SM: Questions were raised about your decision to photograph a young mother and newborn in a smoky environment and two issues arise: how much should a documentarian manipulate the environment and what responsibility do you have for the women’s health?

PB: Her name is Saraswati and her story is an acute representation of the complex web of patriarchies and abuse, with Chhaupadi as the organizing principle. Saraswati was forced to observe Chhaupadi along with her newborn child because of bleeding at child birth. She was dislocated from the rest of her family and could not properly wash herself and exercise any form of menstrual hygiene.

So, by being required to live in unsanitary and inappropriate accommodation because of this tradition her health was placed at risk. Saraswati had other undiagnosed health issues: she was having trouble walking due to swollen legs and ankles — something possibly exacerbated by all the time she was spending sitting down in her room of exile.

The smoke in the room was not a significant factor in her collapse. Saraswati’s health-issues were principally to do with postpartum bleeding and poor maternal healthcare rather than respiratory problems caused by asphyxiation and her condition made worse by her extreme emotional distress following the recent floods that had taken the lives of several friends. The baby, despite the trying circumstances and the distress of the mother, was not sick or ill.

But it became abundantly clear that Saraswati needed to get to a doctor and we decided to intervene and provide the money for a stretcher so that she could get to hospital, which was far away. I wrote about this in more detail on the Magnum Foundation blog. A matter of public record, this post deals with the intricacies of Saraswati’s situation and, especially, why we arranged for Saraswati to be taken to hospital.

Documenting Saraswati whilst exposed to the otherwise normal smoke from the cooking fires that are ubiquitous throughout the region and the commissioning of the stretcher have both been criticized as inappropriate interference. But her life was clearly at risk and what else could we do?

Ethical dilemmas are the nature of the work I do. The difficult decisions that I constantly make in the field are informed by my own background and experiences. Whether perfect or not, they are taken with consideration and presence of mind. We are not just talking about Nepali culture here, we are addressing Hindu culture and the role of women. Growing up in such an environment, myself and many women I know have persistently experienced various forms of subtle injustice, passed off as a benign “respecting of your culture.” And that is not okay.

This work is an investigation and it is crucial to look beyond the surface and recognize what is hidden and appears to be “normal”; listening to the women, even in their silence. Such silence is testament to their resilience and their power to endure in unjust and adverse circumstance. But not complaining doesn’t mean they accept this; most do not have a choice.

It is wrong to accept these and other harmful practices as “cultural norms”. Just because they’re institutionalized does not justify the practices nor the patriarchy and misogyny that lies beneath. To accept that which is on the surface — at face value — as a cultural norm, is to endorse a male viewpoint, completely disregarding the women’s perspective.

How and when we intervene is always a dilemma and something to be approached with great sensitivity. Cooking that causes the room to fill with smoke, is well documented in this cultural context. Long-term exposure to smoke within enclosed environments does, of course, has long-term health implication. Documenting this culture norm is important, as it is a serious issue faced by the women.

We may choose to have a quiet word with the family in question at a later date to advise them of the health implications of such actions; but in most contexts, intervening in the moment in a particularly moralistic or strident way will bring negative consequences for the person you are trying to help, consequences that will endure after I leave.

The resilience of these traditions is incredible. Efforts by Nepal’s Maoist groups during the country’s civil war and subsequent NGOs to pull down Chhaupadi huts failed to make any change. The huts were rebuilt and now the challenge is to stop a return of girls and women sleeping out in the open or hiding their exile all together. To end this practice, longer-term work must be sustained that addresses the belief systems that underpin this practice.

We constantly walk an ever-shifting ethical tightrope. With experience we learn to hold our nerve even if it is heartbreaking and distressing to witness a particular scenario. And, you also learn, how and when to make an intervention that is effective and has minimal negative impact. Predominantly though, the activism comes later in what we do with the work and how we campaign to raise awareness about the issues depicted.