Making It Count

A conversation with Christy Turlington Burns, former model and founder of Every Mother Counts, on the unexpected ways in which motherhood led to a career advocating for maternal health.

IF YOU CAME of age in the early ’90s, as I did, certain images of Christy Turlington Burns will forever be etched into your psyche. As one of the top models of her generation, she featured in iconic ad campaigns for the likes of Calvin Klein, Chanel, and Maybelline. She appeared in the 1995 Isaac Mizrahi documentary “Unzipped” and Robert Altman’s “Prêt-à-Porter,” with a turn in George Michael’s culturally defining “Freedom! '90” video. Few other fashion models in history are as deeply ingrained in the cultural imagination or have proven so profoundly influential. Within the pantheon of women commonly referred to as supermodels — along with Linda, Cindy, Claudia, and Naomi — Burns’ post-runway career is one of the most fascinating. While she continues to dip in and out of the fashion world, Burns has spent the better part of the past two decades working as a humanitarian and philanthropist, with organizations like CARE and (PRODUCT) RED, and in the most hands-on capacity through her own nonprofit organization, Every Mother Counts.

The issues that are central to the work of Every Mother Counts — making pregnancy and childbirth safe for women all over the world — have a deeply personal resonance for Burns. After suffering what could have been life-threatening complications during the birth of her first child, she was motivated to pursue a master’s degree in public health in tandem with her personal crusade to educate people around the issues of maternal health. This work would eventually lead to Burns directing “No Woman, No Cry,” a documentary that highlights the specific struggles around maternal health and mortality in places such as Tanzania, Bangladesh, and Guatemala. The project also served as a catalyst for the launch of Every Mother Counts, an organization that, now in its 12th year, pursues educational and political initiatives all over the world aimed at improving maternal outcomes for women.

More than just a passion project, the organization grew to become Burns’ full-time vocation, a role that has taken her all over the world and cemented her position as a leading voice in the field, and one of the most visible advocates for pregnant and birthing people. It’s a role that she takes very seriously.

When I turn up at the Every Mother Counts offices in Lower Manhattan, Burns herself has just returned from a trip to Kenya and Tanzania, where she spent time visiting hospitals and meeting with local health care providers. This sort of on-the-ground work is still the thing that Burns loves most — meeting women from all walks of life and hearing their stories. When I ask if this is what she imagined her life might be like at this stage — serving as the public face for a globe-spanning nonprofit centered around maternal health — she is remarkably candid. “I don’t know,” she says. “I never anticipated that the work I do now would take on the life that it has, but I can’t say I’m surprised. If people know or remember me for something, I’m happy it’s this.”

I want to dig into the work you do with Every Mother Counts. There is obviously a lot of discussion in our culture about reproductive freedom, but issues around childbirth itself are still somehow less discussed. A friend of mine who recently had a baby told me that even though she felt very educated about the entire process, she still wasn’t fully prepared for how scary it was. She felt like no one was really honest about how terrifying the experience could be. She actually thought that she was going to die.

That fear, for a lot of women, is very real. And fear alone can create a lot of problems. It doesn’t set you up for success, honestly. Childbirth is this thing that’s happened since the beginning of time, and we know that bad things can happen. Sometimes people don’t survive it. We read about it in literature, you’ve seen it in films, but that aspect of it feels like something that can’t really be discussed. I think it’s part of why there’s stigma around talking about birth stories, and why people don’t share exactly how tough it can be. Because it’s still so present, that it could happen. It reminds us that life and death are intrinsically connected, and when you’re that close to one side, you feel the other one just at the other side. It does definitely have that deep sense of potential trauma.

It brings up the issue of how you educate people without also terrifying them.

Yes. Again, just given my role with the organization, I try to feel people out, like, “How much do you want to know?” And I’m also a source for, “Let me know how much you want to know, and I’m here to answer any questions,” because I think that is the best way to pay it forward. And pregnant people themselves, they might not be in the head space to be able to hear potential challenges, but I feel like for anyone else, it’s like, “Let’s be honest. Let’s unveil this thing.”

You’ve spoken very candidly about how your own childbirth experience really set you on this path.

Yeah. It was entirely unexpected to become what we are today in terms of a foundation and doing the work that we’re doing on the scale that we’re doing. But really the impetus for me was just after my first experience becoming a mom, and going into the experience feeling really ready. I was not a baby by any means. I was 34. I had a career, I’d gone back to school, I had a sense of how I wanted to become a mother. I was a very strong believer in midwifery and natural childbirth. I saw that for myself. I had options and my husband was very supportive of whatever I wanted to do.

Living in New York City, there were lots of options. I met with a doula and then she kind of helped me navigate the childbirth world here. I had all the information, all the support in the world, and was so ready. And then the unexpected happened, which was that I had a postpartum hemorrhage because I didn’t deliver my placenta — which sounds a little technical, but usually when you watch a birth or see a birth happen, it kind of just happens. It’s not usually a big drama. That’s one of the things that just gets kind of glossed over in all the books.

