05/31/2013 11:21 am ET Updated Jan 23, 2014

The Toughest Places to Be a Mother

One of the saddest days of my life was going home from the hospital empty-handed two days after I gave birth to my first child. Teddy had spiked a fever and was rushed to a special care nursery for an IV and a battery of scary tests just before I thought I'd be taking him home.

But we were the lucky ones. Teddy got excellent care and recovered fully. But every year, 1 million mothers never get their babies back after finding themselves empty-handed on the very day they give birth. The vast majority of these mothers lose their babies due to lack of very basic care.

This new estimate of 1 million annual first-day deaths comes from Save the Children's 2013 State of the World's Mothers report. These deaths happen everywhere -- including 11,300 a year in the United States -- but 98 percent of newborn deaths occur in the developing world.

The risks are greatest in sub-Saharan Africa. That's also the region that the State of the World's Mothers shows to be the most difficult for mothers. In the annual Mothers' Index ranking of 176 countries, the 14 toughest places to be a mother are all in sub-Saharan Africa. The Democratic Republic of the Congo is the toughest, followed by Somalia.

Imagine giving birth in one of the bottom-ranked countries. Your family's income may be less than $200 a person for the whole year. There's a good chance you were married as a child. If this is your first pregnancy, you may still be under 18.

Even if you're older, you've had little ability to plan the timing or size of your family. You are lucky if you've completed the eighth grade. Like most women in your country, you have no access to modern contraception. You are probably malnourished, putting you at high risk of birth complications.

But you don't know what to do about it because you've had little or no prenatal care. And when labor does come, there will be no skilled health worker to help you deliver. Childbirth could be fatal for you or your baby. There's a one in six chance your child will die by her fifth birthday.

Such is the reality for many millions of women and girls around the world, and nowhere are the problems as stark as in sub-Saharan Africa. But that doesn't mean living in that region, even in very poor countries, destines women and their children to such a fate. Malawi and Ethiopia are examples of two countries making significant progress on reducing child mortality rates.

Save the Children is working together with these countries to expand access to health workers and basic lifesaving care by partnering with their ministries of health, the U.S. Agency for International Development, and foundations and private sector partners like The Bill & Melinda Gates Foundation and Johnson & Johnson.

Even among the toughest places to be a mother, we can find some hope. Nigeria has among the highest maternal and child mortality rates in the world, and the State of the World's Mothers report has found that nearly 90,000 babies die there on the first day of life alone.

So it's welcome news that Nigeria's President has launched the Saving One Million Lives initiative to increase access to lifesaving maternal, newborn and child health services. The government has also taken innovative steps like authorizing the widespread use of antenatal steroid injections for women in preterm labor (to help babies' lungs develop) and a basic antiseptic gel called chlorhexidine to clean the umbilical cord stump at birth (to prevent newborn infection).

U.S.-funded studies in Nepal have shown that at less than 25 cents per use, chlorhexidine will save the life of one baby for every 200 treated. Prenatal steroid injections cost as little as 51 cents and, globally, could save 340,000 newborns a year.

Save the Children is advocating for the Nigerian government to pass the national health bill to provide more resources for such important efforts. At the same time, we're letting Americans know they have a role to play in helping mothers and children around the world.

U.S. leadership has been critical to demonstrating that mothers and babies don't have to die -- for lack of things like a 25 cent tube of antiseptic or a trained health worker at birth.

I know it's not easy to imagine what it's like to give birth in one of the world's toughest places for mothers, but please join me in imagining a world where millions of moms aren't left empty-handed soon after giving birth. An easy and fun way to help is by choosing a gift from our online gift catalog. Every purchase supports one of our life-changing programs and brings lasting joy to a child in need.