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New efforts to criminalize substance use and pregnancy repeat racist history

July 21, 2014

My latest article for Colorlines is about the new efforts to criminalize pregnant women for substance abuse. Sadly these kinds of efforts are not new, nor are they actually helping moms or kids.

The main problem with these kinds of stories, and prosecutions, is they do nothing to address the very real substance abuse and addiction issues facing many people in the United States today. Despite decades of incredible spending and increased incarceration in response to the war on drugs, addiction and substance abuse continue. Some policy makers have acknowledged this reality and begun looking for a different ways to address substance abuse. “We’ve really tried to reframe drug policy not as a crime but as a public health-related issue, and that our response on the national level is that we not criminalize addiction,” said Michael Botticelli, acting director of the White House Office of National Drug Control Policy. “We want to make sure our response and our national strategy is based on the fact that addiction is a disease.”

There is no evidence that incarcerating women who use drugs during pregnancy will do anything to improve their health, or their children’s health. In fact, these criminalizations actually worsen the health of the newborn, and make access to appropriate drug treatment for the mom unlikely. Mallory Loyola, the woman charged under the Tennessee law, was in jail for at least three days before being released on bond, just two days after giving birth, during which her child was in custody of Child Protective Services. Kylee Sunderlin of the National Advocates for Pregnant Women (NAPW), an organization that works closely with women charged under these types of laws, explained that when a baby is diagnosed with what’s called Neonatal Abstinence Syndrome—or, the constellation of symptoms that reflects substance exposure inutero—established treatments for it include skin to skin contact with the mother and breastfeeding. That treatment is next to impossible if the mother is incarcerated and her child is in state custody.

Read the full thing here.

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Three reasons the Hobby Lobby decision is worse for women of color

July 2, 2014

I put together some analysis yesterday for Colorlines about the Hobby Lobby decision. It’s bad news all around, but the impacts are potentially worse for women of color. An excerpt:

While much proverbial ink has been spilled speculating about the impact this will have, few have talked about how women of color might fare under this ruling. On its face there is nothing about this ruling that singles out women of color. But because of our political and economic realities, women of color often bare the brunt of the negative impacts of restrictions on women’s health anyway.

Check out the full article here.


Pregnancy After Transitioning Study

July 26, 2013

I’ve written before about the increase in information, resources and stories about trans pregnancy. While we know a lot more now than just a few years ago because trans folks having babies are getting together to share info, there is still a lot to learn about the experience. 

A provider who is queer, doula and midwife friendly asked me to share this call for participates in a survey about transmasculine pregnancy experiences. If you’re interested in participating, see below. 

Pregnancy After Transitioning Study (PATS)

PATS Anonymous Survey – Online Information Sheet

We are doing a pilot study about transgender men’s’ experiences with pregnancy.  This study aims to better understand how to best assist female-to-male transgender individuals who may want to become pregnant as well as how to counsel about pregnancy and possible birth outcomes. The data collected in this initial unfunded pilot study will offer some guidance to transgender men, and their healthcare providers, who are pregnant or interested in becoming pregnant.  The results from this study will support and guide the development of future outcome-oriented clinical research in this area of intense growing interest and importance

This study is an anonymous online survey of people who identify as transgender men (assigned female at birth with a transmasculine/ transmale/ female-to-male gender identity) and have been pregnant and delivered a baby.  If you self-identify with this population, then we would like to invite you to participate in this study.

If you choose to be in the study, you will complete a survey. This survey will help us learn more about transgender men (assigned female at birth with a transmasculine/transmale/female-to-male gender identity) who have been pregnant and completed the pregnancy.  The survey will take about 20 minutes to complete.  The questions will relate to your experience with fertility, conception, pregnancy, and birth.   To be eligible for the study you must be over 18 years old and have completed a pregnancy within the past 10 years.  You can skip questions that you do not want to answer or stop the survey at any time. The survey is anonymous, and no one will be able to link your answers back to you. Please do not include your name or other information that could be used to identify you in the survey responses.

All study results will be made available to the community through the Center of Excellence for Transgender Health at the University of California, San Francisco. The mission of the Center of Excellence for Transgender Health is to increase access to comprehensive, effective, and affirming health care services for trans and gender-variant communities.  More information can be found at http://transhealth.ucsf.edu

Questions? Please contact the study coordinator Lexi Light (415-206-6453LightA@obgyn.ucsf.edu).  If you have questions or concerns about your rights as a research participant, you can call the UCSF Committee on Human Research at 415-476-1814.

