Description
Your goal is to explain the challenegrs and barriors that individuals face in searching for reproductive rights. Please follow the prompt. I am going to include a few sources, please do not use any other outside sources. the script only needs to be about 200-300 words. here is the prompt
Section 3: Challenges and Barriers (4 minutes)
Global Challenges: Identify major challenges in accessing reproductive rights.
Socioeconomic Barriers: Discuss how socioeconomic factors impact access; examples from the US and Brazil.
Compariso
you can use a few sources to gather information and context about brazil and us for examples but please you do not need to cite anything
attached below are the sources for information
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Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis – The New York Times
9/21/23, 2:05 PM
FEATURE
Why America’s Black Mothers
and Babies Are in a Life-orDeath Crisis
The answer to the disparity in death rates has everything to do
with the lived experience of being a black woman in America.
Simone Landrum getting a prenatal massage. LaToya Ruby Frazier for The New York Times
By Linda Villarosa
April 11, 2018
hen Simone Landrum felt tired and both nauseated and ravenous at the same time in the spring of 2016, she recognized
the signs of pregnancy. Her beloved grandmother died earlier that year, and Landrum felt a sense of divine order when
her doctor confirmed on Muma’s birthday that she was carrying a girl. She decided she would name her daughter
Harmony. “I pictured myself teaching my daughter to sing,” says Landrum, now 23, who lives in New Orleans. “It was something
I thought we could do together.”
W
But Landrum, who was the mother of two young sons, noticed something different about this pregnancy as it progressed. The
trouble began with constant headaches and sensitivity to light; Landrum described the pain as “shocking.” It would have been
reasonable to guess that the crippling headaches had something to do with stress: Her relationship with her boyfriend, the baby’s
father, had become increasingly contentious and eventually physically violent. Three months into her pregnancy, he became
angry at her for wanting to hang out with friends and threw her to the ground outside their apartment. She scrambled to her feet,
ran inside and called the police. He continued to pursue her, so she grabbed a knife. “Back up — I have a baby,” she screamed.
After the police arrived, he was arrested and charged with multiple offenses, including battery. He was released on bond pending
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Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis – The New York Times
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a trial that would not be held until the next year. Though she had broken up with him several times, Landrum took him back, out
of love and also out of fear that she couldn’t support herself, her sons and the child she was carrying on the paycheck from her
waitress gig at a restaurant in the French Quarter.
As her January due date grew closer, Landrum noticed that her hands, her feet and even her face were swollen, and she had to
quit her job because she felt so ill. But her doctor, whom several friends had recommended and who accepted Medicaid, brushed
aside her complaints. He recommended Tylenol for the headaches. “I am not a person who likes to take medicine, but I was
always popping Tylenol,” Landrum says. “When I told him my head still hurt, he said to take more.”
At a prenatal appointment a few days before her baby shower in November, Landrum reported that the headache had intensified
and that she felt achy and tired. A handwritten note from the appointment, sandwiched into a printed file of Landrum’s electronic
medical records that she later obtained, shows an elevated blood-pressure reading of 143/86. A top number of 140 or more or a
bottom number higher than 90, especially combined with headaches, swelling and fatigue, points to the possibility of preeclampsia: dangerously high blood pressure during pregnancy.
High blood pressure and cardiovascular disease are two of the leading causes of maternal death, according to the Centers for
Disease Control and Prevention, and hypertensive disorders in pregnancy, including pre-eclampsia, have been on the rise over
the past two decades, increasing 72 percent from 1993 to 2014. A Department of Health and Human Services report last year
found that pre-eclampsia and eclampsia (seizures that develop after pre-eclampsia) are 60 percent more common in AfricanAmerican women and also more severe. Landrum’s medical records note that she received printed educational material about
pre-eclampsia during a prenatal visit. But Landrum would comprehend the details about the disorder only months later, doing
online research on her own.
