In 2016, documentary photographer Esther Ruth Mbabazi, whose home base is in Kampala, Uganda, was selected to participate in the World Press Photo Masterclass East Africa. That fit perfectly with her life’s work so far, using her talents as a photojournalist to explore and spotlight the changing socioeconomic climate across the African continent through documenting the stories of individuals and communities.
Esther named her master class project, “The Acquaintance,” a slice-of-life portfolio on a traditional birth attendant (TBA), 81-year-old Masa, who practices in the Bududa district of Eastern Uganda, on the slopes of Mt. Elgon. For generations, the TBAs of rural Uganda have been helping expectant mothers with antenatal care and delivery, becoming close acquaintances, indeed, when there was no viable way for the women (or even the men) to reach health-care facilities.
After seeing images from “The Acquaintance” online, we asked Esther about how she came to choose her subject, and asked her to share some insights.
Click: The stories you are telling in this project are so compelling, and they create an indelible picture of labor and birth dangers in Uganda. Can you give some background on the practice of traditional birth attendants?
Esther Ruth Mbabazi: Traditional birth attendants (TBAs) have long been helping expectant mothers with antenatal care and delivery in the small, often remote villages of Uganda.
In 2010, due to the rise of maternal and child mortality rates, the Ugandan government banned the practice of the TBAs. Now, however, many of these problems are being tackled by the establishment of a new NGO-run hospital in Masa’s district. The hospital has created relationships with the TBAs and is encouraging these traditional midwives to advise, educate and bring their patients to the health facility for better maternal services. Masa is one of the few TBAs who are now referring their patients to the health facility.
What inspired you to pursue this particular subject?
I grew up in urban areas, where access to hospitals and medical services wasn’t a problem of accessibility. When I visited a friend working in the Bududa district, I was blown away by the unending hills and steep slopes. I was curious about how pregnant women managed to get access to hospitals for essential checkups and delivery.
Every woman I talked to mentioned the TBAs. I met with a couple of them until I met Masa; something about her personality and warmth drew me to her. News stories about the TBAs made them seem barbaric, but Masa was a very caring woman who seemed concerned only that the women who come to her get the best care and support she could afford them. 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, stepping out of the way only so the midwives could deliver babies.
Can you walk us through your process in photographing the stories you were documenting through Masa?
Masa is a friend in a way, to the women she helps in birthing, to the old tradition of birth attendants in the villages, and now, as a friend to the modern hospital in the area. She monitors and checks on her patients, often reminding them to go for their antenatal visits at the hospital, and makes sure they go for deliveries at the hospital — before this collaboration, women would give birth at home.
When photographing Masa over that week, I mostly was a fly on the wall. I would walk with her and see her work. The stories in this project are a look into the challenges that women face to access health care in rural areas of Uganda. It also celebrates the efforts of people like Masa, who are contributing solutions in their communities.
What are your goals for this project? What do you hope your viewer takes away from viewing these images?
I’d like viewers to know about the challenges other women in less accessible areas go through. But mostly, I would like the viewer to interact with Masa and her dedication to her cause. To appreciate the local heroes in our communities.
Is there a charitable organization you’d like to share with readers? This is the NGO that is bridging the gap and encouraging TBAs like Masa to refer their clients to their hospital: fimrc.org/uganda.
What or who are the biggest inspirations or influences on your work?
I’d say the biggest influence on my work is the interest in social issues. The projects I’ve done start with an interest — a certain level of curiosity, and motivates me to explore an issue and document it, share it with the world.
What’s your best advice for women interested in pursuing their own documentary projects?
Start. You just have to start. The good thing about documentary projects, you can take as much time as you need on a single project — the story isn’t really about you, so it will keep evolving, and you can always find ways to approach it. But you have to take the first step; find an idea, research, reach out to people to possibly photograph, and once you’ve reached out and found interested people, you can’t turn back.
What did you learn in your journey in shooting documentary projects?
To be more present in the stories I document. With these stories, we are amplifying voices and experiences of the people we photograph, so we need to be present — listen, carefully photograph and present the people with dignity.
Photos by Esther Ruth Mbabazi
This article first appeared in the July/August 2020 issue of Click Magazine. Get your issue from the Click & Co. Store, or subscribe so you never miss an issue.
More birth photography stories for you:
Chinelle Rojas protests healthcare inequities for Black women through her birth photography
Documenting one family’s story of newborn twin loss
Why postpartum photography is so different from traditional newborn photography
How to take your own newborn photos at home with any camera
I love the first image of the TBA. She is so striking as she stands in front of the hills in the background. It reminded me of my grandmothers in Malawi, such a familiar feeling. It’s amazing how images can transport you to another place and time. Such an incredible project!