Midwifery and Misconceptions

Living in a city with some of the most well-ranked hospitals in the nation, we sometimes take our access to healthcare for granted. The wail of an ambulance is a frequent annoyance to UAB students, but it’s a noise that many people are grateful to hear – especially those who live in rural areas with limited access to healthcare.

Midwife Lorina Karway is one of those people. Karway is responsible for helping thousands of Liberian women give birth safely. She often uses the light of her cell phone, held in her mouth, to deliver babies in a facility without electricity (UN Women). It’s not an easy feat to accomplish, but courage, intuition, and years of experience guide Karway to success. Childbirth is a common, natural process that veteran midwives handle skillfully, but complications do happen. When they do happen, it can be incredibly dangerous. The nearest hospital is over sixty miles away, and emergencies without swift action can have fatal outcomes. Midwives have successfully operated for centuries without hospitals, but medical equipment and clean facilities with electricity are immensely helpful in high-risk situations.

A smiling midwife holds a newborn baby bundled in a blanket.
“Cmdr. Protegenie Reed, a Navy midwife from Miami, Florida holds a newborn baby during Pacific Partnership 2015.” Source: Sgt. Valerie Epple, Creative Commons.

Midwifery still has a reputation for being illegitimate or unsafe relative to hospital deliveries, but midwives aren’t just second-rate doctors for communities without hospital access. “Skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life,” is how the World Health Organization defines the holistic practice. Part of the negative reputation is because midwives tend to practice in areas where adequate services and equipment are lacking, creating the dangerous situations that Karway faces. Communities without access to healthcare still require some sort of healthcare, and midwives across the world bravely fill that gap.

Two midwives stand next to a curtain in a dim room with photos of babies on the walls.
“Midwives Hasina and Aya Begum wait inside the birthing centre in Koral slum, Dhaka, Bangladesh.” Source: Conor Ashleigh for AusAID.

The danger is not created by practicing midwives, but rather from the community’s lack of access to adequate local healthcare services that extend beyond a midwife’s capacities. A solution to this gap in service would enable midwives to deliver better standards of care, and to ensure midwives can collaborate with hospital assistance when required. Additionally, there is evidence that midwife-assisted births result in better care than births guided by obstetricians (Walters et al). The study by Walter investigates variation within hospitalized care, but similar conclusions were found in regards to remote midwifery. Cost analyses of prenatal and postnatal care from seven different remote aboriginal communities found that “midwife group care (MGP) was likely to be cost effective, and women received better care resulting in equivalent birth outcomes compared with the baseline maternity care” (Gao et al).

Policy solutions have not been aimed at uplifting midwives, but rather to create barriers and even criminalize. Midwifery was essentially outlawed in Alabama for the past forty years, along with a dozen other states. Even where legal, barriers were constructed make it difficult for up-and-coming midwives to obtain training, licensing, equipment, facilities, and adequate pay. This is bad for midwives, and detrimental to women in need of accessible maternal healthcare.

A woman in hijab stands in the middle of a classroom with six pupils in hijab.
“Community Midwifery Education Program.” Source: Aga Khan Foundation/Sandra Calligaro, Creative Commons.

According to the United Nations Population Fund (UNFPA)

  • Over 300,000 women and 2.7 million babies died in childbirth in 2015 alone.
  • Most of these deaths were preventable and caused by a lack of sufficient antenatal, delivery and post-natal care.
  • Almost ⅔ of all maternal and newborn deaths could be prevented by well-trained midwives.
  • Midwifery includes comprehensive reproductive health and community health practices.

Barriers faced by midwives include:

  • Social isolation / poor living conditions; 37% of midwives face harassment at work
  • Lack of professional development opportunities or support through regulation/accreditation
  • “Unequal power relations and gender inequality within the health system and within communities” (WHO).
  • “Private sector markets and medical hierarchy leading to medicalized births, which constrains opportunities for quality midwifery care” (WHO).

 

“International Day of the Midwife.” Source: Lindsay Mgbor/Department for International Development, Creative Commons.

Human Rights Impact

 

Here are some reasons why it’s important to embrace midwifery as an alternative or addition to formal medical care:

  1. Overlooking midwifery increases stigma. This makes it harder for women to access midwives – especially rural and/or low-income families cannot afford or cannot travel to medical centers.
  2. Midwifery is a critical role in some indigenous traditions. Native women have the right to practice traditional knowledge and engage in their own culture. Legislation that stigmatizes or creates barriers for midwives will likely harm indigenous practitioners.
  3. Women have the right to choose what kind of healthcare is best for them. Healthcare is never one-size-fits-all, and it’s important to invest in a variety of options for a variety of patient needs.
  4. Midwifery needs to be an accessible and viable career path. Medicalization of birth and barriers to midwife accreditation essentially act as gatekeepers, forcing aspiring practitioners to attend costly medical school or, for those who can’t afford it, to abandon their dreams.

 

Midwifery is a quality alternative to hospitalized childbirth, but many don’t have the luxury to choose. When distance makes choosing hospitals impossible, midwives fulfill their communities’ needs for reproductive/maternal healthcare. Midwives should be empowered to provide adequate services whether in urban hospitals or rural facilities, with unhindered access to training, education, and opportunity. Per CEDAW, states have the obligation to provide “appropriate services in connection with pregnancy, confinement and the post-natal period.” Let us support midwives as they courageously provide services that no one else will. Let us encourage midwives across the globe to continue their work despite disdain, mistrust, and criminalization. Let us uplift and support midwifery to make the world a better, safer, more accessible place.

 

—–

Craven, Christa, and Mara Glatzel. “Downplaying Difference: Historical Accounts of African American Midwives and Contemporary Struggles for Midwifery.” Feminist Studies, vol. 36, no. 2, 2010, pp. 330–358. JSTOR, www.jstor.org/stable/27919104.

Parry, D. C. 2008. “We wanted a birth experience, not a medical experience”: Exploring Canadian women’s use of midwifery. Health Care for Women International, 29: 784–806.

Thomas, Samuel S. “EARLY MODERN MIDWIFERY: SPLITTING THE PROFESSION, CONNECTING THE HISTORY.” Journal of Social History, vol. 43, no. 1, 2009, pp. 115–138. JSTOR, www.jstor.org/stable/20685350.

Shaw, Jessica. “ The Medicalization of Birth and Midwifery as Resistance.” 20 Mar 2013.
Health Care for Women International. Volume 34, 2013 – Issue 6. www.tandfonline.com/doi/abs/10.1080/07399332.2012.736569?tab=permissions&scroll=top

Women in Saudi Arabia

Saudi Arabia

Saudi Arabia is in the Middle East and occupies about “four-fifths of the Arabian Peninsula”. It is home to Islam’s two holiest cities, Mecca and Medina. When thinking of Saudi Arabia, most people associate it with religion, petroleum wealth, and tribalism. Although, throughout the years, Saudi Arabia has become more urban while experiencing vast technological, educational, social, and economic changes. However, in terms of women’s rights, Saudi Arabia has received much backlash.

Women’s Rights Timeline in Saudi Arabia

In 1955, Saudi Arabia’s first school for girls was created and, in 1970, the first university for women opened its doors. In 2001, women were allowed to get personal identification cards as long as they had permission from their guardian. Furthermore, it was issued to the guardian, not the women. Until 2005, it was cultural practice for women to be forced into marriages even though it was considered illegal. Four years later, in 2009, the first female government minister, Noura al-Fayez, was appointed. In 2012, women were allowed to compete in the Olympics on the national team for the first time. Before the 2012 Olympic Games, there was a possibility that Saudi Arabia could be banned due to gender discrimination. A year later, women could ride bicycles and motorcycles in recreational areas but only if they wear the full Islamic body covering and have a male relative present. That same year, 30 women were sworn into the consultative council, the Shura. In 2015, women could run for office for the first time, which resulted in 20 women being elected to municipal roles in the absolute monarchy. Beginning just last year, women can now go to the sports stadiums and drive. Furthermore, in order for women to get their driver license, they do not need permission from a male guardian and can drive by themselves. Finally, in 2019, there a new law established where women would receive a text message if they got divorced, whereas in the past, their marriage could end without their knowledge. Additionally, they can check their marital status online or in court, but only if she has her husband’s approval or if he has harmed her. Many of these policy reforms still include male supervision. While persecution is a high risk, women are willing to fight for their freedom.

Women2Drive. Source: Wikimedia, Creative Commons.

