This article was posted in Ms Magazine on May 18, 2016 by Denise Dunning, Founder and Executive Director of Rise Up (Let Girls Lead is an initiative of Rise Up, which advances health, education and equity for girls, youth and women everywhere).
"Your blood pressure is running high, but we'll watch it to make sure you don't develop preeclampsia. You should be fine," my doctor told me when I was 30 weeks pregnant with my third child. As I sat on the examining table, my palms started to sweat.
This pregnancy had been a rough ride already - first trimester genetic testing showed that my baby had elevated risk of Down syndrome and I developed gestational diabetes during my second trimester. I lay awake worrying most nights, and still started most mornings with my head in the toilet. But all that, I had a feeling, would seem easy compared to the road ahead.
My first two children were born without medical intervention, and now the prospect of an induction and related complications now loomed large in my mind. Working in the field of women's health, I already knew all too well that the most dangerous thing many women will ever do is have a baby.
The following weeks were a scary blur of doctors and medical exams. Twice a week, I attended stressful antepartum testing appointments where the nurses performed sonograms, monitored my baby's heartbeat, checked my amniotic fluids, and tested my urine for proteins. I had appointments with dieticians who reviewed weekly logs tracking everything I ate, monitored my blood sugar levels after each meal, and adjusted my insulin dosage accordingly. I also continued my regular appointments, where my obstetrician measured my baby's growth and ran blood tests to check my liver functions and platelet levels. I held my breath every time, wondering if something terrible had gone wrong.
Sitting through a seemingly endless series of medical appointments, I couldn't help but think of Joyce and Lizzie. Early in my pregnancy, I was in New York with my Malawian colleague Joyce, advocating for the health of women and girls at the United Nations. While we were in New York together, Joyce learned that her 20 year old sister Lizzie had died when her baby boy was born. After having a normal pregnancy, Lizzie began to hemorrhage during childbirth and was not able to get a blood transfusion. So, like too many women around the world, Lizzie died while giving life.
As the weeks passed, my blood pressure continued to slowly climb, but remained low enough that my doctor reassured me that I would carry my baby to term. I continued my weekly battery of tests, occasionally requesting additional bloodwork as reassurance that both my baby and I were fine.
This pattern continued until the 37th week of my pregnancy, when my six year old came running into my bedroom one Monday morning at 7am. I had hardly slept the night before, and struggled to open my eyes as my daughter put my cellphone to my ear. I heard my doctor's voice on the other end of the line telling me that my recent bloodwork showed that I had developed HELLP syndrome and that I needed to go to the hospital immediately to be induced. So much for my plans for another natural childbirth.
As we drove to the hospital, I tried to stay calm and positive, resisting the urge to look up HELLP syndrome - and it's a good thing I did. What I learned later is that HELLP syndrome is a form of preeclampsia that stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. Or as my labor and delivery nurse put it - really bad news. Put simply, your major organs start to shut down, and if you don't deliver the baby right away, you most likely will have a stroke or liver failure. Globally, one out of four women who develop HELLP syndrome die.
My husband and I got to the hospital by 9am, the induction started at 10am, and I delivered a healthy baby boy just before 4pm. In the end, I was incredibly lucky - unlike Lizzie, I had an excellent doctor, a team of top rate specialists, great health insurance to cover the exorbitant costs, the ability to advocate for myself within the medical system, and access to blood transfusions and other emergency interventions if I needed them.
And the odds were on my side - the majority of maternal deaths are preventable. Women who have access to quality prenatal care, skilled birth attendants, and postpartum care have exponentially better odds of surviving pregnancy and childbirth, and of delivering healthy babies.
But far too many women and their babies don't beat the odds. Every year, more than 300,000 women die during pregnancy and childbirth. Every single day, 800 women die while giving birth - which means that two women will die by the time you finish reading this article. And beyond maternal deaths, 2.6 million newborn babies die every year and an additional 2.7 million babies are stillborn.
Like Lizzie, the vast majority of these deaths could be avoided. Hemorrhage, infection, unsafe abortion, and preeclampsia lead to 75% of maternal deaths - all conditions that are fully preventable. Preventable, that is, if we as a global community make the choice to prioritize the health and wellbeing of women and children.
But the sad reality is that we don't. Women's health remains one of the least funded issues worldwide - even though it is the bedrock of global health, development, and security. Without healthy mothers, we can't have healthy families. And without healthy families, we can't have a safe or sustainable world. But in the year 2016, the health of marginalized women like Lizzie is still, far too often, our last priority.
Working to transform these devastating realities is the mission of Rise Up, an organization I started to advance health, education, and equity for girls, youth, and women everywhere. We invest in the vision, priorities, and strategies of local leaders to achieve large scale change for girls, youth, and women. Rise Up has advocated successfully for 124 laws and policies impacting over 115 million girls, youth, and women in Africa, South Asia, Latin America, and the US.
We invest in advocates like Francesca Adeola Abiola, a Nigerian leader who is working to save the lives of young mothers and their babies through Rise Up's Champions for Change Initiative. Maternal mortality is one of the leading causes of death for 15-19 year-old girls globally, and the reality for girls in Nigeria - where one in 30 Nigerian women dies during pregnancy or childbirth - is no different. With support and funding from Rise Up, Francesca has advocated for implementation of a national policy that increases access to youth-friendly health services in the slums of Lagos. Francesca has successfully convinced decision-makers to provide funding so that young women can access the services they need to stay healthy.
We also support leaders like Monica Atkins, a young leader in Mississippi who is increasing youth access to comprehensive sexuality education through Rise Up's Youth Champions Initiative. The United States is one of only eight countries - including Afghanistan and South Sudan - where maternal mortality is actually increasing. So in a part of the US where maternal death rates for women of color are higher than many sub-Saharan African countries, Monica is working to ensure that all young people can avoid unwanted pregnancy and HIV/AIDS. Using art and poetry, Monica is building a movement of young people who speak out for their rights and demand access to the comprehensive sexuality education they need and deserve.
Saving the lives of women like Lizzie - and millions more women like her - takes political will, financial commitment, and savvy advocates who have the resources they need fight for better laws, policies, funding, and health services. That's why Rise Up has built a network of 370 amazing leaders like Francesca and Monica, investing millions of dollars to support their vision to create large-scale sustainable change for their communities and countries.
Because in the end, the truth is devastatingly simple. Women and their babies will continue to die until we decide that they have the right to live. And without healthy women, we can't have healthy families, resilient communities, or a sustainable world. The choice is ours to make.
Dr. Denise Raquel Dunning is the founder and Executive Director of Rise Up, which advances health, education and equity for girls, youth and women everywhere. She teaches courses at the University of California San Francisco, previously worked for the David and Lucile Packard Foundation and served as a Fulbright Scholar in Honduras. She has a PhD in Sociology from the University of California Berkeley, a Master's in Public Affairs from Princeton University and graduated Summa Cum Laude from Duke University.
Rise Up creates a better future for girls, youth, and women. We strengthen leadership, invest in innovation, build movements, and amplify voices to achieve large scale change.
Rise Up unifies the power of Let Girls Lead, Champions for Change and the Youth Champions Initiative, to benefit 115 million girls, youth, and women globally.