When you scratch the surface, you realize that the mortality of birth is everywhere.
Driving from Kampala to Tororo, I was speaking with a doctor who was sharing the ride with me. She told me that she lost her first born in utero. She had been 30 weeks and developed severe pre-eclampsia. The obstetrician tried to delay delivery for the sake of the baby, and the next morning, there was no heartbeat.
She tells me that the woman in the bed next to her had the same problem - pre-eclampsia at 30 weeks. After the first loss, he took her immediately to the OR for a cesarean. He delievered the preterm infant successfully, but the baby died soon afterward.
Then she tells me of a friend she saw in the obituaries recently. The friend had developed eclampsia at 26 weeks - she had a seizure at home and was brought to the hospital. After she arrived, her condition improved, but her pressures were still high. Knowing that her baby would not survive (the earliest possible survival in Uganda is 28 weeks), the doctors tried to induce her labor in order to spare her a cesarean for a non-viable infant. The first day, the induction failed. The second day, the induction failed. The third day, the induction failed. On the fourth day, she finally went into labor, but when she became fully dilated, she had another seizure. The baby was delivered, and she seized again. Below her, the doctors found a huge pool of blood. She had developed DIC (disseminated intravascular coagulopathy), which meant that was unable to clot her blood, and she died.
I remark to the doctor that in the US, where we have made pregnancy much safer, few people realize how common these complications are, and how dangerous pregnancy can be without access to medical care. She says "In Uganda, after you deliver a baby, we say 'Luwo neko' which means 'You have survived the battle between life and death.'"