neonatal death
Mamas on Bedrest: Implications for African Americans from Familism Study
January 7th, 2013I’ve been mulling over the study, “Maternal familism predicts birthweight and asthma symptoms three years later” by Dr. Cleopatra Abdou and her colleagues. This study, summarized in our last blog post, states that for mamas to be, familism (assessed as maternal endorsement of traditional {cultural?} views on familial obligation) is a stronger predictor of health over and above mamas’ relationships to ethnicity, nativity, and lifespan familial socioeconomic position (FSEP). In plain terms, the stronger mamas’ beliefs in family and familial roles and obligations, the less likely they are to have low birth weight babies and children who develop asthma within the first 3 years of life.
Most people correctly assume that in well to do families, every possible provision is made to ensure that the anticipated infant has every possible advantage to have a strong start in life. It is also well known that children born to families of lower socioeconomic status and with far fewer resources, while no less loved and anticipated, are often at risk of being born low birth weight and subsequently developing a variety of illnesses as a result. But there is a paradox within all of this, first referred to as the Latino Paradox by Markides & Coreil in their 1986 publication, The health of Hispanics in the Southwestern United States, An Epidemiological Paradox. The consensus regarding the paradox is this,
It seems that among certain segments of ethnic minority populations in America, including those who are presumed to be less acculturated to mainstream America and/or to have retained more traditional (cultural) values, particularly surrounding family, unassimilated minorities are among the healthiest Americans, particularly where pregnancy and birth outcomes are concerned.
Since the phenomenon is increasingly observed in other minority groups, including U.S. and foreign born Blacks and Whites, the paradox is becoming more broadly known as the Epidemiological Paradox.
I observed this “paradox” during my clinical practice years, most notably in Hispanic and Asian families. In “traditional” families, when a mama was pregnant there was often an entourage that accompanied her to prenatal visits and although she may have been recommended certain medically accepted treatments, it was abundantly clear that mama was under the watchful eye and in the hands of of her mother, grandmother, aunts, sisters and cousins and whatever they deemed best for mama and her baby would be done (as had been done for generations of babies within that culture) regardless of what any “medical professional” had to say.
What was most striking to me is that Abdou’s most recent publication makes a clear argument that the legacy of slavery (if one can call such an atrocious miscarriage of humanity a legacy) has had profound detrimental effects on African Americans not only from a cultural and economic standpoint, but also from a health standpoint. For almost every chronic disease (i.e. Heart Disease, Diabetes, Asthma, and Most Cancers just to name a few) African Americans are at greater risk for contracting the diseases, fare far worse, suffer more debilitating complications and are more likely to die from the complications of the diseases than any other ethnic group. As a physician assistant student, I learned about the various body systems and how they work to regulate metabolism and enable the body to function. As I looked at African Americans, I couldn’t understand why diseases hit us with what seems like catastrophic effects. The Epidemiologic Paradox puts it all in perspective and gives a partial explanation.
African Americans are the only ethnic group that came to America against their will and were unable to maintain any of their cultural traditions. Families and tribes were separated, languages and dialects were forgotten, lineages were disrupted, tribal/cultural rights and customs were lost. Africans brought to America as slaves had a physiologic make up adapted for a very arid and nomadic lifestyle. In America the climate and food and environment were markedly different. Slaves were purposely separated from their families, communities and tribes, a move made to prohibit congregation and revolution. They were prohibited from exhibiting any of their nativity; dances, languages, oral traditions, dress, even names. They were not free to move about or to even eat foods to which they were accustomed or for which they were physiologically adapted. In so doing, the American Slave Trade effectively obliterated families, cultures, tribes, traditions-and the general health of African Americans.
