Repost: Maternal Mortality Rates Rising, Especially for Women of Color

This article first appeared in The Conversation and is reprinted here, with permission (see below). It's such an important issue. Following four miscarriages, I had a difficult pregnancy and preterm labor. With skilled obstetrical care, I had a healthy, full-term baby (who is now a medical doctor delivering babies herself). But...

I am white and I had excellent health insurance. I want to cry and scream and march in the streets at the blight of Black, Hispanic, and Native women who love their unborn babies just as much as I loved mine. This discrepancy is injustice. This is racism.

And now I hear that OBs are fleeing states with horrendous reproductive rights restrictions, terrified that if they treat problem pregnancies that do not end well (see aforementioned miscarriages), they will face criminal charges and loss of their medical licenses. That means rich white women will get the same good medical care...and poor women, largely women of color, will die.

Will die.

Let that sink in. Now read the article. Each one of those statistics is a woman who loves and is loved. A family. A community.

Risk of death related to pregnancy and childbirth more than doubled between 1999 and 2019 in the US, new study finds

Maternal death rates are higher in the U.S. than in other high-income countries. Tetra Images/Getty Images

Laura Fleszar, University of Washington; Allison Bryant Mantha, Harvard University; Catherine O. Johnson, University of Washington, and Greg Roth, University of Washington

Black women were more likely to die during pregnancy or soon after in every year from 1999 through 2019, compared with Hispanic, American Indian and Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and white women. That is a key finding of our recent study published in the Journal of the American Medical Association. The risk of maternal death increased the most for American Indian and Alaska Native women during that time frame.

Maternal deaths refers to death from any cause except for accidents, homicides and suicides, during or within one year after pregnancy.

Notably, maternal mortality rates more than doubled for every racial and ethnic group from 1999 through 2019. Most maternal deaths are considered preventable because, in the U.S., maternal deaths are most often caused by problems that have very effective treatments, including bleeding after delivery, heart disease, high blood pressure, blood clots and infections.

[politics] Strategies for Reclaiming the Right to Choose

The New York Times recently published a piece by Kate Zernike, "The Long Road to Reclaim Abortion Rights." Because it's behind a paywall and the information is so important, I've summarized it here.

Abortion rights groups have mounted a multilevel legal and political attack aimed at blocking and reversing abortion bans in courts and at ballot boxes across the country. They have rolled out a wave of lawsuits in nearly a dozen states to hold off bans triggered by the court’s decision, with the promise of more suits to come. They are aiming to prove that provisions in state constitutions establish a right to abortion. They are also working to defeat ballot initiatives that would strip away a constitutional right to abortion and to pass those that would establish one, in states where abortion access is contingent on who controls the governor’s mansion or the state house.

Democratic-aligned groups are campaigning to reverse slim Republican majorities in some state legislatures and to elect abortion rights supporters to positions from county commissioner to state supreme court justices that can have influence over the enforcement of abortion restrictions.

The path ahead is slow and not at all certain. Polls show that Americans overwhelmingly say that the decision to have an abortion should be made by women and their doctors rather than state legislatures. But Republican-controlled state legislatures have passed hundreds of restrictions on abortion over the last decade, and legislative districts are heavily gerrymandered to protect Republican incumbents. Litigation in state courts will be decided by judges who in many cases have been appointed by anti-abortion governors.

Abortion rights groups say their cases offer a viable path forward to establish protections in states. Even in conservative states such as Oklahoma and Mississippi, they see an opportunity to overturn abortion bans and establish a constitutional backstop against further restriction. But in other places, the goal of the litigation is to at least temporarily restore or preserve abortion access, now that the court’s decision stands to make it illegal or effectively so in more than half the states, which include 33.5 million women of childbearing age.

In Louisiana, for example, though the state constitution expressly says there is no right to abortion, the legal challenge has allowed three clinics to continue serving women whose plans to end their pregnancies were thrown into disarray by the court’s decision.

By Friday, the groups had temporarily blocked bans from taking effect in Utah, Kentucky, Louisiana, and Florida; judges have set hearings over the next several weeks to consider permanent injunctions. But they lost bids to hold off bans in Ohio and Texas.

