How racism harms pregnant women -- and what can help
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0:01 - 0:05Most of you can probably relate
to what I'm feeling right now. -
0:05 - 0:07My heart is racing in my chest.
-
0:08 - 0:10My palms are a little bit clammy.
-
0:11 - 0:12I'm sweating.
-
0:13 - 0:15And my breath is a little bit shallow.
-
0:15 - 0:18Now, these familiar sensations
are obviously the result -
0:18 - 0:21of standing up
in front of a thousand of you -
0:21 - 0:23and giving a talk
that might be streamed online -
0:23 - 0:25to perhaps a million more.
-
0:25 - 0:28But the physical sensations
I'm experiencing right now -
0:28 - 0:32are actually the result of a much more
basic mind-body mechanism. -
0:32 - 0:36My nervous system is sending
a flood of hormones -
0:36 - 0:39like cortisol and adrenaline
into my bloodstream. -
0:39 - 0:44It's a very old and very necessary
response that sends blood and oxygen -
0:44 - 0:46to the organs and muscles
that I might need -
0:46 - 0:48to respond quickly to a potential threat.
-
0:49 - 0:51But there's a problem with this response,
-
0:51 - 0:54and that is, it can get over-activated.
-
0:54 - 0:57If I face these kinds of stressors
on a daily basis, -
0:57 - 1:00particularly over an extended
period of time, -
1:01 - 1:04my system can get overloaded.
-
1:04 - 1:07So basically, if this response
happens infrequently: super-necessary -
1:07 - 1:10for my well-being and survival.
-
1:10 - 1:11But if it happens too much,
-
1:11 - 1:13it can actually make me sick.
-
1:14 - 1:17There's a growing body of research
examining the relationship -
1:17 - 1:19between chronic stress and illness.
-
1:19 - 1:21Things like heart disease and even cancer
-
1:21 - 1:23are being shown to have
a relationship to stress. -
1:24 - 1:28And that's because, over time,
too much activation from stress -
1:28 - 1:32can interfere with my body's processes
that keep me healthy. -
1:33 - 1:36Now, let's imagine for a moment
that I was pregnant. -
1:37 - 1:39What might this kind of stress,
-
1:39 - 1:41particularly over the length
of my pregnancy, -
1:41 - 1:43what kind of impact might that have
-
1:43 - 1:45on the health of my developing fetus?
-
1:46 - 1:49You probably won't be surprised
when I tell you -
1:49 - 1:52that this kind of stress
during pregnancy is not good. -
1:52 - 1:56It can even cause the body
to initiate labor too early, -
1:56 - 1:58because in a basic sense,
the stress communicates -
1:58 - 2:02that the womb is no longer
a safe place for the child. -
2:02 - 2:06Stress during pregnancy is linked
with things like high blood pressure -
2:06 - 2:07and low infant birth weight,
-
2:07 - 2:10and it can begin a cascade
of health challenges -
2:10 - 2:12that make birth much more dangerous
-
2:12 - 2:14for both parent and child.
-
2:15 - 2:18Now of course stress,
particularly in our modern lifestyle, -
2:18 - 2:20is a somewhat universal experience, right?
-
2:21 - 2:23Maybe you've never stood up
to give a TED Talk, -
2:23 - 2:26but you've faced a big
presentation at work, -
2:26 - 2:27a sudden job loss,
-
2:27 - 2:28a big test,
-
2:28 - 2:31a heated conflict
with a family member or friend. -
2:32 - 2:35But it turns out that the kind
of stress we experience -
2:35 - 2:38and whether we're able to stay
in a relaxed state long enough -
2:38 - 2:40to keep our bodies working properly
-
2:40 - 2:43depends a lot on who we are.
-
2:43 - 2:45There's also a growing body of research
-
2:45 - 2:49showing that people who experience
more discrimination -
2:49 - 2:51are more likely to have poor health.
-
2:52 - 2:54Even the threat of discrimination,
-
2:54 - 2:58like worrying you might be stopped
by police while driving your car, -
2:58 - 3:01can have a negative impact on your health.
