History

Mamas on Bedrest: Implications for African Americans from Familism Study

January 7th, 2013

I’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: Thanks for the Memories…And the Legacy

May 28th, 2012

Today is Memorial Day. The national focus is on the dearly departed men and women who served our country valiantly protecting our lives, our liberties and our pursuits of happiness.

Whenever I think of those who served our country, my mind immediately jumps to my grandfathers. I actually had 3, but I only really knew one. My father’s father, William George Turner,  served in World War I and unfortunately died in February of 1941 just 2 short months after my father’s birth. My mother’s biological father, John Oliver Lane, served and was killed in the line of battle in World War II. My Grandmother remarried and her husband, Alfred Haywood is the man that I remember most as my grandfather. I was lucky to have him until 1984 when he died when I was 18 years old. Each of these men bravely served their countries and I am forever grateful for their contributions.

There is a strong legacy of service in my family, and one legacy of which I am most proud is the legacy of women who were early birth professionals and activists. My Great Grandmother, Queen Elizabeth Perry Turner was a “root woman” and midwife. She birthed most of the children in Inez, NC between the late 1930’s thru the 1940’s and was also very skilled in the use of plants for healing. She and my great grandfather also owned a general store, a huge deal for a black couple in  those days. Lore has it that my great grandmother was “no nonsense business woman”. Grandpa Tom was quite generous and would allow people to pay on credit. Grandma Elizabeth always asked up front, “And how do you intend to pay?” I am quite sure that lead to their collective success.

My paternal grandmother, Hollie Alston Turner was also a natural birth proponent. But rather than work as a midwife, she had 15 babies! All but the last few were born at home with midwives. Since my paternal grandfather died two weeks after my father was born, “Ma” had her hands full caring for the 10 children that she had at home at the time. But Ma still did what she could to enhance births and the lives of babies in her community. Long before it was fashionable, my grandmother donated breast milk. Now mind you, there is a long legacy within the black community of “wet nursing” where African American women nurse the children of their slave owners and share croppers. However, my grandmother was not a wet nurse but a milk donor, much in the spirit of Milk Banking today.

My cousins tease me and say that “birthing” is in my blood. Perhaps they are right. There is something about the birth world that is captivating. For me, knowing the numbers of women who struggle during childbearing, the women for whom childbearing is anything but a natural process, the women for whom access to good, quality prenatal and post parutm care is nearly impossible, I can’t help but to dive in and do what I can to make a difference.

I am so proud of my history, my legacy of service. I am proud of the men in my family who served this country even though they were denied many of the rights that they fought to protect. And I am so proud of the women in my family who loved babies and did all that they could to come into this world safely and to gave them good starts.

To all you Mamas on Bedrest, what is your family legacy? On this Memorial Day, Have a wonderful day and don’t forget to take time to acknowledge your “heroes” and “sheroes”.

Mamas on Bedrest: Potential Circumcision Ban in San Francisco

May 20th, 2011

San Francisco is poised to be the first city to actually ban circumcision in newborn baby boys. The proposed ban is actually now a ballot issue and will be voted upon in the November 2011 elections. If the measure passes, circumcision would be prohibited among males under the age of 18. The practice would become a misdemeanor offense punishable by a fine of up to $1,000 or up to one year in jail. There would be no religious exemptions.

Circumcision has long been a contentious issue. Opponents argue that it is an unnecessary surgical procedure and puts infant boys at risk for injury and infection. Some even claim that the practice is barbaric because in many settings, no anesthesia is used.

(Non-Religious) Proponents claim that the procedure helps prevent infections, especially sexually transmitted infections/viruses such as Chlamydia, HPV (the virus which causes genital warts and cervical cancer), HIV and penile cancer. To these claims, opponents say the issue has more to do with hygiene and safe sex practices than with the foreskin being a harbinger of bacteria.

Religious proponents are concerned. Circumcision is an ancient practice that dates back nearly to the beginning of time. It began when God made His covenant with Abraham and the Israelites stating that they are to be His chosen people and that they would inherit the land of Canaan, “the promised land” (Today this area encompasses Israel, Palestine, Lebanon and the Western part of Jordan). Abraham and his male descendants are to be circumcised on the 8th day after birth as a sign of keeping the covenant with God. Circumcision is a major tenant of Jewish faith and many Arab Muslims (and non Arab Muslims) also practice circumcision believing that they are descendants of Abraham’s first son with, Ishmael (His mother was Hagar, Sarai’s hand maiden whom Sarai ordered in to Abraham to conceive a child so that they could fulfill God’s promise of an Israeli nation. This debate over who is Abraham’s first born and hence his “chosen” descendant is part of the root of the conflict between Israel and much of the Arab world today! Also shows man should not meddle in God’s business. Never works out very well IMHO!)

But getting back to the topic at hand, I find it very disturbing that a municipality is trying to impose a ban on a religious practice. Aren’t we protected against Religious “persecution” by the First Amendment? While I can agree to ending so called “routine” circumcisions, not allowing the practice for people of Jewish/Muslim faith is a very slippery slope.

Proponents of the ban argue that babies are not able to voice their opinions and since circumcision is an “unnecessary” surgical procedure, it should not be performed until the infant can provide informed consent, age 18. I suppose this is true. But does that them mean that I should not have Christened my children because they could not say whether or not they wanted to be blessed by God? Does that mean that other infants should not be baptized because they could drown (if immersed) and this puts them at risk? I know that these religious practices don’t have the same level of “danger” associated with them as circumcision does, but as tenants of faith, they are no less near to the hearts and faith of people.

Opponents also liken the procedure to female genital mutilation, a common practice in some areas of Africa and here I have to disagree. Circumcisions performed by a trained and experienced Mohel are very clean and very gentle procedures. Likewise, circumcisions performed in hospitals by trained medical staff are also quite clean and have low incidences of injury or infection.

Female genital mutilations are typically performed as a way to prevent young girls from becoming sexually active, and once they are sexually active, from deriving any sort of pleasure from the act. It is an act of violence, dominion and a rape of a woman’s sexuality. They are rarely performed in a clean, let alone sterile, environment and instruments used to cut can be a any old piece of glass or metal  (These are my opinions based on what I have read and have learned from patients I have had the opportunity to treat while practicing clinically.) Comparing a religious circumcision, or even a medical circumcision to female genital mutilation is absurd and just plain inaccurate.

But that aside are circumcisions, even at a much lower level, a violation of a baby boy’s genitals? In my opinion and from the circumcisions that I have witnesses and even assisted in, I have to say no. But are they necessary if there is no family history of penile cancer and one is not Jewish? Probably not.

This will definitely be a heated issue and it will be very interesting to follow. I would love to hear your comments and perspectives. Please provide them here or e-mail them to info@mamasonbedrest.com.