The Perils of Pregnancy: One Woman's Tale of Dying to Give Birth

It's a source of joy, fear, pain, love and much more, but for many women, the primal business of childbirth also comes at a very high price. While universally recognized as a milestone of womanhood, pregnancy and childbirth remain among the leading causes of death of women worldwide; every day, one woman per minute dies while giving birth or soon after. An additional 10 million to 15 million women suffer complications or injuries resulting from the act of giving life. (See TIME's special report on women and health.)

The true tragedy, however, lies not just in these deaths but in the fact that they are nearly always preventable. There is proof of that in the latest maternal mortality rates for 181 countries throughout the developing and developed world. Overall, rates are slowly declining, averaging a 1.3% annual decrease from 1980 to 2008. Since 2000, leaders in these nations have been working to set and reach Millennium Development Goals to maintain that momentum and accelerate the improvement. For 2015, the goal is to lower maternal mortality by 75% from 2000 rates, but only 12% of countries are on track to meet that target. (Watch TIME's video about maternal mortality.)

The challenge for the nations falling behind is formidable, but the solutions need not be complex. In countries in which maternal health and survival have been improving, the most effective programs have been the simplest and perhaps the least obvious. In Peru, for example, women from remote regions take advantage of temporary birthing homes near medical centers where they can live and access medical services if they need them. Women in isolated villages in India are paid a small amount to give birth in medical centers — enticing them to overcome cultural taboos against giving birth anywhere but at home. And investments in education for girls throughout the developing world ensure that fewer teens, who are more likely to develop complications during labor, are forced to marry and bear children before they are ready. Programs to curb the continuing toll of HIV infection, which suppresses the immune system and can complicate birth, are also pushing death rates down.

But these successes, say experts, should not overshadow the fact that most nations are still far from being able to claim victory over maternal mortality. And nowhere is that more apparent than in Sierra Leone, where 1,033 women die for every 100,000 live births, one of the highest death rates in the world. Mamma Sessay, 18, whose story follows on the next pages, tragically joined that group when she gave birth to twins in May.

See pictures of Mamma.