Being in this study is optional. If you want to participate, click this link to start the survey: http://bit.ly/PATStudy

Additionally, the researchers at the Center of Excellence for Transgender Health (CoE) at UCSF are doing research that is designed to lead to better programs for transgender people. They want to know if you wish to learn more about their research studies or if you may wish to participate in any of the studies that may be appropriate for you. By clicking this second link & filling in your contact information, you will allow qualified professional people on the staff of the CoE to contact you in the future to ask if you want to participate in any studies.  You will be entering your contact information into a different survey, completely separated from the above anonymous survey.  You have no obligation to actually participate in any study.

By providing your information, if a study on transgender people needs subjects, you may be contacted to ask if you want to participate. You do not have to participate. You may withdraw permission to be contacted at any time by contacting the CoE.  If you do not provide your information, there will be no penalty or loss of benefits to which you are otherwise entitled. 

Participation in research may involve some loss of privacy. However, your contact information will be handled as confidentially as possible. Access will be limited to the data manager and the researcher organizing the study and will require a password. No information will be used for research without additional permission. Your contact information will not be shared with anyone outside the CoE.

There will be no cost or payment to you if you sign this form.   If you have questions now or later, you can talk with the study researcher about any questions, concerns or complaints you have about this study.  Contact the study researcher(s) Dr. Jae Sevelius at 415-597-9183.

If you wish to ask questions about the study or your rights as a research participant to someone other than the researchers or if you wish to voice any problems or concerns you may have about the study, please call the Office of the Committee on Human Research at 415-476-1814  

If you agree to be contacted in the future, please indicate your preferred contact information on the following form https://redcap.ucsfopenresearch.org/surveys/?s=sHwkt3

 


NYC Teen Pregnancy Campaign Brings Shaming to Bus Shelters and Cell Phones

March 5, 2013

In my column at RH Reality Check this morning I wrote about a new NYC Human Resources Administration teen pregnancy prevention campaign that takes shaming to a whole new level. From the article:

The New York Human Resources Administration (HRA) launched a new ad campaign this week that takes the use of shame tactics to prevent teen pregnancy to a whole new level. The ads feature images of young children alongside messages to their would-be teen parents. It’s hard to describe the ads as anything but horrifying and yet another link in the chain of shame-based teen pregnancy prevention efforts.

It might be hard to believe, but there’s a component to the campaign that’s even worse than the ads. At the bottom of each ad is a message: “Text ‘NOTNOW’ to 877877 for the real cost of teen pregnancy.” I followed these instructions, and what resulted was a really screwy game of “choose your own adventure” via text message.

The ads and the text message “game” are really terrible, provide no actual information about how to prevent pregnancy, instead reinforcing the stigma and social isolation faced by teen parents. 

Want to tell the agency what you think about the campaign? You can email the Commissioner of HRA here and also tweet at HRA here.

Read the full article here.


Bringing our own expertise back into health care

November 29, 2012

In my latest column for RH Reality Check I reflect on the statement released by ACOG last week supporting making birth control pills available over the counter without a prescription.

What interests me about this, beyond the issue of improving access to contraception, is how it might mark a continuing shift in the role of medical providers in health care.

As doulas, we probably already understand that there is a movement of people working to take back more control and responsibility for their own health, particularly in the reproductive health arena.

In the article I mention Pati Garcia and the Shodhini Institute, a group that is working to bring back the practice of self-help and particularly cervical self-exams as a way to allow people to be more aware and active in managing their own health.

Doulas, in many ways, are part of this movement to empower and encourage pregnant people to be more educated and more involved in their own health.

I know personally this has been a struggle for me, and I’ve mostly been motivated to be more in charge of my own health by my frustration with providers who have not been able to address my own ongoing health concerns. They’ve suggested drug treatments that haven’t worked, tests I couldn’t afford, or dismissed my concerns outright. These negative experiences mean I’ve never built a long-lasting, trusting relationship with a medical provider. The closest I’ve come was an amazing acupunturist/herbalist I saw for over a year in Brooklyn. But with Western medical providers all of my experiences have been negative.

I think this shift could be a really great development in how we all manage our health, but its going to require a serious re-education effort for many of us who have lost touch with our bodies, have come to mistrust our role as experts over our own bodies.

