The Taliban delegation, representing a government whose two top leaders face active ICC arrest warrants, had just been let in the front door of the bloc that spent five years denouncing its treatment of women. This same government presides over a collapse of basic services that is now starving its own children.

The World Food Program warned on August 4 that conflict, unemployment, rising food prices, and disrupted supply chains are pushing humanitarian needs higher across Afghanistan, and that aid reductions have already shuttered health centers and cut off vulnerable children from critical nutrition services.

Yet even as the humanitarian picture darkens, Brussels opened diplomatic doors to the men running the country.

Here’s why.

Read more

Mazar-e-Sharif, Afghanistan August 2021

On August 14, 2021, I wake before my alarm on a Saturday morning, a sobbing mess, hungover with anxiety. The body, I quickly learn, never lies. My photographer, Jake Simkin, and I meander through the oddly empty Afghan city of Mazar-e-Sharif. The city’s dynamism has been stripped into shuttered stalls as hundreds line up outside the banks, a last-ditch bid to withdraw whatever cash they can to head somewhere else.

There is no longer a way out for us. A rare breeze wafts through the typically static air, carrying something ominous. Frightened families stuff themselves and their belongings into tiny, intricately colored rickshaws, retreating into the city center as their homes on the periphery come under threat. Under a scorching sun, shops are closed, and cars and construction equipment lie abandoned.

Around midday, Jake and I jump into a cab and drive toward what we presume to be the sandbagged front lines, where Afghan and resistance forces are putting up the fight of their lives. There are no signs of fighting.

“I’m scared,” the cab driver unexpectedly croaks. “I don’t want to go any further.”

Our interpreter, Hami, still on his Nokia flip phone, turns to us in the backseat.

“The Taliban has just broken through the first of the three front lines,” he blurts out with a bizarre smile, either out of secret pleasure or to appease my unease. “We are surrounded.”

I return to my hotel room, making call after call. I lie and tell my worried parents I am not near Mazar, which they hear on the news is on the verge of Taliban control. Still, every Afghan government and military official I speak to tells me the city will not fall, at least not for many more days.

The clock ticks, each second stretched thin, refusing to move fast enough toward whatever comes next. We venture out for Afghan street kebabs. After all, it is a Saturday night. Upon leaving our hotel, we are met by pitch-black skies and barren streets illuminated only by a faint crescent moon. We eat quickly, pulling hunks of fatty beef and liver off long metal skewers, noting that the kebab café down a dozen crooked steps is silent, empty, and unusual. Our favorite basement kebab café has never been silent before.

“That Spidey sense,” Jake utters, his voice trailing off.

We forgo our food, throw some money on the table, and head toward the hotel as quickly as possible. In the stifling summer night air, gunfire crackles. My fast walk becomes a run as motorbikes roar closer and closer behind. With my fingers gripping the back of Jake’s shirt, I thrust my body through the blast-proof doors of the ornate, towering hotel overlooking Mazar-e-Sharif.

Everything I think I know about war disappears from my graveyard of memories. I don’t know anything. I do not know what will come. I text a friend in Southern California.

“It’s falling,” I write, my hands shaking as I hurry to the roof in time to watch the Taliban swarm what was supposed to be the bulwark of resistance below. “It’s fallen.”

When I ask him if I will make it out, seeking any semblance of reassurance from a world far away, he says he does not know.

The Taliban’s celebratory gunfire intensifies. Jake and I move away from the glass windows. As a precaution, the hotel staff asks that we avoid taking pictures out of caution that our phones and cameras might be mistaken for weapons. These young staffers bring me warm green tea and assure me I am safe, despite their pinched faces and listless eyes. They’re lying. They don’t know. Nevertheless, I trust these staffers whose names I do not know, in a place where it is hard to find trust.

A message flashes across my phone announcing the cancellation of my flight back to Kabul, scheduled for two days later. The vibration on my phone will not stop. Media outlets are looking for stories. I am now the story, and I do not want to be the story. In this confusing moment, it feels as though the outside world knows more about what is happening in the clouded streets below than I do. I’m trapped inside an isolated, burning bubble. Far away in Australia, my father leaves another voicemail. In the wake of news reports stating Mazar has fallen, he nervously asks again where I am.

Subconsciously wishing I could return to the infantile state of having someone else take care of me, I curl into a fetal position on the wooden floor. It is the color of walnuts, and I fixate on whether I will crack walnuts at Christmas. I always crack walnuts at Christmas. Will I be able to this Christmas? Just for a moment, I am a child who wants someone else, someone older and stronger, to take her out of this unforeseen mess. We are never too old to miss our parents. How had I not comprehended that the city would fall so quickly? I should have known better than to be here. Why was I even here?

I came to Afghanistan again to forget the American life with Uber, air-conditioning, and Sprite Zero, the cozy American life that did not feel like mine, the life once stuffed with celebrities and Hollywood heavyweights and Malibu soirees, Oscars, Grammys, cigar bars with Wall Street powerplayers and egos that could not be deflated. I returned for the forgotten. The small voices. To not forget the small voices. Is anybody there? Could anybody hear them? The ones wrapped in war after war after war? That is why I am here. Some say you should travel only to return home and find your center again. Home, at this point of my life, doesn’t really exist. It is here, in the core of bedlam, that I feel most like myself.

Just like that, in an ordinary moment, the extraordinary city inside a country I had come to love plunges into a medieval, concrete morass I no longer recognize. The takeover is complete, but the earth continues. I snap my eyes open. I’m still on the glass-encased rooftop, and the Taliban is still below. I bounce up and onto wobbly feet.

In a calm and collected manner, Jake and I creep back down to the seventh floor. We lock the blast-proof door behind us. And we wait.

PLEASE CONSIDER A PAID SUBSCRIPTION TO HELP KEEP INDEPENDENT WRITING ALIVE. THANK YOU FOR YOUR SUPPORT.

Subscribe now

Share

Leave a comment

Share Maternal Dispatches with Hollie McKay

They weren’t. Not really.

A study published this year in the New England Journal of Medicine has quietly dismantled one of the most foundational assumptions in American obstetric medicine.

Read more

McKenna West signed up last September as a gestational surrogate through Worldwide Surrogacy Specialists. She’s a working nurse, a single mother of two, and the extra money mattered. For four months, nothing seemed out of the ordinary. Then came the 20-week scan in April, and the doctor doing the anatomy check couldn’t find blood moving through the left side of the baby’s heart.

