0:00:01 > 0:00:05This programme contains scenes which some viewers may find upsetting.
0:00:14 > 0:00:16Push. Push.
0:00:16 > 0:00:18Push. Push.
0:00:22 > 0:00:24SHE GRIMACES
0:00:24 > 0:00:27SHE SQUEALS
0:00:27 > 0:00:29Push, push, push!
0:00:31 > 0:00:35SHE GROANS
0:00:35 > 0:00:39Every second of every day, somewhere in the world,
0:00:39 > 0:00:42a women is being encouraged to push.
0:00:42 > 0:00:46THEY ENCOURAGE HER IN KHMER
0:00:46 > 0:00:49WOMAN SCREAMS
0:00:56 > 0:01:00The result of all that pushing is that every year,
0:01:00 > 0:01:05130 million babies are born, and 130 million mothers experience
0:01:05 > 0:01:10very special feelings of joy and love.
0:01:10 > 0:01:14BABY CRIES
0:01:14 > 0:01:16You did it!
0:01:21 > 0:01:24BABY CRIES
0:01:24 > 0:01:27The opportunities available to these young lives
0:01:27 > 0:01:31will depend very much on where they are born.
0:01:34 > 0:01:36Some will prosper and thrive.
0:01:36 > 0:01:38Others will struggle in the lottery of birth.
0:01:41 > 0:01:44This film will look at the chances and opportunities
0:01:44 > 0:01:47available to babies born in Cambodia, Sierra Leone,
0:01:47 > 0:01:50the United States, and Great Britain.
0:02:02 > 0:02:04Fortunately for these twins,
0:02:04 > 0:02:08they've been born in California.
0:02:08 > 0:02:10That's good for all sorts of reasons.
0:02:10 > 0:02:13Americans have a life expectancy of 78 years.
0:02:13 > 0:02:19But they also have a one in three chance of becoming obese.
0:02:29 > 0:02:31This is baby Suk May.
0:02:31 > 0:02:35She's more likely to be malnourished than go to high school.
0:02:35 > 0:02:40She has a life expectancy of 65 years.
0:02:49 > 0:02:51Hello, baby! Hello!
0:02:51 > 0:02:55- Oh, my God, David!- You are the best!
0:02:55 > 0:02:59Lily Jean well go to school and then work until she is well into her 60s.
0:03:00 > 0:03:03She has a good chance of living to be 100-years-old.
0:03:03 > 0:03:05- Oh!- You're the best!
0:03:05 > 0:03:08- I can't believe that I've had her! - Already!
0:03:09 > 0:03:12WOMAN SCREAMS
0:03:15 > 0:03:18SHE SCREAMS
0:03:25 > 0:03:28BABY CRIES
0:03:28 > 0:03:30The name of this baby is Rachel.
0:03:34 > 0:03:37Welcome to the world, baby Rachel.
0:03:37 > 0:03:39You are a citizen of Sierra Leone,
0:03:39 > 0:03:44and you have a life expectancy of 49 years.
0:03:44 > 0:03:47Luckily, your mother survived having you.
0:03:47 > 0:03:51One in every eight women in this country die in childbirth.
0:04:44 > 0:04:47Although the government recently made healthcare free
0:04:47 > 0:04:49for pregnant women and children under five,
0:04:49 > 0:04:53there are fewer than 200 doctors in the whole of Sierra Leone,
0:04:53 > 0:04:55serving a population of six million.
0:04:57 > 0:05:01This is the Gondama Referral Centre,
0:05:01 > 0:05:04a unique hospital for pregnant women and children.
0:05:04 > 0:05:06It's at the front line of providing care
0:05:06 > 0:05:09for some of the poorest people in the world.
0:05:09 > 0:05:11When did she go into labour?
0:05:11 > 0:05:15- She went into labour this morning. - All right.
0:05:15 > 0:05:18Set up a venous track here and check the blood pressure.
0:05:18 > 0:05:22So one person is working on this one, two people are working on that one.
0:05:22 > 0:05:25That one is more urgent.
0:05:25 > 0:05:28Now we have five of our own clinics
0:05:28 > 0:05:31and another 25 government clinics,
0:05:31 > 0:05:35Ministry of Health clinics, which are referring patients to us.
0:05:35 > 0:05:39In this hospital, we only take patients who have complications.
0:05:39 > 0:05:41We do not do spontaneous deliveries.
0:05:41 > 0:05:43So we have a high Caesarean section rate.
0:05:43 > 0:05:46Mr Suma, get the ultrasound there.
0:05:46 > 0:05:49I want to do ultrasound before we go for there.
0:05:49 > 0:05:50- OK?- OK.