When Landrum complained about how she was feeling more forcefully at the appointment, she recalls, her doctor told her to lie
down — and calm down. She says that he also warned her that he was planning to go out of town and told her that he could
deliver the baby by C-section that day if she wished, six weeks before her early-January due date. Landrum says it seemed like
an ultimatum, centered on his schedule and convenience. So she took a deep breath and lay on her back for 40 minutes until her
blood pressure dropped within normal range. Aside from the handwritten note, Landrum’s medical records don’t mention the
hypertensive episode, the headaches or the swelling, and she says that was the last time the doctor or anyone from his office
spoke to her. “It was like he threw me away,” Landrum says angrily.
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Landrum during a prenatal visit from her doula. LaToya Ruby Frazier for The New York Times
Four days later, Landrum could no longer deny that something was very wrong. She was suffering from severe back pain and felt
bone-tired, unable to get out of bed. That evening, she packed a bag and asked her boyfriend to take her sons to her stepfather’s
house and then drive her to the hospital. In the car on the way to drop off the boys, she felt wetness between her legs and
assumed her water had broken. But when she looked at the seat, she saw blood. At her stepfather’s house, she called 911. Before
she got into the ambulance, Landrum pulled her sons close. “Mommy loves you,” she told them, willing them to stay calm. “I have
to go away, but when I come back I will have your sister.”
By the time she was lying on a gurney in the emergency room of Touro Infirmary, a hospital in the Uptown section of New
Orleans, the splash of blood had turned into a steady stream. “I could feel it draining out of me, like if you get a jug of milk and
pour it onto the floor,” she recalls. Elevated blood pressure — Landrum’s medical records show a reading of 160/100 that day —
had caused an abruption: the separation of the placenta from her uterine wall.
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With doctors and nurses hovering over her, everything became both hazy and chaotic. When a nurse moved a monitor across her
belly, Landrum couldn’t hear a heartbeat. “I kept saying: ‘Is she O.K.? Is she all right?’ ” Landrum recalls. “Nobody said a word. I
have never heard a room so silent in my life.” She remembers that the emergency-room doctor dropped his head. Then he looked
into her eyes. “He told me my baby was dead inside of me. I was like: What just happened? Is this a dream? And then I turned
my head to the side and threw up.”
Sedated but conscious, Landrum felt her mind growing foggy. “I was just so tired,” she says. “I felt like giving up.” Then she
pictured the faces of her two young sons. “I thought, Who’s going to take care of them if I’m gone?” That’s the last thing she
recalls clearly. When she became more alert sometime later, a nurse told her that she had almost bled to death and had required a
half dozen units of transfused blood and platelets to survive. “The nurse told me: ‘You know, you been sick. You are very lucky to
be alive,’ ” Landrum remembers. “She said it more than once.”
A few hours later, a nurse brought Harmony, who had been delivered stillborn via C-section, to her. Wrapped in a hospital blanket,
her hair thick and black, the baby looked peaceful, as if she were dozing. “She was so beautiful — she reminded me of a doll,”
Landrum says. “I know I was still sedated, but as I held her, I kept looking at her, thinking, Why doesn’t she wake up? I tried to
feel love, but after a while I got more and more angry. I thought, Why is God doing this to me?”
The hardest part was going to pick up her sons empty-handed and telling them that their sister had died. “I felt like I failed them,”
Landrum says, choking up. “I felt like someone had taken something from me, but also from them.”
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Landrum at home last November with her sons, Dillon (left) and Caden, during her pregnancy. LaToya Ruby
Frazier for The New York Times
In 1850, when the death of a baby was simply a fact of life, and babies died so often that parents avoided naming their children
before their first birthdays, the United States began keeping records of infant mortality by race. That year, the reported black
infant-mortality rate was 340 per 1,000; the white rate was 217 per 1,000. This black-white divide in infant mortality has been a
source of both concern and debate for over a century. In his 1899 book, “The Philadelphia Negro,” the first sociological case study
of black Americans, W.E.B. Du Bois pointed to the tragedy of black infant death and persistent racial disparities. He also shared
his own “sorrow song,” the death of his baby son, Burghardt, in his 1903 masterwork, “The Souls of Black Folk.”