Their Stories

Rahaf Mohammad al-Qunun fled from Saudi Arabia to Canada; she was seeking a place where she can be free. Even though she left her family behind, now she can make her own decisions. She said, “I don’t have any contact with my family, but I think that’s good for me and for them. I feel like this is my home now. It’s better here.” Two girls, Reem and Rawan, escaped from Saudi Arabia to Hong Kong. Reem claims, “Our rooms were the prison cell and our fathers and brothers were the prison keepers. Saudi Arabia is one big prison.” However, they cannot stay in Hong Kong for long because they are at risk of being possibly removed or prosecuted. If they are forced to return to Saudi Arabia, the outcome could result in imprisonment or death. Cases similar to Reem and Rawn’s tend to often be covered up.

Why Women Run  

One of the most common reasons women flee Saudi Arabia is due to the restrictions placed on where women can travel. Women are not given the right to leave the country without their male guardian’s permission. Furthermore, a woman’s ability to choose her marriage partner is solely dependent on the permission of their male guardian. In January 2019, the country set the minimum age of marriage at 18, but girls aged 15-18 can still become married without the court’s approval. Other reasons include but are not limited to domestic violence, discrimination in employment and healthcare, and inequality in divorce, child custody, and inheritance.

 Technology and its Effect on Women’s Rights

 With every technological advances comes benefits and drawbacks. The benefits can include a platform where people are given a voice to share their thoughts and an accessible platform from anywhere in the world. However, the drawbacks comprise of undesired scrutiny which can make one an easy target. As a result, one of the biggest questions now is “whether it is the responsibility of technology companies to make sure their platforms are not used by governments to repress their citizens.”

In Saudi Arabia, there is an app called Absher, which the government can access. The purpose of the app is for men to approve or deny women to go abroad. As mentioned earlier, some women have tried fleeing the country and must do this secretly due to not having permission from their male guardian. In this case, technology is detrimental for women’s rights because it places a limitation on their freedom. Technological advancement makes it easier for men to have power over women by “policing” the women’s movement. Whenever a woman wants to go to the airport, she cannot leave without the government and her guardian knowing because they receive a text alert; people have gotten around this system. For example, Salwa left Saudi Arabia by getting her father’s phone and replacing his information with her information. Thus, she was able to make consent for her sister and herself, although risking legal consequences. People believe that these apps are causing discrimination to become more normalized. Unfortunately, even though the companies are aware of the circumstances, removing the app would not solve women’s issues in Saudi Arabia. The government in Saudi Arabia has a website that comprises of the same functionality as the app does.

 

Free. Source: Max Pixel, Creative Commons.

The Future

During a session of the United Nations General Assembly in New York, leaders of Saudi Arabia discussed their goal of developing the country by increasing participation from women. In fact, the number of female diplomats has expanded steadily over the years. While the future for Saudi Arabia’s women is unknown, there is “cautious optimism” in regards to women having a bigger role in society and politics.

Addressing Menstruation and Birth Control, Improving Women’s Lives

by Pam Zuber

Nyaya Health: A chant and a dance on the practice of Chhaupadi by the CHWLs and FCHVs
Nyaya Health: A chant and a dance on the practice of Chhaupadi by the CHWLs and FCHVs. Source: Possible: Creative Commons.

Menstruation and birth control.

Discussing these topics sometimes makes people uncomfortable. Why? Society sometimes says that we’re not supposed to talk about what happens down there, that they’re just not proper topics for everyday conversation. Could this discomfort be due to the fact that men have often traditionally served as political leaders, media gatekeepers, and educational instructors? Women’s power, voices, and advancement opportunities have been limited. So have their concerns, even if they’re everyday issues that women have faced since the dawn of time.

Such concerns are extremely important to the survival of our species. Menstruation and birth control are crucial parts of life. Without menstruation and everything that accompanies it, we wouldn’t be here. Depending if people have access to it, birth control is also a factor that can greatly improve or hinder a woman’s quality of life. But, these topics are often taboo. People don’t want to talk about them. People often can’t talk about them or do anything about them. Or, if people talk or act on these topics, they may face stigmas and punishments. Living normally during menstruation and controlling one’s reproductive destiny should be vital human rights everywhere. They’re often not, which has created inconveniences, obstacles, and even tragedy. Luckily, individuals and groups are shedding light on menstruation and birth control and how they impact women and the greater culture.

Menstruation discrimination

Although banned by law, menstruation huts are still a reality in some rural areas of Nepal. They’re part of traditions stating that menstruating women or women who have just given birth are impure or the bearers of bad luck. These beliefs have led people to banish menstruating women to live in huts or cattle sheds, prevent them from touching farm animals, and forbid them from eating certain foods.

Known as chhaupadi, this practice of separating women from the general population puts women at risk. Many of the huts lack heat or bathroom facilities or are far removed from the rest of society. In 2019, a woman and her two children died after they inhaled smoke from a fire inside of this type of hut. A teenager died in 2017 from a snakebite she received while staying in a hut. People who live in such huts may have to travel miles to use toilets, wash, and gather supplies. They cannot attend school and their employment opportunities may be limited.

Under chhaupadi, disadvantaged women face even more obstacles that prevent them from overcoming their disadvantages and improving their lives. They do not have the full measure of human rights that males enjoy, simply because they are menstruating. Similar fears about female impurity have long banned women of menstruating age from the Hindu Sabarimala temple complex in India. As part of a number of protests, two women defied this ban and entered the temple in 2019. Their actions sparked further protests for and against women’s rights in the region and ignited international debate.

Positive period news

In a positive period-related development, access to feminine hygiene products is increasing for many. The states of Illinois, California, and New York provide free sanitary products for their public school students. Educational institutions such as the University of Washington also offer such products and other schools are considering it. These efforts are global. The government of Scotland provides free sanitary products to students who attend schools, colleges, and universities as well as to people who visit leisure centers and libraries. Several states in the United States have also removed the sales tax for such products (the tampon tax) or are considering doing so.

Period. End of Sentence is an Academy Award-winning short documentary that also testifies to the power of proper period care. Directed by Rayka Zehtabchi and produced by Melissa Berton, the film depicts efforts in India to provide sanitary products, end stigma about menstruation, and improve the lives of women and girls. “I can’t believe a film about menstruation just won an Oscar!” said Zehtabchi. The filmmakers acknowledged that Indian initiatives can help girls pursue schooling. “A period should end a sentence, not a girl’s education,” said Berton. Girls in India missed school 20 percent of the time because of menstruation, according to a report by the United States Agency for International Development (USAID). Females who lack sanitary products might use hay, old fabric, rags, or other products during menstruation, which can lead to unsanitary conditions and infections. It could make menstruation more visible and thus subject to scrutiny and stigma, eroding girls’ self-esteem and confidence in their abilities.

Others question whether menstruation really causes girls to leave school but acknowledge that taboos surrounding menstruation do indeed exist. Supporting girls and women is vital. “Providing girls with a product can only get you so far if you don’t have the enabling environment in the school, supportive teachers, and information about what’s happening to your body,” said Columbia University professor Marni Sommer on a National Public Radio interview. Proper period care “is a human right,” noted Sommer. “We shouldn’t have to justify that girls are deserving of an environment where they can just meet their basic bodily needs.”

Destigmatizing menstruation and providing access to menstruation products may create more equality. If women and girls face discrimination and lack essential hygiene products, they may stay home from work, school, civic engagements, and social events. They cannot fully participate in their lives and the lives of others. People who lack sanitary products live lives similar to women who live under the practice of chhaupadi. Just because they menstruate, women and girls affected by both cannot fully engage with the outside world. People are working to highlight and change this.

the movie poster for Period. End of Sentence.
Source: Creative Commons

The cost of unintended pregnancies

Access to birth control is also an important driver of human rights. Like sanitary products, effective and accessible birth control products provide physical and mental health benefits. Both can be valuable tools for improving and sustaining human rights. Physically, birth control helps women prevent pregnancies. This sounds obvious, but it means so much. Pregnancy and labor take tremendous physical tolls on women. Even after childbirth, breastfeeding mothers’ bodies are not entirely their own, and mothers face the physical and mental strain of raising children and running households.

Mental strain can be considerable for mothers. They are charged with taking care of themselves and their children and completing other tasks, such as working various jobs, helping their families, and fulfilling other responsibilities, not to mention trying to find time to pursue various interests. It can be difficult enough to do those things when they’re deliberate choices when women plan the size of their families. Not having access to birth control makes this precarious juggling act even more difficult. Becoming pregnant unintentionally may impact women’s health since they’re gaining weight, dealing with hormone fluctuations, and experiencing other intense physical changes related to pregnancy. Mentally, they may be facing the stress, anxiety, and depression of unwanted pregnancies and the profound life changes they may create.