0:05:50 > 0:05:53'Today I've already done three or four C-sections.
0:05:53 > 0:05:56'We are going to do another two today at least.'
0:05:56 > 0:05:59Push the baby. Small baby.
0:05:59 > 0:06:02Baby, you're going to be OK.
0:06:02 > 0:06:04I see you crying already.
0:06:04 > 0:06:07BABY CRIES Thank you. Hold on.
0:06:08 > 0:06:11We've got it. We've got the baby, we've got the mother.
0:06:11 > 0:06:13- Yeah.- We are doing fine.
0:06:15 > 0:06:16'Through this referral system,
0:06:16 > 0:06:20'we are able to reduce the maternal mortality rate.'
0:06:20 > 0:06:23It's something we want to show to the world,
0:06:23 > 0:06:25to the developing world, that it can be done.
0:06:25 > 0:06:30The goal is to reduce the maternal mortality rate by 75%.
0:06:30 > 0:06:33BABY CRIES
0:06:33 > 0:06:36Yeah, I mean, there is a bladder there,
0:06:36 > 0:06:40but it's also just very, very difficult to get any...
0:06:40 > 0:06:42'Most of the patients that we see
0:06:42 > 0:06:44'are very critical when they come to us,
0:06:44 > 0:06:45'and many of them would die
0:06:45 > 0:06:48'without the medical intervention that we provide.'
0:06:48 > 0:06:49Yeah, she's got a contraction.
0:06:49 > 0:06:53Yeah, I can't get any measurements on this kid at all.
0:06:53 > 0:06:58Apart from the head circumference, which is huge.
0:07:07 > 0:07:09'So this lady has been referred into us.
0:07:09 > 0:07:11'She's clearly had a large bleed,
0:07:11 > 0:07:13'probably from a placental abruption,
0:07:13 > 0:07:15'and the baby has died as a result.
0:07:15 > 0:07:17'She's probably lost 2-3 litres of blood,
0:07:17 > 0:07:19'and she's in a critical condition.
0:07:19 > 0:07:21Still bleeding,
0:07:21 > 0:07:25so we're going to do a Caesarean to try and get the placenta out
0:07:25 > 0:07:27and stop the bleeding as quickly as possible.
0:07:27 > 0:07:30The other one who's waiting has an obstructed labour.
0:07:30 > 0:07:33Also the baby has died as a result.
0:07:33 > 0:07:35She may also have a uterine rupture,
0:07:35 > 0:07:38but this one is a little bit more critical,
0:07:38 > 0:07:42so we do the most critical Caesarean first and the other one has to wait.
0:07:44 > 0:07:47Big stretch. Thank you.
0:07:47 > 0:07:50OK, big push, please.
0:07:50 > 0:07:51From the top. Thank you.
0:07:51 > 0:07:53Keep pushing. Keep pushing.
0:07:56 > 0:07:58OK. Cord round the neck, yeah.
0:07:58 > 0:08:01But I don't think that was the cause of death.
0:08:01 > 0:08:03And no foetal heart present.
0:08:21 > 0:08:24It's from the placenta coming away early.
0:08:24 > 0:08:27That's the baby's oxygen supply, so...
0:08:27 > 0:08:29the mother can also lose a lot of blood.
0:08:29 > 0:08:31We'll be transfusing her
0:08:31 > 0:08:33as soon as we have blood available.
0:08:33 > 0:08:36There's not really a culture of blood donation.
0:08:36 > 0:08:40We've also sent her relatives to donate blood.
0:08:40 > 0:08:42It's not like home, where you can just
0:08:42 > 0:08:43order stuff from the blood bank.
0:08:43 > 0:08:46You have to go and find your blood!
0:08:46 > 0:08:49Had she had quicker access to medical care,
0:08:49 > 0:08:52had she been labouring in a hospital that could do a Caesarean section
0:08:52 > 0:08:54the moment an abruption was detected,
0:08:54 > 0:08:56it's possible the baby would have survived
0:08:56 > 0:08:59and she would have come in in a less critical condition.
0:08:59 > 0:09:03Alrighty. Let's pop the uterus back in.
0:09:06 > 0:09:07Your patient is here.
0:09:11 > 0:09:14I don't think that women have
0:09:14 > 0:09:18necessarily more difficult births than in other places.
0:09:18 > 0:09:21I think the problem is their lack of access to medical care.
0:09:21 > 0:09:25There are very few gynaecologists in the country,
0:09:25 > 0:09:29there are very few other doctors that can provide obstetric care.
0:09:29 > 0:09:32There are very few midwives in the country.