Fast forward to today. African American women and infants have the highest rates of perinatal and infant mortality among all ethnic groups, and in light of Dr. Abdou and her colleagues’ research this should come as no surprise. What cultural heritage do African American women possess and pass on to future generations? African American women as slaves were at the whim of slave owners. African rights of passage from childhood girlish years into womanhood were replaced by random seizure and rape. The children that they bore, whether those of slave owners or of other slaves, were often taken from them either as infants or as children, and ritual pregnancy, birth and infant blessing ceremonies were lost. Traditions and rituals that should have been passed down from mother to daughter were lost and have been replaced with advice on how not to draw attention to yourself as a means to stay safe and possibly avoid sexual attention. Today some might argue that it has been replaced with do whatever it takes to get and keep a man-any man-even if he doesn’t respect you or treat you well in light of the deplorable state or African American relationships and families. But that is a discussion for another time. By and large it is safe to say that the family structure in African American culture is severely fractured, relationships between African American men and women is strained, African American children are at risk for sickness, disease, violence and death and if we accept and understand the Epidemiological Paradox as a veritable and verifiable factor in the health of Americans of different ethnic backgrounds and cultures, then we have to acknowledge that this paradox is no more clearly evident than in African Americans.
African Americans have little to no native culture upon which to draw. Most of us don’t have century old traditions or regal family ties. Many African American mamas have little or no support and move through the prenatal period alone, while at the same time trying to navigate where they are going to live, how they are going to eat and how they are going to pay their bills. If they have other children from other relationships they also face social disdain and at times overt disgust for their station in life. And even when everything is “in order” there is the pervasive perception that African American mamas and their babies are less likely to be of means, education or ability. I say this from experience as when I had my son, I was married and insured and yet the day after my son was born, a social worker came into my hospital room and proceeded to present me with “information I would need” to apply for WIC and medicare for my son. She obviously never looked at my chart for she would have seen that we had private insurance and that we were in no way eligible for-or in need of-WIC.
The current American culture is a capitalistic, solitary, “dog eat dog” type of culture. Americans pride themselves on “pulling themselves up by their own bootstraps”, ”being self made individuals” and “I did it my way.” The work of Dr. Abdou and her colleagues, the Epidemiologic Paradox in other Americans who have retained their native cultures and the life and legacy of African American people shows us that this American lifestyle is unhealthy to say the least and for African Americans (as well as for people of other cultures who become more accustomed, more Americanized), it’s deadly plain and simple.
As Dr. Abdou rightly states, cultural familism is a readily available resource for many women. The next thing we health care practitioners, advocates and public health scientists must do is consider how we’ll take this information and the resources available to us to help craft a cultural resource for African Americans in the hope of not only lowering maternal and infant morbidity and mortality rates, but improving the overall health and well being of African Americans as a whole.
References
Cleopatra M. Abdou, Tyan Parker Dominguez, Hector F. Myers. Maternal familism predicts birthweight and asthma symptoms three years later. Social Science & Medicine, 2012; DOI: 10.1016/j.socscimed.2012.07.041
Markides, K. S., & Coreil, J. (1986). The health of Hispanics in the Southwestern United States An Epidemiological Paradox. Public Health Reports, 101, 253e265.
Mamas on Bedrest: A Call for Compassion, Not Crucifixion
October 10th, 2012
On October 5, 2012 Jeanne Faulkner, R.N. posted on theFitPregnancy Blog about Tragic Teen Pregnancies. Seems yet another young teen aged girl hid her pregnancy and gave birth alone and scared in the bathroom. She subsequently killed the baby and disposed of it in a garbage bag. The baby was later discovered and the girl arrested.
From time to time we hear of such tragedies. I happen to know of one personally, and saw a few others working as a PA in a teen health clinic. It’s a really difficult situation. Those on the outside looking in are appalled by the young mothers’ actions. The media is crucifying them. And many want them punished to the full extent of the law.
But I like Faulkner’ take on the situation. These are young girls, often as young as 14 or 15, having babies. Babies are having babies. For whatever reason, the girls choose not to tell their parents (a question for a whole other post!), friends or teachers. They hide their pregnancies, childishly hoping they’ll go away. But what can we expect-THEY ARE CHILDREN!!! I could go on and on about the first grievous mistake being that they are sexually active in the first place, why is this happening and where are the parents/guardians? But that is all water under the bridge. The more important question is how do we help young girls who are caught up in such situations get the (mental/emotional and physical) help that they need so that they can recover, grow up, become productive adults and eventually have children of their own?
