The hard labour of pregnancy
In the Liberian town of Smell No Taste, a 28-year-old woman overcame unimaginably horrific odds only to inadvertently become the face of maternal mortality in Africa.
In December 2014, Salome Karwah was on the cover of Time magazine, one of five Ebola fighters who were honoured as the magazine’s Person of the Year.
She returned to the same Ebola treatment unit where she had watched her mother die and went back to work as a mental health counsellor, because she believed she had escaped death to help the barely living.
Karwah survived a disease that had laid waste to West Africa, taking with it more than 11 000 people, including members of her own family, whom she had fought so desperately to nurse back to health.
First she was a patient, then a caregiver and, finally, she provided succour to minds broken by an indiscriminate killer.
She endured all of those things and two civil wars — but it was becoming a mother that ended her life.
Let that sink in: she survived two conflicts and the toll of beating a disease that had killed her parents, only to die bringing her fourth child into the world.
In Slavic languages, some words for “pregnant” have the same root meaning as the word “burden”. In Russian, the most commonly used word to describe the condition of pregnancy is beremenaya. Figuratively, it means pregnant. But the literal meaning takes on a dark, quasi-religious meaning of burden or punishment. The word for describing successfully making it through labour in the Shona language is rather telling. You don’t explicitly say a person has given birth or was in labour. “Akapona” you’d say. “They survived.” In Chichewa, a person who is pregnant is said to be “between life and death” — pakati.
Those words provide some insight into the reality of pregnancy and childbirth for many women around the world.
For those in developing countries, the prospect of pregnancy does not conjure the idea of a happy, healthy transition, complete with Pinterest ideas for a quirky gender reveal. Yes, expecting a child is cause for celebration. We react to news of an impending birth with “Congratulations!” But we should be saying “How are you feeling about it?”
It is one of the most dangerous positions to be in. Pregnancy could pose a threat to a woman’s mind and body.
This isn’t about gaining weight or being forgetful. This is about not making it out alive or understanding that sometimes the “baby blues” aren’t about feeling a little despondent — they could be a mental illness.
As of November 2016, the World Health Organisation estimates that about 830 women die each day because of complications during pregnancy and childbirth.
In 2011, the global health body estimated that about 200-million couples in developing countries would like to delay or stop having children, but do not use any method to prevent pregnancy because they cannot get contraception or choices are limited, or for cultural or religious reasons.
But the burden of pregnancy is not limited to developing countries. Despite remarkable advances in medicine in recent decades, maternal mortality rates in the United States have more than doubled over the past 25 years, putting the US in the same category as Afghanistan, Belize and South Sudan. The US spends more than every other country on Earth on healthcare. And it spends more on childbirth-related care than on any other area of hospital care. Marked inequalities across racial and socioeconomic lines regarding family planning services play a significant role in maternal mortality rates there.
I am privileged to have the means and the access should I be fortunate enough to carry a child to term, but I also know that it isn’t always the beautiful, worthy and fulfilling work that it is sold as.
At the very least, some people do not get a pregnancy glow; at worst, they will lose their life or that of their child.
For most of human history, pregnancy has come with a significant threat of death. And every single birth is a miracle under our current circumstances.
There’s more to carrying a child than pregnancy photographic shoots, pretty colour palettes and baby showers, if only we’d stop to understand and curb the risks.
Kiri Rupiah is the Mail & Guardian’s social media editor