0:09:48 > 0:09:52If a lack of resources means high infant and maternal mortality,
0:09:52 > 0:09:55the answer is to provide more resources.
0:09:55 > 0:09:59That's not hard to do. There's enough money in the world.
0:09:59 > 0:10:02It's simply a question of redistributing it.
0:10:04 > 0:10:09Of the 20 worst countries to be born, 19 of them are in Africa.
0:10:09 > 0:10:13A child in Africa is much more likely to die as an infant
0:10:13 > 0:10:14than a child in Europe.
0:10:14 > 0:10:17More likely to suffer from malnutrition,
0:10:17 > 0:10:19less likely to go to school.
0:10:19 > 0:10:22More likely to be a child worker,
0:10:22 > 0:10:25less likely to have access to clean water.
0:10:25 > 0:10:30Much more likely to be a loser in the birthright lottery.
0:11:19 > 0:11:22- Oh, yeah?- Yeah.- We should love each other the same amount?
0:11:22 > 0:11:23- Yeah.- Yeah?
0:11:26 > 0:11:29'It's the kind of thing that happens, I guess, to anybody.
0:11:29 > 0:11:32'Didn't expect it, wouldn't have expected a year ago.
0:11:32 > 0:11:34'Never would have dreamed this was going to happen.'
0:11:41 > 0:11:44We were living in a nice house. We had everything we needed.
0:11:44 > 0:11:46We weren't hurting, our cupboards were full.
0:11:46 > 0:11:49And so, kind of, here we are.
0:11:49 > 0:11:51Just lost everything.
0:11:52 > 0:11:56The economy has just completely collapsed.
0:11:56 > 0:11:58I couldn't pay my rent,
0:11:58 > 0:12:00so I bought a motor home for my family
0:12:00 > 0:12:02with the last little bit of money we had.
0:12:02 > 0:12:06I thought that was the right thing to do.
0:12:06 > 0:12:08Apparently, it's illegal,
0:12:08 > 0:12:10you know, to live in the RV, so...
0:12:10 > 0:12:14Guyan, stop, you're hurting your brother!
0:12:14 > 0:12:17All right, don't have a breakdown. Let's chill now.
0:12:17 > 0:12:19'It's nobody's fault.
0:12:19 > 0:12:23'I don't even think it's my fault. This is life.'
0:12:23 > 0:12:26I've never lived at the top end of the class scale,
0:12:26 > 0:12:27or anything like that.
0:12:27 > 0:12:30I come from poor white trash, you know?
0:12:30 > 0:12:33So I'm...
0:12:33 > 0:12:36hell, even with our situation today,
0:12:36 > 0:12:39I'm probably living better than half of my family.
0:12:41 > 0:12:43'I'm not trying to get pity from anybody.
0:12:43 > 0:12:46'I am trying to get a little bit of a hand up.'
0:12:46 > 0:12:49Not a handout.
0:12:49 > 0:12:52I just want a little bit of support while I pull myself together.
0:13:14 > 0:13:16HPP, or the Homeless Prenatal Program,
0:13:16 > 0:13:18is a family resource centre.
0:13:18 > 0:13:23It initially was a program that focused only on women
0:13:23 > 0:13:26who were homeless and pregnant.
0:13:26 > 0:13:29Taking advantage of that period of pregnancy
0:13:29 > 0:13:31to help a woman change her life,
0:13:31 > 0:13:35or do things that would be healthier.
0:13:35 > 0:13:38- You like that one? You pick whatever you want.- Oh, I prefer this one.
0:13:38 > 0:13:41- OK, whatever you like.- Thank you. - Well, congratulations.
0:13:43 > 0:13:45You're having a boy?
0:13:45 > 0:13:48'I've been doing this for 22 years now.
0:13:48 > 0:13:51'I found the Third World right here in America.
0:13:51 > 0:13:55'I couldn't believe that women were homeless and pregnant
0:13:55 > 0:13:57'and bringing children into the world
0:13:57 > 0:14:00'without a home for them to go to.'
0:14:00 > 0:14:03In the first year, we worked with 72 women
0:14:03 > 0:14:07who were homeless and pregnant, living in the shelter.
0:14:07 > 0:14:10And 22 years later, this last year,
0:14:10 > 0:14:15we delivered 517 babies to women who were...
0:14:15 > 0:14:17not everybody is homeless,
0:14:17 > 0:14:20but everybody is at risk for homelessness.
0:14:20 > 0:14:22The common denominator is poverty.
0:14:26 > 0:14:29This is the Hamilton family residence,
0:14:29 > 0:14:32and, I guess, this is a room for a family of four,
0:14:32 > 0:14:34slash five, if it's a baby.