A specialist diagnosed hypoplastic left heart syndrome, a congenital disability in which the left side of the heart never fully develops.

The condition is serious, but it is not automatically fatal; the Children’s Hospital of Philadelphia describes a staged surgical approach that has become standard treatment for newborns with the defect, with outcomes improving enough that infants who survive the initial operation have a strong chance of reaching adulthood.

That medical reality sits at the center of the dispute.

Read more

“I felt healthy and was in shock this was happening,” she tells me.

I was shocked by the story, and the many I was reading on pregnancy forums as I prepare to welcome my second. Every time I went in for routine prenatal bloodwork, I also noticed syphilis was tested along with the expected white blood cell count, iron, etc. Confused, under the assumption this was a disease from long ago, I asked my doctor why.

“It’s becoming a huge problem again,” she said. “So, we are trying to make sure it is never missed in screening.”

Curious, I went home and dug into the numbers, and I couldn’t let it go. I knew it was something I needed to write about, to explore further.

Read more

I learned that this small, freckle-faced girl was already engaged. Her impoverished parents, struggling further under the country’s plunging economy, saw no choice but to give her to a much older man in exchange for quick cash, following the custom in which the bride’s family receives payment.

The wedding would happen after her first period. Her schooling had ended; her choices had disappeared. I think of her often. I hold the question of whether that day has finally come and shudder to think of her life now. Afghanistan’s continued economic crisis is exacerbating this already widespread practice.

I keep coming back to her doll. She was still playing with a doll. And somewhere, a grown man was waiting for her body to catch up to a contract her parents signed for survival money.

Another time, I was talking to a man from the mountains about his family. I casually asked about his wife and her age, and he said he did not know her age and pointed to his chest, describing her as “still flat” when they married.

I have been thinking a lot about this encounter lately, and whether the word we use to describe this practice is too sanitizing and lets too many people off the hook.

What happens between a fifty-year-old man and a nine-year-old girl on a wedding night is rape. It doesn’t matter that her parents put their names on something, or that a religious leader said some words over the two of them beforehand. None of that changes what happens to her body once the door closes.

Yet the celebratory term “marriage” gives everybody a place to put that knowledge down and walk away from it.

Say “rape,” and people flinch. Say “child marriage,” and they nod, because it sounds procedural, almost bureaucratic, like paperwork, not violence.

Roughly 640 to 650 million girls and women alive today were married before they turned 18. That’s not a historical footnote. That is one in every five women on the planet right now, walking around carrying the lifelong consequences of a decision made for her before she’d finished growing. Every year, 12 million more girls are added to that number. Do the math on that, and it comes out to a girl married off roughly every two and a half seconds.

By the time you finish reading this, several more girls somewhere in the world will have become child brides.

The trajectory isn’t improving fast enough to matter. The United Nations’ own target was to end the practice by 2030. Researchers now say the world would need to move twenty times faster than its current pace to hit that goal. At today’s rate, some estimates put full elimination three centuries away. Three hundred years. Girls not yet born will inherit this.

If you want the map of this, start in the Sahel. Niger alone has a child marriage rate north of 76 percent, which is a number I’ve had to read twice myself to believe. Chad, Mali, the Central African Republic, Guinea, Mozambique — all of them sit somewhere above 45 percent, which means in some of these places it would be strange, almost suspicious, for a girl to reach adulthood still unmarried.

Bangladesh isn’t far behind on the other side of the world, and neither are stretches of rural India, Nepal, and Yemen, where I’ve done my own reporting and heard the same justifications recycled almost word for word from one country to the next.

Afghanistan, too, has its own jarring arithmetic: nearly 29 percent of girls under 18 are married, and almost 10 percent are married before they’re even 15.

It would, however, be a comfortable lie to pretend this is only a problem of deserts and famine and far-off villages. Until shockingly recently, most U.S. states allowed minors to marry with parental or judicial consent and no minimum age floor at all. Some still do. This isn’t a practice confined by geography or religion. It’s a practice enabled wherever adults decide a girl’s body is a negotiable asset before it’s a person.

The men buying these marriages are frequently decades older than the girls they’re marrying, and that is often the whole point. I’ve talked to researchers who track bride-price markets across different countries, and they all describe the same pattern: the younger the girl, the more a family can charge for her.

We would call it exactly what it is if it happened in a suburb outside Chicago. Somehow, when it happens in Ghor province or rural Niger, we reach for softer words — “tradition,” “custom,” “cultural practice” — as if geography changes what a child’s body can and cannot consent to.

I think about the girl in Khost a lot. Her doll on the concrete floor. I don’t know if her wedding has happened yet. But I know that somewhere tonight, a girl just like her is being handed over. The word for the man waiting on the other side of that transaction shouldn’t be “husband.” It should be the word we’d use anywhere else for an adult who has sex with a child.

Rapist.

Until we say that without hesitation, in every language, every article and every UN report, we’ll keep calling a crime a custom and keep failing the girls who should be playing barefoot in the summer sunshine.

PLEASE CONSIDER A PAID SUBSCRIPTION TO HELP KEEP INDEPENDENT WRITING ALIVE. THANK YOU FOR YOUR SUPPORT. MATERNAL DISPATCHES ALSO HAS A PODCAST, WHEREVER YOU GET PODCASTS.

Subscribe now

Share

Leave a comment

Share Maternal Dispatches with Hollie McKay

President Trump hailed the operation, saying Mr. al-Minuki “thought he could hide in Africa” and crediting the Nigerian government’s partnership. AFRICOM said no American or Nigerian personnel were harmed.

The operation involved approximately two dozen U.S. special operations forces, including Navy SEALs, who arrived by helicopter with the intent to capture al-Minuki on islands in the Lake Chad Basin. After a three-hour firefight, an airstrike was called on his compound.

It was, by any measure, a significant counterterrorism result. And yet even as Washington touts the partnership’s successes, a darker ledger is accumulating beneath the headline numbers.

Here is the deal.

Read more

The 2025 standard premium for an OB-GYN in that Florida county clocks in at $243,988 a year, nearly five times the national average of roughly $46,000 for the specialty. The cost has sent practitioners fleeing their field, shuttered labor and delivery wards from rural Pennsylvania to the high desert of New Mexico, and left millions of American women with nowhere to give birth within a reasonable drive of home.

