 Good afternoon. Good afternoon. On behalf of the McLean Center for Clinical Medical Ethics, the Department of Obstetrics and Gynecology, and the Bucksbaum Institute for Clinical Excellence, I welcome you to the first lecture in our 2016-17 series on reproductive ethics. During this academic year, we will present 25 lectures on reproductive ethics, half of them from nationally known figures, and half from nationally known figures in the Chicago area. If you've not picked up a copy of the brochure, the brochure is available in the back. Julie Korr, who is Julie Korr. Julie Korr was the principal organizer of this great program. Reproductive ethics frequently engages social, political, and clinical issues. This series will explore controversies at the intersection of scientific advances, reproductive decision-making, and many ethical and legal considerations. While reproductive ethics encompasses a broad spectrum of topics, this series is organized around three principal themes, obstetrical ethics, assisted reproduction, and family planning and abortion. This year's speakers reflect a diversity of backgrounds and perspectives and include, as I've said, national experts in the fields of medicine, law, and the social sciences. It is now my absolute pleasure to introduce today's distinguished speaker, Professor Dorothy Roberts. Professor Roberts, who was born in Hyde Park and went to the Shoe Smith School through the eighth grade, is the George A. Weiss University Professor of Law and Sociology at the University of Pennsylvania, and also the Raymond Pace and Sadie Tanner Moselle Alexander Professor of Civil Rights. Professor Roberts directs the Penn Program on Race, Science, and Society. An internationally recognized scholar, public intellectual, and social justice advocate, Professor Roberts has written and lectured extensively on the intersection of gender, race, and class in legal issues and has been a leader in transforming our thinking on reproductive health, child welfare, and bioethics. Professor Roberts is the author of the award-winning book Killing the Black Body, Race, Reproduction, and the Meaning of Liberty. Another book, Shattered Bonds, The Color of Child Welfare, as well as a co-editor of six books on constitutional law and gender. Professor Roberts has also published more than 100 articles and essays in journals, including the Harvard Law Review, the Yale Law Review, the Stanford Law Review. Her latest book is entitled Fatal Invention, How Science, Politics, and Big Business Recreate Race in the 21st Century. Professor Roberts has won many honors, including very recent honors in 2016, such as the 2016 Society of Family Planning Lifetime Achievement Award, and the Harvard Women's Law Association 2016 Award, called Women Inspiring Change, and a 2015 Award from the American Psychiatric Association, the Solomon Carter Fuller Award. In about a month, Professor Roberts will deliver this year's invited Tanner Lectures at Harvard on human values. Professor Roberts' talk to us today is entitled The Racial Gap in Maternal Morbidity, Mortality, Why Reproductive Justice Matters. I hope you will join me in giving a warm welcome home, in fact, to Hyde Park to Professor Dorothy Roberts. Thank you. Thank you. Thanks for that warm welcome. A lot of those tidbits came from dinner last night. They were not on my bio. And it is really great to be back in Chicago, University of Chicago in particular, where I was born. I was born and lying in hospital. And I do credit growing up in Hyde Park in the 1960s for my interest in social justice and applying that perspective to my work and my life. And so it's always wonderful to be back in this part of the country. Well, many of you probably know the absolutely atrocious record that the United States has when it comes to maternal deaths. The World Health Organization, a recent report looking at changes in the maternal mortality rate between 1990 and 2013 discovered the astonishing fact that the rate in the United States is increasing, whereas it is decreasing virtually in every other country in the world in both the developing and developed world. There's certainly no place like the United States among Western industrialized nations. And it is not only increasing, it's just a deplorable rate of deaths of women from complications of pregnancy. It was the highest rate that they found of any country, the highest rate of increase of any country they surveyed. And most of the reasons for these deaths are preventable ones. So that makes it not only a tragic fact of pregnancy in the United States, but also an injustice, a human rights violation. Now, another astounding and deplorable aspect of the high rates of maternal mortality in the United States is the fact that there is a huge gap between the rate of death of black women and white women in this country. And it's a gap that has existed for at least five decades. I would believe that if we had data from the time of slavery to today, we would find that it's a gap that has persisted over the entire history of the United States. Black women are four times more likely than white women to die from pregnancy-related causes. And where there are a large black population, those are the places that have the highest rates of maternal mortality and morbidity. Washington, DC, about 50% black. You see has almost double the US rate, which is 28 per 100,000 life births. Fulton County, where Atlanta is situated, triple the rate. And then there are these pockets of really just almost unbelievable, unbelievable death rates, like this county in Mississippi, where now the HWO report referred to women of color instead of black women. But I'm sure that black women make up the bulk of these deaths. The maternal mortality rate is 595 out of 100,000 life births. It's almost incredible. This is kind of statistic you look at and you think you've misplaced a decimal point or something. It just cannot possibly be that. And as the report points out, that is worse than in some countries in sub-Saharan Africa. So this is a persistent, abominable, and inexcusable crisis. It's almost an oxymoron to talk about a persistent crisis, but it is. It's continued for so long and at with such a large gap in outcomes that, of course, we have to ask what can we do about it and what is the cause for these horrible statistics or it's more than these horrible deaths and injuries to women who survived them and what's the solution. And this isn't a