To celebrate our mothers and all mothers this Mother’s Day, we need to do a lot better than hearts, flowers, and Hallmark cards.

As the world battles the gravest global challenge of a century, special attention must be paid to the extraordinary vulnerability of mothers worldwide, 61 percent of whom, between the ages of 18–60, have children under 15.

Most of these mothers work — an overwhelming number, in developing and emerging market countries, work in the informal sector, most of which has shut down to contain the spread of Covid-19.

Without work, these mothers worry — about how to feed their children, how to keep them healthy and sheltered, and how to pay for school or childcare, once school and work start up again. Quarantined in close quarters with husbands who are also out of work, mothers worry, too, about the increased risk of domestic violence, shown to accompany previous periods of economic hardship and confinement.

For low-income pregnant women, these worries multiply. Many health systems, concerned about meeting the flood of patients suffering from Covid-19, have relegated pre- and postnatal care to the sidelines, denying access to hospitals except in emergencies or until the mother is ready to deliver.

In Bamako, the capital of Mali, pregnant and lactating women are afraid to go to the community health centers, where they would normally give birth, go for pre- and post-natal visits, even though COVID-19 patients are not seen there. They worry about contracting, being diagnosed with, or being accused of having COVID-19 and being shamed and separated from their families as a result, says Executive Director Tara Hopkins, of WomenStrong member Mali Health. Indeed, clinic visits have dropped off severely: one physician reported 35- and 15-percent decreases in pre- and post-natal visits, respectively — levels he said he’d not witnessed even during Mali’s Ebola outbreak in 2014. Moreover, although Mali Health has supplied its partner community health centers with personal protective equipment (PPE), other health facilities reportedly having no equipment or training for personnel. No wonder, then, that the new mothers and mothers-to-be are loath to come in.

But Mali Health community health workers, outfitted by Mali Health with PPE, are still visiting pregnant and lactating women, sharing accurate information regarding COVID-19, and encouraging them to continue seeking vital primary and reproductive care at their local health centers. as needed, as are the organization’s facilitators, who have reached out to each of the 5,200+ mothers in their savings group and cooperatives. So far, they’ve seen some success, with the women they serve now feeling confident enough to return to the health centers for safe pre- and post-natal care.

From Mali, one of the world’s poorest nations, to the United States, one of the wealthiest, the situation facing low-income pregnant women and new mothers in those countries’ largest cities is tragically much the same: in New York as in Bamako, they fear contracting COVID-19. The uninsured, faced with the already steep costs in America of pre- and postnatal care and delivery, dread any complications with cost implications, certainly the potentially lethal impacts of COVID-19. Black and Latinx New York mothers, already many times more likely to die in childbirth than white New Yorkers, due in part to their not having their concerns taken seriously or their symptoms correctly identified, are even more fearful and anxious.

Many women of color, keenly aware of these and other deep structural inequities, and watchful of the triage-like sidelining of nearly all maternal and reproductive care so as to focus on COVID-19, fear that when they go into labor, this extraordinary emergency may be invoked to justify denying them their lovingly prepared birth plans and their choices of care and companions. Indeed, this happened in late March, albeit briefly and on a limited basis: certain NYC hospitals tried to ban all visitors — including birthing partners, midwives, and doulas — until a NY doula’s petition garnered some 600,000 signatures and the governor of New York ordered these facilities to reverse course.

Even as they worry about their own safety, doulas and midwives are heartsick at their sudden inability to touch and to comfort mothers, to use their essential skills, intuition, and wisdom to give life and to heal, “to move with our grandmothers’ hands,” as doula educator Sevonna Brown, Associate Executive Director of WomenStrong member Black Women’s Blueprint and co-author of The Sexual Abuse to Maternal Mortality Pipeline, has written.

Amber Rose Isaac was one such mother; for two months, the worsening symptoms of the lovely 26-year-old Puerto Rican New Yorker were roundly ignored. Due to the COVID emergency, she couldn’t get an in-person doctor’s appointment or blood test, and so, concerned for her own safety, she engaged a doula to assist with her birth. By the time she was finally diagnosed with the life-threatening pre-eclampsia-like HELPP Syndrome, her platelet levels were frighteningly low, and forced to leave her doula, her husband, and mother behind, she was rushed into an emergency cesarean section, gave birth to a healthy boy, and died within hours.

Amber’s tragedy is unusual, in that we know it, and can mourn with her family; so many similar heartrending tales go untold now, swept aside by the sheer deluge of devastation and loss.

But far beyond New York and Bamako, beyond overwhelmed health systems and ham-handed maternity care, our mothers, like all essential workers, continue to worry. And like all essential workers, while we may occasionally call them our heroes and buy them a sequined card or box of chocolates, mostly we take our mothers for granted and don’t think of honoring them.

This Mothers’ Day, the international community and governments everywhere must look hard at the immense chasm in care revealed by the COVID emergency. As we emerge from the crisis phase of this pandemic, at the very least we must rededicate ourselves to rebuilding our health infrastructure to enable the provision of quality health care to all women and families. We can start by ensuring that pregnant women, women in labor, and new mothers enjoy ready access to adequately outfitted and staffed clinics, referral systems and qualified tertiary care, and accurate health information regarding lactation, family planning, maternal and family nutrition, and maintaining a healthy lifestyle.

Once those protections are in place, we should be able to look our mothers in the eye and honor them as they have done each of us — with the gift of a long and healthy life.

Founder & Executive Director of WomenStrong International. Director of Millennium Cities Initiative at Columbia University.