The burden extends well beyond Florida: OB-GYNs in New Mexico pay roughly double what their counterparts in surrounding states pay, at $107,961 on average, compared to $59,133 in Arizona and $48,966 in Colorado.

Across all specialties, OB-GYNs rank among the most sued physicians in the country, with 139 claims filed per 100 physicians over their careers, and malpractice premiums have risen for seven consecutive years — a trend not seen since the early 2000s.

In 2025, nearly 40 percent of malpractice premiums across the country went up, continuing a seven-year streak that has squeezed obstetrics harder than almost any other field. The attrition shows: roughly 30 percent of OB-GYNs walk away from delivering babies within 12 years of starting, with insurance costs cited as a driving reason.

At the heart of this quiet catastrophe, critics contend, sits a legal system in urgent need of tort reform, limits on how much a patient can sue a doctor or hospital for, and a higher bar for what counts as genuine negligence. Advocates say it has turned the miracle of childbirth into the highest-stakes liability gamble in American medicine, and that Congress has, for decades, declined to act.

“Malpractice insurance is a costly reality of providing both gynecologic and particularly obstetric care,” Rachel Tetlow, vice president of government and political affairs at the American College of Obstetricians and Gynecologists, tells me. “The threat of malpractice suits looms over the heads of ob-gyns from the time they are in training — it is estimated that roughly 40 percent of ob-gyns experience a claim while in residency.”

So who, exactly, is being protected, and from what?

A critical specialty no one wants to practice

The figures tell a grim story. Seventy-nine percent of OB-GYNs will face at least one malpractice lawsuit during their career, not because the specialty attracts bad doctors, but because birth itself is inherently unpredictable, and American juries have historically awarded substantial damages to families of injured newborns.

Settlement payments in birth-related malpractice cases reported to the National Practitioner Data Bank totaled $4.8 billion in 2023, with a growing number of verdicts topping $10 million.

In Utah, a judge ordered bankrupt hospital operator Steward Health Care to pay a family $951 million — the largest medical malpractice award in state history — after inexperienced nurses gave a laboring mother excessive doses of a labor-inducing drug while the on-call physician slept nearby. Signs of fetal distress went unaddressed for more than 24 hours before a cesarean was performed, leaving the child with permanent brain damage.

In Pennsylvania earlier this year, Jefferson Health was ordered to pay $108 million after a Philadelphia jury found physicians at Einstein Pediatrics liable for brain injuries sustained by a baby delivered by forceps in December 2018. Jefferson has disputed the verdict and plans to appeal.

A Philadelphia jury had not delivered an award of that size since 2023, when Penn Medicine was ordered to pay $183 million after a mother alleged that staff sat on a decision to perform a cesarean section while she was fighting a uterine infection. Her lawyers argued that the delay left her son with cerebral palsy and permanent brain damage. The verdict later grew to $207 million after a Pennsylvania appeals court unanimously upheld the award.

What makes obstetrics uniquely punishing in the liability landscape is a feature invisible to most patients: birth-related claims can be filed until an injured child reaches the age of majority — effectively a 21-year window, compared to two or three years in most other medical specialties. A physician who delivered a baby in 2010 may not face a lawsuit tied to that delivery until 2031.

Tennessee-based physician Dr. Matt Tipton, who has delivered between 30 and 50 babies across emergency medicine, EMS work, and military service, points to several compounding factors.

“A lot of states don’t have caps on malpractice, and several state medical boards have a punitive fee structure, like Florida, where if you get sued three times and lose you’re penalized,” he explains.

Florida’s so-called “three-strikes” rule, passed by voters in 2004, requires the state’s Board of Medicine to revoke a physician’s license after a third medical malpractice judgment against them. The practical effect, critics say, is that doctors facing even questionable claims rush to settle rather than fight them in court.

Dr. Tipton also points to why juries tend to award bigger sums in obstetric cases than in almost any other area of medicine.

“When you have a 26-year-old come in with what’s been a normal pregnancy, and something goes wrong, you lose the mother, the baby, or both — the family is devastated,” he explains. “The loss of total life years is just much higher when you lose an infant and a woman of childbearing age.”

In practical terms, that means the projected cost of a lifetime of care for a brain-damaged newborn, combined with a mother’s lost earnings and the family’s pain and suffering, routinely produces damages that dwarf what juries award in cases involving older patients. That makes birth injury claims among the most lucrative in all of medicine, and among the most aggressively pursued by plaintiffs’ attorneys.

Doctors are absorbing the financial hit directly. In 2025, 36 states reported premium increases. In Pennsylvania and New York, more than 90 percent of reported premiums went up. One Albuquerque OB-GYN’s premiums went from $44,908 in 2018 to $77,394 by 2023 — nearly double in five years. In 2024, she quit performing gynecological surgery. Her premiums dropped to $16,463. She had a word for it: survival.

Deserts spreading across the map

For millions of American women, this is not a policy debate. It is a drive of hours to reach the nearest delivery room.

A 2025 report found that nearly half of all counties in America lack a single obstetrician, midwife, or birthing facility. Between 2010 and 2022, more than 500 hospitals shut their obstetric units, with rural facilities accounting for over 200 of those closures. The pace accelerated in 2025, with rural labor and delivery hospital closures in just the first half of the year nearly matching the total for all of 2024.

Wyoming offers a window into how fast the situation can unravel. A Casper OB-GYN told state lawmakers that 18 months ago her city had six obstetricians. Now there are two.

“My personal assets are at risk,” Dr. Susan Sheridan said, pointing to the state’s lack of damage caps as the reason it has become nearly impossible to recruit specialists.

Meanwhile, the average Medicaid reimbursement for a birth in Wyoming runs approximately $7,500, while the actual cost of that delivery often nears $20,000 — making obstetric services a money-losing proposition even before malpractice costs are factored in.

Tetlow says ACOG sees the legal system itself as a primary force behind those closures.

“The current system is absolutely one of the myriad factors contributing to and exacerbating growing maternity care deserts and accelerating labor and delivery unit closures,” she tells me. “It cannot accurately distinguish bad outcomes from genuine negligence, and the escalating premium costs are borne by physicians and the hospital systems where they work.”