clear cut answer. I would argue that the answer depends on your approach to this problem, whether you see it as a problem that has to do with something wrong with the women who are dying or whether you see it as something wrong with our society which is causing these women to die at these high rates. And this is why I think that a reproductive justice approach matters because it matters to whether you think this is an important problem. One immediate reaction I have to reading these horrifying statistics is why don't we hear more about it? We hear about all sorts of gaps along racial lines or gender lines in the United States. Most people I talk to have no idea that in some parts of the United States, women are dying from pregnancy-related causes at higher rates than in sub-Saharan Africa or that the gap between black and white women is fourfold. We're talking about people who are dying from preventable causes. So you would think it would receive more attention. So even the question, why hasn't it gotten more attention? That's not a question of approach what we're concerned about in this country. And then what's the cause of it is also a question of perspective and approach to the problem as I'll talk about some more. And of course, figuring out a solution to any problem depends on what you think is the cause of the problem. So the fact that this has been a crisis for at least five decades that we know about, that it's getting worse, that whatever the US health care system has been doing isn't working, we know that the current approach is a bad one. Again, unless you think it's just naturally supposed to be this way, which many people do think. So I want to talk about that as well. What do I mean by reproductive justice approach? Well, it is an approach to reproductive health and rights that looks at the full scope of women's and men's sexual and reproductive lives. In other words, it doesn't just focus on a decision to terminate a pregnancy, which for many Americans is what reproductive rights means. Many, many people, I would venture to say if we took a poll of Americans, most would equate reproductive rights with the right to abortion. It's certainly the reproductive health issue that's gotten the most attention in the United States. It deserves a lot of attention, but it certainly isn't the only aspect of women's reproductive lives. So reproductive justice looks at the full scope of women's reproductive health and the decisions that they make that affect their health, and then just as important, what affects the decisions that women make about their reproductive health? In other words, not seeing those decisions as choices that they make in a vacuum, but looking at how the way our society is structured shapes how women make decisions about their health or aren't even able to make decisions about their reproductive health. It includes the right both to have or not have a child. So very importantly, it has to do with women's ability to have children if they want to have children, not just the decision not to have a child. And so for many people, the reason why maternal mortality wouldn't even register as a reproductive rights issue is because these are women who, by and large, wanted to have children. They were planning to have children and died as a result of it. So it doesn't fit into a framework that just looks at the decision to terminate a pregnancy as the full extent of what reproductive rights cover. And also important, it covers the right to parent a child. So policies that would either lead to the death of a woman after she has her child or that removed that child from her unnecessarily as soon as the child is born, those would be concerns of reproductive justice, violations of reproductive justice, as well as what is the environment in which women are raising their children. If it's an environment where you have to be afraid that your 12-year-old is going to be shot for playing in a playground with a toy gun, that's a matter of reproductive justice. It's not just being able to make the decision to have a child, it's the experience of raising your child as well without violence against you or your children because you have become a mother. And it's part then recognizing that all of this is profoundly shaped by social inequality, social structures that value certain women's childbearing and devalue others. And that is embedded in laws and policies that perpetuate generation after generation after generation in new iterations to prevent in a racialized way women from being able, some women from being able to exercise these rights, recognizing all of that, reproductive justice understands that you cannot protect these women's rights without linking it to a broader struggle for justice and human rights in this country and around the world. So that's the framework. Well, what does that then lead to if we have that framework, what does that mean for how we might approach these atrocious rates of maternal mortality and morbidity? I mean, first of all, just at the start, it means that we would recognize now that these are justice issues. Again, the statistics I cited, the deaths of these women, don't even register at all for many Americans as reproductive freedom issues. So at least with the very get-go, one advantage is that we can recognize them and start to think about them as a question of justice and not just as a question of a health problem that has to do with something wrong with the women who are dying at higher rates. Now, this perspective is grounded in black feminist intersectionality. It was black feminists who coined the term reproductive justice and who have been the chief champions and developers of this point of view. It's now, 20 years ago, no one was talking about reproductive justice. Now, it's much more common to hear the term and to have it applied to various programs and scholarly agendas and organizations. But I suppose we forget where it came from. And very often, the women who are the originators and key developers of this way of thinking get completely left out of the discussion with some even mainstream, predominantly white organizations claiming that they discovered it in the New York Times. No, this was a part of black women's organizing that comes out of a particular perspective about inequality. And that perspective, which the Kambahee River Collective talked about in 1977, it recognizes that black women in particular, but this is just true of