From 1915 through the 1990s, amid vast improvements in hygiene, nutrition, living conditions and health care, the number of
babies of all races who died in the first year of life dropped by over 90 percent — a decrease unparalleled by reductions in other
causes of death. But that national decline in infant mortality has since slowed. In 1960, the United States was ranked 12th among
developed countries in infant mortality. Since then, with its rate largely driven by the deaths of black babies, the United States
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has fallen behind and now ranks 32nd out of the 35 wealthiest nations. Low birth weight is a key factor in infant death, and a new
report released in March by the Robert Wood Johnson Foundation and the University of Wisconsin suggests that the number of
low-birth-weight babies born in the United States — also driven by the data for black babies — has inched up for the first time in
a decade.
Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with
4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850,
15 years before the end of slavery, when most black women were considered chattel. In one year, that racial gap adds up to more
than 4,000 lost black babies. Education and income offer little protection. In fact, a black woman with an advanced degree is more
likely to lose her baby than a white woman with less than an eighth-grade education.
This tragedy of black infant mortality is intimately intertwined with another tragedy: a crisis of death and near death in black
mothers themselves. The United States is one of only 13 countries in the world where the rate of maternal mortality — the death
of a woman related to pregnancy or childbirth up to a year after the end of pregnancy — is now worse than it was 25 years ago.
Each year, an estimated 700 to 900 maternal deaths occur in the United States. In addition, the C.D.C. reports more than 50,000
potentially preventable near-deaths, like Landrum’s, per year — a number that rose nearly 200 percent from 1993 to 2014, the last
year for which statistics are available. Black women are three to four times as likely to die from pregnancy-related causes as
their white counterparts, according to the C.D.C. — a disproportionate rate that is higher than that of Mexico, where nearly half
the population lives in poverty — and as with infants, the high numbers for black women drive the national numbers.
Monica Simpson is the executive director of SisterSong, the country’s largest organization dedicated to reproductive justice for
women of color, and a member of the Black Mamas Matter Alliance, an advocacy group. In 2014, she testified in Geneva before
the United Nations Committee on the Elimination of Racial Discrimination, saying that the United States, by failing to address the
crisis in black maternal mortality, was violating an international human rights treaty. After her testimony, the committee called
on the United States to “eliminate racial disparities in the field of sexual and reproductive health and standardize the datacollection system on maternal and infant deaths in all states to effectively identify and address the causes of disparities in
maternal- and infant-mortality rates.” No such measures have been forthcoming. Only about half the states and a few cities
maintain maternal-mortality review boards to analyze individual cases of pregnancy-related deaths. There has not been an
official federal count of deaths related to pregnancy in more than 10 years. An effort to standardize the national count has been
financed in part by contributions from Merck for Mothers, a program of the pharmaceutical company, to the CDC Foundation.
The crisis of maternal death and near-death also persists for black women across class lines. This year, the tennis star Serena
Williams shared in Vogue the story of the birth of her first child and in further detail in a Facebook post. The day after delivering
her daughter, Alexis Olympia, via C-section in September, Williams experienced a pulmonary embolism, the sudden blockage of
an artery in the lung by a blood clot. Though she had a history of this disorder and was gasping for breath, she says medical
personnel initially ignored her concerns. Though Williams should have been able to count on the most attentive health care in the
world, her medical team seems to have been unprepared to monitor her for complications after her cesarean, including blood
clots, one of the most common side effects of C-sections. Even after she received treatment, her problems continued; coughing,
triggered by the embolism, caused her C-section wound to rupture. When she returned to surgery, physicians discovered a large
hematoma, or collection of blood, in her abdomen, which required more surgery. Williams, 36, spent the first six weeks of her
baby’s life bedridden.
The reasons for the black-white divide in both infant and maternal mortality have been debated by researchers and doctors for
more than two decades. But recently there has been growing acceptance of what has largely been, for the medical establishment,
a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of
toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates
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of infant and maternal death. And that societal racism is further expressed in a pervasive, longstanding racial bias in health care
— including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of
black women with the most advantages.
“Actual institutional and structural racism has a big bearing on our patients’ lives, and it’s our responsibility to talk about that
more than just saying that it’s a problem,” says Dr. Sanithia L. Williams, an African-American OB-GYN in the Bay Area and a
fellow with the nonprofit organization Physicians for Reproductive Health. “That has been the missing piece, I think, for a long
time in medicine.”