Arthur Caplan, the founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, says the system is failing both doctors and patients. Malpractice and government meddling, he tells me, “are the two major reasons my med students and those at other med schools I talk to give for avoiding OBGYN.”

He also points out that the tort system does little to protect the patients it is supposed to serve, because the doctors most likely to cause harm are rarely the ones who lose in court. Physicians with established patterns of negligence routinely avoid verdicts by settling claims quietly, while underfunded medical boards lack the teeth to pull licenses.

“Bad apples who truly are bad float through the health care world crossing state lines and getting jobs despite malpractice convictions and letters of censure,” Caplan observes.

Reform stalled, crisis deepening

The solutions most often proposed are not complicated. ACOG has long called on Congress and state legislatures to cap non-economic damages, pain and suffering awards, pointing to California and Texas as evidence that it works. In those two states, payouts were effectively capped, stabilizing premiums and reducing doctor turnover.

Federal action, however, has never materialized, and the reasons are more political than medical.

“Lawyers typically take 30 to 40 percent of the settlement, so they have a strong incentive to pursue the highest number and not settle,” Dr. Tipton says. “That creates perverse incentives throughout the system.”

Caplan is equally direct about why Washington has not moved.

“Lawyers run Congress. Lawyers respect torts and malpractice. Doctors and hospitals are seen as very rich, so no one cares. Costs of insurance are buried in hospital prices and admin overhead so there’s no pressure to reform.”

It has played out that way repeatedly. First of all, the Senate has voted down federal tort reform across multiple administrations, with trial lawyers’ groups pushing back hard each time and directing campaign money toward legislators who might otherwise have backed reform. During the Obama administration, capping judgments was quickly declared a nonstarter by Senate Democrats.

At the state level, the picture is fractured and in some places, moving in the wrong direction. In Colorado, the pain-and-suffering ceiling was raised from $300,000 and will reach $1.5 million by 2028. New Mexico went further still, raising the cap on hospital liability to $6 million while removing hospitals from a state fund that previously helped cover large verdicts. Hospitals and the OB-GYNs who work in them now face the full financial exposure of any judgment against them, with no backstop.

Just 82 percent of the nation’s OB-GYN needs are expected to be met by 2037. The shortfalls will not be evenly distributed. Rural towns, low-income communities, and the places already carrying the highest maternal mortality and preterm birth rates will be hit hardest.

Tetlow holds out little hope for a federal fix anytime soon.

“We are very frustrated by the lack of federal action to reform our broken medical liability system,” she says. “In recent years, even limited reforms garnering bipartisan support have failed to advance, we don’t see immediate opportunities for a clear path forward at the federal level.”

The delivery rooms are closing. And no one in Washington is doing anything about it.

PLEASE CONSIDER A PAID SUBSCRIPTION TO HELP KEEP INDEPENDENT WRITING ALIVE. “MATERNAL DISPATCHES” ALSO HAS A PODCAST, AVAILABLE WHEREVER YOU GET YOUR PODCASTS!

Subscribe now

Share

Leave a comment

Share Dispatches with Hollie McKay

These are not your usual suspects in infant mortality.

Yet a landmark study published this year in the peer-reviewed journal eClinicalMedicine makes a case linking chemicals embedded in all of them to one of the most devastating patterns in global public health: babies born too soon, and too many of them dying.

Read more

Three of those babies needed surgery. All four survived. Yet their lives were changed forever.

Earlier this year, a Cook County jury ordered Abbott to pay the four families $70 million. The jury found the company liable for defective design, failure to warn, and negligence.

It was not an outlier verdict. However, it may not tell the whole story either.

The Verdicts Keep Coming

More than 1,700 lawsuits have been filed nationally. A $495 million verdict against Abbott in Missouri was upheld by a state appellate court in May. A separate $60 million verdict against Mead Johnson, maker of Enfamil, came down in 2024. Together, Abbott and Reckitt, Mead Johnson’s parent company, control roughly 80 percent of the specialty preterm formula market in the United States.

The financial fallout is already reshaping the industry. Reckitt is exploring a sale of its Mead Johnson nutrition division. Abbott CEO Robert Ford has warned investors it will become “extraordinarily difficult for any company to continue providing these medically necessary products” if the verdicts keep mounting.

That warning is not just corporate self-interest. It points to a genuine dilemma at the center of this litigation, one that the verdicts alone don’t resolve.

What the Plaintiffs Argue

The core of the litigation is not simply that babies got sick. It is that Abbott knew the risks and said nothing.

Peer-reviewed studies dating to the 1990s showed NEC was six to ten times more common in formula-fed preemies than in those receiving breast milk. Plaintiffs argue Abbott continued marketing Similac Special Care 24 directly into NICUs for decades — with no warning on the packaging and no disclosure to parents.

Judge John Ehrlich found sufficient evidence of concealment to allow punitive damages. The jury agreed, adding $17 million on top of the compensatory award.

“Four families walked into that courtroom asking for justice,” said Ben Whiting, lead counsel for the Chicago families. “And four families received it.”

What Abbott Argues And Where It Has Won

Abbott has not been losing everywhere.

The company argues that extreme prematurity and very low birthweight, not its formula, drove these outcomes. It also maintains that because Similac Special Care is not sold over the counter, it had no legal duty to warn parents directly, only physicians — a standard it says was already met through labeling and the existing medical literature.

Federal judges have been more receptive to that argument than state juries. Judge Rebecca Pallmeyer, overseeing the federal multidistrict litigation, has granted Abbott summary judgment in all three federal bellwether cases tried so far — each dismissed before a jury heard evidence, largely because plaintiffs could not establish that human milk alternatives were available at the scale NICUs require.

A pending Seventh Circuit ruling could prove decisive. If the court finds these cases were improperly moved to federal court, hundreds could return to state courts — where juries have already delivered more than $625 million in verdicts.

The Science Is Genuinely Contested

This is where the story gets complicated and where the courtroom narrative diverges most sharply from the clinical one.

“There is no evidence that the formulas cause NEC,” Dr. Mark Corkins, division chief of pediatric gastroenterology at the University of Tennessee Health Science Center, tells me. “That is why these court cases make no sense to the folks who understand the actual science.”