So mine did not come out naturally. And so a backing obstetrician had to come in and intervene, and actively manage the extraction of my placenta. But you know, your uterus, it’s all very vascular. There’s a lot of blood involved. I lost a lot of blood and also needed to be catheterized. I had to have antibiotics. I had to be monitored and I had to really take care of myself afterwards, but I didn’t require a transfusion. On a lot of levels — especially now that I know as much as I know — it was sort of seamless, straightforward, and I felt incredibly supported. I didn’t think I was going to die, but it was incredibly painful.

So it was all slightly traumatizing, but I still went home the next day. Over the next couple of weeks, as people were coming to see the baby and I was sort of sharing what had happened, more and more people would respond and say, “Oh, that happened to me,” or this other equally traumatic thing happened to them. It just became really evident that people aren’t talking about their birth stories in a way that could better prepare everyone. I think information is power. And the more that you know, in terms of setting your expectations, the more you can enter these hugely transformative experiences in life while also feeling empowered. And so I think my first instinct was wanting this birthing experience to be as transformative and positive as it possibly can be.

Because even with my complication, I still felt like a warrior after delivering my kid. It didn’t take away from that. However, I would like to have been more prepared and I would also like to make it easier and smoother for other women. I eventually started to work and travel with CARE, which is a big humanitarian organization. I went back to El Salvador, where my mom is from, while pregnant with my second child. And then all of these connections started to happen. I realized that if I had been in a place with fewer resources when I had my first child, I likely would not have survived. A woman can bleed to death in less than two hours.

Then I went back to school to study public health at Columbia. I started to delve deeper into global health. But then, of course, I also learned, while understanding the scope of the issue globally, that the United States was doing incredibly poorly. I became a mom in 2003 and at that time we were ranked 41st in the world for safe motherhood. And today we’re 55th, according to the WHO; so we are continuing to worsen while lesser-developed countries actually have been making strides in the right direction to try to make birth outcomes safer for moms and babies.

So much of the dialogue around reproductive health is focused on access to contraception and access to abortion, which means all the other conversations around maternal health often take a back seat or become wrapped up in that issue.

It’s so difficult because the abortion conversation is so politicized. The impact of it being politicized means that funding gets pulled from places like Planned Parenthood or globally from basic clinics where an entire range of reproductive services are desperately needed; but because of the concern around abortion funding, suddenly no services are offered at all.

There has been a bit of momentum in the last few years around maternal health and family health and making the connection between the two. And yet, there’s still the elephant in the room, which is that there are fewer places where a woman can be educated about their sexual or reproductive health, because it’s not allowed in most schools across the country. When I was first a student in public health, I couldn’t believe that even though abortion was legal in this country, there are a great number of places where it is only just barely legal. That lack of education contributes to maternal mortality. Many women just have so few choices. So many women aren’t able to control how they become pregnant or under what circumstances. How traumatic it is to find out that you’re pregnant if you’re not in a position, where you can’t care for a child, care for yourself, or be a functional person in society. It’s horrible.

You’ve been doing this work for a while now — Every Mother Counts itself has been operating for well over a decade — how has the work changed during that time?

When we started, the objective was really just getting the word out. People were certainly not talking about maternal mortality or morbidity — not in the United States, but also not really globally either. When Every Mother Counts was born, it was really like we were an awareness-raising campaign. We wanted more people to know. This was needed. No one’s talking about it. Let’s bring some faces and voices to some stats that are starting to be talked about a little bit on the global development stage. So, awareness raising is one thing, but real change takes a lot more than that, right? Once people know, what can they do? And then what can we really change, in terms of policy, that will actually really fundamentally change the systems themselves.

In 2020 we celebrated 10 years as an organization. There’s definitely a lot more attention paid to the lives of girls and women. Health care is certainly something that’s more top of mind to people. And just the fact that so many health systems are broken — ours being one of the biggest, most complicated, and most broken of all — that, in and of itself, is really impacting the experiences of so many people.

I learned early on, even traveling with CARE, or with the One Campaign, or with Save the Children, or different other large NGOs who focus on this as one of many issues, that there are so many different aspects that intersect. It’s been made very clear, particularly by something like COVID, that the root causes of poverty and the social determinants around health care are things that are not easily resolved. You can’t just come in and fix it. There’s no silver bullet, no pill, no cure. We actually know how to keep women safe through pregnancy and childbirth, but the equity piece is just still a major issue.

Gender equity and access to services were really a very focal part of our original work. And then beyond just access, it becomes about quality. What is quality respectful care? What does it feel like to be welcomed into any kind of health facility or institution and be treated with dignity and respect? How do you build trust so that a person would then come back into the health system if that’s necessary?

This is clearly an issue that can’t simply be solved by building hospitals or throwing fancy fundraisers — not that those are inherently bad things — but the less glamorous and more complicated work is always around dealing with the politics and trying to implement systemic changes that are often hard to quantify.

