Naming the Wound.
Rewriting the Record.

This thesis carries three inheritances.

My grandmother's. She was a skilled birth attendant in Sierra Leone, trained under Sir Milton Margai before independence. She caught babies in villages where the only clinic was her hands, and she was called into the clinics too, to assist doctors with breech births and the deliveries the hospital could not manage alone. She knew women's bodies through proximity, repetition, and trust. She knew what the data systems still do not: that women's reproductive lives extend far beyond pregnancy, and that what is unspoken still requires care. Everything I am attempting to formalise, she practised. The DrPH after my name is a credential. Her practice was the precedent.

My daughter's. Amanah Seray, whose name means trust. I defended this thesis on the ninth of December, two thousand and twenty-five. I defended it online, from Sierra Leone. U.S. travel restrictions on my country made the journey to Cambridge impossible. So my committee met me on a screen, and my daughter was in the room with me. She did not yet have language for what was happening, but she was there. The work that began as a question about silence had become, in part, a record I could hand her. That she could one day read in a country that no longer required her mother to be in two places at once.

My own. I want to be honest about this. I did not write this thesis only as a scholar or as a founder. I wrote it as a Sierra Leonean woman trying to heal what had felt, for a very long time, so alone. Uterine pain in our country is carried in private. So was mine. The research was not a way of escaping that aloneness. It was a way of moving it, of placing it inside a record that other women could read and recognise themselves in. Twenty-seven women shared their stories with me in Freetown, Lumley, Brookfields, Mountain Cut, Kissy, Waterloo. They were never anonymous to me. They were the company I had not known was possible. The framework I built rests on their voices. It also rests on mine.

"Women's adaptation under constraint is proof of systemic neglect. Documenting that adaptation is an act of indictment, not praise."

Seventeen years of global health work across twenty-five countries taught me how power moves through systems: through metrics, through procurement codes, through the categorical eligibility lines of free health care policies, through the templates of HMIS reporting tools. None of these are neutral. Each is a decision about whose suffering becomes legible. To do research in a context where the data systems themselves are the instrument of erasure is to refuse, in advance, the terms that would render your subject invisible. Methodology becomes politics. Naming becomes infrastructure.

I lead Youterus Health as a founder who refuses to mistake resilience for resolution. Our women in Freetown, in Lagos, in Nairobi, are not waiting to be empowered. They are already labouring through illness, raising children through pain, financing care through asset liquidation. They do not need motivational language. They need infrastructure. They need data systems that see them. They need financing schemes that include them. They need a continent that names what it owes them.

And as a solo mother, I have come to understand leadership as sustained attention. Not performance. Not vision statements. Attention: to the work, to the women, to the daughter sleeping in the next room, to the body that carries all of it. Naming what matters. Refusing what diminishes. Building what should already exist.

Naming the wound is the precondition for rewriting the record. The record is being rewritten now.