Dr. Mark Underwood, emeritus professor of pediatrics at UC Davis, agrees that breast milk is protective, yet draws a critical distinction: “I cannot find any compelling evidence that infant formula contains anything that causes NEC.”

Dr. Steven Abrams, professor of pediatrics at the Dell Medical School at the University of Texas at Austin, goes further. Preterm formulas and bovine-based human milk fortifiers, he tells me, “are an essential part of neonatal care for many infants, larger preterm infants, those who need extra nutrients after they go home, and those with chronic illnesses such as chronic lung disease. Without these products, caring for these infants would be difficult.”

After the 2024 verdicts, the FDA, CDC, and NIH issued a rare joint statement: no conclusive evidence that preterm formula causes NEC. They acknowledged human milk is protective. They stopped well short of calling formula the culprit.

Even the NEC Society, a patient-led nonprofit fighting the disease, has criticized the litigation, arguing that feeding decisions “should be made at patients’ bedsides, not in courtrooms.”

The Real Fear

What neonatologists fear most is not the verdicts themselves. It is what happens if the products disappear.

“That is a very real worry that it will drive the premie formulas off the market,” Dr. Corkins tells me. “If you don’t have breast milk but want to start feeding a premature infant, what do you use?”

The fallback, standard term formula, would leave the smallest babies worse off, Dr. Underwood warns, increasing rates of metabolic bone disease and stunting growth. Some NICUs are already requiring documented parental consent before administering preterm formula, a precaution that adds complexity to some of the most time-sensitive decisions in medicine.

Premature babies need calories to survive. That is not in dispute. The question, still unresolved, is whether the warning labels on the products delivering those calories should have said more.

The Influence Question

The industry has not been passive in shaping the policy environment around these debates.

A Lancet analysis found the six largest American formula manufacturers spent $184.2 million lobbying the federal government between 2007 and 2018, targeting Congress, the FDA, the State Department, the White House, and the USDA. Abbott alone accounted for nearly 80 percent of the $55.1 million declared as formula-related lobbying.

Among the targets: expanded parental leave. Critics argue the industry has long understood that longer paid leave means more breastfeeding and less formula dependency. The United States remains the only OECD country without legislated paid maternity leave, a policy gap that pushes millions of mothers toward formula out of economic necessity rather than choice. The formula industry has denied that opposition to parental leave is motivated by market considerations.

A Longer History And a Global One

The domestic litigation is damning enough on its own terms. Nevertheless, it sits within a much longer and darker history of formula marketing, one that played out most lethally not in American courtrooms but in the clinics and villages of the developing world.

Beginning in the 1970s, aggressive formula marketing across Sub-Saharan Africa, Southeast Asia, and Latin America contributed to a wave of infant deaths that drew global condemnation. The mechanics were well-documented: mothers in maternity wards were given free samples, enough to suppress lactation and establish dependency. When the samples ran out, families who couldn’t afford to keep buying formula mixed powder with contaminated water. Babies died of malnutrition and waterborne disease at scale. Nestlé bore the brunt of international criticism, triggering a boycott that remains active today. The practice, however, was industry-wide.

The WHO responded with the International Code of Marketing of Breast-milk Substitutes in 1981 — prohibiting free samples in health facilities, banning direct-to-consumer advertising, and requiring honest labeling. More than 100 countries have since incorporated elements of the Code into national law.

Compliance, however, has remained inconsistent.

A 2020 investigation by the Bureau of Investigative Journalism found formula companies, including Nestlé, using Instagram to market to consumers in Southeast Asia in ways that raised concerns over potential violations of the WHO Code. A separate 2024 report by the Swiss watchdog Public Eye and the International Baby Food Action Network found Nestlé adds sugar and honey to infant milk and cereal products sold in dozens of low- and middle-income countries — products sold with no added sugar in Switzerland, where the company is headquartered. The implication is straightforward: regulatory asymmetry allows standards to vary based on what markets can and cannot enforce.

Defenders of the industry point out that formula has also saved lives in contexts where mothers cannot breastfeed due to illness, malnutrition, or death, and that blanket condemnation of formula marketing ignores the genuine public health role the products play in resource-limited settings. UNICEF and the WHO both acknowledge that formula remains essential when breastfeeding is not possible, and that the goal is informed choice, not prohibition.

The tension between those positions, formula as lifesaver versus formula as commercial product marketed without adequate guardrails, is the same tension animating the American litigation, just playing out on a global scale and without the benefit of a jury.

Where This Leaves Us

The litigation will continue for years. The science will remain contested. And somewhere in the middle are the families, and the neonatologists, trying to make the best decisions possible with incomplete information.

What is clear is that premature infants are among the most vulnerable patients in medicine. What is less clear is who bears responsibility when they get sicker — the disease, the biology of prematurity, the products feeding them, or the institutions that marketed those products without fuller disclosure.

The courts are working through that question one verdict at a time. The answers, so far, depend heavily on which courtroom you’re in.

PLEASE JOIN ME OVER AT THE “MATERNAL DISPATCHES” PODCASTS WHEREVER YOU GET YOUR PODCASTS.

Subscribe now

Share

Leave a comment

Share Maternal Dispatches with Hollie McKay

In a muddy open field on the outskirts of Kyiv, on another snowy afternoon, a man wanders aimlessly outside a newly established evacuation medical tent. Blood-stained bandages wrap around his head and left arm. A small trail of blood follows him across the frozen ground.

As I approach, his glazed eyes dissolve into sobs. He pulls up a photograph of a smiling German Shepherd on his phone and tells me, through tears, that Russian soldiers shot his beloved Ralph “for fun” as they withdrew from his newly occupied hometown of Bucha.

Inside the tent, a rare pocket of warmth amid the freeze, a toddler unloads and reloads small crates of strawberry yogurt to entertain herself. Nearby, her mother methodically packs and unpacks their single suitcase, the only belongings they managed to bring in their frantic dash for safety.

Not far away, another mother, Maria, sits cross-legged on the floor, cradling a tiny newborn wrapped in fleece blankets, sleeping soundly through it all. Artillery thuds through the pale afternoon sky, growing louder, yet Maria doesn’t flinch. Her baby boy — Mark, I understood — was born just days into the full-scale invasion in a Kyiv suburb called Vorzel, under a storm of bombs and gunfire.

Maria presses him closer, a fleeting smile crossing her face, one that falls quickly when I cautiously ask if this is her first child.

