When a Film Becomes a Lifeline

In 2004, the Ethiopian Parliament made the bold decision to decriminalize abortion, in an attempt to reduce maternal mortality caused by unsafe abortion. Three years later, I embarked on a trip to shoot a short documentary film on the impact that access to safe abortion care was already having on women in the country.

The film was allowed to develop from an idea into a reality due to a genuine commitment to telling this story, and to being in the right place at the right time. During the Q&A after the screening of my short film Love, Labor, Loss (about a devastating maternal health injury called obstetric fistula) at the National Advocates for Pregnant Women Conference in 2006, an audience member asked what my next project would be. I responded that I wanted to make a film about unsafe abortion. Like obstetric fistula, it was an invisible problem, and few video resources were available. There needed to be a “face” put to the issue.

An executive vice president of Ipas, Anu Kumar happened to be in the room and she later said to me, “If you want to make a film about unsafe abortions, I’ll make sure you make a film about unsafe abortions.”

And that’s when my film Not Yet Rain was born.

Leading the Region in Reproductive Health Policy

The decision to shoot the film in Ethiopia—rather than in any of the other countries in sub-Saharan Africa that suffer from high rates of maternal death and disability from botched and/or self-induced abortions—was based on Ethiopia’s recent change in legislation. Prior to the 2004 law, a woman who received an abortion was at risk of incurring criminal charges. Under this new law, a woman could seek a legal abortion if she was a minor, if she was raped, and if her life was in danger. This was a very radical move for an African country.

So, after several months of planning, I departed to the capital, Addis Ababa, with my assistant (a 19-year-old spoken-word poet named Bekah, whom I mentor as a teaching artist). We set out for nearly three weeks, ready to film testimonials of the women, families, and health care workers who were affected by this new law.

Working with Saba Kidanemariam, the incredible country director of Ipas Ethiopia, we quickly created a production plan that included shoots around the capital as well as a site visit to Ziway, a small lakeside town 100 miles south of Addis. Through Saba, I was introduced to the health care workers and various advocates who had already been informed about my mission. After learning more about the specific purpose of the film, the clinicians and health care advocates spoke to current patients and family members of patients who had died, asking if they would be interested in telling their stories for the film.

Although I have covered many difficult global health issues, such as obstetric and traumatic fistula, the impact of war on youth, and AIDS orphans, this shoot quickly became the most emotionally difficult one I have ever done in my career.

Belynash and Tigist received safe abortions thanks to a change in Ethiopian legislation.

Lasting Despair

The first person I interviewed was an elderly woman dressed in red. She told me the heartbreaking story of her daughter’s completely preventable death. She knew her daughter was sick with a headache and fever, but had no idea that a traditional medicine man had wrapped a catheter around an umbrella and put it into her daughter’s uterus to end her unwanted pregnancy.

The woman was solemn and stoic as she began to speak about her daughter, who was only 17 years old when she died from her unsafe abortion. Recounting the traumatic story, though, the mother began weeping and talking about the guilt she suffered over her daughter feeling like she couldn’t confide to her that she was pregnant or that she had sought an unsafe abortion. Had she known the truth, she could have informed a health worker and her daughter may have survived. But instead, this frantic mother took her daughter from clinic to clinic where no one could identify the root cause of her sickness. When they arrived at the final clinic, the daughter finally came forward with the truth. But by then it was too late to save her.

“You are reminding me of something I have forgotten,” the elderly woman said as tears ran down her face.

Although this happened 14 years before I interviewed her, it felt as if she were telling the story for the first time.

Ayanos Taye, a nurse midwife at the Ziway Health Clinic, believes that free, safe abortion care is important, particularly for poor women, and that it can save their lives.

Lifesaving Care

I didn’t meet the two young women—Tigist and her friend Belynash—who would become the focus of my film until four days before I was supposed to leave Ethiopia.

Both young women had been raped and were pregnant; neither understood what pregnancy was, exactly, or how it had started. They heard about a procedure to stop pregnancy and came to the clinic to seek services. As I was filming, the girls were told by clinic staff that they had arrived too late—they were too far into their pregnancies for the first trimester abortion procedures that the clinic was prepared to perform.

