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A‌ ‌Measure‌ ‌of‌ ‌Failure:‌ ‌Maternal‌ ‌Mortality‌ ‌in‌ ‌the‌ ‌US‌ ‌ by‌ ‌Paige‌ ‌Kelleher‌

In order to measure a system as large and multi-faceted as the American healthcare system, it takes a multitude of indicators asking essentially the same question: in this area, are we failing or are we succeeding? Maternal mortality rate, or the rate of women dying in childbirth or from pregnancy-related causes, is an example of one such indicator. It’s also an example of a question where the answer is clear that not only are we failing, but also, that our failure is only getting worse. In order to address this problem in its entirety, we must first evaluate it, both for white women and also for the women of color who are disproportionately affected by it. Then we will examine the system-wide pitfalls that have become the causes for maternal mortalities, and finally see what it takes to rebuild the system to achieve its end success: benefitting and saving the lives of mothers of all races. 

According to the World Health Organization, Maternal mortality is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy…but not from accidental or incidental causes.” Maternal mortality rate is normally measured within 100,000 live births. So, when it comes to maternal mortality rate, how does America stack up? Among western countries, not well. According to a 2018 report from the Centers for Disease Control and Prevention’s National Vital Statistics System, nearly 18 in every 100,000 live births resulted in a maternal mortality; that’s 658 women in 2018 alone. Internationally, the United States is ranked 55th. Out of 10 similarly wealthy and developed countries, the US is ranked 10th. And out of those, America is the only developed country in which maternal mortality rate is actively rising. 

The chart shown, published by the Lancet, records unofficial data from 1990, 2000, and 2015 in the number of deaths per 100,000 live births.

But are these rates the same for women of all races? The same statistics from the CDC’s National Vital Statistics System found that “the maternal death rate for black women was more than double that of white women: 37.1 deaths per 100,000 live births compared to 14.7.” These statistics prove that this isn’t just a health crisis; it’s also one of the widest racial disparities in the United States. According to the CDC, “a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes” (Martin, ProPublica). 

But why is this? Why is infant mortality the lowest it’s been in fifty years, and maternal mortality rate the highest? And why is it so much worse for women of color? The answer is as complicated and multifaceted as the American healthcare system itself. 

First, there’s an unfortunate lack of understanding of the indicators for common pregnancy related complications. While infant death is on the steady decline due to nationwide narrowed, specific care, maternal mortality is on the up: “in the last decade or so, at least 20 hospitals have established multidisciplinary fetal care centers for babies at high risk for a variety of problems. So far, only one hospital in the U.S. — NewYork-Presbyterian/Columbia — has a similar program for high-risk moms-to-be” (Martin, NPR). And the lack of these programs have lasting effects; researchers at the California Maternal Quality Care Collaborative, who spent years studying preeclampsia, a very common complication in maternal mortality, found that “despite triggers that clearly indicated a serious deterioration in the patient’s condition, health care providers failed to recognize and respond to these signs in a timely manner, leading to delays in diagnosis and treatment.” (Martin, NPR) 

But complications like preeclampsia are not widely known due to the second issue with maternal mortality rate in the US: lack of reporting. The statistics mentioned before from the CDC’s National Vital Statistics System are the first since 2007, and are still yet purported to be majorly conservative. The system for keeping track is left to a single checkbox on the death certificate, and even then, it’s handled by states who didn’t adopt the checkbox all at once. 2018 was the first year that all states reported and required a comparable check box. In England, where preeclampsia deaths are less than one a year, “maternal deaths are regarded as systems failures. A national committee of experts scrutinizes every death of a woman from pregnancy or childbirth complications, collecting medical records and assessments from caregivers, conducting rigorous analyses of the data, and publishing reports that help set policy for hospitals throughout the country” (Martin, NPR). In the US, this is settled on a state basis, if at all.