“I had to leave my other two behind when I went to the hospital to give birth,” she says, her voice breaking. “They’re with relatives in Bucha — under Russian occupation.”

The communication lines are down. Maria can no longer reach them. Tears stream down her face as she murmurs, “I don’t know if they are okay, or when I’ll see them again.” Then, more firmly, as if willing it into truth: “Soon. Soon.”

Maria has no idea where she will go from here. She has just arrived at this ad hoc, government-established transition point after traveling the humanitarian corridor. Fear and uncertainty cling to the women like a second skin. Many are alone, with no clear path ahead. A young woman nearby, heavily pregnant, sobs into her phone.

As the artillery grows louder, she leaps up, pacing wildly between the tent flap, pulling at chunks of her hair on the edge of a panic attack. Someone kindly tries to restrain her, but she writhes free, wailing. Why should she be restrained? Why must she hold herself together for anyone’s sake?

Outside, snow-crusted canary yellow buses arrive one after another, filled with the elderly, the young, people with disabilities, and the afraid. Most passengers seem too worn down to approach the table of thickly buttered sandwiches and sweet tea prepared by local women and city council volunteers.

One of the saddest sights I witnessed that day was a teenage boy standing alone in the snow for hours, eyes scanning the field each time a new convoy arrived. He holds a sign with his mother’s name. I will never forget him. I will never forget his mother. I will never stop wondering if she made it out alive.

As the nearby shelling thickens and black smoke slithers across the sky, we jump into a small car bound for the supposed safety of the city center. Kyiv is the ultimate prize in Moscow’s eyes. With each battered suburb, the capital ticks louder — a charge yet to detonate.

No one complains. Complaining serves no purpose. War has irrevocably torn apart every life. Everyone has lost someone; everyone has lost something. Nothing will ever be the same, no matter how the coming weeks, months, or years unfold.

Every day, more checkpoints appear along the roads. Traffic backs up for miles as cars zigzag through concrete barriers and soldiers examine IDs. My driver, a twenty-something NGO volunteer and Soviet-era historian named Viroslav, avoids all talk of war.

Instead, he asks about my favorite films, operas, and Oscars fashion. Anything but this.

More than three years on, some questions I keep turning over:

What happened to the children left in Bucha? Russian forces occupied Bucha for roughly a month. When Ukrainian forces retook it in late March 2022, they found evidence of systematic atrocities: bound bodies, execution-style killings, torture. Maria’s older children were there during that month. The International Criminal Court has since issued arrest warrants for Russian officials involved in the deportation of Ukrainian children. But the children who were not deported, who lived through an occupation and survived, carry something that has no official count and no dedicated documentation. Who is keeping track of them?

How do we define “winning” when the civilian cost is this? Western policy discourse has largely framed this war in terms of territorial outcomes and security architecture. That is not an illegitimate frame. Nevertheless, the women in that tent, and the hundreds of thousands like them, are not abstractions in a strategic equation. At what point does the humanitarian accounting enter the room where decisions are made?

Why does atrocity require spectacle to maintain attention? Bucha broke through. Mariupol broke through. The maternity ward strike broke through. However, the slow, grinding destruction of ordinary life, the mother who cannot call her children, the boy with the sign, does not produce the visual that sustains outrage. Who decides which suffering is legible, and which quietly disappears?

What does “support for Ukraine” actually mean for civilians three years in? Military aid figures are reported in billions. Civilian mental health infrastructure, support for displaced persons, and the reconstruction of destroyed maternity and pediatric hospitals receive a fraction of the coverage and resources. The gap between stated values and actual priorities is not abstract. It is Maria, still waiting, somewhere.

And the boy. I have never stopped thinking about him. In a war that has produced this much visible horror, the image that haunts me most is simply a teenager standing in snow, holding a piece of paper with his mother’s name. Some losses don’t announce themselves. They stand there, scanning the horizon, waiting for something that may never arrive.

This is what war does.

PLEASE CONSIDER A PAID SUBSCRIPTION TO HELP KEEP INDEPENDENT WRITING ALIVE. “MATERNAL DISPATCHES” ALSO HAS A PODCAST, AVAILABLE WHEREVER YOU GET YOUR PODCASTS!

Subscribe now

Share

Leave a comment

Share Dispatches with Hollie McKay

As quickly as I felt myself falling apart, I pulled myself back together, soothed by the tiny foot I could tickle at the top of my abdomen, savoring what would be the final hours of just baby and me, two breathing souls as one. I cannot wait to meet her in the flesh, and to share her with our nearest and dearest, although I already know that a part of me will grieve the cocoon of just us.

I had almost forgotten the tremendous pull of childbirth’s undertow. What started as tempered waves that my husband Ryan and I giggled through rapidly built into cresting surges I sang through like a wannabe opera singer speaking in tongues, and very quickly into guttural moans that sounded more wounded wild animal than woman — my nails sinking into Ryan’s palm as I begged him and the tender-spoken midwife Ashleigh to help me.

That, almost always, is the transition: the crossing into the last stretch. At this point, you convince yourself that you are dying until some unspeakable higher power overtakes you, until the surreal becomes real and the wailing child you felt but never heard nor saw finally bursts earthside.

On the last day of summer in 2023, I came home from the wild of distant assignments and became a mother for the first time, to a baby girl, Raven Rita, who cracked me open in ways I could never have fathomed. This past Monday, on a perfect northern Virginia July afternoon, with sunlight spilling through the half-drawn blinds, my baby became a big sister.

Rumi Evelyn Rosa arrived earthside in a single push and was everything I had envisioned in that liminal space between sleep and awake. Rumi is our rainbow baby, yearned for long before she had a name.

Rumi’s name emanates from the 13th-century poet born in what is now Balkh Province, Afghanistan, whose words have quietly walked beside me through the hardest places: the rubble, the grief, the questions with no clean answers. Rumi’s timeless work, however, was never entrenched in darkness. He wrote about love, about holding on, and about finding the sacred inside ordinary days. Afghanistan lives in both Ryan’s bones and mine, and probably always will.

Roaming far-flung parts of the world toting a backpack stuffed with a flak jacket and notebooks with fraying edges and tear-smudged words, praying for a white light of protection, I longed for a little family more than I ever knew how to put into words. I feared, more than anything, that it would never happen.

