Stacy Ann Walker could have died.

During what she thought was going to be a normal exam, Stacy learned that she would need to have a C-section. While recovering in the hospital, she began to have breathing problems and after some testing was told that her heart had been scarred by an earlier bout of rheumatic fever. Shortly after, she also learned that she had heart failure, an enlarged heart, and problems with multiple heart valves.

She was 29.

The mental health of mothers cannot be studied in isolation, as just a psychological snapshot in time. Their complex lives both past and present must be taken into consideration. When I was researching marriage, motherhood, and social support in Korogocho, an informal settlement in Nairobi, stories I heard underscored how a range of life experiences conspire to affect a woman’s mental health. I heard life histories like this:

When Ann was 17, she met Fredrick, got pregnant and moved in with him when she was 18. Two years later, Fredrick got arrested and was gone for two years. When he came back, she got pregnant with child No. 2 within a month but then left the relationship seven months later because of ongoing conflict. When she was about 23 with a 2-month-old and 5-year-old, Frederick shot her. Two months later, he himself was killed. Four months later, she met the man who would become her second husband. After living together for three years, he took her back to his home to meet his family. She then had her third baby.

When childbirth takes place without skilled birth attendants or adequate emergency obstetric care, a woman may suffer from obstetric fistula. Women with fistula live with uncontrollable urinary and/or fecal incontinence, because a hole has formed between the birth canal and bladder or rectum. They have usually survived prolonged/obstructed labor, often lost their child to stillbirth, and frequently face severe social isolation and stigma. There are also now more and more women suffering from iatrogenic fistula caused by injuries during pelvic surgery, especially obstetric or gynecological surgery. Between 1 million and 2 million women currently need fistula repair, with thousands of new cases each year. However, most fistulas can be treated, enabling women to resume healthy, productive lives in their communities. Recognizing this, the United Nations has issued a call to end fistula by 2030.

“Midwifery is a fix, it is not an add-on,” said Franka Cadée, President of the International Confederation of Midwives (ICM) at the Nairobi Summit on ICPD25. The World Health Organization designated 2020 the Year of the Nurse and the Midwife in recognition of the invaluable contributions of these two professions.  To meet the Sustainable Development Goals by 2030, midwives and nurses must be valued and utilized as essential members of the health workforce.  Increased utilization of skilled midwives will also help countries achieve universal health coverage and improve access to sexual and reproductive health services, two key actions from the 1994 International Conference on Population and Development (ICPD).

In the quarter century the Wilson Center’s Environmental Change and Security Program has been pondering the issues for which it’s named, the world’s demographic future has been wobbling. A key concern of analysts: How many people will farmers need to feed in 2050? Mainstream projections have teetered between 8.9 billion and 9.8 billion, amounting to an increase of between 13 and 21 percent over today’s 7.7 billion. This significant variation in projections is rarely acknowledged by prognosticators. Many simply round up today’s latest guess and state confidently that there will be 10 billion people in 2050—though just a few years ago, the number most confidently stated was 9 billion.

We’ve got a crisis impacting our mothers and a crisis impacting our babies, said Dr. Lisa Waddell, Senior Vice President of Maternal Child Health and NICU Innovation and Impact Deputy Medical Director at the March of Dimes, at a recent Wilson Center event launching the Maternal Health Initiative’s CODE BLUE series, developed in partnership with EMD Serono, a business of Merck KGaA, Darmstadt, Germany. She was referring to non-communicable diseases (NCDs), which impact maternal health in the United States and globally. NCDs kill 18 million women of reproductive age each year, accounting for two in every three deaths among women.

The Nairobi Summit on ICPD25 was an opportunity for the global community to re-commit to the unfinished objectives of the 1994 International Conference on Population and Development’s (ICPD) Programme of Action and accelerate the progress to achieve the Sustainable Development Goals by 2030.