Unintentional pregnancies can also burden women and their families financially. Women may take unpaid maternity leaves, turn down promotions or specific positions, or quit their jobs to raise children. They may have to allocate a considerable part of their incomes to pay for childcare. Mothers who re-enter the workplace may not earn the same incomes, have access to the same opportunities, or achieve the same advancements as colleagues who never left the paid workforce. Health and financial issues, unintended pregnancies, and other types of stress can strain women’s relationships with their partners. It could cause women to feel unfulfilled with their lives and feel that they’re not doing all that they want to do because they must fulfill the various responsibilities in their lives.

The worth of birth control

Birth control may shift this balance, helping women do what they want to do instead of what they feel they must do. Access to birth control gives women agency. There are mixed messages about this agency. Just as some higher education institutions are providing sanitary products, some are providing birth control access to their students. Arguably, they’re not providing full access. For example, institutions such as the University of Oregon operate health centers that employ pharmacists who prescribe birth control pills and other forms of contraception. They do so without appointments and charge $15.00 per visit. Not requiring appointments may make it easier for students to visit in spite of busy schedules. Charging $15.00 might make it easier for students for affording such visits. On the other hand, the university isn’t paying for birth control itself. Students must use health insurance or pay out-of-pocket to cover the costs of birth control. This means that people may go without much-needed birth control because they can’t afford it. They may not be able to pay for the $15.00 pharmacist visitation fee or other costs as well.

Sanitary napkins, tampons, birth control pills, and other forms of contraception often aren’t expensive, but the lack of them are. Women who don’t have them may face much more expensive financial, emotional, and physical costs in the future. Providing assistance and access to such items can change an individual woman’s life and transform society as a whole.

About the author: Pamela Zuber is a writer and editor who has written about human rights, health and wellness, business, and gender.

The Crisis in American Journalism Is a Labor Rights Crisis (Part I)

by Andy Carr

a photo of a newsstand
news. Source: Anthony Lazaro, Creative Commons

To say American media has struggled in recent decades would be an understatement, but the past weeks of extensive newsroom layoffs cut especially deep. As CNN reported on January 24, from Monday to Thursday of that week, at least 1,000 journalists were laid off nationwide, including 15 percent of BuzzFeed News personnel (approximately 220 individuals), 7 percent of various Verizon-owned entities’ staff (including HuffPost, AOL, and Yahoo News), and widespread cuts at Gannett, America’s largest newspaper owner. At BuzzFeed News alone, the entire national news desk staff was gone by January 25, along with all but one of the LGBT-focused reporters at the company and the national security staff.

That devastating week’s news follows years of similar stories far beyond the present decade’s startups and digital innovators. Last spring, Sridhar Pappu and Jay Stowe of the New York Times provided a concise yet devastating account of the shifting media landscape since the dawn of the twenty-first century, including the collapse of marquee legacy publications like TIME magazine:

When Time Warner merged with AOL in 2000, the company seemed poised to conquer the internet. History, however, had other plans. Subscribers and advertisers turned away from the core publications. Budgets shrank. Layoffs became commonplace. In 2014, Time Inc. was spun off from the Time Warner mother ship, and in 2015 it left the Time & Life building for a comparatively modest space on Liberty Street in Lower Manhattan.

TIME, along with parent company Time Inc.’s other leading magazines, like Sports Illustrated, Fortune, and Money, had been purchased in fall 2017 by media conglomerate Meredith Corp., before putting the Time portfolio up for sale just six months later. Gannett, meanwhile, recently was described as “the most voracious acquirer of local papers in the news business,” publishing national outlets like USA Today and major-market papers “including The Arizona Republic, the Milwaukee Journal Sentinel, and The Cincinnati Enquirer.” Even Gannett is exposed to looming concerns: Alden Global Capital, a New York-based global hedge fund founded in 2007, offered a hostile bid to takeover Gannett for $1.4 billion. As The Week reported earlier in January,

[The] strategy of buying and cutting [media staff] is exactly the one that Gannett pursued as it grew into the biggest newspaper owner in the country. Alden is following Gannett’s own logic, taken to its furthest extreme. So far, wherever Digital First [Alden’s media subsidiary] has gone, ‘a bevy of job cuts’ has followed. [So, if] Alden succeeds in its bid, it will be a waking nightmare for anyone who cares about newspapers.

Many such stories have wrenched the field of journalism since the 1990s, and one need not look far back into archives to see the expansive damage. The Weekly Standard, a conservative outlet which in its waning months of operation “exhibited a cover-to-cover vibrancy that had eluded it for more than a decade,” was “snuffed” out of existence by owner Phil Anschutz last December; Glamour announced last November that the 80-year-old print version of the magazine would cease production, “shifting to a digital-only operation” after January 2019; international titles with U.S.-based parent organizations, like men’s magazine ShortList and Cosmopolitan Australia, also closed in 2018. Among America’s local and regional newspapers, the bludgeoning has proved even more draconian: approximately “1,800 local papers have closed or merged since 2004,” according to a 2018 CNN report.

As I wrote late last year, journalism—and journalists, individually—are linked inextricably to human rights concerns, as the “chroniclers” of human rights abuses, making them known to the world, as advocates and agents of human rights causes they cover, and as the targets of increasingly frequent abuses globally. The stunning decline of American news media broadly affects both deep-dive investigative journalism and analysis, along with on-the-ground reporting of current affairs. In so doing, these structural changes to the industry threaten journalism’s integral role in cataloging, reporting, and advancing human rights.

an older man reading the newspaper
Reading the newspaper. Source: Nicolas Alejandro, Creative Commons

These systemic changes to the news media landscape often have been grouped into two broad categories: the overall consolidation of American mass media, among other industries, since the end of the twentieth century (a two-time subject of John Oliver’s Last Week Tonight, back in 2017), and the massive shift to mobile and online-based advertising, where aggregate revenue overwhelmingly is concentrated in leading digital companies like Facebook and Google. According to a 2018 estimate reported in Adweek, those two companies alone account for “around 85 percent of every new digital dollar” entering the mobile and online ad spaces. Facebook in particular already functions “as one of the world’s largest distributors of information,” a reality it “acknowledged” in early 2017 “by announcing the Facebook Journalism Project.” The Project “calls for the company to forge deeper ties with publishers,” to help “develop training programs and tools for journalists,” and to “help train members of the public to find news sources they trust, while fighting the spread of fake news across its site.” While Facebook had met with thousands of publishers by mid-year 2017; actual financial support, i.e., the transfer of advertising revenue streams or any other profit-generating opportunities, remain illusory, and outside the scope of Facebook’s efforts.

Clearly, American mass media faces several structural challenges, but why is any of this relevant for human rights-related concerns?  Why is the labor crisis in journalism a human rights concern unto itself? The effects are manifold.  First, media consolidation has been found to affect the “viewpoint diversity” of media broadly – meaning, consolidation might restrain the variety of views and issues covered in papers and online outlets.  As early as 1999, the late Senator Paul Wellstone (D-MN) wrote about his concerns about the early stages of media consolidation as a threat to American democracy.  In a Federal Communications Law Journal article, Sen. Wellstone expressed grave concerns about a then-pending merger of CBS and Viacom, among a “recent wave of mergers among media companies,” all of which might pose threats “for our representative democracy” and accordingly “warrant the highest level of scrutiny by … antitrust agencies” (p. 551).  The Senator continued, presciently arguing that America’s media is not just any ordinary industry.  It is the life-blood of American democracy.  We depend on the media for the free flow of information that enables citizens to participate in the democratic process.  As James Madison wrote in 1822, ‘A popular government without popular information, or the means of acquiring it, is but a prologue to a farce or a tragedy, or perhaps both.’  That’s why freedom of the press is enshrined in our Constitution.  No other industry enjoys that kind of protection (p. 551-552).

Speaking of the media’s macro-role, Sen. Wellstone concluded that, for America’s “democracy to work, we depend on the media to do two things.  We depend on them to provide citizens with access to a wide and diverse range of opinions, analyses, and perspectives” and, second, “we depend on the media to hold concentrated power—whether public or private power—accountable to the people” (p. 552).  Thus, “greater diversity of ownership and control” confers superior ability among journalists “to perform those functions” which are so vital.  The empirical record for that proposition, admittedly, is mixed – as a 2009 study by Daniel E. Ho and Kevin M. Quinn in the Stanford Law Review found twenty years after Sen. Wellstone’s article was published.  (The question remains an open, hotly debated one, nonetheless, especially among legal scholars.)