It did.

Our girls are the best thing we have ever done, and the best we ever will do. Motherhood, for me, is the culmination of everything I have done right in my life: the seemingly wrong turns and poor decisions that all led me to this altar of pure right.

Yet, what I did not expect, going into this matrescence odyssey for the first time years ago, and what no amount of field reporting prepared me for, is the sheer statistical improbability of any of it. The miracle is not mystical. It is mathematical. The math, once you start digging, is staggering.

Our daughters remind me that life itself is the miracle — that you, I, and everyone sitting near you right now are proof of it.

The numbers that should not add up

In the waning days of this pregnancy, I dug up some facts: a woman is born with roughly 1 to 2 million eggs. By the time she reaches puberty, most of them are already gone. She will ovulate perhaps 400 times in her lifetime. A man produces around 525 billion sperm across his life, releasing roughly 200 to 500 million in a single act. Of those, only a few hundred will reach the fallopian tube. Only one will breach the egg.

The probability of any specific sperm fertilizing any specific egg is somewhere in the vicinity of one in 400 quadrillion, and that is before you account for the genetic lottery of what comes next.

Each human carries roughly 3.2 billion base pairs of DNA. When two people conceive, those base pairs recombine in ways that will never be repeated. An estimate widely cited by biologists puts the number of possible genetic combinations from a single couple at more than 70 trillion. That child, that precise arrangement of matter and memory and inherited sorrow, has never existed before and will never exist again.

You are one in 70 trillion possibilities. For you to be born at all, everything had to line up exactly, miraculously, right.

What has to go right

The egg must be viable. The sperm must be motile, morphologically sound, and fast enough. Fertilization must occur within a 12- to 24-hour window. The resulting embryo must successfully implant, and roughly half do not. The body must not miscarry, which it does in an estimated ten to twenty percent of known pregnancies, and far more in pregnancies that end before a woman even knows she has conceived.

The embryo must develop a beating heart by week six. The neural tube must close by week four. The lungs, the last organ to mature, must be ready by the time the world outside demands them.

Every cell division must replicate with fidelity across a body that begins as a single cell and ends up as 37 trillion cells.

The odds of a genetically normal embryo progressing to live birth have been estimated at 25-50 percent per cycle under the most favorable conditions for the most reproductively healthy people. For most women, in most circumstances, across most of human history, the numbers have been far worse.

What I keep thinking about

On top of this, I am all too aware that in many pockets of this planet, giving birth is the most dangerous thing a woman can do. The World Health Organization and its UN partners estimate that a woman dies every two minutes from causes related to pregnancy or childbirth. Where the safeguards, the trained personnel, and the basic tools to keep mother and child alive do not exist.

The miracle, I have come to understand, was never in the rarity of a heartbeat. It is in the persistence — that against every one of these odds, against every peril stacked in its way, something as singular and unrepeatable as a human being keeps finding its way into the world. Still arriving. Still opening its eyes for the first time.

My newborn daughter, swaddled in a soft cloth dotted with baby chicks and sleeping soundly in our sun room, does not know any of this yet. Rumi only knows hunger, warmth, the sound of my voice, the scent of my skin, and the taste of sweet breastmilk.

But I know. And I find I cannot stop counting the ways she should not exist, and marveling, still, that she exists at all — that both my children do, and that I do, too.

I have spent my life documenting what the world takes. This is what it gives back. What an astonishing privilege, to be alive for it.

Subscribe now

Share

Share Maternal Dispatches with Hollie McKay

Leave a comment

A 22-year-old man was shot by firing squad in South Hwanghae Province in 2022 — not for violence, not for theft, but for listening to 70 South Korean songs, watching three South Korean films, and distributing them to others. His offense, documented in testimony compiled by South Korea’s Unification Ministry, amounted to pressing play.

That killing is one of hundreds of cases cataloged in a landmark report released last month by the Transitional Justice Working Group, a Seoul-based human rights organization, which found that executions in North Korea surged 247 percent between 2020 and 2024 compared to the previous five-year period — with at least 153 people executed or sentenced to death during those years alone.

The findings draw on interviews with 265 North Korean defectors, reporting from five media organizations with in-country contacts, and satellite imagery mapping 46 execution sites across the country. Together, they paint the most granular picture yet of a state that has quietly transformed cultural consumption into a capital offense.

Read more

The immediate consequences include severe pain, hemorrhage, infection, urinary complications, and in some cases death. These are not rare edge cases. They are routine. Because FGM is performed primarily on girls between infancy and age 15 — often without anesthesia, often by non-medical practitioners — the physical trauma occurs on bodies that have not consented and cannot adequately protect themselves.

The long-term effects are equally severe and substantially more invisible. Women who have undergone FGM face elevated rates of chronic pain, recurrent urinary tract infections, menstrual problems, cysts, and nerve damage. Sexual function is frequently affected, sometimes profoundly. Scar tissue can make intercourse agonizing.

Childbirth becomes a different kind of crisis. Obstetric complications in FGM-affected women include prolonged labor, increased rates of cesarean delivery, postpartum hemorrhage, and elevated neonatal mortality. A 2006 WHO multicountry study of more than 28,000 women found that those who had undergone FGM were significantly more likely to experience complications during delivery — and their babies were significantly more likely to die. Those findings have since been replicated and reinforced. The WHO updated its clinical guidelines on FGM complications as recently as April 2025.

The psychological harm is documented as well: higher rates of post-traumatic stress disorder, anxiety, depression, and social withdrawal in women who have been cut. Many describe the experience of undergoing FGM as a foundational trauma — one that shapes their relationship to their own bodies, to healthcare systems, and to the adults who were supposed to protect them.

None of this is contested. The WHO, the United Nations, UNICEF, every major medical body that has examined the evidence has reached the same conclusion. There is no clinical context in which FGM confers a health benefit. There is no version of the data that supports the practice.

This isn’t just a problem for another continent. Its here at home, too.

Read more

Major General Erdenebat Batsuuri, a Mongolian officer with over 30 years of peacekeeping experience, landed on May 14 to lead the newly established Gang Suppression Force, which replaces the ineffective Kenya-led Multinational Security Support mission and operates under a broader mandate, allowing it to conduct independent operations when necessary.

The symbolism is hard to miss.

