Twenty years ago, American fashion model Christy Turlington Burns experienced "the unexpected" after giving birth -- something that she says ignited a passion for tackling the nation's flawed approach to maternal health care.
"I went into my first pregnancy ready for that phase of my life, with a lot of options and choices in who would provide the care that I received," she said in an interview last week. "And, yet, in an otherwise perfectly healthy pregnancy, I had the unexpected happen. It can happen to any of us."
Shortly after giving birth to her daughter, she experienced a postpartum hemorrhage, noting that without the help she received, she would have bled out quickly -- a vivid reality for many women around the world.
A postpartum hemorrhage -- which is severe bleeding of the mother after delivery -- is the leading cause of death among women during childbirth, according to the Centers for Disease Control and Prevention.
"That was really the day I became a maternal health advocate," said Turlington Burns, whose advocacy brought her to Arkansas last week. "I think that personal experience got me to wonder how women with less access and less options get through the same experience."
After her 2003 complication, Turlington Burns said she was most shocked that nobody was talking about the maternal health care crisis.
"The first thing that I did was talk to my sisters, my friends, my circle, you know? My community," she said. "Sort of sharing my birth story and then learning from so many others that they also had similar complications. I realized we weren't sharing those. I started that conversation, sharing and talking about it, connecting with other mothers and other women."
Just two years later, she gave birth to her son. According to her, it was during her second pregnancy, while on a trip to Central America with CARE, an international organization dedicated to fighting global poverty and world hunger, that she had an epiphany.
"On that trip, I had my 'aha! experience' of, you know, had I had the same complication I had with my first birth in a rural under-resourced community," she said, before pausing, "I would have died. I'm certain that I would have."
Despite a busy work life, two kids and an array of responsibilities, Turlington Burns used the years after her 2005 birth to acquire a master's in public health from Columbia University and produce her first film: "No Woman, No Cry."
The 2010 film walks viewers through the lives of "at-risk pregnant women in four parts of the world."
Turlington Burns' directorial debut showcases stories from Tanzania, Bangladesh, Guatemala and the United States.
"That was my first experience making a film although I had long had a dream to make a documentary film," she said. "It just became very evident to me that that was the story that I was ready to tell and had something to contribute to."
Dedicated to providing a more personable conversation around the issue, she added that "No Woman, No Cry" was one of the first films that put faces and voices to the existing statistics.
"At the global stage, there was a lot of emphasis on data and the importance of data," Turlington Burns said. "It definitely got people to notice and to sort of prioritize the issue for the global community, but the data and numbers alone were not enough."
The data-centric issue was lacking stories from real people, real mothers and real experiences, she said.
"I think [the film] had a really meaningful impact," Turlington Burns said. "Data now just gets better and better. I think the way people use data and the way we use it to tell stories has only improved."
EVERY MOTHER COUNTS
In 2010, she founded Every Mother Counts, a nonprofit organization whose latest efforts landed in the state ranked with the highest maternal mortality rate: Arkansas.
"Giving Birth in America: Arkansas" premiered Wednesday as the seventh part of a film series launched by the group in 2015 that aims to shine a light on the maternal challenges mothers are facing from state to state. The films also work to explain how preventable these deaths, issues and challenges are.
"There's nothing more compelling than a human telling their story and having the opportunity to give them the time and the respect that they deserve to hear that story," she said. "Then it's about taking it in and supporting them to get them through whatever trauma might be there, whatever pain and whatever ongoing challenges that they might have."
Continuing to center women and mothers in the conversation is a critical key to their long-term success and the success of better maternal health care, she said.
"The name Every Mother Counts itself is such a powerful name because it's a statement, it's what our goal is, it's what our mission is all about but it also places mothers at the center of that conversation, of their health care and of their experiences," Turlington Burns said.
She said in her 20 years of advocating, awareness has always been the goal.
"Like, that's what we're trying to do and we're trying to keep maternal health and mothers at the center of the conversation around our health care, our pregnancies and childbirth," she said. "It seems like it would be obvious, but it's actually not."
She added that raising awareness is difficult at times due to the fact that allocating solutions for issues that affect women is inherently more difficult than issues surrounding men.
"For whatever reason, women, and our lives, aren't valued the same way as our counterparts," she said. "It's been a harder conversation or topic to get more resources allocated for. Research, science, studies ... those things just don't happen often the way that they do with men and that's just the reality."
Despite that reality, Turlington Burns added, with a laugh, that she remains hopeful in the conversations happening and the growing involvement of women around the world.
"We know that when there are women in positions of power -- whatever they might be -- that they're going to be bringing the issues that we deal with or the challenges that we face to the table with them."
However, being a woman alone is not enough, she said.
"Not all women agree, but, I think if you've gone through the experience that puts you that much closer to being able to understand what it would be like to not have resources, to have something go wrong, to not have the support for the paid leave or the access to the quality health care."
Throughout the conversation, comments by Turlington Burns highlighted the fact that these issues and how they affect people are changing constantly.