The third reason is perhaps the most problematic – and human – of them all. It is also the most deadly for women of color: implicit bias. According to the American Bar Association, “there is little reason to believe that physicians have not been exposed to the negative narratives about racial minorities that circulate in society—discourses that become the stuff of unconscious negative attitudes about racial groups.” So much so that “providers are less likely to deliver effective treatments to people of color when compared to their white counterparts—even after controlling for characteristics like class, health behaviors, comorbidities, and access to health insurance and health care services.” (American Bar Association) Serena Williams, world famous tennis player, winner of 23 Grand Slam singles titles, and black woman, dealt with this firsthand with the birth of her daughter Alexis in 2017. The day after giving birth, she noticed a peculiar shortness of breath. Due to her known history of blood clots, she requested a CT scan with contrast and blood thinner right away. However, the nurse “thought her pain medicine might be making her confused…‘I was like, a Doppler? I told you, I need a CT scan and a heparin drip’…The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs” (Haskell). For Black, Latino, and Indigenous women, these incidents aren’t as rare as they should be, and often with fatal consequences.

So where do we go from here? The CDC Foundation of Maternal Mortality Data used data from four states to find more than 20 “critical factors” that contributed to pregnancy-related deaths. According to this, “the average maternal death had 3.7 critical factors.” It would be foolish to put blame on any one of these problems as the sole cause for such a high maternal mortality rate in America. Instead, it’s imperative we attack these issues across all fronts. Approaching maternal mortality as the systematic health crisis that it is might open doors and opportunities for better research, identification, and diagnosis of common fatal pregnancy related complications. Comprehensive and accurate reporting with thorough investigations will make it easier to recognize the common factors of maternal mortality and diminish them. And finally, attacking the personal and systematic implicit biases in our entire health care system, such as “policies that make public health insurance unavailable to undocumented immigrants as well as documented immigrants who have been in the country for less than five years” will fully equip our systems to serve, protect, and save women of all races. (American Bar Association)

In a time when women’s reproductive health is on the ballot year after year, it’s important to recognize our goals. If it is true that we are actually concerned about saving human lives, then it is important that we redirect our attention to the crisis: admitting to American mothers that we are failing them, and admitting to ourselves that it’s time to do better. Then, doing better. 

Author: Paige Kelleher

Citations

Belluz, Julia. “We Finally Have a New US Maternal Mortality Estimate. It’s Still Terrible.” Vox, Vox, 30 Jan. 2020, www.vox.com/2020/1/30/21113782/pregnancy-deaths-us-maternal-mortality-rate.

Haskell, Rob, and Photography by Mario Testino. “Serena Williams on Motherhood, Marriage, and Making Her Comeback.” Vogue, www.vogue.com/article/serena-williams-vogue-cover-interview-february-2018.

“Implicit Bias and Racial Disparities in Health Care.” American Bar Association, www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/.

“Maternal Mortality Ratio (per 100 000 Live Births).” World Health Organization, World Health Organization, 11 Mar. 2014, www.who.int/healthinfo/statistics/indmaternalmortality/en/.

Nina Martin, ProPublica, and Renee Montagne. “The Last Person You’d Expect To Die In Childbirth.” NPR, NPR, 12 May 2017, www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger.

Nina Martin, ProPublica. “Nothing Protects Black Women From Dying in Pregnancy and Childbirth.” ProPublica, www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth.

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Immigration and the 2020 Presidential Election by Idan Kashani

As the 2020 presidential election edges closer, the question of immigration is more decisive than ever. Since his inauguration in 2017, Donald Trump has proven to the American people and to the world that he does not care about human rights, especially those of immigrants coming to the United States of America. He has consistently disrespected and dehumanized the undocumented immigrant community, calling them rapists, drug dealers, and criminals. Trump fails to recognize the contributions all immigrants, documented and undocumented, make to the American economy and society every day. According to the nonpartisan Congressional Budget Office, undocumented immigrants pay an estimated 7 billion dollars into the social security fund annually, money that they will never benefit from due to the administration’s discriminatory immigration policy that is harmful to the economy and society of the United States.