-
3:03 - 3:05Harvard Professor Dr. David Williams,
-
3:05 - 3:09the person who pioneered
the tools that have proven these linkages, -
3:09 - 3:12says that the more marginalized
groups in our society -
3:12 - 3:16experience more discrimination
and more impacts on their health. -
3:17 - 3:20I've been interested in these issues
for over a decade. -
3:20 - 3:23I became interested in maternal health
-
3:23 - 3:26when a failed premed trajectory
instead sent me down a path -
3:26 - 3:29looking for other ways
to help pregnant people. -
3:29 - 3:30I became a doula,
-
3:30 - 3:32a lay person trained to provide support
-
3:32 - 3:35to people during pregnancy and childbirth.
-
3:35 - 3:37And because I'm Latina
and a Spanish speaker, -
3:37 - 3:41in my first volunteer doula gig
at a public hospital in North Carolina, -
3:41 - 3:44I saw clearly how race and class
impacted the experiences -
3:44 - 3:46of the women that I supported.
-
3:47 - 3:50If we take a look at the statistics
about the rates of illness -
3:50 - 3:52during pregnancy and childbirth,
-
3:52 - 3:55we see clearly the pattern
outlined by Dr. Williams. -
3:56 - 3:58African-American women in particular
-
3:58 - 4:01have an entirely different
experience than white women -
4:01 - 4:04when it comes to whether
their babies are born healthy. -
4:04 - 4:08In certain parts of the country,
particularly the Deep South, -
4:08 - 4:10the rates of mother
and infant death for black women -
4:10 - 4:14actually approximate
those rates in Sub-Saharan African. -
4:15 - 4:16In those same communities,
-
4:16 - 4:19the rates for white women are near zero.
-
4:21 - 4:24Even nationally, black women
are four times more likely -
4:24 - 4:27to die during pregnancy and childbirth
-
4:27 - 4:28than white women.
-
4:28 - 4:31Four times more likely to die.
-
4:31 - 4:34They're also twice as likely
for their infants to die -
4:34 - 4:36before the first year of life
-
4:36 - 4:37than white infants,
-
4:37 - 4:39and two to three times more likely
-
4:39 - 4:42to give birth too early or too skinny --
-
4:42 - 4:44a sign of insufficient development.
-
4:45 - 4:49Native women are also more likely
to have higher rates of these problems -
4:49 - 4:50than white women,
-
4:50 - 4:53as are some groups of Latinas.
-
4:53 - 4:56For the last decade as a doula
turned journalist and blogger, -
4:56 - 4:58I've been trying to raise the alarm
-
4:58 - 5:01about just how different
the experiences of women of color, -
5:01 - 5:02but particularly black women,
-
5:03 - 5:05are when it comes to pregnancy
and birth in the US. -
5:05 - 5:08But when I tell people
about these appalling statistics, -
5:08 - 5:12I'm usually met with an assumption
that it's about either poverty -
5:12 - 5:14or lack of access to care.
-
5:14 - 5:18But it turns out, neither of these things
tell the whole story. -
5:18 - 5:22Even middle-class black women
still have much worse outcomes -
5:22 - 5:25than their middle-class
white counterparts. -
5:25 - 5:28The gap actually widens among this group.
-
5:29 - 5:32And while access to care
is definitely still a problem, -
5:32 - 5:36even women of color who receive
the recommended prenatal care -
5:36 - 5:37still suffer from these high rates.
-
5:38 - 5:40And so we come back to the path
-
5:40 - 5:44from discrimination to stress
to poor health, -
5:44 - 5:49and it begins to paint a picture
that many people of color know to be true: -
5:49 - 5:51racism is actually making us sick.
-
5:52 - 5:54Still sound like a stretch?
-
5:54 - 5:58Consider this: immigrants,
particularly black and Latina immigrants, -
5:58 - 6:02actually have better health when
they first arrive in the United States. -
6:02 - 6:06But the longer they stay in this country,
the worse their health becomes. -
6:06 - 6:11People like me, born in the United States
to Cuban immigrant parents, -
6:11 - 6:14are actually more likely to have
worse health than my grandparents did. -
6:15 - 6:17It's what researchers call
"the immigrant paradox," -
6:17 - 6:19and it further illustrates
-
6:19 - 6:21that there's something
in the US environment -
6:21 - 6:22that is making us sick.
