CARUARU, BRAZIL – Maria Fernanda da Silva, 39, is a traditional midwife from Caruaru, a city in the interior of Brazil’s Northeast region. She has been working as a midwife since she was 12. She started helping her mother, who is also a midwife, at age 9.

“My mom called me her ‘little assistant,’” da Silva says.

She says she became more than an assistant at age 12 when a woman in her community needed help and her mother was out of town.