After Harmony’s death, Landrum’s life grew more chaotic. Her boyfriend blamed her for what happened to their baby and grew
more abusive. Around Christmas 2016, in a rage, he attacked her, choking her so hard that she urinated on herself. “He said to me,
‘Do you want to die in front of your kids?’ ” Landrum said, her hands shaking with the memory.
Then he tore off her clothes and sexually assaulted her. She called the police, who arrested him and charged him with seconddegree rape. Landrum got a restraining order, but the district attorney eventually declined to prosecute. She also sought the
assistance of the New Orleans Family Justice Center, an organization that provides advocacy and support for survivors of
domestic violence and sexual assault. Counselors secreted her and her sons to a safe house, before moving them to a more
permanent home early last year.
Landrum had a brief relationship with another man and found out in March 2017 that she was pregnant again and due in
December. “I’m not going to lie; though I had a lot going on, I wanted to give my boys back the sister they had lost, ” Landrum
said, looking down at her lap. “They don’t forget. Every night they always say their prayers, like: ‘Goodnight, Harmony.
Goodnight, God. We love you, sister.’ ” She paused and took a breath. “But I was also afraid, because of what happened to me
before.”
Early last fall, Landrum’s case manager at the Family Justice Center, Mary Ann Bartkowicz, attended a workshop conducted by
Latona Giwa, the 31-year-old co-founder of the Birthmark Doula Collective. The group’s 12 racially diverse birth doulas, ages 26 to
46, work as professional companions during pregnancy and childbirth and for six weeks after the baby is born, serving about 400
clients across New Orleans each year, from wealthy women who live in the upscale Garden District to women from the Katrinaravaged Lower Ninth Ward and other communities of color who are referred through clinics, school counselors and social-service
organizations. Birthmark offers pro bono services to these women in need.
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Landrum and her doula, Latona Giwa. LaToya Ruby Frazier for The New York Times
Right away, the case manager thought of her young, pregnant client. Losing her baby, nearly bleeding to death and fleeing an
abusive partner were only the latest in a cascade of harrowing life events that Landrum had lived through since childhood. She
was 10 when Hurricane Katrina devastated New Orleans in 2005. She and her family first fled to a hotel and then walked more
than a mile through the rising water to the Superdome, where thousands of evacuees were already packed in with little food,
water or space. She remembers passing Charity Hospital, where she was born. “The water was getting deeper and deeper, and
by the end, I was on my tippy-toes, and the water was starting to go right by my mouth,” Landrum recalls. “When I saw the
hospital, honestly I thought, I’m going to die where I was born.” Landrum wasn’t sure what doulas were, but once Bartkowicz
explained their role as a source of support and information, she requested the service. Latona Giwa would be her doula.
Giwa, the daughter of a white mother and a Nigerian immigrant father, took her first doula training while she was still a student
at Grinnell College in Iowa. She moved to New Orleans for a fellowship in community organizing before getting a degree in
nursing. After working as a labor and delivery nurse and then as a visiting nurse for Medicaid clients in St. Bernard Parish, an
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area of southeast New Orleans where every structure was damaged by Katrina floodwaters, she devoted herself to doula work
and childbirth education. She founded Birthmark in 2011 with Dana Keren, another doula who was motivated to provide services
for women in New Orleans who most needed support during pregnancy but couldn’t afford it.
“Being a labor and delivery nurse in the United States means seeing patients come in acute medical need, because we haven’t
been practicing preventive and supportive care all along,” Giwa says. Louisiana ranks 44th out of all 50 states in maternal
mortality; black mothers in the state die at 3.5 times the rate of white mothers. Among the 1,500 clients the Birthmark doulas
have served since the collective’s founding seven years ago, 10 infant deaths have occurred, including late-term miscarriage and
stillbirth, which is lower than the overall rate for both Louisiana and the United States, as well as the rates for black infants. No
mothers have died.