As much as 90 percent of the capital has fallen under gang control. Approximately 26 criminal groups operate across densely populated Port-au-Prince. The country has not held a presidential election since 2016. In 2025 alone, more than 8,000 cases of gender-based violence were recorded, a 25 percent rise over the previous year, and Haiti has witnessed a 1,000 percent increase in sexual violence against children since 2023. Around half of all gang members are estimated to be children, with a 200 percent surge in forced recruitment last year. At least 16,000 people have been killed since 2022, and more than 1.5 million have been driven from their homes.

Into all of this, the world is sending another general with another mandate and another 12-month clock.

Read more

April 30 passed without a signed agreement, and with it, the fate of 1.3 million Zambians dependent on American-funded antiretroviral drugs slid deeper into uncertainty. The Trump administration had given Zambia an ultimatum: sign a deal by April 30 or lose all United States support for its HIV program — the same program that has kept the country’s public health infrastructure from collapsing for more than two decades.

What Washington wanted in return was not accountability, or even reform.

It wanted minerals. Here is what went down.

Read more

The enclosure at the Honolulu Zoo is not cruel by the standards most people would apply to a zoo: there is grass, shade cloth, a companion. Vaigai arrived in 1992, captured from the wild as Mari was, and the two have shared that concrete-edged patch of Honolulu ever since — flanked by roads, city noise, and the rhythms of one of the Pacific’s most densely populated urban corridors.

But consider what that space is measured against. Asian elephants in their natural habitat walk up to 4 miles a day across home ranges that can span hundreds of square miles. They live in complex matriarchal societies, transmit knowledge across generations, grieve their dead, and maintain relationships across decades. In Honolulu, Mari and Vaigai have each other and a lot not much larger than a suburban backyard.

That gap, between what these animals are and what the law allows to be done to them — is now before the Hawaii Supreme Court.

Read more

Read more

Amnesty International’s annual death penalty report mapped a world in which state-sanctioned killing is not a relic of a crueler era but an accelerating practice: driven, in most cases, by governments with little tolerance for scrutiny and even less for dissent.

So, what is going on?

Read more

Two days earlier, while working under the blistering sun in his family’s fields, Abdul stepped on a landmine. The boy from a poor farming family wasn’t even born when al-Qaeda slammed planes into New York’s Twin Towers on September 11, 2001, the attack that sent foreign armies flooding into his country, reshaping its soil and its people for generations. He has never known Afghanistan at peace. He does not know what that would feel like.

Abdul is a child of a war he never chose, a confronting illustration of how conflict persists long after foreign powers withdraw and the cameras move on. The landmines don’t leave when the soldiers do. Neither does the grief.

Throughout the decades of war in Afghanistan, hospitals became a harbor in the thrashing waters, places where the wounded could be pulled briefly from the current. None more so than the EMERGENCY Surgical Center for War Victims, run by the Italian NGO of the same name in the heart of Kabul. Founded in 1999, EMERGENCY has treated hundreds of thousands of war-wounded Afghans at no cost, operating on a principle its founders consider non-negotiable: that access to medical care is a universal right, not a privilege rationed by wealth or politics. Its wards have filled and emptied and filled again through Soviet withdrawal, civil war, the Taliban’s first rise, the American invasion, and the Taliban’s return. The patients change; the wounds do not.

In a bed not far from Abdul, a child injured in a blast lies moaning, blind and disoriented. He calls for his mother, again and again, his cries weakening with every breath. The sound fills the ward and then seems to fill something larger: the room, the building, some older and more interior space.

There is something that happens to a person at the slippery threshold of death, something that strips away everything acquired and learned and leaves only the most ancient wiring intact. Soldiers have long called out for their mothers in their final moments on the battlefield. So have the elderly in hospital beds, children under rubble, and men who have not spoken tenderly in decades. It is one of the most documented and least examined phenomena in human experience.

The neuroscience is not metaphorical. Oxytocin doesn’t simply generate warm feelings, it reshapes the brain. During birth and breastfeeding, it carves actual neural pathways in both mother and child. The amygdala, which decides what is threatening and what is not, gets calibrated in infancy to a very specific set of inputs: her voice, her smell, the cadence of her breath. Safety, at the neurological level, is first learned from one person. That lesson never fully leaves.

Under extreme duress — acute pain, hemorrhagic shock, the dissociation that accompanies near-death — the prefrontal cortex, responsible for reason and self-regulation, effectively goes offline. What remains is the limbic brain, running on its oldest instructions. And the oldest instruction of all is to find her. The word that surfaces is the word the nervous system learned before it learned anything else.

Researchers studying near-death experiences have found the same motif across cultures, across centuries, across wars that had nothing else in common. In the oral histories of World War One nurses, it is one of the most recurring details, boys from Lancashire and Alabama and Alsace, separated by language, united in their last word. The maternal voice, heard in utero and in infancy, activates the same neural pathways as physical safety. When everything else fails, the brain goes looking for her.

I will never forget the way my grandfather reached for his mother in his final days of hospice care, a man who had spent a lifetime building his own stoicism, brick by careful brick, undone at the end by something older than any of it. He was not alone in this. Combat medics have documented the pattern for generations: men who have killed, who have commanded, who have not cried since childhood, whispering mama as the blood pressure drops.

This isn’t sentimentality. At the biological level, the mother is the original definition of safety. Calling for her at the end isn’t weakness. It is the most honest thing the body knows how to do.

Still, many of these boys in this chillingly busy hospital for the war wounded fight for their lives alone.

A weary Italian doctor pulls me aside and confides, in the careful tone of someone who has made peace with something he cannot fix, that poverty sometimes forces families to abandon loved ones with life-altering injuries. Many do not experience this as cruelty. They experience it as survival. A disabled child can mean starvation for the rest. It can mean a mother, in the most devastating arithmetic of poverty, cannot mother.

The boy in the ward keeps calling. The name he reaches for is the same name boys have always reached for — in trenches, in rubble, in the white corridors of hospitals far from home. Mor, mother in Pashto.

Tears stream down my cheeks. I don’t wipe them away.

PLEASE CONSIDER A PAID SUBSCRIPTION TO KEEP INDIE WRITING AND JOURNALISM ALIVE. THANK YOU FOR YOUR SUPPORT. ❤️

Subscribe now

Share

Leave a comment

Share Maternal Dispatches with Hollie McKay