Regardless of consolidation’s effects on viewpoints in journalism, the effects on reporters’ professional capabilities—to fulfill the democratic functions outlined by Sen. Wellstone and to highlight, in particular, human rights stories at home and around the world—are less ambiguous.  On the one hand, the renewed implosion of the field has exposed journalists to protracted, targeted, organized abuse online, especially through social media attacks, which journalists have used to share job opportunities and freelance gigs during the cycles of layoffs, and just as often to provide support to or commiserate with former colleagues and other industry peers.  As writer and journalist Maya Kosoff put it in a January 29 tweet, she was “overwhelmed by how helpful and supportive people have been [through Twitter] over the past week” of layoffs, and dedicated to finding ways “to pay it forward” to others in the field.

For present purposes, worries run deeper.  As writer Rebecca Traister put it in a reflective tweet amid the layoff chaos in late January, it is difficult to “fathom the number of talented journalists being taken away from the work they were in the midst of doing this week.  This is a travesty” – and a harbinger of what is to come in the event of further consolidations and layoffs.  To take just one example, BuzzFeed News reporter Mike Giglio—among those who were laid off last month—produced extensive, in-depth stories during his more than five years with the company.  His reporting on U.S. involvement in Syria regularly touched upon the complexities of both foreign policy stratagem and the dire concerns of civilians exposed to human rights abuses.  Last fall, Mr. Giglio perceptively deconstructed the geopolitical morass of the Jamal Khashoggi killing, accounting for the crosscutting interests of Turkey, Iran, Saudi Arabia, and the U.S. with deeply reported interviews and analysis.

After the BuzzFeed News desk was effectively “demolished,” dozens of talented reporters and writers like Giglio are now forced into an unforgiving job market, sitting on dormant stories and leads.  Similar stories at the abovementioned outlets reeling from layoffs—from HuffPo to AOL, Gannett to the more-recent purges at McClatchy—abound.  The gutting of newsrooms around America is a profound pain for writers and their families, personally.  But the ongoing thinning of journalism’s most-talented ranks undermines the whole public’s access to vital information needed to hold human rights abusers to account as well.  The stakes are high.

International Women’s Day: Continuing the Fight while Celebrating the Victories

a picture of Peruvian women in front of a mountain range
Peru. Women in the Colca valley. Source: Pedro Szekely, Creative Commons

Today is International Women’s Day. This year’s theme is “Think Equal, Build Smart, Innovate for Change.” In her context statement about the theme, UN Women Executive Director Phumzile Mlambo-Ngcuka states that the changing world continues to shape the lives of people and “we have to be intentional about its use to positively impact the lives of women and girls. [The theme] puts innovation at the centre of efforts to reflect the needs and viewpoints of women and girls and to resolve barriers to public services and opportunities.” Innovation highlights the game-changers and activists willing to “accelerate progress for gender equality, encourage investment in gender-responsive social systems, and build services and infrastructure that meet the needs of women and girls.” The goal of today is to celebrate the incredible achievements of women and girls who seek to overcome their marginalized status in their communities, level the representation across various academic disciplines and professional fields and undo the cycles of intersectional injustices to bring about a more equitable world.

History

What started as a response to a women’s labor strike in New York 1909 became an international movement to honor the rights of women and to garner support for universal women’s suffrage. In 1913-14, International Women’s Day was a tactic to protest World War I as a part of the peace movement. The UN adopted 8 March as the official date in 1975 during the International Year of Women. Gender equality and the empowerment of all women and girls is Sustainable Development Goal #5 in 2015.

Celebrating some game-changers and activists

The list below is not extensive. Its purpose is to assist you in your search to discover and know what women are doing and have done around the world.

Kiara Nirghin: Won Google Science Fair for creating an orange and avocado peel mixture to fight against drought conditions around the world. She will join Secretary-General António Guterres.

Elizabeth Hausler: Founder of BuildChange.org, an organization that trains builders, homeowners, and governments to build disaster-resistant homes in nations often affected by earthquakes and typhoons.

Jaha Dujureh: Founder of SafeHandsforGirls.org, an organization fighting to end child marriage and female genital mutilation (FGM).

BlackGirlsCode.com: A San Francisco based organization seeking to increase the number of girls from marginalized communities in STEM fields by 2040.

Shakhodat Teshebayeva: When the water crisis threatened her livelihood, she organized and mobilized a women’s group to advocate for a place for women at the discussion table regarding equal access to water.

Mila Rodriguez: Cultivates safe spaces for young people to use music to promote peace in Colombia.

Wangari Maathai: late Nobel Peace Prize Laureate from Kenya who initiated the GreenBeltMovement.org by planting trees for the cultivation of sustainable development and peace.

Next Einstein Forum: Continental STEM forum in Africa

Una Mulale: the only pediatric critical care doctor in Botswana who works to combine medicine and art to bring healing to the body and the soul.

The Ladypad Project

This coming week, Dr. Tina Kempin Reuter and Dr. Stacy Moak will take 12 UAB students to the Maasai Mara in Kenya. The team, in collaboration with the I See Maasai Development Initiative, will fund education on women’s health rights and provide 1500 girls with materials, including underwear and reusable pads, for menstrual hygiene management. The project was awarded a grant through Birmingham’s Independent Presbyterian Church Foundation.

Continuing the Fight

International Women’s Day is not only about celebrating the accomplishments of women and girls, but it is also about shining a light on the continuing injustices faced by more than half of the world’s population. From femicide and early marriage to FGM and sexual violence and exclusion from peace talks, gender inequity discounts the contribution of women and girls to the overall value of humanity. Kofi Annan, the late UN Secretary-General, posited that the empowerment of women proves more effective than any other tool for development. Noeleen Heyzer concludes that although there are women’s issues and rights still to be raised and respected, including those outlined in the Convention on the Elimination of All Forms of Discrimination Against Women, there are many that we must continue to protect. March is Women’s History Month and our contributors will write about issues that continue to impact the lives of women and girls around the world.

 

Health Care Is a Human Right

by Pam Zuber

a photo that reads "Save the ACA."
“Save the ACA”. Source: Creative Commons.

Being sick or struggling with a chronic medical condition can harm health, emotions, and finances. Sickness can hurt various aspects of a person’s life and impact society as well. It causes people to miss days of work. It creates financial costs if people have to cover medical expenses for uninsured people. Isn’t it better to help treat and prevent illness in the first place? One would think so, although some people don’t believe that health care is a fundamental right. But, restoring and maintaining health improves the quality of life and so much more. Ensuring proper health care can produce a healthier, happier, and more productive society.

What are some federal government attitudes about health care?

Attitudes about health care are different in different areas. There are many diverse opinions and proposed solutions regarding health care in just the United States alone. The Patient Protection and Affordable Care Act (also known as the Affordable Care Act, the ACA, and Obamacare) represents a microcosm of this diversity. Although it became law in 2010, the Affordable Care Act has garnered considerable controversy before its creation and continues to generate controversy after its passage. Much of this controversy has coalesced around party affiliations. Some members of the Republican Party have decried the ACA a form of socialism because it’s a federal government program that works with state government programs. In this view, the ACA is un-American because other countries sponsor their own state-funded health care programs.

While not a socialist state, Canada is one such country. According to a Canadian federal government website, “Canada’s publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health systems. Known to Canadians as ‘medicare,’ the system provides access to a broad range of health services.” Canada’s federal government funds, administers and sets policies for this system under legislation known as the Canada Health Act (CHA). The goal of the CHA is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers,” according to the Government of Canada. The CHA thus features complex interactions between federal and provincial governments and the Canadian health care system. This is reminiscent of how the U.S. federal government administers and funds government programs in U.S. states as part of the Affordable Care Act.

How is New York approaching health care?

Federal governments aren’t the only government bodies that feel strongly about health care. In January 2019, the administration of New York, New York mayor Bill de Blasio announced that the city would offer health care for uninsured residents. City residents would pay for health services on a sliding scale. Known as NYC Care, the initiative would provide mental health care and substance abuse care. “We recognized that obviously health care is not just in theory a right,” de Blasio said. “We have to make it in practice a right.” “Health care is a right, not a privilege reserved for those who can afford it,” stated the mayor. “While the federal government works to gut health care for millions of Americans, New York City is leading the way by guaranteeing that every New Yorker has access to quality, comprehensive access to care, regardless of immigration status or their ability to pay.”

