The willingness to sacrifice for another is a virtue at the foundation of cooperation and cohesion within society. [1] This willingness to sacrifice allows individuals to collectively invest in the social welfare at every level of organization from the family to the tribe; neighborhood to the state; and from one’s nation to our collective humanity. This willingness to sacrifice cannot be completely replaced by any alternative organization. Command economies and dictators must rely on it or risk losing their control, and even the capitalist system of exchange is predicated on a system of trust rooted in sacrifice. [2] Absent this trust, there are not enough rules or enforcement mechanisms in place to ensure the survival of society – something will have to change or there is a strong risk of collapse.

Societies are established and maintained on a proper balance of complementary virtues that allow individuals to coexist in all their complexity. These virtues must be maintained in proper balance. An over-emphasis on sacrifice for the public good without providing a concomitant measure of authority and welfare to those who are sacrificing can easily lead to exploitation. This balance thus becomes critical to the sustainability of the entire society.

Complicating matters further, there is a distinction between public and private sacrifice, and a two-fold nature to that distinction. First, we speak of the public or private nature of the purpose of the sacrifice. Some sacrifices are primarily public in their purpose (such as serving in the military in wartime) and others are more private (such as saving for a rainy day). But second, we may also speak of whether a particular sacrifice, no matter what its purpose, is performed in or out of the public eye. Injustice can easily occur when sacrifices that are public in purpose become "hidden" from our view. So, for example, when a wounded soldier cannot access appropriate healthcare, the cost of the public sacrifice has been unjustly shifted to the individual alone in a private sphere out of the public eye. When the media brings the question back into public view, we can recognize this as the injustice it is. Both public and private sacrifices are needed for social stability, but when sacrifices for the public good are shifted to private actors, the imbalance becomes exploitative as individuals are asked to carry a greater cost while society continues to reap the same benefit. Our society is full of these imbalances, but some are more difficult to recognize than others.

Motherhood is just such a sacrifice. Having a family is personally fulfilling in ways very few other sacrifices can claim, but we are deluding ourselves if we believe that the public does not obtain a substantial benefit from each child that is born. And yet, we have difficulty recognizing this because the sacrifice takes place out of public view. The issue comes into focus with regard to maternal mortality. Ninety percent of these deaths are preventable [3], but to prevent them would take a high degree of social mobilization around the problem. But that mobilization cannot be forthcoming if we as a society cannot "see" the need for it. That is why reducing maternal mortality will require a dramatic shift in how we conceptualize maternal sacrifice.

Maternal Mortality: Background
In 2000 at the Millennium Summit of the United Nations, every member state committed to eight ambitious goals to be achieved by 2015. These are referred to as the Millennium Development Goals (MDGs). One of these goals was to reduce maternal mortality by 75% from each country’s 1990 rate. In 1990, nearly 500,000 women died from complications related to childbirth every year – about one woman per minute. Since then, a monumental effort has been underway to provide adequate care to these women and in just 15 years the global maternal mortality rate has been cut nearly in half. Unfortunately, the gains were not universal across all countries, and many – including the United States – actually got worse over this time period. [4]

There are a myriad of reasons for the mixed progress and they are not easily reducible for the purposes of this small essay, but contributing factors include:

Structural Factors

Access Problems

Cultural Problems

Identifying the factors that lead to increased maternal deaths is not the challenge. For example, one might assume that countries with poor maternal health are just not investing enough money to help create safe birthing experiences. Using data from the World Health Organization, Figure 1 shows no consistent relationship between health care investment and programming and maternal mortality across six countries. The challenge is that progress on one of the factors is not sufficient to reduce maternal health risks.

Figure 1: Comparison of Predictors of maternal health progress with MDG progress


Health Predictors

Maternal Mortality Progress


3.5% of GDP spent on health

-62% Reduction


9% of GDP spent on health

+25% Increase


17% Contraceptive Usage

-42% Reduction


53% Contraceptive Usage

+14% Increase


First birth at age 18

-53% Reduction

South Africa

First birth at age 22.5

+21% Increase.