"When I first started Every Mother Counts, we really were lacking just consistent maternal death reporting," she said. "Today, there's a maternal mortality review board in just about every state, if not all of them. That alone allows us to have a better understanding of what's actually happening."
Leading as executive producer of "Giving Birth in America," she added that the ever-changing aspects of maternal health partially inspired the series and its approach to the crisis.
"We're looking at the challenges we face on a national level, but then also we're asking: 'What are the similarities between California and New Mexico?' or 'What are the similarities between Florida and Louisiana?'"
Producing the films and telling the stories of mothers and families across the nation have revealed more factors than the team assumed, according to Turlington Burns.
Climate change causing women to be displaced from their homes while pregnant is just one example of the nuances revealed as the group continues to establish conversations and awareness.
She also reiterated that understanding how this crisis is affecting Black women is key to finding solutions.
In Arkansas, Black women are more than twice as likely to die from pregnancy-related causes as white women, according to information provided by the organization.
Zenobia Harris, director of the Arkansas Birthing Project, also touched on the importance of addressing the gaps in maternal health care accurately and with an open mind.
"Going through pregnancy, there's some commonalities for all women," Harris said. "You know, things that we experience as we go through pregnancy. However, unfortunately, for women of color, when they find themselves in the medical care system, they often feel like they're not heard, understood or listened to when they have problems or are experiencing discomfort.
"Sometimes those are key indicators that there might be a problem occurring that needs further attention. When they don't get the attention and they have poor outcomes, it increases the distrust that already really exists, unfortunately."
Turlington Burns said that one of the goals of efforts by Every Mother Counts and the film series is to understand the layers and to acknowledge that one solution won't work everywhere.
As a group, the nonprofit is dedicated to determining issues in communities and addressing them in a way that will establish long-term success even if it looks different for each community or state.
THE CRISIS IN ARKANSAS
The Wednesday premiere of "Giving Birth in America: Arkansas" tells the story of three women and their challenges during and after their pregnancies in the state.
Scenes from the 20-minute film show the vivid tale of three mothers: Ashleigh, Wensie and Tynesha.
Their stories depict the burden that came with living in rural areas, not having paid leave, not feeling heard by their providers, not having insurance coverage after 60 days, not having different kinds of support and more.
Born in California, Turlington Burns shared that some of the struggles shown in the Arkansas-centric film are threads seen in every state, while other aspects are specific to certain communities. She said she hopes the film will open the floor for conversations on how to decrease the state's growing maternal mortality rate.
"I think by bringing so many stakeholders together, to the same table, in the same room, that's where conversations happen and that's where relationships begin," she said. "It's really in those relationships that the solutions around how to have that kind of coverage across the state can really happen. You really need that be owned at the state level. It has to be a local thing that people believe in and are all on the same page about."
Dr. Nirvana Manning also spoke on the complexity of tackling the crisis in Arkansas and efforts by the Arkansas Maternal Mortality Review Committee.
Manning currently serves on the committee and is an obstetrician and gynecologist with the University of Arkansas for Medical Sciences.
"I think [the committee] has been huge," Manning said. "We can anecdotally sit around this table all day and try to think of ways to do this, but this really breaks it down. We have a specialist in the room, we have obstetrics, we have experts in cardiology, we have anesthesiologists, we have social workers, we have community health care workers, we have doulas and [midwives]. Those collective interdisciplinary roots can really start to look at these deaths from a different lens that I would never even think of."
Online resources provided by Every Mother Counts break down various "tools," which Turlington Burns described as a "road map" to change.
The website even offers a specific guide for change in Arkansas.
In its 42-page entirety, the guide covers everything from background on state-specific statistics to suggested policy solutions.
Also included in the resource guide is a list of discussion questions for those watching the Arkansas film on EveryMotherCounts.org.
The four suggested policy solutions are listed on Page 22 as: extending postpartum Medicaid coverage, supporting and encouraging respectful maternity care, strengthening the maternity care workforce and increasing access to mental health support.
Other areas of the guide further break down what those policy suggestions entail and how local community members can get involved.
"I think that will be a really useful resource and guide for folks who are hearing about this for the first time," Turlington Burns said.
She said she believes the "real heroes" are the mothers and women across the nation working hands-on in their communities to combat the maternal health care disparities.
Harris also highlighted the impact community members have had working through the Arkansas Birthing Project and its sister-friend program.
Under the program, pregnant mothers are paired with a sister-companion that provides support and aid throughout and after the pregnancy. Support from the group also directs the mother to helpful resources in her direct community.
"[Our programs] use a sort of kinship model so that women feel like they're a part of a bigger circle of support and companionship during that period," Harris said. "We also continue to provide support as they have the baby and as the baby is growing that first year."
Turlington Burns stressed that though community involvement is crucial, support on a state and federal level is also crucial.
"They shouldn't have to be doing this," Turlington Burns said. "They should have more support within the state. The health system should be embracing them, learning from them and integrating them into health care so that, you know, there's more continuity of care all the way through.
"The hope is to start the conversation, but there's also a real connection to national and state policy. That needs to happen."