PHOTO ESSAY: Birth Is a Dream, Maternity in Africa

He has photographed mothers across several African countries with some of the highest maternal mortality rates in the world. By aiming his lens on the humanity of these women before, during, and after labor, Paolo Patruno hopes to inspire action on maternal health in Africa.

I started the Birth Is a Dream project in Malawi, where the words for pregnancy in the local language—'pakati' and 'matenda'—translate into 'between life and death' and 'sick'. That’s where I met English midwife Rachel MacLeod in 2011. She was working in the labor ward of the Bwaila Hospital in Lilongwe, Malawi and she opened my eyes to the maternal health crisis in Sub-Saharan Africa.

I began capturing the lives of women and mothers in Malawi, and later added to the project as I traveled to the Democratic Republic of Congo and Uganda. In each country, I visited public and private hospitals, health centers in rural areas, and shadowed traditional birth attendants at home births.

I’m a man. I’m a white man. I’m a white man with a camera. That makes my project a huge challenge, but I have received so much encouragement to go ahead, to give a voice to the African mothers through my photos. This is why I hope to continue and expand my Birth Is a Dream project.

While documenting the lives of these mothers, I saw things that shocked me, such as a midwife yelling at a woman in labor to stop crying. I also met nurses and midwives who were heroes, saving the lives of mothers and children on a daily basis, despite strained resources and crowded facilities. I saw that the conditions in which women give birth can vary widely, even within the same community. Many women give birth in facilities without adequate equipment and services, or at home without skilled providers. Some women deliver their babies without access to power or running water.

In particular, women in poor and remote communities, far from the nearest health services, are most at risk. And of these, young women and girls are in the most danger: In many communities girls still marry when very young and contraceptive advice is poor or non-existent.

The death of a mother—an all too common outcome of these conditions—is a human tragedy. Her death endangers the lives of the surviving newborn and young children. Girl children are often pulled from school and required to fill their lost mother's roles. A mother's death makes it harder for the family to obtain life's necessities and escape the crush of poverty. As I’ve traveled throughout Africa over the past ten years, I have seen how important women’s roles are, not just for families, but for entire communities.

Thankfully, a great many maternal deaths are preventable when pregnancy and childbirth are attended by skilled health professionals (nurses, midwives, or doctors). As a humanitarian photographer, I feel I have a duty to use my camera to raise awareness about the maternity crisis. This project shows the dangers of childbirth, but I also aim to capture the positive stories, the poetry of maternity. I hope to continue to expand this project to other countries in Africa. As I continue to travel and document motherhood in Africa, I am compelled by the dreams of the women I meet along the way. I am determined to make people aware of this issue and to show that a safe birth should be a reality for every mother—not just her dream.

About Paolo Patruno

Paolo Patruno is a photographer and World Pulse community member based in Italy who is focused on humanitarian issues and social-documentary. He works with NGOs, aid, and nonprofit organizations to create evocative and compelling images which promote action and change for the sake of the most vulnerable people in the world. He documents health care, education, human rights, sustainable development, and poverty. He continues to work on his personal long term project covering the maternity crisis in Africa.


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Comment on this Editorial


Paulo, you did a very good job here. A picture is worth a zillion words. Through those pictures I have been deeply touched. It touched me to see mothers lying on the floor after delivery due to lack of adequate space. It touched me to see a blade being used to remove stitches. I have been deeply touched to see how many women give birth at once in the same room with no privacy. I am even more touched that you are a white man telling these stories. THANK YOU!

Best regards, Precious

My pen speaks

Thanks Precious ! Maternity crisis in Africa is an untold matter. And I'm trying to use my camera to give a voice to the african mothers.

Best, Paolo

Thank you so much for your photos! They are amazingly powerful and spoke to my soul! Your work is inspiring-thank you for your courrage!


"I am a woman, that's my weapon!" ~Catherine Robbins

Paolo, very good work. My sister is pregnant and I showed her your photo essay. Needless to say, she was floored. I'm really happy that you're male and are so interested in birth, especially in those places where it can be so dangerous. It's refreshing and wonderful how much you care. Thank you.