We all knew that unless they were able to get safe surgical abortions, they would resort to unsafe methods that can include inserting sticks and other sharp objects into the uterus, and drinking dangerous herbal concoctions.

In an effort to get them the safest services possible, the clinic referred them to the Adama Hospital, the larger regional hospital, where doctors had access to pain medication and equipment more advanced than what was available at the local clinic level. Both Tigist and Belynash were terrified at the hospital, given that they had never even had a gynecological exam. They were especially shy knowing the exam would be done by a male OB/GYN, with his medical students observing.

When the doctor started to evaluate Tigist, she cried and screamed. My translator, Asnaketch, who had become a motherly figure to the two girls, tried to console her. It was there that Tigist told us she was afraid to die in childbirth as her mother had. Asnaketch did her best to comfort her, but at one point nearly fainted from the intensity of the experience.

Bearing witness to all of this was a surreal experience. I became incredibly angry. Angry that rape is so prevalent everywhere. Angry that so many young women like Tigist lose their mothers in childbirth. Angry that girls don’t have the information about family planning and contraception that could prevent unwanted pregnancies. Angry that safe abortion isn’t provided for any and all women in need. Angry that the world can be so incredibly cruel to young girls. I was so angry I nearly punched a wall.

Sesay Tefare, a nurse midwife at Ziway Health Center, uses manual vacuum aspiration (MVA) to terminate first trimester pregnancies at the clinic level.

The Aftermath

When I came home and began to edit the film, all those emotions were directed into the telling of the story. Although it was hard to watch the footage from this shoot for 7-8 hours at a time, every day, the film came together in a powerful way that showed the challenges women face. But it also demonstrated their resiliency.

The film had a very broad reach; it was screened by universities and community-based organizations, shown at global health conferences, and even used as a tool for the African Union (to foster discussion about the incredibly high maternal mortality rates in the Africa region).

Possibly the most surprising response I received was an email from a girl in the Middle East who lived in a country where abortion was illegal. She told me she and her boyfriend had watched the film and had decided that they were going to save up enough money to travel to Ethiopia for a safe abortion. She wanted to know if I could make a recommendation to a health care facility there. I was floored, and

I passed her request on to someone who could give appropriate advice to her. Clearly, this film had a wider reach than I could have imagined.

Filmmaker Lisa Russell with Tegest, who lost her 17-year-old daughter due to an unsafe abortion procedure.Photo: Bekah Dinnerstein

Since the Ethiopian shoot, I have filmed several interviews with women who resorted to unsafe abortion in Sierra Leone. While the women I interviewed in Ethiopia relied mostly on sticks and herbs for self-induced abortions, the women in Freetown, Sierra Leone, relied on the help of “pharmacists.” One woman told me that a popular method to terminate an unwanted pregnancy was to take 50 tablets of doxycycline, a malaria preventative, at 2:00 a.m. with a full can of Coke. Another popular method they told me about was drinking a local blue laundry detergent. This, the women were told, would end their pregnancies safely.

Each country may have its own potion or procedure to self-induce an abortion, but they all lead to the same gruesome results: death, disability, and despair.

Not Yet Rain ended up being more than an advocacy film for safe abortion care. It was a critical resource for women who faced unwanted pregnancies in restrictive areas. In this sense, the film became a lifeline to women and girls in need of unbiased, nonjudgmental reproductive health care and advice. I am proud to have my name on such a film as its director.

A security guard who survived seven self-induced abortions now refers victims of abuse and women with unwanted pregnancies to local health services.

Lisa Russell, MPH, is an Emmy® Award-winning documentary filmmaker and global health advocate who has more than 10 years’ experience producing films and creative projects/outreach campaigns with UN/NGO agencies. Since completing her Masters in Public Health (MPH) in 1998, and then learning the craft of filmmaking, Lisa has become a leader in bridging documentary filmmaking with global development and social activism and has an extensive portfolio of work that spans the globe.

Photos by Lisa Russell, unless otherwise noted

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