An Open Letter to Lady Sybil of Downton Abbey




Dear Sybil:

First of all, you aren’t alone.  Now in 2012, in July of 1920 when you died, and all the years before that, you weren’t then and aren’t now, alone.

Because even today, every 90 seconds a woman in the world dies from childbirth.   As has been written in other blog posts, of the estimated 210 million women who become pregnant each year, 20 million will experience life-threatening complications.  And 50% of maternal deaths take place in the 48 hours after delivery – just like yours.

You may be wondering what, exactly, killed you. It’s a condition know as eclampsia.  First, you had preeclampsia, evidenced by high blood pressure accompanied by a high level of protein in the urine. Untreated, preeclampsia becomes eclampsia, which is the final and most severe phase, often leading to seizures, coma, and death. We don’t know – even now – exactly what causes it.  Only that being diagnosed early with preeclampsia and being treated for it lessens your chance of it developing. As one of your doctors noted: “once the seizures begin, there’s nothing to be done.”

Here in the United States, pregnancy is still a huge risk to both mother and child.  The U.S. is ranked 50th in the world for maternal death rates, and that’s just because we’ve been steadily declining (death rates nearly doubled  between 1990 and 2008. Compare that to the fact that worldwide, maternal death rates were nearly cut in half during approximately that same period). Every year there are 6 million pregnancies, which basically means every year almost 6 million women are exposed to an enormous number of life-threatening conditions. In recent years, an average of 875,000 women have experienced one or more pregnancy complications in the United States. It’s just one reason why we are so incredulous every time another law passes permitting abortions only in the case of a “threat to the life and health of the mother.”

All pregnancies – as you’ve discovered – potentially threaten the life and health of the mother. Pregnancy is incredibly dangerous for a woman.

But back to you.  The strange thing is that you were living just on the cusp of a revolution in maternal health care. Maternal death rates began to drop dramatically and uniformly in developed countries around the 1930s, mostly due to better training for doctors (trained and experienced midwives had performed the deliveries in the past), and the introduction of a drug which effectively attacked a strain of fever that had been one of the leading causes of maternal death. Both sadly and ironically, conditions such as yours went from being the 3rd leading cause of death in developed nations to the first.

My friends had strong reactions to your death, and not just because we’re invested in your family and in your lives.  But because you were the one who got away. My smart, strong, independent, politically active and feminist friends had barely a chance to get to know you well before you were off to rallies for women’s rights and then to Ireland, having shrugged off your upper class upbringing and married the chauffeur whom you had always loved.

Now it’s true that a lot of us have since become interested in Edith – poor Edith – who is not quite as beautiful as you or Mary and has struggled as the middle child to find her place in the world. When she’s offered a position as a writer for a newspaper column shortly after your death, all we could think was “because that’s what unattractive women without husbands do – get jobs.”

But even so, you were the one who ultimately suffered the greatest punishment of all. You weren’t to be allowed your freedom and your happy life with your loving, working class husband. And truth be told, the pain and fear you went through touched a nerve for so many of my friends – even the middle class, healthy ones who are more likely to come through a pregnancy without complications.

I haven’t been through that stage of my life yet, but as a young woman in her late 20s, I am surrounded by friends who have. Becky has been trying to get pregnant for almost 4 years, and has suffered two miscarriages already. She didn’t see your death coming, and it impacted her deeply.  Jamie’s cousin had had placenta previa, a dangerous condition which left both mother and child fighting viciously for their lives. She, also, was struck silent and then deeply upset by your death.

Jessica Valenti, a feminist author and activist, wrote a compelling article in a magazine called The Guardian about a year ago which has stayed with me. In it, she details her own unexpected battle with pre-eclampsia, and the war she and her newborn daughter each fought to survive.  And how mother and child had then later struggled to bond as naturally as she had been led to believe they would.

On the fringes of such stories, I can hardly imagine such fear and pain for my life.

The risks are many, even almost 100 years after your death.  Today, three of the “Four Horsemen of Maternal Mortality” as they are called, are severe bleeding, infections post childbirth, and high blood pressure (preeclampsia and eclampsia, as you experienced).

The fourth is, of course, unsafe abortions. Every year, 42 million women seek abortions to terminate unwanted and unplanned pregnancies.  Half of those procedures are deemed unsafe, and 68,000 women die as a result each year, accounting for 13% of the global maternal mortality rate.  Of those who undergo an unsafe abortion and manage to survive, 5 million of them suffer serious, long-term health complications. Where you live in the United Kingdom, abortion wasn’t legal until 1967 – and even then, the law didn’t extend to Ireland.  It is only recently, after the death of a woman named Savita Praveen Halappanavar, who was denied an abortion at an Irish hospital and later died from pregnancy-related complications, that the country is considering altering their strict laws regarding abortion.

Of the hundreds of thousands of women who died last year due to complications from pregnancy, most of them suffered deaths that could have been fairly easily avoided. 35% of babies around the world are still delivered without the aid of a nurse, midwife, or doctor, significantly increasing the chances that mother or child or both will die.  Too many are delivering children with no prenatal care, no electricity, and in locations prone to infections and disease.

One of your doctors insisted that all was well, and both you and your baby would be fine. The other appropriately diagnosed you and claimed that your life would be at risk unless you were rushed to the hospital and the baby immediately delivered. As it turns out, the latter was right.

Better information, increased access to health care facilities, and the attention of competent health care professionals all dramatically increase the chances of survival and dramaticallydecrease the chances for complications and health problems for both mother and child.And some studies show that increased access to contraception and family planning could decrease maternal mortality rates by almost 1/3.

It’s too late to save you.  And I don’t know how my friends and I will feel as we wait for next week’s episode to show us how it is possible for a family to come through such a tragedy – even though hundreds of thousands of families do, every year, all over the world.

But what we can do is press on.  We can continue our work to end maternal mortality, which we’ve had quite a lot of success at over the past decade especially.  True, we have a long way to go before we are able to say that we have reduced these deaths by 75% from 1990 to 2015, as the United Nations Millenium Development Goals declare. But 13% of countries are on track to meet that goal and since 1980, there’s been a 35% decrease in maternal deaths globally.  This is progress.  Although it’s slow, we are at least heading in the right direction, increasing access to contraception to avoid unwanted pregnancies in the first place, expanding health care services to the most vulnerable (poor, rural women in developing countries), and training health care professionals in maternal care.

We’re better off now than we were at the time of your death. But the truth is that your death could have easily happened in the world we live in today as well.  And saving the lives of the 210 million women who will get pregnant this year needs to remain one of the highest and most urgent priorities of the global community.

We’ll miss you, Sybil.

– Abigail, a fan.





This post is originally published on Left Standing Up and is cross posted with permission.


Photo credit: homestilo via photopin cc.

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