It’s sad, really, when you think about how much we’ve relinquished to the “experts” and how much we’ve minimized our own experiences of our bodies and our health. We rely instead on tests and book knowledge and medical studies, rather than our own daily experience of our lives and our health.

In my ideal world both things would be useful, but in equal degrees.

Armed with the knowledge of our own bodies, rhythms, cycles and changes we can much more effectively partner with medical providers when necessary. We could go to them with knowledge that will help them know how to treat our illnesses, rather than expecting them, from seeing us once or twice a year, to have all the answers. Then we won’t need these prescription-filling visits to remind us to take care of our health—we’ll be taking that responsibility on ourselves.

I’m proud that doulas are playing a role in empowering folks to make this shift–to trust their own intuition, their role as experts on what is happening in their bodies. In the coming weeks I’ll have more information from Shodhini Institute and Pati Garcia about this work.

Read the rest of the column here.


Call for Submissions: Saving Our Lives: Black Women, Pregnancy and Childbirth

July 17, 2012

Black Women Birthing Justice, a group based in Oakland, is putting together a much needed anthology about Black women, pregnancy and childbirth.

Details:

Birthing Justice – Saving Our Lives will be an anthology of critical essays and personal testimonies that explore African American, African, Caribbean and diasporic women’s experiences of childbirth from a radical social justice perspective. We seek writings by midwives, doulas, natural childbirth advocates, reproductive rights activists, moms and moms-to-be, sociologists, feminist and Africana studies scholars, and historians that document state control and medical violence against black pregnant women, revitalize our birthing traditions, and honor and record empowering and sacred birth experiences. We are particularly interested in essays that document activism and resistance.

Read more here, and consider submitting! Such an important conversation.


“Model Minority” myths and maternal health

July 5, 2012

A belated post about my column last week for RH Reality Check, in response to the Pew Foundation report about the “rise of Asian Americans.”

Last week’s report from the Pew Research Center, The Rise of Asian Americans, has stirred up much controversy. Many advocates in the Asian American and Pacific Islander (API) community are arguing that the findings further a damaging idea about Asian Americans — the “model minority” myth. Advocates have said that these myths, which include the idea that Asian Americans are wealthier, more educated, and happier than other groups (all purported in the Pew report) are damaging because they hide the real challenges that exist for Asian Americans and Pacific Islanders, in particular for certain national and ethnic minorities that fall under the API umbrella.

One place this “model minority” concept can have negative implications is in discussions of health disparities. Whether due to population size or misconceptions about the health of Asian Americans, we do not often hear about the specific health disparities facing the API community. In the discussions about race and health, people of color are often grouped together, and disparities are talked about in terms of the gap between white people and people of color (Asian Americans included). These simplifications ignore the differences between racial groups, and even within nationalities and ethnicities within those racial subsets. Because of the Pew report, and as part of my focus on race-based health disparities and maternal child health, I decided to look further into the data on Asian Americans and Pacific Islanders.

What we do know is that API women suffer from higher rates of certain negative maternal and child health outcomes than their white counterparts.

Read the rest here.


New column: Preparing for the trans baby boom

June 20, 2012

My latest column for RH Reality Check was published this week. An excerpt:

This shift in attention toward the issues facing trans and gender non-conforming pregnancy is indicative of a bigger shift overall — more and more trans and gender non-conforming people are giving birth. As Pati Garcia, a Los Angeles doula and midwife-in-training put it during our panel: “We’re on the cusp on a trans baby boom.”

Trans health as an overall field is still in its nascency. Our understanding of hormone therapies, gender reassignment surgeries, and much more is still being developed, so it’s no surprise that the field of pregnancy and parenting for trans people is also new and developing.

Within the needs of trans people in pregnancy and birth is the challenge of addressing what seems like an obvious connection: between pregnancy and femaleness. Trans people are often neglected in the arena of pregnancy and birth because of the strongly-held notion that only female-identified people experience pregnancy and birth. While not all trans people, whether they were assigned female at birth or not, can experience pregnancy (because of infertility or hysterectomy), some can and do, prompting the need for our pregnancy and birth providers to accommodate.

It’s not easy, as it’s a process that is intensely gendered. Everything from maternity clothes to the language of health care providers carries the assumption that the pregnant person identifies as female (and often that the other parent identifies as male). Language is an obvious barrier from the get-go: maternal health, pregnant women, all of the language associated with pregnancy and birth is gendered. From body parts to actors, all is coded in a way that would make a pregnant person who is not identified as a female feel uncomfortable.