At the border, refugees from Central American countries fleeing gang violence, poverty, corruption, and threats to their lives are having their children stripped from them and are being held in inhuman conditions that have no place in a developed country. ICE has been given the power to mentally and physically torture refugees, and is not being held accountable for sexual crimes committed by its employees. From 2014 to 2018, a total of 4556 allegations were made by immigrant children put in concentration camps of sexual harassment by ICE agents and employees in the camps. President Trump has refused to take action against ICE over their gross abuses of authority.

Beyond the border, ICE has transformed from an agency responsible for tracing and capturing dangerous foreign individuals and harmful goods that entered the country to a secret police that uses fear, intimidation, violence, and profiling to oppress immigrant communities and tear families apart. ICE raids target neighborhoods based on racial and socioeconomic profiling, and as a result lower income neighborhoods with significant nonwhite populations routinely deal with ICE agents knocking on their doors demanding to be let in despite not having any form of warrant nor probable cause. Immigrants are also targeted at work, while shopping, and in their cars. The judicial system in the United States has always operated on the basis of innocent until proven guilty, but ICE regularly detains US citizens and legal residents on the basis of their race or occupation and forces them to prove that they are, in fact, in the United States legally. This goes against everything we, as Americans, stand for, and everything that the founders of the country fought for over 244 years ago when we declared our independence from British tyranny.

Through his actions against immigrants in the United States and his white supremacist rhetoric, incumbent President Donald Trump has clearly communicated to us his dislike for immigrants and his love of Neo-fascism. Unfortunately, the Democratic establishment sabotaged Senator Bernie Sanders’s 2020 presidential campaign in order to preserve their corruption and the interests of the American oligarchy. Bernie Sanders was championing a breakthrough immigration plan that would humanize immigrants in the USA and recognize our need for immigration in our country. His plan was the most progressive of all the democratic candidates and was our preferred immigration plan here at the Monarch Project. However, Joe Biden’s immigration plan, the full text of which is available at his website, includes a reversal of Trump’s restrictive asylum policies, provision of aid to those stuck at the border, the end of excessively long detention and investment in an efficient case management system, reversal of the public charge policy, protection of dreamers, and the termination of the Muslim Ban. In November, we must stand up and vote Donald Trump out of office to protect the immigrants in our communities and at the border. While we do not agree with Joe Biden on many matters, the consensus on immigration is a clear one.

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COVID-19 & its socio-economic & racial consequences by Aarav Dubey

Originating in Wuhan, China, the novel coronavirus (COVID-19) has taken the world by storm. The respiratory virus spreads through highly infectious droplets, having caused more than 1.4 million cases world-wide in 185 countries as of today 7th April 2020. The Johns Hopkins COVID -19 page provides updated data regarding infections, deaths, and recoveries.

Labelled a global pandemic by the World Health organization (WHO), the virus unfortunately also gave rise to severe socio-economic problems in economically weaker communities. The 2018 income and poverty data from the Census Bureau around 12% of the US population are living in poverty– clearly suggesting that poverty clusters are concentrated in the communities of color, people with disabilities, and the elderly. Since the elderly are at a great risk from the disease, a person’s economic wellbeing is directly proportional to their capability to access essential items and survive the severe medical conditions. 

This is observed in the USA and all across the world as low-income individuals and families face significant challenges that prevent them from protecting themselves and others from COVID-19. This is solely because they are not in a position to stay put at home and provide basic amenities for their families. Low-income workers do not have liberty to work from home and keep their jobs as most of them are hired for blue-collar jobs, reports CNBC. An added consequence of this is the lack of disposable income these households have: leaving their housing security at risk and them jobless  reports Washington post. Facing this unprecedented situation, they are forced to choose between paying for food, health care, and other necessities or keeping up with rent; this puts their housing situation in great jeopardy, resulting in either homelessness or without necessities, putting them in a position of vulnerability during this pandemic.