0:14:34 > 0:14:39So, um, we get the single bunks,
0:14:39 > 0:14:40so there's four beds,
0:14:40 > 0:14:43and one dresser.
0:14:43 > 0:14:46And that's the extent of the furniture.
0:14:46 > 0:14:48I'm grateful for it, even if it is
0:14:48 > 0:14:51a little reminiscent of a jail cell. SHE LAUGHS
0:15:04 > 0:15:09It's sad that in America today, that there are the numbers
0:15:09 > 0:15:12that we have here that walk through our doors.
0:15:12 > 0:15:17That in a year that we'll see 3,500 families
0:15:17 > 0:15:20that need help with something.
0:15:20 > 0:15:22That need help with pregnancy,
0:15:22 > 0:15:25getting healthcare, getting food.
0:15:25 > 0:15:29What it tells me about America today is that the gap
0:15:29 > 0:15:33between those that have and those that don't have
0:15:33 > 0:15:34is really growing.
0:15:34 > 0:15:37And there are many, many more people
0:15:37 > 0:15:41that are slipping into abject poverty, really.
0:16:23 > 0:16:25HIS VOICE SHAKES
0:16:29 > 0:16:31HE SOBS
0:17:22 > 0:17:24TODDLER CRIES
0:20:27 > 0:20:31I'm a single mum. At the moment, it's just me and my daughter, Grace.
0:20:31 > 0:20:36She's two next month, and we'll be having a little boy soon, hopefully.
0:20:36 > 0:20:38They've got two different dads.
0:20:38 > 0:20:43I have a good relationship with Grace's dad,
0:20:43 > 0:20:48and the father won't have any input in this baby's life at all.
0:20:48 > 0:20:52He doesn't really want any input, so I've accepted that.
0:20:52 > 0:20:55I can't force someone to be a dad if they don't want to be.
0:20:55 > 0:20:58SHE BLOWS A RASPBERRY
0:20:58 > 0:21:00SHE LAUGHS
0:21:00 > 0:21:02'I was working, and then
0:21:02 > 0:21:06'when I found out I was pregnant with Finlay, I stopped working.'
0:21:06 > 0:21:08Say, "Finlay, wakey wakey!"
0:21:08 > 0:21:10SHE BLOWS RASPBERRY
0:21:10 > 0:21:12Wake up!
0:21:12 > 0:21:14Say, "Wakey wakey!"
0:21:14 > 0:21:16'I thought, well, I might as well
0:21:16 > 0:21:18'just go on benefits till I've had this baby,
0:21:18 > 0:21:21'then go and look for work or whatever.'
0:21:21 > 0:21:25So, yeah, I'm on income support, child tax credits, and child benefit.
0:21:25 > 0:21:28I was looking at going into college in September,
0:21:28 > 0:21:33but I failed the maths test, so I'm not going to college now.
0:21:35 > 0:21:37- Right, these are for Molly. - Ba-ba-bunny!
0:21:37 > 0:21:40SHE GIGGLES
0:21:40 > 0:21:45'I do feel a little bit guilty. The fact that, obviously,'
0:21:45 > 0:21:48I'm relying on the government to help with me...
0:21:48 > 0:21:51and that's why I don't think I am
0:21:51 > 0:21:54a stereotypical single mum on benefits,
0:21:54 > 0:21:57because I do want to work.
0:21:57 > 0:22:01It's just the fact that funding for my kids, to put into nursery,
0:22:01 > 0:22:05there isn't a job in this area where I live currently
0:22:05 > 0:22:08that is going to give me that income
0:22:08 > 0:22:11that I need support my kids.
0:22:11 > 0:22:14Are you going to lie down, then?
0:22:14 > 0:22:15Yeah?
0:22:18 > 0:22:20'When I did look into it,
0:22:20 > 0:22:26'it would work out to be about £1,400 a month for both of them,
0:22:26 > 0:22:28'and, well, unless I'm a millionaire,
0:22:28 > 0:22:30'I'm not going to be able to afford that.'
0:22:47 > 0:22:51SHE SINGS
0:26:35 > 0:26:39Kind of cold. Sorry about that.
0:26:39 > 0:26:43Now we know the head's up here, try pushing forward.
0:26:43 > 0:26:44- Exactly, yeah.- OK.
0:26:44 > 0:26:48- You're going to try and spin it this way?- Mmm-hmm.
0:26:48 > 0:26:50- All right, my dear, a lot of pressure, OK?- Mmm-hmmm.
0:26:56 > 0:26:58SHE GASPS
0:28:44 > 0:28:46- Hello!- Hiya, how are you?
