in the way that I shot the film. Critics have noted that I seemed to bring my photojournalist’s eye to the way I filmed the action, and I agree. I wanted the visual impact to be intimate and immediate, and I tried to make the viewers feel present in the situation and part of the fight.

How did you find the protagonists, the midwives at the center of the story of “Birth Wars”?

During the pre-production process I spent a lot of time at maternal health seminars and workshops of midwives all over Mexico, and I built trust with many of them. I started to document the lives of some of the characters that really struck me, with the intention of following them over time. I wanted to make a character-driven film, in the trenches of the healthcare sector, with a real narrative arc.

My goal was to show viewers the issue by taking them on a journey deep into the scenes that I was covering. I also didn’t want clichés and stereotypical footage. In the beginning, I followed several stories and situations, but over time, it became apparent which characters truly welcomed me into their lives in a way that would allow me to convey this complex issue in a responsible way – i.e. Rafaela López Juárez and Guadalupe Guzmán Cruz.

I also thought it was very important to explore doctors’ perspectives. Many are burned out as they work inside a broken system. Overall, I have never been a person to follow formulas. My decisions are always based on a gut feeling that is guided by my many years working as a photojournalist. I now look back and am amazed by how their stories panned out. I never could have  imagined the odyssey that Rafaela would make in her search for a meaningful job, or how Guadalupe would come to represent the collective fight of thousands of traditional midwives who are truly the front-line health workers of their communities.

What did you want the film to say? What impact do you want the film to have? Is it having that impact? And are the midwives featured in “Birth Wars” part of your impact campaign, representing the film around Mexico and the world? 

With this film, I sought to contribute to changing the narrative about maternal health, and especially the approach to childbirth. I wanted to show that there are options, and that a woman has the right to choose whether, how, where and with whom she gives birth. Ultimately, this requires a dramatic paradigm shift in the obstetric model of healthcare, from a doctor-driven system to one that returns the decision-making power to women and focuses on natural processes.

I also wanted to show a healthcare system that is broken and failing, and where discrimination routinely causes poor health outcomes for vulnerable women. Even if doctors want to offer quality care, the environments in which they must work in the public system restricts them. I hope the film will promote dialog about what can be done to make hospital systems more humane and how midwives can be a major part of the solution in providing women with quality, evidence-based care, wherever they choose to give birth.

The film is starting to make an impact. Within Mexico, it has screened all over the country and is being used to accompany a new Congressional initiative to recognize the role of midwives. In the international arena, Birth Wars has been selected for a number of recognized film festivals, and we have been invited to screen at influential conferences. I had expected that the cancellation of most festivals would have curtailed this momentum, but the relaunch of so many festivals as virtual events has actually dramatically broadened the audiences that we can reach. At the recent Ambulante en Casa festival in Mexico, nearly 3,000 viewers accessed the film in one day and hundreds of them dialed into the Q&A session. Online festivals are unexpectedly giving us access to untapped audiences. 

The midwives featured are very active in the impact campaign and will continue to be. They not only attended the premiere and its press interviews but were also part of the panel at the Mexican Congress and at the online Q&A sessions for Ambulante. Many more opportunities for them to be involved are being set up for the future.

Photo by: Erika Oregel. Janet Jarman, Director, Cinematographer, Producer of BIRTH WARS films a family near Acatepec, Guerrero, Mexico, with sound mixer Maria Cristina Santos Monroy.

What resonance do you think “Birth Wars” will have in the United States, especially for women?

Midwives in the U.S. confront the same types of prejudices and establishment rejection as they do in Mexico, and I hope that showing evidence of what midwives actually do and the difference that they can make in a woman’s life will resonate here as well. In many countries, midwives assist most low-risk births, leaving obstetricians to handle only emergency cases requiring medical intervention. In the U.S., midwives attend only around ten percent of births as opposed to close to three quarters in France and more than half in the U.K.

The maternal health situation in the U.S. is worsening. Surprisingly, the U.S. is the only developed nation where the maternal mortality rate is actually increasing. People of color are particularly at risk, a reality that organizations such as New York-based Every Mother Counts and ProPublica have brought to national attention.

I feel that “Birth Wars” could also help raise awareness and show women that there are other valid alternatives for giving birth. I hope that viewers will connect strongly with the Mexican women pictured in “Birth Wars.” There are no borders when addressing women’s struggles and rights. 

You work together with your partner Filip Lein who edited and co-produced “Birth Wars.” How is that? What’s your co-creation process like? You can both answer this question! 

Janet: For me, one of the most important aspects of making this film, apart from working with an incredible field team of Mexican women, was knowing that I could always call or come home to someone who deeply understood everything about how I work, everything about how I think and everything about the story I wanted to tell. To work with this confidence was a true gift, on many levels. 

In a way, Filip has always been a trusted colleague. Before making films together, he was a constant intellectual sounding board for all of my still photo projects and story ideas. Making a film amplified this process. I never felt like I was working with my partner per se. I felt like I was working with a great mind and with a person who had the same end goal. 

One critical part of our teamwork is that we have very complimentary skills. I have always respected Filip’s ability to concentrate intensely for hours on end while synthesizing mountains of information, and I know that he truly trusts my storytelling instincts and journalistic judgement. Our identical work ethic is our primary glue, I would say. We are both stubborn, perfectionist, and we expect a lot from ourselves. We did decide a long time ago that we should not be in the field together. This also helps!

Admittedly, creating our first feature-length documentary was daunting and overwhelming, but fortunately, we had worked on many shorter projects prior, and we could rely on lessons learned. One of these lessons was the art of respectful communication, which is really the key to making any relationship work, whether professional or personal. We can basically communicate our way through any issue; although, I am sure he wishes I would generate less material in the field, and I still don’t understand his excessive use of bullet points in working documents.  

Filip: In the beginning when Janet and I started to work together we received a lot of pushback from friends and family who warned that this was a recipe for disaster and would lead to tension in our relationship. We were not really worried about this since we have complimentary skills and we communicate very well.

In the beginning of each project we jointly research and develop the idea into a concrete plan. Luckily, we have a similar worldview. Once we have raised a sufficient amount of funding, Janet puts her team and equipment together while I handle the legal/finance aspects and set up my editing suite. We stay in close contact as she travels between the field and the office, and we discuss the footage to date that I am doing extensive preliminary edits on. Once the shooting wraps, I develop the first draft of script and edit and then we mold this together until final cut and into post. As the Director, Janet offers detailed feedback and suggestions, but I make every cut. Yes, there will be tense moments, but we always find a way to resolve these in a harmonious way, believe it or not!

Pamela Yates

Pamela Yates is a an award-winning filmmaker and co-founder/Creative Director of Skylight Pictures, a company dedicated to creating feature length documentary films and digital media tools that advance awareness of human rights and the quest for justice by implementing multi-year outreach campaigns designed to engage, educate and activate social change.

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