Coronavirus, however, is not responsible for all the damage dealt in this situation, for we are letting the threat of this virus divide us. The pandemic is affecting certain individuals more than others, stirring up a mix of fear and hatred within the populous. “The virus is not doing the dividing,” said Professor Jason Beckfield, sociology department at Harvard University. “The dividing is a function of what people are choosing to do with the virus. People are able to shift blame away from themselves or shift blame onto people they dislike.” Coronavirus has been used to scapegoat people of Chinese origin around the world. Phrases like ‘Chinese Virus’ and ‘Kung Flu’ have become trending on Twitter. This pandemic has also escalated tensions between generations, with some younger people referring to the deadly virus as “#BoomerRemover” since it impacts them the greatest.

The aggression towards Asian individuals has been noticed around the globe through countless reported incidents of aggression. From refusing to sit next to Asian individuals on public transport, to incidents of verbal and physical attacks, the fear of the virus has consumed people around the world with hatred. One such scenario follows a Japanese singer in Italy, who was “evaded in Milan, made terrible gestures on the train, and directly ranted at.” In another incident, Jonathan Mok reported pictures of his bruises from being assaulted in London. He reports having been kicked in the head and told “I don’t want your coronavirus in my country.” In a few places across Thailand, South Korea, Vietnam and Italy signs have been put up forbidding Chinese people from entering restaurants and shops.

To combat the stigma and xenophobia surrounding the COVID-19 outbreak, it’s now more important than ever for us to collectively take responsibility to combat and raise our voice against such discrimination. Institutions like the World Health Organization (WHO) and the Center of Disease Control (CDC) have put out accurate information through pamphlets and articles with the intent of fighting the stigma against people of Asian descent. The CDC website even states that “diseases can make anyone sick regardless of their race or ethnicity.” The WHO writes that “stigmatization could contribute to more severe health problems, ongoing transmission, and difficulties controlling infectious diseases during an epidemic.”

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ICE Raids in Sonoma County – A National Threat Localized

Ever since his inauguration in 2017, president Donald Trump has routinely targeted innocent, hardworking undocumented immigrants in communities around the United States with ICE raids, arresting members of our communities and putting their families in danger. While Sonoma County’s sheriff does not cooperate with ICE, they can still sweep in unannounced at any time and start knocking on doors.

What can we do as a community, and what is already being done to protect our people from ICE raids?

In 2017, the North Bay Organizing Project launched the North Bay Rapid Response 24 hour hotline at (707) 800-4544, a hotline dedicated to providing legal assistance to immigrants in the North Bay and protecting our communities from ICE tyranny (Click here for their website). If you or someone you know believe(s) that ICE is in the area or have information about a potential raid, follow this procedure.

  1. Call the hotline at (707) 800-4544. When notified of a potential or current ICE raid, North Bay OP will send members of their 700-strong legal team to investigate the threat. If the threat is deemed credible, they will notify those who may be affected, send legal observers to hold ICE accountable and connect those arrested to immigration lawyers dedicated to stopping ICE, and make ICE’s presence known to everyone in the county. It is critical to call the aforementioned hotline, as it is the most effective way to make your voice heard
  2. If and ONLY IF the threat is confirmed as credible, make as much noise as possible. Post about the impending raid on social media, message friends who may be in danger, and encourage others to do so. If you see something, say something. ICE has repeatedly violated the rights of detainees simply because they could. When people are watching, filming, and gathering evidence, they must be held accountable.
  3. If targeted by ICE, KNOW YOUR RIGHTS!
  4. Assist with evacuation. ICE has been known to strategically target neighborhoods with large immigrant populations, often knocking on doors with a list of names and addresses. If you know someone in danger of being arrested, help get them and their family out of their home and to a safe location to hide from ICE during the raid. Raids are done en masse, and if a person is not home consistently they often will not be hunted down.

Together we can protect our community from Donald Trump’s racist, destructive agenda to make America white again.

