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