By the time the woman arrived at the hospital, she had nearly bled to death.

She went into labor on a warm September day earlier this year, and made the trek from her rural village in the small West African country of Gambia to a nearby clinic. The baby was delivered successfully, but after the birth, the nurses at the clinic couldn’t stop the mother’s bleeding. She suffered from a complication in which her placenta — which is normally expelled after labor — clung to her uterus, preventing the blood vessels that once nourished her child from closing properly. When she arrived at the bigger hospital across the river, the blood loss had caused the color to drain from her skin. Her organs were close to failing.

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But the facility’s sole doctor was not there.

The Essau District Hospital serves as the primary point of specialized care for over 50,000 people. It is also chronically underfunded, and all the more so since the US curtailed billions in funding for global health earlier this year, forcing similar clinics and hospitals dependent on aid to shutter worldwide. Pregnant people in the hospital’s birthing wing these days sometimes lie two to a hospital bed, and often there aren’t enough medications, blood donations, or trained staff to go around.

Retained placentas affect up to one in every 33 births, and in rich countries, they’re relatively easy to treat. In places like the Gambia, however, where the complication is rarer and where giving birth is still very dangerous, about one in 10 people who develop the complication will die.

What stands between those people and a safe birth is not advanced treatment or technology. It is not a state-of-the-art hospital or even a specialized doctor. What makes the biggest difference in a country like the Gambia is the presence — or absence — of a skilled birth worker, most often a midwife, who has the training needed to deliver a baby safely and adapt quickly when common complications arise.

With no doctor present that day at Essau District Hospital, Jainaba Ceesay, a senior midwife, sprang into action. She pried the placenta out of the woman’s body and swiftly transfused two pints of blood. With some food and antibiotics, the mother made a full recovery. But had Ceesay or a midwife like her not been on the scene, the mother almost certainly would have died.

“There are little resources, but we still manage,” Ceesay told Vox by phone a couple of weeks after the delivery. “We make sure all of the available resources are utilized well, and with the knowledge that we have, we use that to help the mothers and their babies.”

But there are now fewer midwives like Ceesay around the world than there were just a year ago. The simple tools, tests, and treatments they need to help their patients are in much shorter supply as well. And it’s all because of President Donald Trump’s deep cuts to foreign aid, which — driven partly by America’s ongoing culture wars over abortion — are making pregnancy much more dangerous throughout the global South.

Inside this story:

• What it takes to give birth safely
• The progress we’re about to lose
• The midwives who aren’t giving up
• We could save so many more lives

Maternal death was once far too common around the world, but it is now exceedingly rare in rich countries. We have every tool we need to make it just as rare almost everywhere else, but for that to happen, we need ambulances that can get people to the hospital in time. We need the $5 emergency birthing kits with their gloves, gauze, and antiseptic wipes. “It’s extremely important for all of us that women survive and that they thrive after childbirth,” said Anna af Ugglas, chief executive of the International Confederation of Midwives. “Women dying actually keeps countries and societies in poverty.”

In many countries those resources still aren’t in place, which is why midwives around the world have become masters at making do with what they have, often saving lives under impossible conditions and for meager pay. “When a crisis happens, the midwives are there,” said af Ugglas. The question now is whether we will be there for them. Because while restoring some of the funding lost in Trump’s cuts would help, money alone won’t save parents. We need more midwives.

What it takes to give birth safely

Let’s start with the good news. Giving birth globally has gotten a lot safer than it used to be.

Maternal deaths worldwide plummeted by 40 percent between 2000 and 2023, thanks largely to the marvel of modern contraceptives — which help reduce the number of unwanted or risky, and by extension, deadly, pregnancies — and simple but lifesaving innovations like obstetric drapes and care kits.

Those interventions were only possible because many more people began giving birth at a clinic or hospital instead of at home. Skilled health workers, who include nurses, midwives, and doctors, delivered over 80 percent of babies worldwide in 2019, up from 62 percent in 2000.

In the United States, the most dangerous rich country in the world for expectant parents, the lifetime risk of dying from pregnancy or childbirth is roughly 1 in 4,000. And in a much safer country like Japan, it’s roughly 1 in 35,000. Globally almost 700 people die from preventable pregnancy-related causes every single day, over 90 percent of whom live in low and lower-middle-income countries.

One simple reason is that people in low-income countries tend to give birth to more children than in rich nations, which compounds their risk. But that’s only part of the story.

Another is the lack of medical care. In Nigeria, for instance, where roughly 1 in every 100 births proves deadly, there are less than four obstetricians and gynecologists for every........

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