Stories about the de Blasio proposal highlighted that this health care would be available to all New Yorkers, even undocumented immigrants. This proposal occurred at a time when immigration was a hotly contested topic. In fact, immigration was so contested that the topic helped spark a partial shutdown of the U.S. federal government in December 2018 and January 2019 because of debate over funding for a wall between the United States and Mexico to prevent illegal immigration. The de Blasio administration’s decision to fund health care for undocumented immigrants reflected the view that health care should be universally accessible to all, regardless of financial cost or political repercussions. In this view, health care is a human right and the right thing to do.

Why is healthcare a right?

Health care is a human right in part because health – or more accurately, bad health – can permeate every area of a person’s life. It can even have repercussions far beyond a single individual. Say a person is struggling with depression. Depression is a mental illness. It’s also physical one since depression can cause pain, other physical symptoms, or conditions such as substance abuse. (Pain and other conditions can cause depression as well, which underscores the importance of treating mental and physical illnesses so they don’t influence each other.) Depression is more than mental and physical pain. It can wreak havoc on other areas of people’s lives. For example, conditions such as depression may prevent people from going to work. If people take frequent absences, their coworkers may have to perform work extra work to compensate for their absent coworkers. Or, taking frequent absences could lead depressed people to lose their jobs. Losing their livelihoods means people may have trouble paying for food and shelter. People without jobs may not be able to support their families. People who are depressed may lack the physical and mental energy to attend parent-teacher organization meetings, to vote, to run for office, to manage their lives, or to contribute to the lives of others. They can’t fully exercise their human rights because they’re struggling to meet their basic needs. Basic access to mental health care could prevent these struggles and ensure basic rights.

What is the status of current health care initiatives?

It’s clear that spending a little money early may prevent future health problems (and possibly save money) in the long run. But, it appears that some entities don’t want to spend money on such purposes. Others have reluctantly, grudgingly accepted health care initiatives. In 2017, the U.S. Congress passed the American Health Care Act (AHCA). This legislation would have prevented Medicare expansion and other aspects of Medicare funding and would have reduced taxes for some insurers and higher income people. The legislation never took effect, so the ACA remained intact. Commentators have noted that despite efforts to reverse the Affordable Care Act, the ACA is “gaining in popularity – despite the repeal-and-replace rhetoric Trump and fellow Republicans have voiced for years.” The commentators note that politicians realize this and are using the increasing acceptance of the program to bolster their own political fortunes. They recognize that gutting a popular program could hurt their own popularity. The administration of U.S. president Donald Trump issued rules regarding the implementation of health care programs in U.S. states in 2018, for example. This acknowledged that the programs exist, serve many people, and are well-liked and well-used by voters who could determine the political future of the administration and its members. The administration’s rules vividly illustrated the old adage, “If you can’t beat ‘em, join ‘em.”

What is the future of health care?

The future of universal health care is uncertain. On one hand, the Affordable Care Act continues. Conservative administrations and everyday voters have acknowledged the ACA and support it to various degrees. There is still considerable pushback to the ACA and similar initiatives, however. Not surprisingly, some of this pushback is from entities that could be affected by universal health care plans or other health care reforms. Private insurance companies often oppose universal health care reforms because they could affect their profits. The companies and other free-market supporters say that universal health care and other reforms are a direct rebuke to capitalism and the practice of small government. The Partnership for America’s Health Care Future is one such opponent. This organization includes a number of private insurance companies and health-related entities. Interestingly, though, it also includes a number of politicians from the Democratic Party and people affiliated with the party, such as workers from the presidential administrations of Bill Clinton and Barack Obama.

On the other hand, this organization is operating at a time when other Democrats are criticizing their fellow party members for not being progressive enough. A number of Democratic candidates running for the U.S. Congress in 2018 supported a single-payer health care system known popularly as Medicare for All to replace private health insurance. A Reuters poll in that same year reported that growing numbers of voters affiliated with both the Democratic and Republican parties also favored Medicare for All-type policies. A growing number of people and some politicians support universal health care. Other politicians and private corporations don’t. Given the increasingly divided political climate, it’s uncertain whether we’ll reach workable decisions about health care any time soon. But, given the far-reaching impact that good health can provide, aren’t they worth a try?

 

Pamela Zuber is a writer and an editor who has written about human rights, health and wellness, business, and gender.

 

Charles Billups: An Overlooked Civil Rights Icon

On Wednesday, February 13th, the Institute for Human Rights co-sponsored an event alongside UAB’s Department of English and the Jemison Visiting Professorship in the Humanities about the legacy of civil rights activist Reverend Charles Billups. The lecture was led by civil rights scholar Dr. Keith Miller (Arizona State University) then followed with a conversation from Billups’ daughter, Rene Billups Baker.

Charles Billups’ was a pastor at New Pilgrim Baptist Church in (Birmingham, Alabama) and one the founders of the Alabama Christian Movement for Human Rights (ACMHR), a faith-based organization addressing civil rights from 1956-1969. Members of ACMHR would meet every Monday night to coordinate boycotts and lawsuits relating to segregation. Billups was a friend of fellow ACMHR member and civil rights icon Reverend Fred Shuttlesworth and was the first person on the scene after Shuttlesworth’s house was bombed. Shuttlesworth would also be the one to drive Billups to the hospital after he was beaten by members of the Ku Klux Klan.

With the civil rights movement facing discouragement nationwide, Billups was chosen by the ACMHR to lead the 1963 Children’s Crusade in Birmingham because he attended all their strategy sessions. During the demonstration, local law enforcement warned demonstrators that if they were to not back down, they would turn the dogs and fire hoses loose. Matching their physical force with the soulful force of civil rights activism, Billups taunted these threats and, as fate would have it, firefighters refused to spray the demonstrators. As a result, the Children’s Crusade, and the larger Birmingham Campaign, become a model for non-violent direct-action protest and overall success for the civil rights movement.

The Salute to the Foot Soldiers (1995), Kelly Ingram Park, Birmingham, AL, USA. Source: Steve Minor, Creative Commons

As a result, this moment had arguably turned to the tide for the Civil Rights Movement, grabbing national attention from the New York Times and galvanizing organizers nationwide. The next year, President Lyndon B. Johnson signed the Civil Rights Act of 1964 which put a legal halt to racial discrimination in educational, employment, and public institutions. Years later, per Martin Luther King, Jr.’s request, Billups would move to Chicago, only to be murdered by an unknown gunman in November 1968; according to Baker, the police didn’t investigate her father’s murder.

After her father’s death, Baker claimed she was angry with the world as well as God; all Baker wanted back was her father. For years, she didn’t even like to murmur the words or discuss “civil rights”. However, through the years, she has learned to forgive and wants younger generations, such as her nieces, to know about her father’s pivotal role in the Civil Rights Movement. With a greater appreciation for her father’s perseverance and sacrifice, Baker closed by saying that he, MLK, Jr., and Shuttlesworth are all smiling down on her agreeing, “She’s alright now”.

Baker’s book, My Life with Charles Billups and Martin Luther King: Trauma and the Civil Rights Movement, can be purchased here.

Predatory Preparers: Exploitation Through Tax Returns

2 tax return forms, a 2018 tax return form and 2017 tax return form, black glasses and a calculator.
2 tax return forms, a 2018 tax return form and 2017 tax return form, black glasses and a calculator. Source: DPP Business And Tax https://www.dpp-businesstax.com/, Creative Commons

For most adults in the United States, the year starts with the tax season.  During this time, they have their tax returns prepared and filed and either pay any taxes they owe or receive a refund if they overpaid their taxes throughout the prior year.  This year, the tax season began on January 28 and continues until April 15.  There are a few different ways one can go about filing their tax return.  One way is to purchase an IRS-approved tax preparation software, like TurboTax or TaxSlayer, and file their return on their own.  One could also prepare their return manually, but the IRS prefers that people file electronically to decrease potential errors.  The last method is to seek out the help of a professional through a commercial tax preparation organization or a non-profit one.  Commercial organizations often take advantage of the low-income filers whose returns they prepare and who often qualify for the Earned Income Tax Credit, which results in a larger refund. 

The Earned Income Tax Credit 

The Earned Income Tax Credit (EITC) provides a subsidy to households with low incomes.  It was created in 1975 with the intentions of temporarily lessening the tax-burden for the working-poor after the 1973-1975 recession.  In 1978, the Revenue Act turned it into a permanent credit.  Since its creation, the EITC has been adjusted many times to make it more effective and requires tax-filers to meet certain criteria to receive it.  Since being implemented, the EITC program has distributed about $67 billion to about 28 million families. 

