I was a gynecologist in Bo, Sierra Leone, when Mariama arrived on a motorcycle in front of our clinic. She was heavily pregnant and pale, sandwiched between her mother and father. She was 16, bleeding and in a lot of pain. Two nurses helped Mariama, whose name has been changed to protect patient privacy, off the motorcycle and put her on a stretcher. One of them put in an IV line while I palpated her abdomen and asked her family what had happened. Four days earlier, Mariama had gone into labor and like half of women in the developing world, she tried to deliver without the help of a skilled health worker. Instead, she stayed at home and was assisted by a traditional birth attendant. Things did not go well. After three days, the family decided to bring her to the hospital. It was the rainy season, and traveling was especially difficult. Before getting hold of the motorbike, the family had gone part of the way by boat. It took them a full day to reach the hospital.

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