From a medical perspective, we know what the most common causes of maternal mortality are and how to adequately address them. The challenge is that change in any subset of factors may not be sufficient, on its own, to have any aggregate impact. Success requires flexibility and cooperation among many different groups. One consistent factor, among those countries which made progress reducing maternal mortality, was that each had a national action plan to invest in and coordinate maternal care. Successful action plans will address structural, cultural and access barriers. Without this coordinated social investment, reducing maternal mortality may prove impossible.

Even so, any program to reduce maternal mortality must also extend to changes in social and cultural values, without which coordinated social investment may prove impossible.

Rethinking Public and Private Sacrifices
With that background, I want to return to maternal care specifically within the context of the United States. In the United States, perhaps more than in most countries because of a cultural ideal of individualism, we see a very strong boundary between public and private matters. For instance, in the United States we recognize military service to safeguard our national security as a public good. Regardless of what one may think of how the military has been deployed over the years, most Americans readily recognize the sacrifice of these soldiers as a public sacrifice. It is a personal choice to join the military, but the benefits we all receive from the risks soldiers take and the security they provide is deemed worthy of our collective national investment. As a nation, we provide medical care, educational and job opportunities, and pensions for those who agree to undertake these sacrifices for the public good. Despite disagreements over how to use the military, we collectively recognize the toll on bodies and minds, and when a soldier is killed we collective mourn the loss because we recognize them as an extension of our country. We build monuments—many monuments--in their honor as a reflection of our national priorities, and in the process we help individual families heal because of the collective support these monuments represent.

This is all good, valuable and necessary. The challenge is that we have lost our balance with regard to other types of sacrifice. The impact of this imbalance can be seen in the U.S. maternal mortality rate. While there are many differences between military service and motherhood, there are some parallels that should cause us to pause and reflect on our value system and what can be done to address the cost we are asking each individual to bear for the public good.

Currently, there are approximately 3.2 million individuals who work for the Department of Defense (directly, by contract and in supporting roles in the larger defense industry). In any given year approximately 3.8 million women will give birth. With those figures in mind, consider the incidence of mortality over the last 13 years in which we have been at war in Iraq and Afghanistan.

Figure 2:  Defense Industry Personnel Deaths to Maternal Deaths in the United States 2001-2014


Defense Industry Personnel



































Years at the beginning and end are combined as the wars were ramping up and then winding down (Source, http://icasualties.org/). Maternal mortality numbers between 2001 and 2008 are likely under counted because of difference in recording maternal deaths.  Data from WHO (see notes).

One can look across time for our nation and we will still find that more women have died due to complications with childbirth than U.S. soldiers have died in war. This includes periods of such great social and world upheaval as the World Wars and the Civil War for the United States. I want to be careful with this comparison because there are many ways that these figures are not strictly comparable, but even this crudely derived ratio is instructive. More importantly, that we construe the nature of the one sacrifice to be public, compared to how we construe the nature of the other to be private, is a severe impediment to the implementation of programs and practices that would reduce maternal deaths and provide opportunities for healing for the families of mothers thus lost.

Rebalancing Our Virtues
The purpose of this comparison is not to argue that one is more important than the other because of the number of deaths. Each life lost is of infinite worth and such a comparison would be callous and disingenuous to those who have lost a loved one regardless of the circumstance. The point of the comparison is to help the reader see the difference in how each sacrifice is categorized, and the divergent public benefits that accrue to those sacrifices which are considered publically valued compared to those which are not. It is the imbalance in how we honor certain types of sacrifices to which I want to call the reader’s attention.

If ninety percent of these deaths are indeed completely avoidable, what does it say about our society that we do not currently possess the public will to invest the economic, political and cultural resources necessary to even have a national conversation about this issue?