how politics operates in the United States and globally in general. But black women have a particular perspective on this because we are at the intersection of racism, sexism, and often class inequality as well. And so they recognize that they were committed to struggling against all of these oppressions that intersect into major interlocking forms and systems, structures of disadvantage and privilege. Now, before I get to a reproductive justice approach to this topic, I think it's important to highlight that it is competing with other approaches which are very popular in the United States. So for example, when NIH just launched its largest ever study of breast cancer genetics in black women, the acting director in the press release stated that the purpose of this study was to address the unique breast cancer profiles of African-American women and learning about the origin of cancer disparities. Now, I don't have time to go into the implications of a study to look at breast cancer genetics. I am not saying that genetics don't play a role in breast cancer and perhaps even in disparities in breast cancer. But the idea that the reason for the gap in breast cancer mortality in the United States is because of a unique genetic profile of African-American women focusing on genetics as opposed to all the structural inequalities that contribute to the racial gap is, I think it's problematic. I think that it would have been far better to explain what this study was doing, even conceive of the study in a way that focused more on the structural inequities that certainly play a significant role in the racial gap. It is simply not the case that race creates unique genetic profiles. Race is a political invention to divide human beings and it's not true that a particular race of women have a unique genetic profile. I'm not even sure what that means to say that African-American women have a unique genetic profile. Which ones? How much African ancestry do you have to have to have a unique genetic profile? Certainly given the vast genetic variation among people in Africa, let alone those who are mixed with other ancestries to be African-American women, the fact that they suffer from such huge gaps in deaths from breast cancer, deaths from pregnancy-related causes is far more likely to come from social inequities than from something unique about their genes. But this idea also is very prominent in other kinds of studies like this one published in the American Journal of Obstetrics and Gynecology that tested the hypotheses that black race independent of other factors increases the risk of extreme preterm birth and its frequency of recurrence. Again, I would ask, what does black race even mean? Are they hypothesizing that there's some kind of essence in black people that you can separate from all the social inequalities black people experience? How could you possibly do that? And in the study, they did control for a few variables, but they certainly didn't control for every single possible factor that could affect the higher rates of extreme preterm birth among African-American women. And so they conclude a probable genetic component that may underlie the public health problem presented by the racial disparity in preterm birth. So I'm looking at other kinds of studies that ask questions about similar problems, higher rates of reproductive health-related bad outcomes for African-American women. And is this the approach that we should take to dealing with the staggering gap in maternal mortality? Another approach looks at what is wrong, maybe not genetically, with African-American women that cause these horrible gaps in reproductive health outcomes, but whether there's something wrong with black mothers in how they're raising their children that produces these harms. So when Newsweek reviewed how poverty affects the brain, studies that are looking at how poverty has a material impact on the brains of poor children, many of these studies involving African-American children in particular. Newsweek summed up the policy implications that programs wouldn't focus just on the children, but on the mother who grew up in poverty and as a result hasn't developed coping skills and is therefore highly unlikely to be passing them on to her children. The idea that there is a neurological effect from poverty, especially in African-American children, and the responsibility should be on the mother to help children cope with this problem. So here we have two approaches, both of which look at what's wrong with black women, either innately or in their behaviors that result from their disadvantage in our society. Now, another approach, and some of you may know these Chicago researcher physicians. I love their work. They are constantly fighting against those approaches and looking at what it could be in the inequities, social inequities that produce these gaps. Not what is wrong with the women, but what is wrong with our society. And this fairly recent study found a very striking association between the amount of time African-American women grow up in poverty and birth outcomes. And they concluded that relatively small improvements in the economic environment of African-American women across the life course would translate into beneficial birth outcomes and narrow the racial disparity in infant mortality rates. So this is an aspect of structural inequality that is very racialized in the United States, which is that black people are much more likely to spend their entire lives in poverty than white people are, than even poor white people are. And it's something that is often omitted from studies that control for the current socioeconomic status of women in the study and then conclude, oh, there's got to be something innate in black women that's causing this. They never look at the impact of the length of time over an entire life course of living in poverty. So that's one simple variable that's often not controlled for that is a problem with many of these studies that conclude that genetics is the primary reason for these gaps in reproductive health outcomes. And so instead of thinking about race as naturally producing these reproductive health disparities like gaps, differences in preterm birth and infant mortality, in maternal mortality and morbidity, another approach, which researchers like Collins and the others are looking at and many others, which is more in line with reproductive justice, is looking at the way that racism