Ramona S. Diaz's 'Motherland': Documenting Grace, Kindness and Organized Chaos in the World's Busiest Maternity Ward

In Motherland, award-winning Filipina-American filmmaker Ramona S. Diaz takes us into the heart of the planet's busiest maternity hospital, in one of the world's poorest and most populous countries. The Dr. Jose Fabella Hospital in Manila, Philippines, averages an astonishing 60 deliveries a day. Using an observational approach, Motherland drops its viewers—at times uncomfortably—into the hospital's continuous stream of activity. Set against the backdrop of a country grappling with widespread poverty and a cultural shift in its relationship to the Catholic Church, Diaz paints an intimate tableau of a nation's reproductive policy and culture. What stand out are the relationships that emerge organically in front the lens; though these relationships may be brief, the interactions and candid conversations they reveal between women, and also the staff at Fabella, are what ultimately define the culture of this unique place.

A natural storyteller, Diaz spoke to Documentary by phone earlier this week.

What inspired you to document the maternity ward at Dr. Jose Fabella Memorial Hospital?

Ramona S. Diaz: I was in the Philippines doing research for another film on reproductive justice and reproductive rights; I was researching a reproductive health bill before congress. The Catholic Church is strong and powerful, and I felt like the country was turning a corner. I wanted to make a film about the social and cultural drama surrounding the bill, which gave access to contraception to everyone in the Philippines, as well as sex education and also prenatal and maternal health. A seemingly simple bill, but controversial in the Philippines.

Someone told me to visit Fabella—called the "baby factory" in Manila. I went, thinking it would be part of the research, but when I got there it was obviously the film. It was very, very obvious to me that this is where my story was. I'd be dealing with all the things I was interested in, such as reproductive health, reproductive justice and women’s rights.

At what point did you decide to take an immersive approach to documenting this place? With so much to explore in terms of the broader social and economic context surrounding reproductive rights in the Philippines, why cinema vérité?

That decision came very early on as we were filming. I think you have to make a conscious decision, because your shooting changes; it has to be purposeful. When I first visited the hospital, dropped into this place, I thought, "What the heck is happening here? It’s organized chaos!" And then you figure out there is a method to the madness. You start listening to the conversations—the communities of women that formed on those beds were fascinating. That's really what drew me to the hospital. I wanted to give the audience that same experience, of just being dropped into this place. You get to know people. I thought that was the most effective way to tell the story.

I remember telling Nadia Hallgren, my cinematographer, "This is completely cinema vérité and we are not doing interviews." And she said, "Okay, that's great." But then, on the first and second day she asked, "So should we interview the list?" and I said, "Nadia, it's completely immersive and observational and we are not interviewing anybody." She's shot a lot of observational films, where they end up interviewing people, but I thought, No, we are not going to do that. We are going to go completely observational on this one. I didn’t interview anyone.

The timeline of the events that are revealed in the documentary feel very contained. How long were you and your crew in the ward?

We shot for six or seven weeks, 12-to-16-hour days. We followed only three or four women during their six-week stay and I purposefully chose to follow women who had given birth prematurely and were doing Kangaroo Mother Care. If you give birth to a healthy baby, you are in and out in 24 hours.

I was given access to [the hospital] by the Minister of Health. I had to go up—really high up—to get carte blanche access. But I knew real access always happens on the ground. The people who give you access are the staff, nurses and the caregivers, because even if you have a kind of bureaucratic access, nothing’s ever going to happen if the people on the ground are not on the same page.

I was at the hospital an entire month before Nadia arrived because I wanted to know its inner workings. By the time we started shooting, I knew [if I saw] a labor nurse carrying a baby on a certain floor, who was looking for the mother, that would be the first time the mother would see her baby. I wanted the staff to fully understand what I was trying to do and be on my side. And they were! They started to understand and know what I was looking for, so they became my embedded producers. They would point me to certain women.

The film focuses predominantly on a handful of women whose circumstances were each unique, but also highly complementary. Were there any stories that you wanted to tell that didn’t fit into the overall structure of the film?