Jennie Joseph, CPM, was quoted in the article and I think that her words bear repeating. Joseph describes “labor madness”, a trance-like state many women enter into during labor, a sort of primal defense mechanism from the pain and overwhelm of the situation.
“Women from all walks of life disappear into an inner place (during labor). They retreat from the fear and pain and the overwhelming nature of what their body is doing. They don’t really know what’s going on and without help some panic. When a woman is supported by a caring midwife, nurse, doctor, doula and family we can call her back from that place. We can support her, help her and get her through the experience. But when a woman is alone the terror, pain and hormones kick some women into autopilot where they panic and do whatever they have to do to save themselves from this life-threatening situation.”
“And if it’s a young teenage girl, all alone, in pain, not fully understanding what’s going on, terrified of what will happen when her parents find out…that’s a recipe for labor madness right there.”
Labor madness. I like that term and I believe that it is fitting. We all like to believe that pregnancy, labor and childbirth are these ethereal states in which a woman experiences her truest feminine self. This occurs for many women. But for many of us, pregnancy, labor and childbirth can be fraught with hellacious complications, fear, chaos and at their worst, catastrophic if not deadly complications.
As mamas on bed rest, we’re on the front lines of complicated pregnancy. Yet most of us are grown women. Many of us are married or at least with a partner in the picture and if not, we have family, friends and a support system. We’re on the internet, reading websites, chatting with other mamas and gathering information in order to best prepare ourselves for whatever may lay ahead. This is the difference between pregnancy in a woman and a girl. As women, if we don’t have a support system, we know how to find one.
Young girls aren’t necessarily that savvy. Yes, many have grown up women’s bodies, but not the wisdom of age. Think back to your teen years. Were you fully equipped to manage all the feelings and emotions you were experiencing? Now add pregnancy, and all its physiologic (hormonal) changes, and you can readily see that trainwreck poised to happen.
I am not saying that what this young girl did was right. It absolutely wasn’t. But there are so many levels at which things went wrong I would find it difficult to prosecute her for a crime. I highly doubt that her actions were premeditated or that she acted out of malice or guile. She was afraid. It’s that simple. And she’ll be further traumatized by the criminal justice system. Will she ever receive counseling? Will she ever heal? I mean really heal???
I see this story as another reminder that women of all ages need support and compassion during pregnancy. For young girls, they need not only support but also caring and compassionate guidance-preferably before they become pregnant but most certainly after-to help them understand the complex physical changes they’ll experience as well as the myriad of emotional changes. Oh what a different story this would have been if this young girl had been able to talk to someone about what was happening! Oh what a difference it makes forMamas on Bedrest to have this support network!
I don’t know what will be next for this young girl or others like her. What I do know is that rather than crucify her in the media, we all need to show her compassion. She needs help so that she can heal. And we as a culture need to be thinking about what we can do to help end this type of tragedy in teen pregnancies.
Mamas on Bedrest: Standing for Little Brown Babies by Supporting Their Mamas
September 18th, 2012Welcome to the Third Edition of the Black Birth Carnival. Hosted by Darcel of The Mahogany Way Birth Cafe and Nicole of Musings From The Mind of Sista Midwife.
The Topic: Infant Mortality Awareness: Saving OUR Babies.
Many birth workers are talking about the alarming infant mortality rates in this country, but none are talking about infant mortality in the Black Community. That’s where this Blog Carnival comes in. We will talk about statistics, try to figure out why, and most importantly what we can do to help lower our infant mortality rates. This post will be updated with live links linking back to the other participants posts
I have a real thing for little brown babies. Having had two of my own, I can honestly say that they are the most precious (and most beautiful) beings in the world to me. Having also lost two pregnancies, sadly I also know the pain of losing precious souls.
It’s hard to believe that the United States has one of the higher infant mortality rates in the world, with African American babies dying at nearly 2-3 times the rate of White and Latino infants. According to the Office of Minority Health, a unit within the US Department of Health and Human Services,
African Americans have 2.3 times the infant mortality rate as non-Hispanic whites. They are three times as likely to die as infants due to complications related to low birth weight as compared to non-Hispanic white infants.
- African Americans had twice the sudden infant death syndrome mortality rate as non-Hispanic whites, in 2008.