A scientific examination of 26 studies of nearly 16,000 subjects first conducted in 2003 and updated last year by Cochrane, a
nonprofit network of independent researchers, found that pregnant women who received the continuous support that doulas
provide were 39 percent less likely to have C-sections. In general, women with continuous support tended to have babies who
were healthier at birth. Though empirical research has not yet linked doula support with decreased maternal and infant
mortality, there are promising anecdotal reports. Last year, the American College of Obstetricians and Gynecologists released a
statement noting that “evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support
provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”
In early November, the air was thick with humidity as Giwa pulled up to Landrum’s house, half of a wood-frame duplex, for their
second meeting. Landrum opened the door, happy to see the smiling, fresh-faced Giwa, who at first glance looked younger than
her 23-year-old client. Giwa would continue to meet with Landrum weekly until her Dec. 22 due date, would be with her during
labor and delivery and would make six postpartum home visits to assure that both mother and baby son remained healthy.
Landrum led Giwa through her living room, which was empty except for a tangle of disconnected cable cords. She had left most
of her belongings behind — including her dog and the children’s new Christmas toys — when she fled from her abusive boyfriend,
and she still couldn’t afford to replace all her furniture.
They sat at the kitchen table, where Giwa asked about Landrum’s last doctor visit, prodding her for details. Landrum reassured
her that her blood pressure and weight, as well as the baby’s size and position, were all on target.
A note of affirmation from one of Giwa’s prenatal visits with Landrum. LaToya Ruby
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Frazier for The New York Times
“Have you been getting rid of things that are stressful?” Giwa asked, handing her a tin of lavender balm, homemade from herbs
in her garden.
“I’m trying not to be worried, but sometimes. …” Landrum said haltingly, looking down at the table as her hair, tipped orange at
the ends, brushed her shoulders. “I feel like my heart is so anxious.”
Taking crayons from her bag, Giwa suggested they write affirmations on sheets of white paper for Landrum to post around her
home, to see and remind her of the good in her life. Landrum took a purple crayon, her favorite color, and scribbled in tight, tiny
letters. But even as she wrote the affirmations, she began to recite a litany of fears: bleeding again when she goes into labor,
coming home empty-handed, dying and leaving her sons motherless. Giwa leaned across the table, speaking evenly. “I know that
it was a tragedy and a huge loss with Harmony, but don’t forget that you survived, you made it, you came home to your sons,” she
said. Landrum stopped writing and looked at Giwa.
“If it’s O.K., why don’t I write down something you told me when we talked last time?” Giwa asked. Landrum nodded. “I know
God has his arms wrapped around me and my son,” Giwa wrote in large purple letters, outlining “God” and “arms” in red, as
Landrum watched. She took out another sheet of paper and wrote, “Harmony is here with us, protecting us.” After the period, she
drew two purple butterflies.
Landrum’s eyes locked on the butterflies. “Every day, I see a butterfly, and I think that’s her. I really do,” she said, finally smiling,
her large, dark eyes crinkling into half moons. “I like that a lot, because I think that’s something that I can look at and be like,
Girl, you going to be O.K.”
With this pregnancy, Landrum was focused on making sure everything went right. She had switched to a new doctor, a woman
who specialized in high-risk pregnancies and accepted Medicaid, and she would deliver this baby at a different hospital. Now she
asked Giwa to review the birth plan one more time.
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Landrum and Giwa during a prenatal visit at Landrum’s home last November. LaToya Ruby Frazier for The New
York Times
“On Nov. 30, I go on call, and that means this phone is always on me,” Giwa said, holding up her iPhone.
“What if. …” Landrum began tentatively.
“I’m keeping a backup doula informed of everything,” Giwa said. “Just in case.”
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“I think everything’s going to be O.K. this time,” Landrum said. But it sounded like a question.
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When the black-white disparity in infant mortality first became the subject of study, discussion and media attention more than
two decades ago, the high rate of infant death for black women was widely believed by almost everyone, including doctors and
public-health experts, to affect only poor, less-educated women — who do experience the highest numbers of infant deaths. This
led inevitably to blaming the mother. Was she eating badly, smoking, drinking, using drugs, overweight, not taking prenatal
vitamins or getting enough rest, afraid to be proactive during prenatal visits, skipping them altogether, too young, unmarried?
