FOR the past six years I have been photographing birth, looking at its universal as well as cultural aspects, and the struggle to provide women with safe, respectful care. An estimated quarter of a million women die each year from pregnancy-related causes like pre-eclampsia. Though the number of women who die in pregnancy or childbirth is half what it was 20 years ago, most of these deaths could have been prevented.

My interest in the subject started when I was 18 and on a semester-abroad program in the Dominican Republic, where I ended up with a Spanish immersion internship in the maternity ward of a public hospital. I inserted catheters, waited alone with women laboring on bare plastic mattresses — family members were not admitted — and tried not to pass out while drawing blood. I’d had only a few years of high school Spanish, and I’d had no training for the work. Nine years later, I thought about those experiences with disbelief, and I was curious. So I returned to the hospital and began to photograph.