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Impeachment and the Travel Ban – Impact on Sonoma County

On the 18th of December, 45th President of the United States of America, Donald Trump, was impeached by a vote in the House of Representatives. Contrary to popular belief, a president being impeached is NOT the same as them being removed from office. Donald Trump will face trial in the Senate, who will determine whether he is unfit enough to be removed from office. Since 2017, citizens of Iran, Venezuela, North Korea, Syria, Yemen, Somalia, and Libya have been banned from entering the United States. While the ban officially exempts those who are visiting immediate relatives as well as international students, large amounts of international students from Iran were recently denied boarding to their flights because their visas were cancelled. If Trump is removed from office, the travel ban will remain, and Mike Pence will most definitely uphold it. However, with the 2020 election coming up, it is up to us, the American people, to ask our democratic candidates the following question: Will you unconditionally repeal the un-American Muslim Ban?

Currently, congress is preparing a bill called the National Origin Based Anti-discrimination for Nonimmigrants Act, whose sponsors include candidates Bernie Sanders and Elizabeth Warren. Said act will prevent any type of nationality based refusal of entry to the US.

While the ban is aimed at Muslim majority nations, the impact of the ban can be felt in our own community here in Sonoma County. The county is home to a sizable population of Iranians, the group hit the hardest by the ban. Local resident Aida Dargahi helped her brother in law apply for a B-2 visa to visit her family in Petaluma in 2017, and he came very close to receiving his visa to travel to California. However, the travel ban hit the Tehran based engineer, who neither received a visa nor a refund of his $160, a significant sum for someone living in Iran. At Sonoma State University, a similar narrative exists. The electrical engineering department is run by Fareed Farahmand, an immigrant from Iran, and employs multiple hardworking Iranian professors who work hard every day to make this country a better, smarter place. Farahmand himself expressed his frustration at the travel ban, claiming that it has greatly reduced the arrival of Iranian international students, who are known for being hardworking scholars. My own father arrived in the United States in 1978 from Iran as an international student, completing high school and going on to graduate from San Francisco State University. He currently holds a PhD and works as a professor, educating and enlightening the youth of our county. Had there been a travel ban in place in 1978, he would not be here today, making a contribution to the society of the United States, a nation founded and advanced by immigrants.

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Compiling a list of CVA violators

With the current policy of the Trump administration, ICE is pressuring local sheriffs to provide information to ICE to support their attack on immigrants and their communities in the USA. In 2017, former governor of California Jerry Brown signed the California Values Act, intended to prevent local law enforcement from cooperating with ICE. Despite this, numerous sheriffs in northern and southern California are continuing to cooperate with ICE in defiance of California law. While the Sonoma County Sheriff doesn’t cooperate with ICE, neighboring Marin County passionately cooperates with ICE to oppress immigrant communities. At socoIMM, we believe that immigrants have the right to be safe in their homes and their communities, which is why we are actively working to create a list on our website where we document all the sheriffs departments that violate the CVA and cooperate with ICE. If you are aware of a local sheriff that cooperates with ICE, please contact us at socoimmigrants@gmail.com so we can list said county on our active list. Together we have the power to hold these violators accountable.

The following list is under construction and constantly being updated thanks to YOUR input!

Marin County Sheriff – http://iceoutofmarin.org/marin-sheriff/ (information about the sheriff’s countless violations of human rights, including but not limited to deporting immigrants based on charges and not convictions, separation of families, dismissal of allegations, and creation of a pipeline from jail to deportation)

Sheriff Robert T. Doyle
E rdoyle@marinsheriff.org

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Our Mission

Sonoma County has been and continues to be a county of immigrants. In today’s volatile political climate, the basic rights of immigrants are being violated. We believe that immigrants are a key part of our society and economy and we refuse to allow such injustices to continue. We believe that people outweigh politics and that protecting the human rights of immigrants should not be a partisan affair. We envision a future in which immigrants are celebrated for their invaluable presence in our society, and a future in which our undocumented peers no longer have to live in fear and hiding.