It is not that we lack such resources: when we collectively categorize a problem as a public concern, we have demonstrated time and again the capacity to come together and provide the balance needed, as we do with veterans. Our current challenge is neither compassion nor capability; rather, our weakness in addressing maternal mortality is locked into the way we have defined the loss as a private sacrifice. By making maternal mortality a strictly private loss, we have collectively washed our hands of responsibility for it, and have shifted the burden to women and their families to bear alone.
In this we stand condemned on two levels: moral and economic.

Morally, if an individual has the capacity to act to save the life of another – and fails to do so--we would judge them quite harshly. Consider our reaction to the Good Samaritan parable. The priest and the Levite are universally condemned by those who read the story – even though these two persons technically had a religious excuse for not helping. Why do we judge them so harshly? Christ taught us that our common humanity should trump our concern for ritual religious purity. These maternal deaths are completely preventable and out of pure love for the other we stand condemned for not acting in such a way to save their lives. The challenge with maternal mortality is there is only a limited amount any one individual can do. We must develop the collective will to act.

From an economic standpoint, failing to act as a society also does not make sense. The loss of each woman is not the cost that is born by the family alone. If we value the role of the woman in society and in the home, this loss is surely born by far more than just the family. The pertinent statistics are more dramatic outside the United States, but they are no less true here. If the lost woman’s children survive at all, they are more likely to grow up malnourished, and under-educated, in need of greater medical care, and missing the powerful emotional bond that forms between a child and mother that is so important to the function of the family and society at large. [5] The society also loses all the talents, skills, ideas, and productivity of each of these women. The social and economic cost to society from every maternal death is far greater than any investment required to correct it.

The Role of Public Memorials
Here in the United States, the top causes of maternal mortality include a series of general health complications that, when combined with pregnancy, result in greater maternal health risk. For example, women with cardiovascular disease are at a significantly higher risk of maternal death. [6] These general health related problems require that we have a conversation about race, income inequality, maternal leave policies and changes in diet and exercise that can improve overall health outcomes. [7] Concurrently, several problems stem from our over reliance on C-sections - which leads to maternal death from infections (13.6%), hemorrhage (11.4%), and blood clots (9.6%). Change in the rate of C-sections will require changes in the legal, insurance, business and cultural systems.   

These are not problems that any one individual can change on their own. There are no organizations one can donate to that will directly reduce the level of blood clots women experience due to having a C-section, or increase maternal leave polices so women can gain access to the time off they need to fully recover from childbirth. The only way I see for our society to make the necessary cultural, economic and political systemic changes to reduce maternal mortality is for us to move the discussion into the public sphere, and begin to rationalize collective investments into motherhood. Which is to say, that while motherhood is personally fulfilling to many women, women and motherhood are also valuable to society at large. To allow the benefit of motherhood to continue to accrue to society at large while these women bear an increasing cost and risk to their own lives constitutes a moral failure on our part as a society.

Some may justifiably ask if there is any precedent outcome improvement based on shifting the conversation from the private to the public sphere. The answer is yes. One example is breast cancer. Up until the 1970s breast cancer (among other types of cancer) was highly stigmatized and considered a private affair. This private stigma prevented women (primarily) from being able to seek the resources they needed to address the problems and severely limited the number of resources dedicated towards addressing breast cancer risks. As advocacy organizations pushed to move the discussion of breast cancer into the public sphere, several important changes happened. Public advocacy for screening was introduced and those affected by breast cancer were no longer isolated in private. Their voices could be united and become stronger, catalyzing a national debate about where resources should be committed for research and about governmental action to address the problem. For instance, breast cancer research has identified several environmental toxins that could be better regulated/eliminated in order to reduce the overall breast cancer rate. Furthermore, by bringing the breast cancer discussion into the public sphere an important psychological healing could also take place. The results have been a significant reduction in breast cancer fatalities, even while diagnosed rates have been on the rise. None of this would have been possible had breast cancer remained a hidden and private affair.