Qualifications for the credit include being a U.S. citizen or resident alien all year, not being married while filing separately from one’s spouse, having an investment income of $3,500 or less, not being a qualifying child of someone else, and having a valid Social Security Number by the due date of the return.  The amount of money that qualified individuals receive for the EITC depends on factors such as “earned income, gross adjusted income, filing status and whether or not they have a qualifying child.” 

The Problem 

Many people choose to file their taxes through for-profit tax-prep organizations.  These organizations are often concentrated in areas where a large percentage of the population is made up of people with lower incomes who qualify for significant refunds through the Earned Income Tax Credit program.  They prey on the people who need the money from the EITC the most.   

In order to increase their profit, they put a great deal of effort into publicizing their services in a way that overshadows the far less expensive, sometimes even free, methods of filing tax returns.  Paul Weinstein, who co-authored a study on tax preparers with the Brookings Institution and the Progressive Policy Institute, suggests that most taxpayers could “have their taxes prepared for less than $100.”  According to Weinstein, tax-filers spend an average of $275 on the preparation of their taxes during the filing season.  The authors of the study found that individuals filing for the EITC spent $309 in Washington D.C. and $509 in Baltimore.  This means that these individuals were spending between 13 and 21 percent of their return to cover the cost of tax-preparation. 

There has also been evidence that suggests that individuals who qualify for the EITC and file through professional tax-preparers are more likely to have errors in their tax return than those who do not qualify for the EITC.  According to an investigation by the Government Accountability Office in 2015, about 60% of all professionally prepared taxes had errors, while between 89% and 94% of filers who qualified for the EITC had errors in their professionally prepared taxes.  This is a problem of significant concern, since people with low incomes are more likely to be audited by the IRS.  For people who receive the EITC, this could result in their refund being withheld until the end of the auditing process. 

Predatory tax-prep organizations may often go unnoticed, but many are recognized and forced to face the legal repercussions of their actions.  For example, Laquinta Q. Fisher of Lawton, Oklahoma was found guilty of a tax fraud scheme on January 24, 2017.  After lying to her clients and telling them that they could receive a refund for simply having a dependent child, she added fake income and fake dependents to their returns to increase their EIC.  She “was sentenced to 18 months in prison, three years of supervised release, and ordered to pay $133,955 in restitution to the IRS…” 

Scrabble pieces spelling out "Earned Income Tax Credit."
Earned income tax credit stock photo. Source: Simon Cunningham, Creative Commons

Signs of a Predatory Tax-Prep Organization 

There are a few warnings signs you may want to look out for if you are concerned that a tax-prep organization may be predatory.  Since these groups target low-income tax return-filers, they often tell potential clients that they can promise them a large refund.  One red flag to watch for is if a preparer is being paid based on a percentage of the refund their client receives.  They have a clear source of motivation for trying to increase the refund.   

It is also possible that such an organization would have false credentials.  Every tax preparer is legally required to have a Preparer Tax Identification Number (PTIN).  The IRS has a directory of PTINs that can be used to look up a preparer with their name and location.  The PTIN can tell you if the preparer is “a certified public accountant, enrolled agent or a lawyer.”  It is also important to note that the directory does not prove that a preparer is qualified.  It is also a red flag if an organization suggests that they are endorsed by the IRS, as the IRS does not endorse any tax preparers. 

Another warning sign is if a preparer does their work in “temporary pop-up shops” that will be gone after the tax season ends.  In that case, there is no office for you to go to if any problems arise with your tax return.  It is a red flag if the preparer says that they will deposit you refunded into their bank account or asks you to sign a return that is incomplete.  

Why Is This A Human Rights Issue? 

In addition to being ethically questionable, the actions of commercial organizations that prey on low-income households also have the potential to negatively impact people’s access to their human rights.  For many people who are targeted by these organizations, every single dollar counts.  Every penny of the tax refund they receive is used to pay for the necessities, like food, water, power, rent, and clothing.  According to Article 25 of the United Nations’ Universal Declaration of Human Rights, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services…”  Many households rely on the refund they receive to access this right.  It is important that we spread awareness of this issue so we can prevent as many people as possible from being exploited by tax-prep organizations and connect them with the resources they need. 

Impact America: SaveFirst 

Impact America, originally Impact Alabama, is a non-profit organization that was founded to develop “substantive service-learning and leadership development projects for college students and recent college graduates.”  SaveFirst is one of Impact America’s programs, which provides free tax preparation services in communities which are often targeted by predatory tax-prep organizations.  College students who volunteer with SaveFirst are trained and IRS certified to prepare tax returns.  In 2018 alone, SaveFirst was able to prepare tax returns for 13,713 families and saved those families $5.5 million in fees.  Since 2007, they have prepared returns for 76,867 families and saved them $26.2 million.  The work done by Impact America helps to decrease the number of people that are being exploited by predatory organizations by giving them access to much better resources and services. 

If you are interested in scheduling an appointment with SaveFirst at one of their many tax-prep locations, you can do so here. 

 

Health & the Black Body

A black woman expresses surprise
Pop Art Explanation Explain by JanBaby, Creative Commons

Introduction

The field of medical anthropology is charged with exploring how cultures determine health outcomes and how health determines culture within a given population.  Culture is here defined here as the continuous process by which humans create and communicate shared values, customs, and knowledge within a society; health is here defined as the state and process by which an individual promotes well-being and quality of life.  Medical anthropology is especially interested in marginalized populations, exploring how these groups both suffer from health disparities and overcome these disparities through culturally-particular sources of resilience and strength.  At the core of medical anthropology’s exploration is the concept of our three ‘bodies’: (1) our physical body, i.e. the body of lived experiences; (2) our social body, i.e. how culture symbolizes and represents our personhood; and finally (3) our body politic, i.e. how our bodies are regulated, surveilled, and controlled over our lifetime (Scheper-Hughes & Lock, 1987). Individuals suffering from any form of violence (direct, indirect, and / or structural) typically suffer worse health outcomes, unless other protective factors (e.g. resilience, medical intervention) can transform this violence.

Of particular importance within the American ‘health culture’ is that of black bodies – how Americans of African descent suffer from higher rates of diseases, illnesses, and sicknesses than their counterparts from European descent.  This health-based intersection of nationality, ethnicity, and violence is not only a concern of medical anthropologists – many other academic disciplines are working hard to predict, control, and prevent health disparities within Americans of African descent.  For example, I currently manage a health and clinical psychology laboratory at UAB under the direction of UAB Psychology professor Dr. Bulent Turan.  Our lab explores the biopsychosocial burden of stigma on health outcomes in African American populations.  The question of how culture enacts stress, trauma, and negative health outcomes in minority populations, and how to prevent this from happening in the future, is a huge task – first undertaken by medical anthropology, now including diverse fields such as health psychology, public health, neuroscience, peace and conflict studies, and medical sociology.  In honor of Black History Month, this blog post explores how cultural prejudice and hate quietly kills Americans of African descent.

The Allostatic Model of Stress
The Allostatic Model of Stress, Author’s Collection

Allostasis and Structural Violence

One of the most prominent and empirically-validated theories to explore the relation between culture and health is that of allostasis, first proposed by Drs. Peter Sterling (a neuro-biologist) and Joseph Eyer (an epidemiologist) in 1988.  These scientists and their research team sought to explain how stressful life events impact an individual’s health, first drawing on Walter B. Cannon’s famous dictum of homeostasis– the idea that our bodies attempt to ‘correct’ itself in response a changing environment. Homeostasis explains why, when you step outside on a cold day, that your body begins to sweat to cool you down. However, Sterling and Eyer ran into an obstacle with homeostasis.  Individuals react widely differently to physiological stress, and Cannon was unable to explain why this might be the case.  Sterling and Eyer proposed that stress over the lifetime creates ‘wear and tear’ within our bodies – higher amounts of stress (for example, chronic stress resulting from racial discrimination) create a higher allostatic load(AL). High allostatic load, according to Sterling and Eyer’s research, results in symptoms including:

  1. High blood pressure / hypertension
  2. High levels of fatty deposits in our blood stream
  3. Blood clotting
  4. Atherosclerosis (hardening and narrowing of arteries)
  5. Suppression of our immune response system
  6. High demands of oxygen by our heart
  7. Having a stroke
  8. Congestive heart failure / heart attack

Allostatic theory (and subsequent empirical support) is quick to add that not all stress is damaging to an individual – eustressoccurs when challenging life events actually make us stronger (for example, the stress your body endures during a challenging workout at the gym).  However, chronic and unpredictable stressors are embodied and produce the aforementioned health concerns (this kind of stress is called distress).  Therefore, it may be assumed that individuals at a high risk of distress over the lifetime are placed at high risk for negative health outcomes, ranging from momentary physiological arousal to premature death.