Read the whole article here.

It was inspired by my panel at the Philadelphia Trans Health Conference, so big props to Pati Garcia (aka Chula Doula), Ryan Pryor, Abigail Fletcher and Lucia Leandro Gimeno, my co-panelists. It was an amazing conversation about trans and gender non-conforming centered midwifery and doula care. And the room was full! I love how many more people are focusing on these intersections, because there is much work to be done.


Proof that anti-abortion laws hurt ALL pregnant women

March 7, 2011

We’re only just starting to see the impacts of new extreme anti-abortion legislation that has been passed around the country.

As I argue in this post, these laws also restrict the choices of women who want to parent. I’m going to try to keep an eye on the stories that highlight these connections because I think it busts open the myth that anti-choice activists are only focused on restricting abortion. They’re actually focused on restricting women’s autonomy in a myriad of ways related to pregnancy.

From Nebraska State Paper:

Nebraska’s new abortion law forced Danielle Deaver to live through ten excruciating days, waiting to give birth to a baby that she and her doctors knew would die minutes later, fighting for breath that would not come.

And that’s what happened. The one-pound, ten-ounce girl, Elizabeth, was born December 8th. Deaver and husband Robb watched, held and comforted the baby as it gasped for air, hoping she was not suffering. She died 15 minutes later.

The sponsor of the controversial Nebraska statute, Sen. Mike Flood of Norfolk, told the Des Moines Register that the law worked as it was intended in the Deavers’ case.

“Even in these situations where the baby has a terminal condition or there’s not much chance of surviving outside of the womb, my point has been and remains that is still a life,” Flood said in an interview with the Iowa newspaper.

The law, the only one of its kind in America, prohibits abortions after the 20th week. It is based on the disputed argument that a fetus may feel pain at that stage. It took effect last October.

These situations, while rare, do happen. Not all women, when faced with a fetus that is known not to be viable, would choose to terminate early. Some would want to carry the fetus to term, and spend that time in whatever way they choose.

The point is: she should have a choice. No one should be forced to carry an unviable fetus to term. No one should have lawmakers interfering with a medical decision that should be kept between the family and the medical providers.

“Our hands were tied,” Danielle Deaver of Grand Island told The Register in a story published Sunday.  “The outcome of my pregnancy, that choice was made by God. I feel like how to handle the end of my pregnancy, that choice should have been mine, and it wasn’t because of a law.”

Also, what kind of BS argument is that about fetal pain? For one thing, the research behind the idea of fetal pain is super sketchy. And for another, what about the suffering of this newborn as it died?

I’ll keep saying it over and over: anti-abortion laws don’t just hurt women who want to terminate their pregnancies. They also hurt women who want to parent.

h/t Mary M.


California pregnancy-related deaths triple in the last decade

February 4, 2010

A new investigative report released by California Watch reports that maternal mortality rates in California have seen a spike in recent years, almost tripling in the last ten years.

To me, there is one clear cause of this kind of increase, and that’s the c-section rate, which according to California Watch have increased 50% in the same decade in CA.

The World Health Organization recommends a c-section rate of about 10%. We currently have a national average of 30%. In some hospitals it’s as high as 90%.

C-sections are major abdominal surgery. There are risks involved, and with so many c-sections, you’re going to start having deaths as a result.

We need less c-sections. Period.

The other thing this report revealed was that there was significant increase in maternal mortality among non-Hispanic whites, a group traditionally excluded from maternal mortality and low infant birth weights. Well again, this is probably because of the c-section rates, which might even be higher among this group than women of color.

The idea that increases in technology use could actually harm women, rather than help them, is impossible to believe for the OB-GYN community:

When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience, according to participants at the San Diego event. The idea that California was moving backward even in an era of high-tech birthing was implausible to some.

This is exactly the point. Overusing technology it’s just as harmful as under-utilizing it. The bottom line is that OB-GYNs are trained as surgeons, and their dominance of maternity care is proof of that–they are performing more and more surgeries than ever.

We need practitioners who are trained to care for women birthing without technology, namely midwives. Technology has a role, but it should be the exception not the rule. And let’s be clear here. It’s not just c-sections that are to blame. It’s also increasing induction rates, epidurals and other medical interventions that disrupt the process and are more likely to cause interventions.

“For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth,” Camacho wrote in an e-mail.


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