0:28:46 > 0:28:48- I'm OK, thank you.- OK to come in?
0:28:48 > 0:28:51- Yeah, of course.- Thank you. - Do you want a tea or coffee?
0:28:51 > 0:28:54OK, do Mummy's blood pressure.
0:28:54 > 0:28:56Want to sit on Mummy's lap?
0:28:56 > 0:29:00No, she's watching. She quite likes to watch, doesn't she?
0:29:00 > 0:29:03'I just wanted someone to love and someone to love me back as much.
0:29:03 > 0:29:10'When you have a baby, it's just, like, magical, I think.
0:29:10 > 0:29:12'When they put her in my arms,'
0:29:12 > 0:29:14it was a surge of love that I've never felt.
0:29:14 > 0:29:16I didn't think I could love anyone that much.
0:29:16 > 0:29:21There isn't actually any words that can describe how I felt,
0:29:21 > 0:29:23because I was just so overwhelmed.
0:29:23 > 0:29:25And this little thing would rely on me,
0:29:25 > 0:29:27and she's actually part of me.
0:29:27 > 0:29:30And, like, I'd actually done it. It was amazing.
0:29:30 > 0:29:32Start your breathing.
0:29:32 > 0:29:33Breathe in for four.
0:29:33 > 0:29:36SHE BREATHES IN
0:29:36 > 0:29:39..and out for eight, and let everything just relax.
0:29:39 > 0:29:43This is all muscle, so your baby's in a massive, muscular bag,
0:29:43 > 0:29:44and it's going to come through
0:29:44 > 0:29:47the tunnel which has already been dug by Grace.
0:29:47 > 0:29:49- I know, yeah! - So she's already come out,
0:29:49 > 0:29:51so the next one's going to come out even easier.
0:29:51 > 0:29:53The tunnel's been dug
0:29:53 > 0:29:55and even the vagina is muscle,
0:29:55 > 0:29:59so the more you chill out, the better the baby will glide.
0:29:59 > 0:30:00And stress the baby out.
0:30:00 > 0:30:03So you've just got to think, "It's going to be over soon.
0:30:03 > 0:30:05- "I'm dying to see my baby."- I am!
0:30:05 > 0:30:07You're dying to see this baby, yeah!
0:30:07 > 0:30:11So when the going gets a bit tough, think, "My baby'll be here soon."
0:30:11 > 0:30:15'I think there is advantages.'
0:30:15 > 0:30:16But I think there's more disadvantages
0:30:16 > 0:30:19in being a single mum because, you know,
0:30:19 > 0:30:22when your child does that first crawl, that first word,
0:30:22 > 0:30:25you know, the first tooth, first actual, proper word
0:30:25 > 0:30:28and, you know, there is no-one to share that moment.
0:30:28 > 0:30:33Like, with Grace, I rang my sister or I rang a family member
0:30:33 > 0:30:35and was ecstatic down the phone to them like,
0:30:35 > 0:30:37"I can't believe it," and stuff.
0:30:37 > 0:30:39So, there is, that's a bad side.
0:30:39 > 0:30:42You don't have that sharing that moment, you know,
0:30:42 > 0:30:43just you and your child,
0:30:43 > 0:30:45you don't have anyone else to share that moment with.
0:30:45 > 0:30:50It's cos your arms are getting so big. Cos you are.
0:30:52 > 0:30:54Right.
0:31:13 > 0:31:16THEY SING
0:32:23 > 0:32:30Poverty leads to lack of education because if there is enough money
0:32:30 > 0:32:35to educate a child, that child grows up educated.
0:32:35 > 0:32:40He has enough knowledge, enough information to take decisions,
0:32:40 > 0:32:42to know what is needed to do.
0:32:42 > 0:32:48But poverty has been a big enemy in communities like this
0:32:48 > 0:32:52and the effect has been a high mortality rate,
0:32:52 > 0:32:54which is really unacceptable.
0:33:20 > 0:33:22She ruptured her uterus, most likely.
0:33:22 > 0:33:27You can feel the foetal parts underneath her skin, you know,
0:33:27 > 0:33:28her abdominal layer,
0:33:28 > 0:33:33so we will have to operate urgently that we have to stabilise her first.
0:33:36 > 0:33:39I have now been working 25 years in Africa.
0:33:39 > 0:33:42I've seen this immense suffering of women
0:33:42 > 0:33:44and nobody seems to be doing much about it.
0:33:44 > 0:33:47It's very difficult to do it because you need trained obstetricians
0:33:47 > 0:33:48to do this kind of work.
0:33:48 > 0:33:52It's very strenuous and you need some dedication.