gets embodied, recognizing that race isn't a natural category that produces these outcomes, but it is a political or social category that has biological consequences because of the impact of social inequality on people's health. And in the case of maternal morbidity and mortality, we could point to a number of structural inequities that probably contribute to these gaps. Black women are less likely to be insured, more likely to be uninsured. They have less access to high quality health care, including reproductive health care, access to abortion, access to family planning, prenatal care, and also postpartum care, which is very important to this issue with the studies that have looked at this like the World Health Organization report finding that, as I mentioned at the end, that in many of these cases, white women may have the same complications from birth as the black women, but they're more likely to get medical care that avoids a death. So it's also the postpartum care that's important. And African-American women are more likely to have chronic health conditions that are risk factors for maternal morbidity and mortality, like diabetes and heart disease. Again, though, going back to what I was saying, why? Why do they have those chronic health problems? Because of the kinds of factors that Collins and the others found, because of a whole slew of ways that racism is embodied that aren't even being studied yet, just the stress from experiencing discrimination. There are more and more studies finding that that is a chief contributor to health inequities. But what about the higher rates of incarceration of black women, which doesn't just start in adulthood? We know that black girls are more likely to be expelled from school, more likely to be arrested in school, more likely to be assaulted by police officers in school. You know, I could go on and on. All you have to do is read the newspaper every day. You could see all the stresses that black girls and young women are under. And many of those stresses that haven't even been studied yet, certainly aren't controlled for yet in many, many of these studies that claim that there is something innate that's causing the problem. You all recognize Dr. Steve Whitman, who passed away recently from Mount Sinai, another wonderful physician researcher trying to explain the health inequities in Chicago in this study, finding with his collaborators that breast cancer deaths for black women are twice that of white women in Chicago. And looking at the question of why this finding gives us some clue, because in 1980, black and white women died at the same rate from breast cancer. In fact, white women had a slightly higher incidence of breast cancer. And the two groups died at the same. Over the course of the next two decades, this gap emerged. And it wasn't because black women's health got worse. It was because white women's survival rates were double. Their deaths were cut in half. And the researchers concluded from that. And there could be lots of different explanations for why this would happen. But it's very unlikely that it happened because of something innate in black women. It's much more likely the most plausible explanation, as Dr. Whitman said to me when I spoke with him about it, that there were amazing advances in breast cancer detection and treatment over the course of those 20 years. And white women got the advantage of it. And black women got absolutely no advantage from it in Chicago. Now, another aspect of reproductive justice, besides focusing our attention more on the structural inequities that produce these gaps in death from pregnancy-related causes, is to think about the way in which this country has approached these deaths to ask, why has this injustice continued for so long? And to think about it in the context of a long history of devaluation of black women's childbearing and motherhood in America. Now, we don't look at the problem as just a medical issue that emerged out of the blue in 2016. We have to understand, why did it emerge at all? And again, if we're asking, what is it about our society that allows this horrific difference in death and injury to occur, why is it that black women are dying at such high rates? It's not just a statistical association. There's something that's producing this in our society. And so one aspect of reproductive justice is to look at the history of injustice against black women in America and understand that that legacy shapes the way that policymakers, the medical profession, those who are creating our health structures in the United States, approach childbearing by women of different races in America. You can't isolate the question of who dies in childbirth from the question of, how has America as a nation and the policies and laws that created and supported it treated the childbearing of black women? And as I point out in my book, Killing the Black Body, there is a consistent, intense, and deplorable history in the United States stretching from slavery all the way to today of devaluing black women's childbearing. Beginning in slavery where black women's reproductive labor was profitable for slaveholders. And therefore, it was important to control their reproductive labor. After all, their babies belonged to the slaveholder. And black women's reproduction was a form of generating more enslaved laborers for the nation, which is connected to the idea that race is inherited because it was important for black women to produce more slaves. In other words, the idea that black women naturally produced children who could be enslaved, that that's a biological process instead of a social, political, created process. This takes maybe a lot to explain it, but I hope you get the idea. I think this is really profound. And it affects how black women's childbearing is thought of to today, that black women were seen to be the reproducers of slaves rather than a racist, white supremacist, legal structure producing slaves. Do you see what I mean? OK. Oh, I've lost my. OK, well, I'll do this. Oh, it's back. OK. So that was written into US law and policy from the time of slavery. And it had multiple implications for how black women's reproductive decisions and childbearing were treated, including an approach to black women by the medical profession during slavery that they could be experimented on, including these gynecological experiments by J. Marion Sims without anesthesia, because they were property. I