A primary driver of chronic, unpredictable distress is structural violence, defined by Galtung (1969) as cultural inequalities (especially lack of access to power) preventing individuals from reaching their full potential. Structural violence is often difficult to pinpoint because there is no one culprit – no one person is responsible for unequal access to healthcare for Americans of African descent; our social system itself is configured to place minorities at a greater risk for distress and lower health outcomes.  Farmer (2004) correctly locates several insidious causes for structural violence across cultures, citing historical factors, political forces, latent racism and other forms of unconscious bias, and economic orders as a few examples.

To summarize, here are the takeaways of the complex relation between allostatic theory and structural violence:

  • Vulnerable populations have unequal access to power within a society.
  • These populations experience distress due to this unequal access.
  • Chronic distress manifests in the physical bodies of these populations, leading to high allostatic load.
  • High allostatic load results in health disparities.
  • These health disparities go unaddressed due to unequal access.

While indeed tautological, this feedback loop illuminates the vicious cycle many Americans of African descent embody – bodies unjustly assailed and structures unfairly positioned.

A conceptual map, noting five impacts on human health: individual behavior, social circumstances, genetics and biology, medical care, and physical environment
Social Determinants of Health Map by Jsonin, Creative Commons

Black Bodies & Intervention

As previously mentioned, many medical anthropologists conceive of three ‘bodies’ of health: physical, social, and political. The relative health of these bodies acts on one another; it is therefore paramount to address health promotion in a holistic fashion – not only ‘curing the disease’ but also disarming cultural forces that predisposed disease in the first place.  Below, I organize threats to and interventions for health in Americans of African descent, according to their physical, social, and political bodies.

Physical

Physical bodies are the stuff of muscles, of skin, of blood.  For Americans of African descent, population-level physical health and wellbeing is simply incomparable to Americans of European descent in major ways, including: higher rates of diabetes; of hypertension; of coronary heart disease; of cardiovascular disease; of prostate, lung, and breast cancer; and of asthma-related death.  Furthermore, American adolescents of African descent suffer disproportionally from sexually transmitted infections.  The infant mortality rate of these Americans is approximately three times higher than infants born to American mothers of European descent.  Geronimus, Hicken, Keene, and Bound (2006) demonstrated Americans of African descent experience higher allostatic load than other Americans, controlling for demographic variables, such as education and poverty levels.

According to a systematic review by Crook et al. (2009), there are a few promising avenues for intervention to address physical health in Americans of African descent.  These include placing health centers within communities of marginalized populations, using trained volunteer community health workers, and hiring nurses from within the communities of these populations.  Additionally, ‘traditional’ healthcare settings (i.e. hospitals) are not necessary to delivery physical health interventions; these interventions can be administered in community centers.  Of critical importance here is self-representation – members of marginalized communities empathize with and deliver quality care to members of other marginalized communities.

Social

Our social bodies are reflective of cultural norms, symbols, and values.  This body may be conceived of as psychosocial experiences. Our social body is maintained by the attitudes other people have about us.  In the case of Americans from African descent, bias, prejudice, and discrimination oftentimes characterize their social body.  Clinical-community psychologist Dr. Lyubansky of the University of Illinois at Urbana-Champaign, is quick to assert that this phenomena looks like “racism not always by racists”.  In line with allostatic theory, chronic and unpredictable experiences with bias and discrimination induces stress; which, again, causes stress and disease.

Dr. Janice Gassam, applied organizational psychologist, draws on scientific and popular literature relating to social stigma and discrimination and recently published a short guide to disarming unconscious bias.  First, we must be aware of our biases; one way to do this is by taking Harvard’s Implicit Association Test.  Next, members of majority or privileged populations must make a long-term commitment to reducing bias; this phenomenon will not happen overnight.  Next, specific behaviors related to bias must be neutralized; this includes unfair hiring practices and medical maltreatment.  Finally, Dr. Gassam asserts that teamwork with members of minority populations can fundamentally disarm cultural bias – evidenced by Edward B. Tichener’s and others’ research on the Mere Exposure Effect.

Political

Finally, the body politic refers to the relation of an individual and her or his political milieu, specifically how the human body is a political tool.  The relation is bidirectional as it relates to health and medicine: bodies are both governed by political decisions while also exerting power over the political process. Some bodies (and their corresponding health or otherwise) are prioritized within a political system; other bodies are ignored or violated.  A striking example of the violation of political bodies in American culture is voter suppression; we may look to the recent Georgia gubernatorial election and the myriad audacious tactics to keep Americans of African descent out of the voting booth.  If individuals cannot vote for policies that may benefit their physical and social health, these individuals do not have political health.

Within the context of the United States of America, voting behavior is the primary way disenfranchised individuals exert political control; it is therefore paramount to empower minority voters so these individuals may elect leaders dedicated to championing causes related to health promotion within marginalized communities.  The think-tank Center for American Progress offers five ways to protect the votes of Americans of African descent: (1) eliminate strict voter ID laws; (2) prevent unnecessary poll closures; (3) prohibit harmful voter purges; (4) prioritize African American voters in political outreach; and especially (5) recruit African American candidates for political office.  Marginalized Americans must be able to vote for policies and representatives that can break the health disparity cycle.

Conclusion

Observing, predicting, preventing, and controlling health disparities within marginalized populations is an immensely complex issue. As stated in the beginning of this post, medical anthropologists take a cultural standpoint to examine these issues; one prominent theory in this discipline is the systematic examination of ‘bodies’ – how these bodies are affected by health and disease alike. Other fields, such as health psychology, take a more empirical approach – locating specific points of intervention within an individual’s biopsychosocial health processes.  This post combines these approaches, explaining how health deficits arise within the communities of Americans of African descent, utilizing allostatic theory and structural violence.  To reduce these health disparities, chronic stressors and structural barriers plaguing these communities must be transformed.  This transformation begins by accepting a simple fact about black health: the stress from hate can kill you.

References

Crook, E. D., Bryan, N. B., Hanks, R., Slagle, M. L., Morris, C. G., Ross, M. C., Torres, H. M., Williams, R. C., Voelkel, C., Walker, S. & Arrieta, M. I. (2009). A review of interventions to reduce disparities in cardiovascular disease in African Americans. Ethnicity & Disease, 19(2), 204-208.

Farmer, P. (2004). An anthropology of structural violence. Current Anthropology, 45(3), 305-325.

Galtung, H. (1969). Violence, peace, and peace research. Journal of Peace Research, 6(3), 167-191.

Geronimus, A. T., Hicken, M., Keene, D. & Bound, J. (2006). “Weathering” and age patterns of allostatic load scores among black and whites in the United States.American Journal of Public Health, 96(5), 826-833.

Scheper-Hughes, N. & Lock, M. M. (1987). The mindful body: A prolegomenon to future work in medical anthropology. Medical Anthropology Quarterly, 1(1), 6-41.

Sterling, P. & Eyer, J. (1988). “Allostasis: A new paradigm to explain arousal pathology” in S. Fisher and J. Reason (Eds.) Handbook of Life Stress, Cognition and Health. Hoboken, NJ: John Wiley & Sons.

Policing Our Imagination

a Black Lives Matter sign
Ferguson Solidarity Washington Ethical Society. Source: Johnny Silvercloud, Creative Commons

On Thanksgiving evening, while many of us were still enjoying or recovering from a day of family and feasting, Emantic Bradford Senior – who is currently battling cancer – was waiting for his son EJ to come help him with his chemo medicine. “He was my best friend,” Senior says, “and my nurse. He treated me like I was his kid.” As EJ got ready to leave his father’s house that night, Senior, as he always did, asked his son if he needed any money. EJ was on his way to join eager Black Friday shoppers at the Galleria in Hoover. Late that night, Senior’s stepson woke him up. “You talked to EJ?” he asked. “Not since he left the house,” Senior responded, rousing himself. He showed Senior his phone, opened to a video posted on Facebook depicting a chaotic scene at the Galleria, shoppers running and screaming in panic. At this point, the Hoover Police Department had released a statement that there had been an altercation at the shopping mall around 10:00 PM and that police had shot and killed the instigator as he fled the scene. We’re “very, very proud” of the response of our officers, the statement said, for “engaging the subject and taking out the threat.” It was 12:30 AM. Emantic Bradford Junior – EJ – had been dead for two and a half hours at this point, but this would not be confirmed to the family until the next morning. Seeing the social media reports, Senior immediately called the Hoover PD to ask if the police had killed his son. “We’ll call you back in 10 minutes,” they told him. Ten minutes went by, no phone call. Senior called back. Again, “Someone will have to call you back.” This went on for a while until Senior finally demanded to know if that was his son – lying lifeless and uncovered on the cold, white floor – in the photos on Facebook. “I’m sorry, sir, I can’t give you any information at this time. You’ll have to call the county.” In frustration and terror, Senior calls the county police – he is put on hold, transferred, put on hold again, until finally a man gets on the line and confirms that yes, EJ is dead. Several hours go by, and the Hoover PD releases another statement: we got the wrong guy. 