-
6:23 - 6:24But here's the thing:
-
6:24 - 6:27this problem, that racism
is making people of color, -
6:27 - 6:30but especially black
women and babies, sick, is vast. -
6:30 - 6:32I could spend all of my time
with you talking about it, -
6:32 - 6:36but I won't, because I want to make sure
to tell you about one solution. -
6:36 - 6:40And the good news is, it's a solution
that isn't particularly expensive, -
6:40 - 6:42and doesn't require
any fancy drug treatments -
6:42 - 6:43or new technologies.
-
6:43 - 6:46The solution is called, "The JJ Way."
-
6:47 - 6:49Meet Jennie Joseph.
-
6:49 - 6:52She's a midwife
in the Orlando, Florida area -
6:52 - 6:55who has been serving
pregnant women for over a decade. -
6:55 - 6:58In what she calls her easy-access clinics,
-
6:58 - 7:02Jennie and her team provide prenatal care
to over 600 women per year. -
7:03 - 7:08Her clients, most of whom are black,
Haitian and Latina, -
7:08 - 7:09deliver at the local hospital.
-
7:10 - 7:14But by providing accessible
and respectful prenatal care, -
7:14 - 7:16Jennie has achieved something remarkable:
-
7:16 - 7:21almost all of her clients give birth
to healthy, full-term babies. -
7:21 - 7:24Her method is deceptively simple.
-
7:24 - 7:27Jennie says that all of her appointments
start at the front desk. -
7:27 - 7:31Every member of her team,
and every moment a women is at her clinic, -
7:31 - 7:33is as supportive as possible.
-
7:33 - 7:36No one is turned away
due to lack of funds. -
7:36 - 7:40The JJ Way is to make the finances work
no matter what the hurdles. -
7:40 - 7:43No one is chastised for showing up
late to their appointments. -
7:43 - 7:45No one is talked down to or belittled.
-
7:46 - 7:50Jennie's waiting room feels more like
your aunt's living room than a clinic. -
7:50 - 7:53She calls this space
"a classroom in disguise." -
7:54 - 7:56With the plush chairs
arranged in a circle, -
7:56 - 7:59women wait for their appointments
in one-on-one chats -
7:59 - 8:00with a staff educator,
-
8:00 - 8:02or in group prenatal classes.
-
8:03 - 8:05When you finally are called back
to your appointment, -
8:05 - 8:07you are greeted by Alexis or Trina,
-
8:07 - 8:09two of Jennie's medical assistants.
-
8:09 - 8:13Both are young, African-American
and moms themselves. -
8:13 - 8:15Their approach is casual and friendly.
-
8:15 - 8:17During one visit I observed,
-
8:17 - 8:20Trina chatted with a young soon-to-be mom
-
8:20 - 8:22while she took her blood pressure.
-
8:22 - 8:26This Latina mom was having trouble
keeping food down due to nausea. -
8:26 - 8:28As Trina deflated the blood pressure cuff,
-
8:28 - 8:31she said, "We'll see about changing
your prescription, OK? -
8:31 - 8:33We can't have you not eating."
-
8:34 - 8:38That "we" is actually a really crucial
aspect of Jennie's model. -
8:38 - 8:43She sees her staff as part of a team that,
alongside the woman and her family, -
8:43 - 8:44has one goal:
-
8:44 - 8:46get mom to term with a healthy baby.
-
8:47 - 8:51Jennie says that Trina and Alexis
are actually the center of her care model, -
8:51 - 8:55and that her role as a provider
is just to support their work. -
8:55 - 8:58Trina spends a lot of her day
on her cell phone, -
8:58 - 9:00texting with clients
about all sorts of things. -
9:00 - 9:04One woman texted to ask if a medication
she was prescribed at the hospital -
9:04 - 9:06was OK to take while pregnant.
-
9:06 - 9:08The answer was no.
-
9:08 - 9:12Another woman texted with pictures
of an infant born under Jennie's care. -
9:13 - 9:16Lastly, when you finally are called back
to see the provider, -
9:16 - 9:19you've already taken your own weight
in the waiting room, -
9:19 - 9:21and done your own pee test
in the bathroom. -
9:21 - 9:24This is a big departure
from the traditional medical model, -
9:24 - 9:27because it places
responsibility and information -
9:27 - 9:29back in the woman's hands.