0:33:52 > 0:33:54We want three units of blood at least.
0:33:55 > 0:33:57They can get it from other donors.
0:34:00 > 0:34:02'This woman who has just come in with her uterus ruptured,
0:34:02 > 0:34:05'she has two days of labour. I don't know where she's coming from.
0:34:05 > 0:34:08'I think she's coming from a very far off place.
0:34:08 > 0:34:11'Had she known that after six or seven hours
0:34:11 > 0:34:15'if she couldn't deliver, she should have come to the hospital.'
0:34:15 > 0:34:18Perhaps her life would not be in danger.
0:34:21 > 0:34:24I have to do this because I have to see the midline, OK?
0:34:27 > 0:34:29Is there anything more we can do?
0:34:47 > 0:34:52They gave some herbs, right? It looks like herbs.
0:35:00 > 0:35:03Mr Suma, I want to make a team decision now.
0:35:03 > 0:35:06- We are going to operate her now. Is that all right with you?- Yes.
0:35:06 > 0:35:09You think you are OK at that end? Are you sure?
0:35:09 > 0:35:12You do understand that we could have her dead on the table,
0:35:12 > 0:35:14she could die, right?
0:35:14 > 0:35:15OK, let's go.
0:35:20 > 0:35:23Hold it up. Knife again.
0:35:32 > 0:35:35Here's the baby. The diagnosis is correct.
0:35:35 > 0:35:38Unfortunately, it's outside the uterus.
0:35:39 > 0:35:41Oh, it's smelling.
0:35:41 > 0:35:46Three antibiotics, please, Ampicillin, Gentamicin, everything.
0:35:55 > 0:35:58Here you are. I'm sorry about this.
0:35:59 > 0:36:01Be careful. Don't let it drop.
0:36:02 > 0:36:05Don't worry about the placenta. Take it away.
0:36:08 > 0:36:11No. For God's sake, no.
0:36:12 > 0:36:16I want to finish this up very quickly. She has got to survive this.
0:36:16 > 0:36:20This is all. Nothing else. We only want her to survive.
0:36:20 > 0:36:23If I have to take the hysterectomy, she might not survive.
0:36:27 > 0:36:32I think we are going to cut the tubes and get the hell out of here.
0:36:32 > 0:36:37Do you understand? Thank you.
0:36:37 > 0:36:41Thank you. Thank you. Thank you.
0:36:41 > 0:36:44Thank you too.
0:36:44 > 0:36:49All right. Get her off the table, please, as quickly as possible.
0:36:51 > 0:36:55She'll have a stormy recovery, that's absolute.
0:36:55 > 0:36:56It'll be very stormy.
0:36:58 > 0:37:01This patient has only about a 50% chance of surviving.
0:37:02 > 0:37:07And we do what we can. We do what we can.
0:37:20 > 0:37:23We shed tears last night.
0:37:25 > 0:37:29Her condition did not improve at all.
0:37:29 > 0:37:31The doctor did all his best
0:37:31 > 0:37:34but later on at night she passed away.
0:37:38 > 0:37:41When I see a woman like this, I think, obviously
0:37:41 > 0:37:43she has many children
0:37:43 > 0:37:46and who is going to take care of these children.
0:37:46 > 0:37:48Even if she was alive,
0:37:48 > 0:37:51it's difficult to take care of five or six kids.
0:37:52 > 0:37:57How much more when these kids don't have a mother to look after them.
0:37:58 > 0:38:00It's terrible.
0:38:32 > 0:38:36It is every woman's right to have a safe delivery.
0:38:36 > 0:38:41You do know that if a mother has children and she dies,
0:38:41 > 0:38:4450% of those children whom she has given birth to
0:38:44 > 0:38:46will also ultimately die.
0:38:49 > 0:38:52We, as Doctors Without Borders, we don't get into politics.
0:38:52 > 0:38:57But sharing of resources is very important, isn't it?
0:38:57 > 0:38:58Sierra Leone is not a poor country.
0:38:58 > 0:39:01It has a lot of diamonds, it has iron.
0:39:01 > 0:39:06If you saw the stamps which were produced here before, it said,
0:39:06 > 0:39:10"Land of iron and diamonds." Is this wealth going to the people?
0:39:10 > 0:39:11These are questions you have to answer
0:39:11 > 0:39:15and the politicians have to answer. I am a simple doctor.
0:39:27 > 0:39:32Greed, selfishness and acts of corruption -
0:39:32 > 0:39:36all these things contribute hugely to poverty.
0:39:38 > 0:39:41And until it is reversed
0:39:41 > 0:39:47then the gap will ever grow bigger and bigger.
