 Good morning, Hank, it's Tuesday, so last week the Washington Post published a brilliantly reported gut-wrenching story about a 17-year-old girl, Susan, navigating the complexities of an unexpected high-risk pregnancy in Sierra Leone. Susan's mother died in childbirth, and the story helps us understand the incredibly difficult choices people must make in a country where one in 20 women will die from being pregnant. I thought this story was really important, so I retweeted it, and the response to my tweet that received the most engagement, and therefore that Twitter showed the most people, was, how did she become unexpectedly pregnant? Did she have sex without protection? Where did the surprise come from? Now, as it happens, that question is answered in the article, which I encourage everyone to read, but I want to focus on the response, because at first, blush, it seems merely offensive. Like, if you read the sentence, an unexpectedly pregnant 17-year-old girl whose mother died giving birth to her must navigate an impoverished healthcare system to try to survive her extremely high-risk pregnancy, it rather misses the point to focus on the word unexpectedly. But I think there is something near-universal driving that response, which is that we all look for reasons not to care, and especially reasons not to intervene. Like these days, a new horror pops up in our feeds every 280 characters or every 10 TikTok seconds, and we cannot possibly respond to all of these crises, so we look for reasons not to. They did that to themselves. They shouldn't have gotten addicted to drugs. There are bad guys on both sides. There's nothing I can do anyway. Those idiots deserve it. The government's corrupt. She should have expected to get pregnant. As we've discussed recently, Hank, nobody can care about everything all of the time. There are limits to empathy, and indeed, there must be. Like, 155,000 people are going to die today, and if I grieved each of those losses, the way I would grieve the death of a loved one, I wouldn't be able to function. But if our way out of having limited empathy is to deny or minimize the suffering of others, we are doing them, and ourselves, a great disservice. The truth is, there will always be a reason not to care. Governments are corrupt. People do make bad choices, and if a person or a cause has to pass some imagined purity test in order to receive our compassion and attention, we won't be able to extend our compassion to anyone, including ourselves. Susan's pregnancy was unexpected. She'd been told she couldn't get pregnant. But more to the point, health disparities are not driven by personal choices or values. They are driven by inequity and injustice. We know that it's about systems and equitable access, in part because we know that through system strengthening, it is possible to radically reduce maternal mortality. Like because Sierra Leone's health care system is getting stronger, in part due to investments made by our community, maternal mortality there has declined by more than 10% just in the last five years. These improvements are happening because of commitments from the government, because of the incredibly hard work of Sierra Leonean health care workers and support staff, and also because people are choosing to care. People in our community and elsewhere are choosing to focus their attention and their resources to help bring about a world where no one dies for want of a blood transfusion or an emergency C-section. This is not about whether someone should have expected a pregnancy. This is about whether someone should be able to expect to survive pregnancy. PS, if you want to donate to our project to radically reduce maternal mortality in Sierra Leone, the link is pih.org slash Hank and John. You can learn more in the doobly-doo where you can also read the Washington Post article and whether you can donate or not. Thank you for caring. Hank, I'll see you on Friday.