There were many stories. But in the end, you don't think of the ones that didn't fit in. It's a puzzle. There will always be pieces that you love, but will never fit in the overall structure of the film, so at some point you have to forget those things.

The weaving of ambient sounds illuminates the character of the ward. There's a din that adds to a persistent sense of urgency and underscores the tireless work and labor required to support Fabella. We keep returning to the woman with the megaphone, dispensing order and guidance. Is she bureaucracy personified?

Yeah, and I think she personifies tough love too. This is bureaucracy on the one hand, but also the kind of tough love that the staff shows the patients. I love that she would go to places that you don’t necessarily hear in other hospitals. Before visiting hours, every morning, she would go on and on for an hour or more—she's half preacher and half standup comic. She is so funny and she also reveals a lot about the culture—what the culture holds dear. All the norms are in that speech.

For all the impersonality, order and procedural rigor required for the ward to function, the relationships you capture demonstrate a sense of camaraderie and tenderness. I noted an emphasis placed on community and communalism—shared experiences, shared beds, shared wisdom—even shared milk.

That's what drew me to Fabella when I first visited—these communities of women that form instantly. It's an instant bond because they are sharing very private spaces. They have to negotiate the space quickly with different women. Some of them leave, others return and some women stay, but they form very intense relationships. And they are fleeting relationships because you know they will never see each other again outside the hospital, or ever again in their life, unless both of them happen to be back at Fabella in the same bed the next year. That's highly unlikely.

There's a kindness and a grace that I didn't expect—it's really incredible. Also, it was very important for me to not define [the women] by their poverty or their disempowerment. They are human beings. They are sexual. They are funny. They are very bawdy. They are human beings. It's really important that the audience see that.

I noticed a genuine sense of agency.

Yes, I wanted them to tell their story on their own terms, without any kind of sentimentality—to be real, layered, nuanced and kind of messy. Like lives are, right? They are messy.

There was a tearful exchange between a mother and her daughter. Even with all the birthing and feeding that's occurring on such a large scale in the maternity ward, I think it was that scene that gave me such a profound sense of reproduction in the film.

Aira really touched me. She was so young and her mother would come every day from so far away with barely any money for transportation. That mother-daughter relationship was so touching.

I truly love that relationship—the waiting for the boyfriend who never came. And it's like a conversation you'd have with your mom, right? Aira is so hopeful and says, "Oh yeah, he might come tomorrow," and her mother says, "He always says he'll come, but he never comes." And then [Aira] tries to defend him, "Well, he never promised he would, he just said he'd try." To me, it's a mother-daughter relationship that people can recognize, beyond the very specific situation they find themselves in.

Can you tell me about your decision to end the film with the celebration of the 100 millionth baby?

We filmed that the very last day. We didn't know it was happening. I only found out because I went to the press person to thank him for having us and for supporting the project. I remember him saying, "Oh, you are leaving tomorrow morning? Well, that’s good; you won't be battling with the press in the evening." I asked, "Why would we be battling with the press—what are they doing here?" He told me about the 100 millionth baby being born in Fabella, and I said, "This is crazy! You didn't think that was important to tell me?" So, we decided to film it. Nadia was leaving for New York the next day, early in the morning, and the baby was going to be born at midnight. You are there so you have to shoot it, and we did. I didn't know whether I was going to use it or not, but I felt like we should shoot it—that it would be the last thing we would shoot.

And then when we were cutting [the film], I felt like [the footage provided] a sort of bursting of the bubble. I wanted to immerse the audience in this place—in the hospital—and then pull the rug from under them. This [scene] opens up to reality—what’s happening in government—to show that there's a disparity between what the government sees as this 100 millionth baby, and the hope that it will bring, and the actual reality on the ground, seen for 93 minutes.

We are here, this is the situation and this is the official discourse. In the halls of government and in congress, it's the official line.

Motherland premieres October 16 on POV, and will stream online on pov.org through October.

Sandra Ignagni is a documentary filmmaker, holds a PhD in feminist political economy and works at IDA.