When the Personal Becomes Global

One NGO worker’s story of motherhood and maternal health

The author with her daughter, circa 2020

Every year, USAID-supported programs reach millions of women across more than 25 countries, working to reduce maternal and newborn deaths, improve the quality of care, strengthen health systems, and expand access to mental health support. But behind every statistic is a story—not just of survival, but of joy, longing, and loss. As someone who has contributed to this work and experienced firsthand the need for supportive care before, during, and after pregnancy, I know how deeply personal the global can become. I know that every woman—no matter where she lives—deserves the best experience possible, a truth I felt in my bones only after traveling my own complicated path to motherhood.

My babies were born 19 months apart, just as I was entering my fifth decade. By then, I’d already done most of the things I’d wanted to do as a middle-class, socially minded American. I’d served for two years with the Peace Corps in Malawi. I’d gotten an undergrad degree in anthropology and a master’s in nursing. I’d practiced as a certified nurse-midwife in a community clinic. And I’d scored my dream job with a prestigious university doing the global health work that I’d hoped to make my career. This dream job led me to the Kingdom of Eswatini in southern Africa, where I met the man who would become my girls’ father.

The silent heartbreak of miscarriage

For a privileged, focused, curious American, this was perhaps an unusual path, but it was one that ticked all the boxes: education, exploration, career, relationship, children. A success story. A travelogue. Maybe even a love story, and with all the births—a good medical drama to boot.

But here’s what only a few people knew: from the ages of 35 to 38, I had four back-to-back miscarriages. I was a global health midwife with a meaningful job, a steady income, a kind partner, and a chronic, all-consuming heartache. All I wanted was to be a mom. To bring a child of my own into this messy, wonderful world. But even if my mind was ready, my body was not.

I miscarried while jogging through a five-mile Turkey Trot race. I miscarried at our home in southern Africa, locked in the bathroom. I miscarried during an interminable flight from Johannesburg to Dubai, and through a three-week work trip to Pakistan. And, finally, I miscarried on Christmas Day, when the bedtime books and handknit sweaters for my niece and nephew were simply too much to bear. I retreated to my childhood bedroom and gave in to the most desperate sadness I’ve ever known.

But I was lucky. Because I work in maternal health, I had a network of experts at my fingertips to consult for emotional support and professional guidance. I could afford the yoga classes and massages that offered moments of relief. I also knew in my heart that my ability to produce children did not define my value as a woman, or prove my worth as a human being, beliefs that torment so many women in similar situations. But most importantly, I was fortunate to receive the high-quality care that I needed during an incredibly difficult time.

For too many women globally, skilled, empathetic healthcare during pregnancy, birth, and the postpartum period is not a given. That’s why USAID has supported efforts to increase access to respectful maternal and newborn care, integrate mental health into routine services, and train health workers to recognize and respond to perinatal distress.

As someone who personally understands the impact of these kinds of interventions, it has been a privilege to work for an organization that champions the importance of integrated, comprehensive maternal health care and that works with local organizations to ensure these services reach the women and families who need them most.

Motherhood and mental health in the global health context

Our first daughter finally arrived on a blistering hot January day in Cape Town, South Africa. She had a full head of long, dark hair and looked like no one in either of our families. Waking up to her every day was like getting the best surprise gift over and over again. Her sister came quickly afterward, another big-eyed beauty with no discernible family resemblance.

Before our second was born, I thought, I know how to do this. But I was quickly overwhelmed. I celebrated my 41^st birthday with two babies under two years old, holding down a job that supported my family and that required frequent global travel. I pumped breastmilk in economy airplane bathrooms and empty offices in conference halls, praying that I was producing enough to keep my supply up. I suffered through four bouts of mastitis, sweating like a demon with my laptop propped on my belly, answering emails with a sleeping infant at my side. My older daughter wailed when she saw me pack. I missed my younger daughter’s first steps.

This was exactly the life I asked for. It was everything I’d ever wanted. And yet, there is no word in the English language for the level of exhaustion and worry I felt in those days. I lashed out at my husband with a rage neither of us recognized. Nothing he did was good enough. But deep down, I was sure that I was the one who was failing.

The most common complication of pregnancy isn’t physical

I look at these periods of my life from the vantage point of six more years, and I see what was happening. The bleak depression that accompanied my miscarriages. The terrible anxiety that arrived during my second maternity leave. Even as a trained midwife, I did not know that perinatal mental health disorders are the most common complication of pregnancy and the postpartum period, that one in five women around the world suffers silently—as I did.

At 23%, mental health conditions—including deaths to suicide and overdoses related to substance use disorder—are the leading cause of maternal deaths in the United States. This is shocking and unacceptable. These deaths are preventable with early detection and intervention. American women deserve better.

But don’t all women everywhere deserve better?