Hi Sally, I'm so honored hearing positive comments from women; that means I've approached and documented the matter with respect for the women dignity. Thanks. Paolo

This is amazing work Paolo and so important! I just returned from my second trip to Tanzania where I spent a good portion of my time with a pair of five year old Maasai twins named Hope and Lazaro who lost their mother in childbirth. They are currently living at an SOS Children’s Village outside of Arusha.

My life has been forever changed by those two and my evolving relationship with them has framed my value and purpose. I am rather certain Hope and Lazaro’s mother would have wanted to be around to nurture her dynamic little twosome, and I am more than certain Hope and Lazaro would have basked in her love. Everyone loses out when a woman dies in childbirth and the word is radically held back. I think your next photo assignment should be documenting images of children who have lost their mother’s to maternal mortality. Sharing their light and love with others is another piece of this unacceptable tragedy. Their lives are forever shaped by this unimaginable loss.

A very huge thank you for sharing these captivating visual images of this appalling problem, your work is helping to move the world forward so justice can be found for all women and children. I hope our paths cross again in the near future as I will be working to secure educational funding for orphaned and vulnerable children in Tanzania. Many of whom lost their mother’s to maternal mortality.

Hi Wendy, thanks a lot for comment and sharing your experience; a mother's death affect the life of all the family, the lives of the surviving newborn and any other young children. I had already in mind to document stories from the orphaned, so thanks for suggestion. If you think SOS Children’s Village could be interested to produce photographic about the matter, do not hesitate to contact me to explore potential collaboration. Thanks, Paolo

Hi Paolo,

This is a wonderful presentation and you are wonderful to bring this awareness through your photography and words.

I work with my NGO in LIvingstone, Zambia. Also, I know Bill Gates did a study that shows if a mother has a disease when she is pregnant the child will ALWAYS be born with an I.Q. of 80 or less. They are uneducatable. I also have studied the brain and know a child's brain cannot learn as much as it should academically because of early childhood malnutrition or the mother's malnutrition when pregnant. I have seen myself over and over how when a mother is pregnant it is not the JOY we mother's in America feel. It is worry, pain and suffering over how will I feed this new person. So, it is very sad from the start of life to come into the world with that energy around us.

So, everything you can do to raise the awareness and BEG for attention and help, earns you a special place in heaven.

If I can help you find other places to make your presentation visible, let me know. I want to help.

It is unusual, but getting less so, to see a man fighting for women's rights and equality.

Keep up the good work and let me know if I can help in any way.

Ubuntu (I am who I am because of who we are together),


Wendy Stebbins Founder/CEO I AM ONE IN A MILLION Non-Profit Organization focused on helping street orphans and vulnerable children in Livingstone, Zambia Africa.

Hi Wendy, thanks a lot for your comment, your appreciation and encouragement. Do not hesitate to contact me if you should find any opportunity to make my project visible, so to discuss about that. I'm using my FB page to share and update for everything related with the project; so you can like me, and share with your friends too.

My aim is to go ahead documenting the matter in new african countries, so I'm looking for support and collaboration that could make that possible.

PS If any opportunity to document the maternity conditions in Zambia should arise, please let me know.

Thanks again Best, Paolo


Thanks for answering my message. I went on your FACEBOOK page and clicked "Like" and wrote a message. WIll also tell others to do this.

While I cannot personally help you financially, I am suggesting you go to and read through it. I think your project is PERFECT for this free way to get funding. SImple and I think it can work. Let me know what you think.

CIAO and UBUNTU, Wendy

Wendy Stebbins Founder/CEO I AM ONE IN A MILLION Non-Profit Organization focused on helping street orphans and vulnerable children in Livingstone, Zambia Africa.

I will try to think of a person who could help you in Zambia and let you know, though it will take me some time to decide on the right person.

Ubuntu(I am who I am because of who we are together),


Wendy Stebbins Founder/CEO I AM ONE IN A MILLION Non-Profit Organization focused on helping street orphans and vulnerable children in Livingstone, Zambia Africa.

imagin give with in darkness using a touch which can't also provide enough light.better we hope for the better.our eyes are open no more suffering women.thats my campaign