0:44:18 > 0:44:23I'm just frustrated and emotional and upset.
0:44:23 > 0:44:26I'm looking forward to the rest of this birth.
0:44:43 > 0:44:45She can wait and see. That's one of her options.
0:44:45 > 0:44:48Another option is Pitocin.
0:44:48 > 0:44:50Another option, potentially, is a Foley bulb,
0:44:50 > 0:44:55which is basically a straw that you put into the cervix
0:44:55 > 0:44:59and fill with water and it kind of puts traction on the cervix and
0:44:59 > 0:45:04she can walk around with that and she has a free range of mobility.
0:45:04 > 0:45:09Then the other option is that they can make out.
0:45:09 > 0:45:12Have breast stimulation and that often will get labour going.
0:45:23 > 0:45:29This is the eighth letter that I've wrote and it's the bump at 35 weeks.
0:45:29 > 0:45:33I said, "Hello, baby. So, what can I say? You're a little mover now.
0:45:33 > 0:45:37"You never stop moving or trying to get into my ribs.
0:45:37 > 0:45:41"Grace puts her ear on my belly to hear you
0:45:41 > 0:45:44"and the other day she tried to feed you chocolate mousse
0:45:44 > 0:45:48"through my belly, which I thought was quite funny.
0:45:48 > 0:45:52"You seem to move around more when you hear her voice
0:45:52 > 0:45:57"which I think is cute and I hope you both have a strong and close bond."
0:46:01 > 0:46:05"Grace has gone for a week to her dad's and I miss her loads."
0:46:14 > 0:46:17"Your name has finally been decided and it isn't changing
0:46:17 > 0:46:20"unless you come out a girl."
0:46:20 > 0:46:23One more. Big push.
0:46:23 > 0:46:27"It's Finlay William James Clark. I hope you like it, little man."
0:46:27 > 0:46:33It's cos you're stretching, it hurts like hell, OK? All right?
0:46:33 > 0:46:34"Right, little man,
0:46:34 > 0:46:37"I think I've finished moaning and blabbering for now."
0:46:39 > 0:46:41A little, tiny push.
0:46:41 > 0:46:44Blow, blow, blow, blow, blow.
0:46:44 > 0:46:48"All that's left to say is we all can't wait to meet you
0:46:48 > 0:46:51"and me and Grace just want you to join our little family soon.
0:46:51 > 0:46:53"Love you, baby. Mummy."
0:46:54 > 0:46:56Aargh.
0:46:56 > 0:46:59No, no, no. Legs up. Legs up. Look down. Here's your baby.
0:46:59 > 0:47:03- Hello.- I'm really sorry.- Why are you sorry?- It's gone everywhere.
0:47:03 > 0:47:05What's gone everywhere? It's only water.
0:47:05 > 0:47:07Now your placenta. Nice and relaxed.
0:47:07 > 0:47:11- Oh, my God, why is he blue? - Why is he blue? He's beautiful.
0:47:13 > 0:47:17Lift your top up. Let's put him on you. Let's put him on you.
0:47:17 > 0:47:19Oh, God, I don't know what to do.
0:47:19 > 0:47:23Hold him. Hold him.
0:47:23 > 0:47:25You're doing fine.
0:47:25 > 0:47:29Hold him tightly. He's your baby.
0:48:27 > 0:48:30Good. Good push.
0:48:33 > 0:48:36Strong, steady, steady push.
0:48:36 > 0:48:41Strong, good, steady, big push.
0:48:41 > 0:48:46- All the way back.- Excellent. Beautiful, Starr.
0:48:46 > 0:48:48Steady push.
0:48:48 > 0:48:52- Here she comes.- Excellent. Here she comes. Not quite.
0:48:52 > 0:48:54Another little push.
0:48:54 > 0:48:57STARR GROANS
0:48:59 > 0:49:03- Here she is.- My baby. - Take your baby.
0:49:03 > 0:49:06You did it, Starr.
0:49:12 > 0:49:17Yeah. Oh. Baby.
0:49:17 > 0:49:20Congratulations, Dad.
0:49:20 > 0:49:24Yeah, I know. I know. That's it.
0:49:24 > 0:49:26Get mad, go ahead and get mad.
0:49:26 > 0:49:31- Oh, my goodness. Oh, my goodness. - She is so tiny.
0:50:21 > 0:50:27Oh, there's a barf. You didn't like that. Did you not like that?
0:50:29 > 0:50:32Oh, she's so cute.
0:50:34 > 0:50:38- She's tiny.- Yeah.
0:50:38 > 0:50:42- What do you think? - I think it's cute.