USAID’s role: a global effort to prioritize maternal mental health

Four years ago, as the world emerged from the confusion and loss of a global pandemic, I was brought in on a USAID-funded project working in dozens of countries around the world to improve maternal and newborn health. Co-leading the perinatal mental health portfolio for this project would become a highlight of my global health career.

The energy around this under-recognized and underfunded issue was electrifying. Finally, the global health community was taking the devastation wrought by this silent burden seriously. Funders were now truly listening to the women, advocates, researchers and organizations who had been working for years to call attention to the critical importance of mental wellbeing around the time of childbirth. Surviving pregnancy and birth are not enough, they said. All women everywhere deserve physical and mental health and well-being. Without it, we cannot care for ourselves or our families. Without it, our children suffer, our communities suffer, and our societies suffer.

And so, USAID began to invest meaningfully in this shared vision. In India, Nepal, Afghanistan, and Kenya, we helped launch or expand programs that offered integrated, low-cost education, support, and care for women experiencing maternal mental health issues. Then, through a global community of practice, USAID funding helped link these, and many other, programs together—enabling technical learning, adaptation, and collaboration across countries and continents.

These programs didn’t just reduce suffering. They contributed to resilient health systems and helped women and babies thrive. And when mothers are healthy—physically and mentally—they can care for themselves and their children, raise healthy families, and contribute to more stable, prosperous communities. That is the ripple effect of investing in global health.

The cost of losing momentum

Despite the overwhelming data on the relationship between a woman’s mental health and her children’s health and survival, at the end of January, USAID’s life-saving programming in perinatal mental health abruptly ended with the new administration’s Stop Work Orders. This investment had been laying the groundwork for scalable, integrated maternal mental health care, helping national health systems pilot solutions and strengthen capacity.

Every day since, I have grieved this decision—the loss of momentum, of technical leadership, and of a commitment to our world’s women and families.

I know firsthand that the experience of pregnancy and motherhood can be joyful. As a midwife, a mother, an evidence-based public health practitioner, and an American, I also know that it can be lonely, scary, difficult, and loaded with cultural expectations. Any woman approaching motherhood, especially with the added stressors of trauma, adolescence, stillbirth or early infant loss, political instability, natural disasters, social isolation, or extreme poverty—like so many of the women served by USAID-funded programs—deserves every bit of additional support she can get.

A bereavement suite at a hospital in Harare, Zimbabwe, sponsored by S.A.L.T. Africa, where parents can say goodbye to their babies with dignity and privacy.

A Mother’s Day reflection

I’m not sure what my girls will do on this Mother’s Day. Maybe breakfast in bed. Maybe handmade cards, or, more likely these days, CapCut videos. I will take a moment to revel in the life I get with them, a life I couldn’t have imagined from the colorless fog of miscarriage or the heart-pounding insomnia of their babyhoods. I will feel deeply grateful for getting through those tough times to arrive at this good part, for the global village that supported us along the way.

I’ll be thinking about the fact that, for some, Mother’s Day is painful. I’ll feel grateful for our partners and collaborators around the world, like the amazing volunteer staff of S.A.L.T. Africa in Harare, Zimbabwe, who renovated a special "Bereavement Suite” within the city’s large referral hospital. It’s a beautiful, private space painted by a local artist with flowers in soft colors and outstretched hands, and outfitted with a plush couch and a delicate bassinet. For the first time, grieving parents can now say goodbye to their babies in their own ways, in their own time. And I’ll recall the mothers S.A.L.T. Africa counsels, the ones with tiny babies born too soon, who live at the hospital for weeks or months at a time, providing around the clock care.

And I’ll be thinking of the lost momentum. The programs USAID funded across the world—from Nepal to Nigeria—that were changing the narrative around maternal mental health. Programs that reminded us that surviving childbirth isn’t enough—that all women, everywhere, deserve to thrive in motherhood. These are not just abstract goals; they are lived experiences, delivered in clinics and communities every day by people who believe that every woman’s mental health matters.

I fear that in the wake of USAID’s suspended maternal mental health work, we won’t just be remembering the women and babies we’ve lost—but the ones we failed to reach in time. Every woman deserves to survive pregnancy and birth without lasting wounds to her body or her mind. Anything less is a failure of our shared humanity.

Honoring mothers everywhere

In honor of this Mother’s Day, please consider offering a donation to S.A.L.T. Africa, to contribute to their efforts to address maternal mental health and provide support to girls, women, and families experiencing perinatal loss.

And if you believe—as we do—that every woman deserves access to maternal mental health care, please raise your voice in support of continued U.S. leadership in global health. USAID has shown what’s possible. It’s up to us to make sure that work continues.

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About the author

Laura Fitzgerald is a certified nurse-midwife, writer, and global health leader with over 20 years of experience in reproductive and maternal health, health systems strengthening, nursing and midwifery, and HIV prevention. She lives with her family in Mbabane, Eswatini. The views expressed in this post are entirely her own, and do not reflect those of any past or current employer.