“I want my mom.”
I still remember hearing those words from a twelve-year-old pregnant patient during my internship at a public maternity hospital in Quito, Ecuador. She had become pregnant after being sexually abused by a neighbor and came from a low-income community with limited access to education and health care resources. When I met her, she was alone in a hospital bed during labor, crying and asking for her mother to be beside her. Those words stayed with me long after that day. At a young age, she was experiencing motherhood before fully understanding childhood herself.
Later, I witnessed the delivery of her baby. Before entering the room, one of the physicians told the medical students not to ask whether she wanted skin-to-skin contact with the newborn because she had already expressed fear and emotional distress regarding the pregnancy. During postpartum care, she later admitted that she had hidden the pregnancy from her mother because she was afraid no one would believe her. Since the abuse was only discovered at the time of delivery, the police arrived at the hospital shortly afterward to begin documenting a rape report.
I grew up in Ecuador, surrounded by many of the same structural inequities I later witnessed firsthand during my medical internship in Quito. I realized that many of these young women were not simply “unaware” of their conditions or unwilling to seek prenatal care. Most of them came from rural areas of Ecuador with limited access to health care facilities, preventive medicine, transportation, education, and social support systems. Their outcomes were strongly influenced by structural and socioeconomic barriers long before they arrived at the hospital. These experiences helped me recognize how maternal complications are often not only medical problems, but also reflections of deeper systemic inequities.
It was also difficult to witness how some health care providers approached these patients with judgment rather than empathy. Young pregnant women were often blamed for their circumstances without considering the realities of poverty, abuse, limited education, and lack of access to health care resources. In many cases, patients were advised to maintain healthy pregnancies while living in environments where adequate nutrition, medications, and consistent prenatal care were not realistically accessible.
At that time, my focus was mainly clinical. I was learning how to recognize symptoms, improve outcomes, and provide treatment during obstetric emergencies. However, as I continued my training and later began my Master of Public Health studies in the United States, I started to understand maternal health from a broader perspective.
Although the United States has greater health care resources compared to many Latin American countries, I have learned that the same fundamental problem persists: Structural barriers continue to prevent marginalized women from accessing quality maternal care. In Ecuador, I witnessed how poverty, limited education, lack of transportation, food insecurity, and reduced access to prenatal care affected maternal outcomes in rural communities. In the United States, minority and underserved populations, particularly Black women, continue to experience significantly higher maternal mortality rates compared with White women. In addition, barriers related to insurance coverage, health care costs, and language differences can delay prenatal care and negatively affect maternal outcomes. The countries are different, but the inequity is the same.
I came to the United States carrying the memory of that twelve-year-old girl, and of all the women I cared for who deserved more than what the system offered them. That is why I am pursuing both obstetrics and gynecology and public health, not only to treat patients, but also to understand and address the conditions that put them at risk in the first place. I hope to contribute to maternal health research focused on prevention, access to care, and equity in the United States and eventually, in my home country of Ecuador. The patients changed, but the systemic failures remained. That is exactly why this work matters to me.
Sofia Chicaiza is a physician.
