By Nicholas Kristof
One of the misimpressions people have about the world is that it’s going to hell.
Perhaps that’s because humanity’s great triumph over the past half-century — huge reductions in poverty, disease and early death — goes largely unacknowledged. Just about the worst thing that can happen to anyone is to lose a child, and historically, almost half of children died before reaching adulthood. We happen to live in a transformational era in which 96% of the world’s children now survive until adulthood.
That arc is visible here in Sierra Leone, a country that remains heartbreakingly poor — yet where the risk of a child dying is less than half what it was 20 years ago.
You may have heard of Sierra Leone as “the most dangerous place in the world to give birth.” No longer true: Deaths in pregnancy and childbirth have plunged 74% since 2000, according to United Nations figures.
In a remote health center, I met Yeabu Kargbo, 19, who had just given birth with the help of a trained midwife, after a full set of prenatal visits. Medical care for pregnant women and babies is mostly free now in Sierra Leone, as is contraception.
Kargbo’s mother, who was offering unsolicited parenting advice that Kargbo pretended not to hear, is illiterate and had six children. Kargbo herself has a sixth grade education and said she wanted to stop at three children — and with the country’s improving health care and education, she has big plans for her new baby girl.
“I want this child to go to university,” she said.
Sierra Leone is still a dangerous place to give birth by international standards. But I’ve been visiting West Africa since I was a law student in 1982, and one reason I often write about reproductive health is that I’ve seen too many women dying unnecessarily in childbirth in the region. The improvement in well-being is stunning.
More than 90% of pregnant women in Sierra Leone now get prenatal care, and the great majority are assisted during delivery by a trained midwife, nurse or doctor. After delivery, nurses put babies to the breast right away and counsel moms on exclusive breastfeeding practices, reducing infant mortality.
At the bustling maternity ward in the city of Makeni, a nurse told me that women in labor now often arrive on the backs of motorcycles, which doesn’t sound great — until she explains that they used to arrive in wheelbarrows.
Health centers are beginning to take on cervical cancer, a hideous disease (sometimes diagnosed partly by the stench of rotting flesh) that kills more people worldwide than maternal mortality but gets much less attention. Some girls in Sierra Leone now get the HPV vaccination against it, and some clinics offer low-cost screenings that bathe the cervix in vinegar and look for lesions.
Meanwhile, obstetric fistulas are being repaired, giving girls their lives back, at a pace that couldn’t have been imagined 20 years ago.
Enormous challenges remain, including turmoil to the north in Mali and Burkina Faso that could destabilize the entire region.
But one reason the world doesn’t do more to help poor countries is exhaustion, a sense that nothing works. I fear that misperception is driven partly by journalists like me, and by aid workers, advocates and other bleeding hearts.
We pounce upon crises, so what the public hears about in Africa is carnage in Sudan, hunger in Somalia and massacres in Ethiopia. Those are real problems that deserve more attention, not less — but we don’t do enough to illuminate the backdrop of gains in health, education and well-being.
Many people believe that global poverty is hopeless — 87% said in a 2016 survey that poverty had stayed the same or gotten worse over the previous two decades — while, in fact, the share of the world’s people living in extreme poverty has plunged from 38% in 1990 to about 8% now. Historians may eventually look back and conclude that leaps in human well-being, health and child survival were the most important things happening in the world in the early 21st century.
I’m winding up my annual win-a-trip journey, in which I take a student with me on a reporting trip. This year’s winner is Maddie Bender. We met President Julius Maada Bio of Sierra Leone, and I asked him if he thought journalistic obsession with crises was damaging.
“Sure,” he said, “we do blame you.”
We are privileged to live in an age of miracles. This is biblical: The blind see (cataract and trichiasis surgeries!); the lame walk (clubfoot correction!). Age-old maladies such as leprosy, polio, fistula, Guinea worm and river blindness are receding, and this progress is as authentic as all the perils that make the headlines.
There are many reasons to tear our hair out, but let’s also take a nanosecond to acknowledge the growing number of children who are not hungry, the increasing share of moms who are not dying in childbirth, the proven ways we have to make a better world. That is how I can wind up a visit to one of the world’s poorest countries and emerge with hope.