EJ had been shot and killed by a police officer who wrongfully assumed that he was the person instigating violence at the mall that night. In the precious hours between the police department applauding the officer’s “heroic” actions for stopping a violent crime and admitting that EJ “very likely wasn’t the shooter,” EJ’s image was misconstrued and misrepresented in the news and on social media – at first, to fit the profile of a killer, and later, as someone who made some bad choices that resulted in his untimely death. There was a desperation to prove that this situation was different, that it was an isolated incident, and that it did not serve as an example of police brutality against people of color. A narrative about EJ’s life and the circumstances of his death was planted, one that justified the officer’s actions and placed the blame on EJ himself. And this is where we end up:

EJ had a gun.

Right…and Trayvon Martin was wearing a hoodie. Eric Garner was hustling cigarettes. How could we know that Tamir Rice was holding a plastic toy and not a real gun? And maybe the most egregious justification of all: Michael Brown “looked like a demon.” There is always some way to extract the wrongful killing of a black man by police officers from the systemic problem of police brutality. There is always something we can point to and say well, this had nothing to do with skin color and everything to do with…fill-in-the-blank. 

But let’s be clear: EJ wasn’t shot because he was carrying a gun (which he was licensed to own and trained to use). EJ was not perceived as a “good guy with a gun.” EJ didn’t brandish a weapon in the sense of acting threateningly with it. He didn’t have to – he was the weapon. And the words of Claudia Rankine ring in our ears:

“Because white men can’t

Police their imagination

Black men are dying”

The unnamed officer didn’t regard EJ as a person in that moment but as a black man with a gun, which in his imagination and under Alabama law, justified three shots to the back, ending EJ’s life. But we can’t help but wonder – to appropriate Matthew McConaughey’s powerful line in A Time to Kill – what would have happened if EJ were white. Even mass shooters – who are nearly always white – are often apprehended by police officers without being harmed. When they do die, it’s usually because they take their own lives. For example, after he opened fire on unsuspecting worshipers at the Emanuel AME Church in Charleston, police chased Dylan Roof through two states before they caught him and took him to Burger King to get something to eat. Travis Reinking had a history of mental illness, had threatened violence multiple times, his many firearms had been confiscated – and then returned – before he walked into a Waffle House and shot four people. “He just didn’t seem like a violent person,” one coworker said of Reinking, joining with others who insisted that he was “intelligent and polite.” Reinking fled the scene, and officers chased him into the woods before he was apprehended unharmed. At a movie theater in Aurora, police mistook James Eagen Holmes for a fellow officer because of “the tactical clothing he was wearing.” In other words, he looked like them. But one look at EJ Bradford, and that was it. A black man holding a gun, standing near the victim…bang, bang, bang.  

I imagine that police officer didn’t walk into that shopping mall that night intending to kill a black man. The nature of the situation forced him to make a snap judgement, and according to the official report, it took about three seconds to assess the situation, identify EJ as the target, and take him out. And it wasn’t until his family started demanding answers that they even questioned whether or not they had gotten the right guy. Ultimately, it was concluded that the officer “reasonably exercised his official powers, duties, or functions” when he fired those shots. And in a legal sense, it’s hard to argue with that. But we need some context here – there is a larger problem that must be addressed.

a cardboard sign that reads "We're not anti-police, we're anti-police brutality"
We’re Not Anti-Police, We’re Anti-Police Brutality. Source: Jagz Mario, Creative Commons

The lives of black people in the United States have been and continue to be conditioned and defined by violence – structural, institutionalized, everyday violence and brutal retaliation by the state and other groups against their demands to be seen and heard and regarded as human. Black bodies are weaponized in the popular imagination, associated with crime and danger, and the full participation of black people in society is subjugated by a collective consciousness that centralizes whiteness and systematically excludes people of color. The truth is that compared to white people, people of color are disproportionately killed by police officers in the United States. This is not because all white police officers are explicitly racist but because of where we hold space for black bodies in our broader cultural ethos. What gives police brutality its life force is the same thing that makes it harder for black people to buy houses, get into college and acquire health insurance. This refined yet insidious form of racism resides deep in our collective consciousness, and it engenders the unspoken but deeply felt sentiment that non-whites are threatening and dangerous, that we need the state to protect us from them. 

And where does this come from? When slavery ended, the South (and eventually the rest of the country) adopted slightly more palatable systems of subjugation and discrimination against the newly freed citizenship. The preservation of the white male patriarchy depended on one thing – fear. As long as white people continued to be terrified of black people, white supremacy reigned unimpeded. Over time, laws ensuring civil rights and protections for people of color were slowly updated and selectively enforced. To be sure, these were victories. Progress, however, is not a zero-sum game. As overt ideals and expressions of racism were put asunder on paper, they didn’t go away. Instead, they burrowed down deep inside of our subconscious. On the surface, we developed new ways of explaining the unequal distribution of resources and power and opportunity without ever outwardly implicating skin pigmentation. We relegated black people to conditions of poverty, denied all but a few access to the middle class, and then blamed those left behind for bringing about their own woes. We associated violence in black communities not with poverty and lack of access but with blackness itself. We moved black bodies from the plantation to the prison system, once again denying them their freedom, but this time blaming them for it. Not all of them, of course, but enough to sustain the image and the fear.

Shop owners at the Galleria will tell you that there is a “black” side and a “white” side of the mall. Where do you think the police presence was concentrated that night? When it comes to spaces occupied by black bodies, the police force tends to emphasize the “force” over the policing. And yet…“You just don’t bring guns into a crowded mall,” the Hoover mayor admonished in his statement about the wrongful killing. How ironic. Okay, Mr. Mayor, tell that to the NRA. Better yet, if that’s such an obvious unspoken rule, try to make it a law in Alabama and see how far you get. At the very least, say what you mean: if you’re black, don’t carry a gun into a shopping mall. Because for people of color, certain constitutional rights must be qualified.

This is refined racism: when white people hear of the wrongful killing of a black man by police officers, we latch on to some element of the story that distracts us from the color of the victim’s skin and emphasizes some other factor that explains the officers’ actions. Rather than trying to understand what it means to be a black person in this country, to confront our own implicit biases and to acknowledge our complicity in upholding a racist social order, we look for something, anything, to assure ourselves that this was an isolated and unavoidable incident (at least on the part of the officer). In doing so, we sustain the devaluation of black bodies and black minds and justify the power of the state to marginalize people of color, to treat them as an inconvenience and to perceive them as a threat that needs to be neutralized by whatever means necessary. In situations like this, that is where our minds naturally go. We make our excuses, we qualify our apologies, we blame the victim. The story gets whitewashed. And just like that, Trayvon’s death, Philando Castille’s death, EJ’s death are their own faults.

So how do we change this reality? It is going to take more than providing courses to police officers on racial sensitivity and limiting the use of force. If we truly want to live in a world where the state treats people of all skin tones equally, white people must police their imaginations. We must actively work to decentralize whiteness, aggressively refute the narrative that people of color pose a threat to our society, and unequivocally demand that they be protected rather than forcibly policed. The political justice system won’t change until our collective consciousness changes, until we break ourselves of false equivalencies and false associations around blackness, until we recognize what the enduring legacy of slavery and centuries of subjugation and oppression have done to individuals and families and communities, until we give the black man a chance to be the good guy. We are all stakeholders in this process; if we’re going to move forward as a society, we have to do it together.

The Galleria reopened at six o’clock the next morning, as scheduled, because consumer capitalism can’t be bothered by the death of a black man. The Christmas shopping season went ahead full stride, while Emantic Bradford Senior was left to mourn the death of his son, to contend with his disease alone, to wallow in the pain of never again getting to hear his son call him ‘daddy.’ After two months of investigation, the Attorney General of Alabama ruled that the nameless officer who shot and killed EJ was “justified” in doing so. Under Alabama law, no crime was committed. But EJ’s mama, April Pipkins, leaves us with an important question: “If this happened to your child, would you still call it justice?”

The answer is no, you would call it murder.