Book Reviews: The Brutal and Hopeless Beauty of Ballet

 Bright Burning Stars, by A.K. Small (Algonquin Young Readers)

Ballet, for all its ethereal beauty, is brutal physically and even more devastating emotionally as young dancers distort their bodies and vie with one another for the precious few openings that lead to stardom. Nowhere is this pressure-cooker atmosphere more evident than in the boarding schools that feed dancers into prestigious companies. Bright Burning Stars examines the price of such success and asks whether a friendship can survive it.

The story centers on two young women in their final year at the Paris Opera Ballet School. Kate and Marine have been inseparable, best friends, declaring that if they cannot both receive the coveted Prize, neither will have it. As the year progresses, however, pressures mount. Marine, still unable to come to terms with the death of her twin brother who was her inspiration in ballet, descends into anorexia. Kate throws herself into an infatuation with the charismatic senior male dancer, with the result of an unintended pregnancy. Instead of drawing Kate and Marine closer for support, each turn for the worse only seems to widen the gulf between them.

The strengths of the story include strong, flowing prose; engaging characters that change and grow; a vivid depiction of a world that few outside the profession of ballet ever experience; a passionate portrayal of the sensual glory of ballet as an art form; and keen insight into the psychological and physical stresses on dancers. These are significant strengths, indeed, enough to captivate the reader. The narrative kept me turning the pages and caring about the fate of Kate and Marine.

On the down side, watching the two main characters slide into mental illness (for example, eating disorder, severe codependence, obsession, suicidal ideation) was unrelentingly grim. The absence of adult supervision and care was exemplified by the scene, late in the book, where Kate goes to the director with concerns about Marine’s life-threatening symptoms and is essentially blown off and accused of trying to eliminate a rival.

Either these young women are particularly dysfunctional or else the entire realm of ballet is remarkably deficient in healthy relationships. That much I could buy, however, and even the way the school encourages toxic competition at the expense of the health of its students. What was less believable was the ease with which Kate and Marine turned their lives around. Both suffer from serious disorders, neither receives competent psychotherapy – or any counseling at all – and yet a simple “realization” seems sufficient to resolve their problems.

Short Book Reviews: A Shooter Takes Hostages at an Abortion Clinic

Jodi Picoult’s latest novel, A Spark of Light, tackles the abortion debate and pulls no punches. The story opens in Mississippi’s sole remaining abortion clinic, where a gunman has killed several people, including the clinic’s owner, gravely wounded several more, and is holding the rest – staff and patients – as hostages. The police negotiator is desperately trying to talk him down before the SWAT team takes control, and also to keep secret his discovery that his own daughter is inside. One of the hostages is an anti-abortion protester who’s gone undercover to try to obtain incriminating evidence of wrongdoing that will shut the clinic down. As if that weren’t dramatic enough, in another part of the state a teenaged girl has been charged with murder after a self-induced abortion through pills she’d bought on the internet.

All of this is explosive enough, but Picoult doesn’t simplify, preach, or condescend. Every one of her characters, from the shooter to the spy to the negotiator, to the critically injured doctor and intrepid nurses, to the girl who was at the clinic to get oral contraceptives to the elderly woman facing a terminal diagnosis, come across as people with their own histories, tragedies, and deeply held beliefs. More than that, Picoult leaves the reader to draw their own conclusions from a spectrum of sympathetic but ultimately incompatible agendas.

What happens next is even more challenging to the reader. Instead of moving forward chronologically, each successive section moves us back in time. We see the stage before the events we’ve just witnessed, and the stage before that, and so forth, until the day is ordinary, the work routine, beliefs are yet untested and courage untried. Poignantly, we see the people killed by the shooter as alive and vital. The final section draws together all the disparate threads to make the story whole.

For me, however, the most moving part of the book was the Author’s Note, where Picoult talks about her interviews with people all along the spectrum from opposing abortion under any circumstances to advocating for no restrictions whatever. She points out that a significant number of abortions are done for financial reasons, and offers suggestions for reducing the number by addressing that desperation. Raising the minimum wage and offering government-funded child care and universal health care would all make it financially more feasible to bear and raise children. Discouraging employers from firing or refusing to hire pregnant women is another approach.

Finally she writes,

Honestly, I do not believe we, as a society, will ever agree on this issue. The stakes are too high and both sides operate from places of unshakable belief. But I do think that the first step is to talk to each other – and more important, to listen. We may not see eye to eye, but we can respect each other’s opinions and find the truth in them. Perhaps in those honest conversations, instead of demonizing each other, we might see each other as imperfect humans, doing our best.