0:50:42 > 0:50:44- You think she's cute?- Yeah.
0:50:44 > 0:50:45- Yeah?- I think the baby's cute.
0:50:49 > 0:50:52Oh, that's a great one. OK.
0:51:07 > 0:51:11My mother gave birth to me and she was taken care of.
0:51:11 > 0:51:14I think that it is necessary to take care of mothers.
0:51:15 > 0:51:18There must be a distribution of resources.
0:51:18 > 0:51:22I think we are rich enough to give everybody access
0:51:22 > 0:51:24to this kind of care.
0:51:24 > 0:51:27But there are people who are not willing to share.
0:51:30 > 0:51:33I like to think that one of the things we are doing here
0:51:33 > 0:51:34is showing a model of the way that we can
0:51:34 > 0:51:37actually reduce maternal mortality
0:51:37 > 0:51:41by providing antenatal care in clinics,
0:51:41 > 0:51:43by providing ambulance services
0:51:43 > 0:51:46and by providing a hospital which has a 24-hour cover
0:51:46 > 0:51:49with someone that can do a Caesarean section.
0:51:49 > 0:51:50By all of those things
0:51:50 > 0:51:52we are showing a reduction in maternal mortality
0:51:52 > 0:51:55and we actually do it relatively cheaply.
0:51:55 > 0:51:58We worked out that we could provide this level of care
0:51:58 > 0:52:03for about 1.7 Euros per person for the whole of Sierra Leone.
0:52:03 > 0:52:06It's not huge amounts of money. It's not hugely expensive.
0:52:06 > 0:52:10The interventions that we do are not hugely difficult to do.
0:52:24 > 0:52:28- Baby.- No, it's not baby, it's Finlay.- Baby.- Baby Finlay.
0:52:30 > 0:52:35I want him to be a wrestler and a rugby player.
0:52:35 > 0:52:38He's got like a little smashed up nose
0:52:38 > 0:52:41so I think he should be a wrestler for that.
0:52:43 > 0:52:44With me being on my own,
0:52:44 > 0:52:49I've got the one really to moan or anything about me being tired.
0:52:49 > 0:52:52Especially in the early hours of the morning where I can get a bit tired.
0:52:52 > 0:52:55Do you want to give him some more milk?
0:52:55 > 0:52:58'I don't really let things get on top of me. Not really.'
0:52:58 > 0:53:00You don't need to hold his head.
0:53:00 > 0:53:04'I don't really have a lot of worries.
0:53:04 > 0:53:07'Obviously, I'm always worried about my kids and stuff.'
0:53:07 > 0:53:10Other people might find it a real big struggle
0:53:10 > 0:53:11but I don't find it difficult.
0:53:16 > 0:53:17You all right?
0:53:20 > 0:53:24Gracie, wait, remember. Wait for Finlay.
0:53:24 > 0:53:26Where's she gone?
0:53:26 > 0:53:29Right, come on then. This way to the park.
0:53:29 > 0:53:32'People might have more, but in the end of the day,
0:53:32 > 0:53:35'I'm happy with what I've got. I wouldn't change it.
0:53:35 > 0:53:37'They may have a bigger house decked out
0:53:37 > 0:53:43'with everything they've ever wanted and they might have 20 cars outside'
0:53:43 > 0:53:46but, at the end of the day, what I wanted was a roof, children
0:53:46 > 0:53:50and a job and, well, I can get a job when, obviously,
0:53:50 > 0:53:54the kids are old enough but I'm just happy with what I've got.
0:53:54 > 0:53:57I don't want... I don't live above my means. I'm just happy.
0:55:13 > 0:55:17- Have you got the baby? - I have the baby. We get to go home.
0:55:17 > 0:55:18- Are you ready?- I'm ready.
0:55:22 > 0:55:27- Bye.- Bye. Have a good one. - Have a very happy Monday.- You too.
0:55:27 > 0:55:29- Good luck with your beautiful baby. - Thank you.
0:55:55 > 0:55:57We are not out of options in life.
0:55:57 > 0:56:01I think it is really frustrating some days and some days,
0:56:01 > 0:56:07you know, it's hard to deal with but, you know, we are not out of options.
0:56:07 > 0:56:12We have, you know, some things going on. We'll figure it out.
0:58:08 > 0:58:12What's in store for a child born in Sierra Leone today?
0:58:12 > 0:58:15Explore the hidden and sometimes unexpected stories
0:58:15 > 0:58:20behind the figures. Go to bbc.co.uk/whypoverty
0:58:20 > 0:58:23and follow the links to The Open University.
0:58:25 > 0:58:29Subtitles by Red Bee Media Ltd