That’s a very, very good point. We often talk about impact here in terms of qualitative and quantitative; they both really matter. Again, focusing on the experience of a patient or the experience of a community. Advocacy is sometimes one of the more frustrating areas of the work, but it’s so needed. And to have people out there sharing testimonies, demanding change, calling representatives — that stuff really does matter.

It’s hard to sustain. And it certainly takes certain kinds of people who feel comfortable in that realm and are confident enough to do it and have the energy. It’s exhausting work. But it does make a difference, actually. And I feel like it makes a difference at the local level, at the state level, the national level, and then at the global level too. And so, yeah, it’s not necessarily that sexy always. And you’re absolutely right too — building a hospital is oftentimes a shortsighted solution.

I've seen more empty hospitals than I could count. You see things that are partially built. You see things with names on them, but then inside … nothing. To me, our focus has really been better used on transportation, getting people to and from, or getting the care to the communities. And then supplies. Sometimes really basic supplies. In Kenya and Tanzania, if a woman goes to the hospital, she’s responsible for also bringing her own supplies, unless it’s a private hospital. But she, in some instances, will have to bring her own blood, if she should need it. What are you actually delivering your baby on? She has to bring that. She has to bring her own food. She has to share a bed. There are so many things that are so incredibly challenging.

I’ve talked to many celebrities about their charity work or particular causes they have championed, but I can think of very few for whom that work has become …

Their entire life?

Yes. And when so much of this work is so deeply challenging, or involves seemingly intractable broken systems, how do you sustain this level of energy and commitment without burning out completely?

This is the right question for this particular moment in my life. My daughter was just with me on the trip to Africa. And she’d been with me before, maybe 10 years ago, when she was 8 years old. And she’s been with me on Guatemala trips with Every Mother Counts in the past. And it was her birth that essentially birthed this part of my life, which she loves. But she’s constantly asking me, “Mom, you’re 53. When are you going to start to find a way to step back?” And I guess, as I was saying at the beginning, I started with a film — sharing my story and just trying to raise awareness. I wasn’t expecting to ultimately take on so much of this work myself.

Up until recently, I would try to look ahead: What’s next? What’s the big-picture thing? But it’s really hard to do when there’s so much to do on a daily basis. When this project came along, I was really at a place where I could put my whole self in. And I guess I’ve learned, almost by putting myself wholly in, that I don’t think I could have done it in any other way. That’s just me and how I am, which is why I don’t think I really can step back. There’s no exit strategy, per se.

But I don’t know that I will ever not be doing this work because, first of all, I know it won’t be solved in my lifetime. It is hard for a lot of people to dedicate so much time on something and to know that. I know that. And yet, I’ve seen enough progress that it makes me want to keep going. And then at the end of the day, it’s one person at a time, one woman at a time. And I think I’m still one of those people that’s more like, each person I educate about it, each person I have a direct connection with, and I know that their experience was better because they had access to the kind of care that I would want for everyone ... It sounds kind of cliché, but I feel like that’s what keeps you going and makes it all worthwhile.

I am stuck on the idea of your daughter calling you out about being 53. We are almost the same age, which is to say we are still young!

I know. I know. I know. And it’s funny. Also, when I started getting into this work, I remember my mom even saying, “Oh, you’re going back to school.” And “Oh, you’re going to start this thing. Oh, you work so hard.” And if she had any sense of how hard the people that I get to meet and spend time with really work, it’s such a small thing, in a way, what I do. Even though the goal is big, the mission is big, the impact is also big. Also, it’s not manual labor. It’s using what I have. It’s being able to see something, say something, recognize who are the people involved who can be, really, the solution. I have probably the easiest job of all the people that I engage with.

Being on the ground in these places and really interacting with these incredibly underserved populations and hearing their stories also keeps all of this stuff, all of the work, in perspective.

That’s a really important point. I feel like travel sometimes does that most powerfully, where you just step outside of your normal routine, your comfort zone. And yet, so many of us haven’t been able to travel for a while. And there is also that other side, which is where you’re out so much that you aren’t really dealing with reality. There’s that thing too, which I see a lot. People just constantly going and seeking outward, as a way to remain constantly distracted and to never really have to deal with themselves.

Travel really should expand our view of the world and, ideally, make us more understanding and empathetic. I don’t understand people who travel to remote places only to stay in these sealed-off spaces where they don’t actually interact with anyone.

I’ve always really wanted to see things, be where people are. Part of why I love New York — even though, obviously, New York has changed so much in our lifetimes — is that you still have to be confronted with things that are difficult and unpleasant on a daily basis. And I was thinking that for all the beauty that I see outside of New York and in more rural parts of the world, which I crave and I really feel like I thrive in, I also need to be close to humanity. I need to be with people, in all the good and bad ways. I don’t want to just be reading about things. That’s not enough. I want to actually go there. If I’m going to try and make something better, then I want to actually be there. I want to be right in the middle of it.