This is why I started The Mother’s Monument Project five years ago. When I discovered through my research that more women had died in childbirth than soldiesr had died in war, I felt called to do something to bring attention to this sacrifice. My vision for The Mother’s Monument Project was for it to become a national symbol and call to action within the United States. There is currently no such monument to honor the deaths of mothers in pregnancy/childbirth anywhere in this nation, even though there are many monuments to soldiers and generals. It is time to rectify that blindness on our part as American citizens.

As the project has developed, our intention has become to turn this monument into a national and international symbol of the need to provide balance to the ideas of sacrifice and public good in this critical area of concern. Mothers count, and it is time that we begin to recognize them for their contributions to the public. This is one means, albeit singular, to begin this public conversation.  We hope others will contribute their own ideas for jumpstarting that conversation, as well.

When they first hear about the memorial, some people immediately get it, while others struggle to understand how public art can make a difference with regard to maternal mortality. Not everyone identifies with maternal loss and the need for the public to recognize and rally around that loss. In my mind, the struggle to identify with these losses is this very reason that we need to expand the symbols and values that we promote in the public sphere.

We erect monuments for two purposes, the first is to provide a focal point for the expression of grief and healing, and the second is to promote public values that we aspire to develop. The Mothers’ Monument was originally conceptualized in terms of the latter, but it is already becoming a place of healing as well. Unlike war, maternal deaths are not completely avoidable. Even in the safest countries, every 100,000 births or so will still see a death.

Knowing these losses will always be with us, we are making Mother Monument into a living memorial. It is not just a static monument, but also incorporates an interactive component where families who have lost a loved one are able to create accounts on the website and upload photos and stories about their loved one to share with the world. We have already heard from several individuals that this aspect of the monument has helped them to heal by letting others get to know this beloved individual in some meaningful way. This grief, that they could only bear privately in the past, can now move into the public and be shared with all of us.

As we increase our vision of what constitutes a valuable public sacrifice, it is our hope that the nation will develop an increased will to balance the investments we make in our society’s members. This balance will not diminish any other sacrifice, but will actually insure that we do not lose understanding of sacrifice’s true value by affirming its many manifestations.

To SquareTwo’s primarily LDS audience, let me say that I believe this work heeds Elder Cook’s call for the Saints to be on the forefront of positive change in our society by helping to create a world that is more receptive and accommodating to women and their families. [8] I hope you will join with us in this vision to change the world!

Special Invitation
If you have lost a partner, daughter, mother, sister or friend we invite you to contact us so that we can share your loved one’s story through the monument project. For those who are interested in seeing the monument come to fruition, we would be most honored to have your support. If you would like to learn more about the monument, please visit our website.


[1] Nathanson, Stephen, 1989, “In Defense of ‘Moderate Patriotism’,” Ethics, 99: 535–552. Reprinted in Primoratz (ed.) (2002). [Back to manuscript]

[2] Nancy Folbre, The Invisible Heart: Economics and Family Values, New York: The New Press, 2002. [Back to manuscript]

[3] http://www.who.int/mediacentre/factsheets/fs348/en/ . [Back to manuscript]

[4] http://www.who.int/gho/maternal_health/countries/usa.pdf?ua=1 . [Back to manuscript]

[5] http://commonhealth.wbur.org/2014/10/true-cost-maternal-mortality . [Back to manuscript]

[6] http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html . [Back to manuscript]

[7] http://www.nhlbi.nih.gov/health/health-topics/topics/hdw/atrisk.html . [Back to manuscript]

[8] https://www.lds.org/general-conference/2011/04/lds-women-are-incredible?lang=eng . [Back to manuscript]

Full Citation for this Article: Stearmer, S. Matthew (2014) "The Mothers’ Monument Project: Rethinking Sacrifice by Making Maternal Mortality Visible," SquareTwo, Vol. 7 No. 3 (Fall 2014), http://squaretwo.org/Sq2ArticleStearmerMonument.html, accessed <give access date>.

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