- African American mothers were 2.3 times more likely than non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
- The infant mortality rate for African American mothers with over 13 years of education was almost three times that of Non-Hispanic White mothers in 2005.
The OMH website goes on to list all the data from the US Centers for Disease Control and Prevention regarding infant mortality in the United States. At all indices, African American infants fare far worse than their White or Latino counterparts.
The statistics are alarming, yet I encourage you to read through them. I believe that change in the African American community-whether it’s regarding infant mortality, maternal mortality, health care delivery disparities, crime, homicide or anything else-is going to have to be an inside job. It is all well and good for university researchers to study what is going on in African American communities. It is fine if news outlets want to report on activities going on in African American communities. But little to none of these analyses makes one hill of beans difference if they are doing nothing to change the situation on the ground, and by my observations they aren’t doing much. Raising awareness is good but action is imperative.
I recently wrote a blog post called, Mamas on Bedrest: I’m Pro-Action! It engendered a lot of controversy because people felt that I was politicizing birth, bringing in the Pro-Life/Pro-Choice debate. I’ll admit that I chose the term “Pro-Action” as an attention grabber, but the meaning I’ve placed behind it is entirely different.
“Pro-Action” is a term that I believe we all have to embrace. So often in our culture, we vent “righteous indignation” over one thing or another, yet we fail to act on our beliefs. I believe failure to act is in large part responsible for the demise of our communities and our culture. Being “Pro-Action” means putting movement behind the lip service and working to effect change.
After reading the statistics on infant mortality in African American infants, you might sit back with a feeling of helplessness and hopelessness. It is a daunting problem and one that as individuals cannot possibly tackle effectively. But as individuals in collective, we can make an enormous impact. So how does one become “Pro-Action”? What does that look like when working to curb infant mortality?
- It’s working within your immediate neighborhood, community or congregation to assist mothers who are pregnant. Perhaps you give them a ride to their prenatal visits or watch their children so that they make it to visits unencumbered (we all know that even pregnant, you can move faster without the little ones along!).
- If mamas are on bed rest (my particular soft spot), it’s going by their homes and making sure that they have healthy meals and groceries, making sure that they are comfortable, talking to them, reassuring them, helping around their homes and with their children and family responsibilities.
- It’s talking openly and honestly to teenagers about sex and contraception. Let’s face it, the “sex outside of marriage is a sin” speech ain’t workin’ and hasn’t worked for decades. I think it’s time for a new approach (just my opinion here).
- It’s educating teen-aged girls about why teen pregnancy is not a good idea. Again, address not only the moral arguments, but also address the concrete data in the medical literature that clearly shows that teenagers have higher rates of maternal and infant mortality. Contrary to popular beliefs, pregnancy is not a benign condition. Many things can and do go wrong and they tend to go wrong in the extremes-amongst young girls under 20 and women over 40.
- It’s grassroots organization like Mamas of Color Rising here in Austin, TX. This group of low income African American and Latina mamas has come together to train birth attendants of color to be with mamas of color as they labor and deliver. They are supporting and training midwives of color who will attend births of low income mamas of color. They have lobbied for and are on the crest of seeing rules changes in the Medicaid laws of Texas such that Midwives will be able to care for and attend to pregnant women on Medicaid and be reimbursed for their services. And in just mere weeks, this dynamic group of mamas will see the grand opening of a free prenatal clinic for low income women of color who will be able to receive prenatal care in the midwifery model. Yes, these mamas are definitely “Pro-Action”!
I could go on and on, but I think you get the picture. Pick an area that pricks your heart and then Take Action! Get out and get involved. If each one of us becomes involved in each of our respective communities, soon, our efforts and our reach will coalesce and we’ll find that we are one large collective effecting change on a grand scale.
This Blog Carnival is once such example of change in action. Let’s keep the ball rolling and all be “Pro-Action” for our mamas, our babies and our communities.
Other Posts in this Carnival
Health Programming and It’s Impact on Black Infant Mortality-By Amy Hereford
Black Infant Mortality and Your Responsibility. By Darcel of The Mahogany Way Birth Cafe
Stop The Talking…Implement Solutions! By SistaMidwife Productions