-
9:29 - 9:32So rather than a medical setting
where you might be chastised -
9:32 - 9:35for not keeping up
with provider recommendations -- -
9:35 - 9:38the kind of settings often available
to low-income women -- -
9:38 - 9:41Jennie's model is to be
as supportive as possible. -
9:41 - 9:44And that support provides a crucial buffer
-
9:44 - 9:49to the stress of racism and discrimination
facing these women every day. -
9:50 - 9:53But here's the best thing
about Jennie's model: -
9:53 - 9:56it's been incredibly successful.
-
9:56 - 9:58Remember those statistics I told you,
-
9:58 - 10:01that black women are more likely
to give birth too early, -
10:01 - 10:03to give birth to low birth weight babies,
-
10:03 - 10:07to even die due to complications
of pregnancy and childbirth? -
10:07 - 10:11Well, The JJ Way has almost entirely
eliminated those problems, -
10:11 - 10:13starting with what Jennie calls
"skinny babies." -
10:14 - 10:16She's been able to get almost all
her clients to term -
10:16 - 10:19with healthy, chunky babies like this one.
-
10:20 - 10:22Audience: Aw!
-
10:22 - 10:25Miriam Zoila Pérez:
This is a baby girl -
10:25 - 10:27born to a client of Jennie's
this past June. -
10:28 - 10:31A similar demographic
of women in Jennie's area -
10:31 - 10:33who gave birth at the same
hospital her clients did -
10:33 - 10:36were three times more likely to give birth
-
10:36 - 10:38to a baby below a healthy weight.
-
10:39 - 10:42Jennie is making headway
into what has been seen for decades -
10:42 - 10:44as an almost intractable problem.
-
10:45 - 10:47Some of you might be thinking,
-
10:47 - 10:49all this one-on-one attention
that The JJ Way requires -
10:49 - 10:52must be too expensive to scale.
-
10:52 - 10:53Well, you'd be wrong.
-
10:53 - 10:57The visit with the provider
is not the center of Jennie's model, -
10:57 - 10:58and for good reason.
-
10:58 - 11:02Those visits are expensive,
and in order to maintain her model, -
11:02 - 11:04she's got to see a lot
of clients to cover costs. -
11:04 - 11:07But Jennie doesn't have to spend
a ton of time with each woman, -
11:07 - 11:12if all of the members of her team
can provide the support, information -
11:12 - 11:14and care that her clients need.
-
11:15 - 11:18The beauty of Jennie's model
is that she actually believes -
11:18 - 11:21it can be implemented
in pretty much any health care setting. -
11:21 - 11:24It's a revolution in care
just waiting to happen. -
11:25 - 11:28These problems I've been sharing
with you are big. -
11:28 - 11:31They come from long histories
of racism, classism, -
11:31 - 11:34a society based on race
and class stratification. -
11:34 - 11:37They involve elaborate
physiological mechanisms -
11:37 - 11:38meant to protect us,
-
11:38 - 11:40that, when overstimulated,
actually make us sick. -
11:41 - 11:44But if there's one thing I've learned
from my work as a doula, -
11:44 - 11:48it's that a little bit of unconditional
support can go a really long way. -
11:48 - 11:50History has shown that people
are incredibly resilient, -
11:51 - 11:52and while we can't eradicate racism
-
11:52 - 11:55or the stress that results
from it overnight, -
11:55 - 11:58we might just be able to create
environments that provide a buffer -
11:58 - 12:01to what people of color
experience on a daily basis. -
12:01 - 12:04And during pregnancy,
that buffer can be an incredible tool -
12:04 - 12:06towards shifting the impact of racism
-
12:06 - 12:08for generations to come.
-
12:08 - 12:09Thank you.
-
12:09 - 12:13(Applause)
- Title:
- How racism harms pregnant women -- and what can help
- Speaker:
- Miriam Zoila Pérez
- Description:
-
Racism is making people sick -- especially black women and babies, says Miriam Zoila Pérez. The doula turned journalist explores the relationship between race, class and illness and tells us about a radically compassionate prenatal care program that can buffer pregnant women from the stress that people of color face every day.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 12:25
Brian Greene edited English subtitles for How racism harms pregnant women -- and what can help | ||
Camille Martínez accepted English subtitles for How racism harms pregnant women -- and what can help | ||
Camille Martínez edited English subtitles for How racism harms pregnant women -- and what can help | ||
Camille Martínez edited English subtitles for How racism harms pregnant women -- and what can help | ||
Joseph Geni edited English subtitles for How racism harms pregnant women -- and what can help |