At Essence magazine, where I was the health editor from the late ’80s to the mid-’90s, we covered the issue of infant mortality by
encouraging our largely middle-class black female readers to avoid unwanted pregnancy and by reminding them to pay attention
to their health habits during pregnancy and make sure newborns slept on their backs. Because the future of the race depended
on it, we also promoted a kind of each-one-teach-one mentality: Encourage teenagers in your orbit to just say no to sex and
educate all the “sisters” in your life (read: your less-educated and less-privileged friends and family) about the importance of
prenatal care and healthful habits during pregnancy.
In 1992, I was a journalism fellow at the Harvard T.H. Chan School of Public Health. One day a professor of health policy, Dr.
Robert Blendon, who knew I was the health editor of Essence, said, “I thought you’d be interested in this.” He handed me the
latest issue of The New England Journal of Medicine, which contained what is now considered the watershed study on race, class
and infant mortality. The study, conducted by four researchers at the C.D.C. — Kenneth Schoendorf, Carol Hogue, Joel Kleinman
and Diane Rowley — mined a database of close to a million previously unavailable linked birth and death certificates and found
that infants born to college-educated black parents were twice as likely to die as infants born to similarly educated white parents.
In 72 percent of the cases, low birth weight was to blame. I was so surprised and skeptical that I peppered him with the kinds of
questions about medical research that he encouraged us to ask in his course. Mainly I wanted to know why. “No one knows,” he
told me, “but this might have something to do with stress.”
Though I wouldn’t learn of her work until years later, Dr. Arline Geronimus, a professor in the department of health behavior and
health education at the University of Michigan School of Public Health, first linked stress and black infant mortality with her
theory of “weathering.” She believed that a kind of toxic stress triggered the premature deterioration of the bodies of AfricanAmerican women as a consequence of repeated exposure to a climate of discrimination and insults. The weathering of the
mother’s body, she theorized, could lead to poor pregnancy outcomes, including the death of her infant.
After graduating from the Harvard School of Public Health, Geronimus landed at Michigan in 1987, where she continued her
research. That year, in a report published in the journal Population and Development Review, she noted that black women in
their mid-20s had higher rates of infant death than teenage girls did — presumably because they were older and stress had more
time to affect their bodies. For white mothers, the opposite proved true: Teenagers had the highest risk of infant mortality, and
women in their mid-20s the lowest.
Geronimus’s work contradicted the widely accepted belief that black teenage girls (assumed to be careless, poor and
uneducated) were to blame for the high rate of black infant mortality. The backlash was swift. Politicians, media commentators
and even other scientists accused her of promoting teenage pregnancy. She was attacked by colleagues and even received
anonymous death threats at her office in Ann Arbor and at home. “At that time, which is now 25 or so years ago, there were more
calls to complain about me to the University of Michigan, to say I should be fired, than had happened to anybody in the history of
the university,” recalls Geronimus, who went on to publish in 1992 what is now considered her seminal study on weathering and
black women and infants in the journal Ethnicity and Disease.
By the late 1990s, other researchers were trying to chip away at the mystery of the black-white gap in infant mortality. Poverty on
its own had been disproved to explain infant mortality, and a study of more than 1,000 women in New York and Chicago,
published in The American Journal of Public Health in 1997, found that black women were less likely to drink and smoke during
pregnancy, and that even when they had access to prenatal care, their babies were often born small.
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Experts wondered if the high rates of infant death in black women, understood to be related to small, preterm babies, had a
genetic component. Were black women passing along a defect that was affecting their offspring? But science has refuted that
theory too: A 1997 study published by two Chicago neonatologists, Richard David and James Collins, in The New England
Journal of Medicine found that babies born to new immigrants from impoverished West African nations weighed more than their
black American-born counterparts and were similar in size to white babies. In other words, they were more likely to be born full
term, which lowers the risk of death. In 2002, the same researchers made a further discovery: The daughters of African and
Caribbean immigrants who grew up in the United States went on to have babies who were smaller than their mothers had been
at birth, while the grandchildren of white European women actually weighed more than their mothers had at birth. It took just
one generation for the American black-white disparity to manifest.
When I became pregnant in 1996, this research became suddenly real for me.