mean, you might say, well, that was back in the 1800s. But there are many, many examples of black women being devalued still by the medical profession. One example just very recently, last December, Barbara Dawson, 57-year-old woman goes to the emergency room. She's saying she can't breathe. They won't treat her. She begins to scream that she can't breathe. What's the answer? Arrest her. They call the police on her. She is dragged at the hospital into the parking lot. You can hear the audio of this with hospital staff and the police trying to drag her off the ground into the police car. And one of them, we don't know if it's the hospital, the police saying, you're going to jail no matter what. And finally, they bring her back into the emergency room and within 24 hours, she's dead from a blood clot in her lung. The idea that, well, this isn't the only example of collaborations between police and hospitals in South Carolina, Medical University of South Carolina the police and hospital staff collaborated to drug test the black women in the hospital and have them arrested if they tested, pregnant women have them arrested if they tested positive for drugs. The collaboration between police and hospital staff to arrest black women I think is just one but very striking illustration of the devaluation of black women patients. And in this country, I in one of the important reports on maternal mortality and morbidity conducted by the Center for Reproductive Rights, National Latina Institute for Reproductive Health and Sister Song women of color reproductive justice collective in their interviews of black women across the country they found frequent complaints that these women felt that they were being devalued and dehumanized when they went to the hospital, especially public hospitals for labor and delivery care. For example, Tiffany describing the scene when she was 17 years old of the delivery ward in the basement of the hospital in Jackson, Mississippi just crowded with women who were in pain and just being left there to suffer until the baby was about to come out. And others feeling that because they were uninsured, they were treated with less respect. So this devaluation of black mothers again, stemming from slavery produced a number of stereotypes about black women that I think are very powerful to this day in U.S. thinking people, Americans thinking about black motherhood and policy and then that affects policies that then affect the outcomes for black women giving birth in hospitals in the United States. One of the stereotypes that originated in slavery still circulating today is that black women are hypersexual and therefore hyperfertile and that this is a problem for policymakers. In other words, black women's childbearing seen not as something that they should have control of that's something that should be fostered and supported, but as a problem that needs to be controlled. So the image of the Jezebel originated in slavery to justify slave holders rape of black, of their enslaved women and their female slaves, the idea that black women are naturally promiscuous so cannot be raped and that these women children who then called mulatto children who were being born on plantations all over the country defined by law to be black. Again, that's a legal definition. They could have been defined as white. So right there is a problem with talking about African-American women having a unique genetic profile because they could have been these most of the African-Americans in this country could be defined as white because or many of us because we have African ancestry. I mean, European ancestry, but that was a legal definition that connected to a negative stereotype of black women to justify the exploitation, sexual and reproductive exploitation of black women. That stereotype that black women are hyperfertile circulates in the United States today. Along with it was the mammy who was seen as asexual, safe, but a good caretaker of white people's children as long as she was supervised by the white mistress, but what was her relationship to her own children? She had not only no authority over her own children, but she also was portrayed as being a negligent mother to her children. There was a myth of black infant mortality being linked to careless mothers who smothered their children in bed because they were so lazy and not uncaring of their children. This idea that black mothers don't really care about their children, it is very present to this day. I could give another talk on the child welfare system and the high rates of removal of black children from their mothers and studies that show that it's much easier for social workers to remove black children from their homes than white children for the exact same risks and the comments that have been collected by researchers about this lack of caring and connection. Surely that has an impact on why this country has not done something about the high rates of maternal mortality among black women in the nation. Another common stereotype, this has extended into the 1980s, this became very popular in the 1980s under the Reagan administration to support abolishing the welfare system. What was that all about? That was about the myth that black women had babies just to get a welfare check and then they didn't care about the children afterward. Again, these have real implications. That was the stereotype, the welfare queen that was circulated and it worked. In 1996, Bill Clinton signed the law that abolished the entitlement to welfare in this country. And if you read the preamble to that law, it's all about how to keep, they don't necessarily say African American, but how to keep women on welfare from having so many children. And so this idea that black women are having too many children and that is a public policy problem is very, very embedded in US policy decision making. I think we can move on to the 1990s and the myth of the pregnant black crack addict who nurses reported and this was reported in major newspapers like the New York Times, the LA Times, Wall Street Journal that it deprived black women of maternal instinct. For some reason, it was assumed there was something about black women in particular and the chemical effect of crack cocaine in particular was not said about any other women who use drugs during pregnancy that it deprived them of maternal instinct. Again, gross devaluation of the mothering of black women attributed to some kind of biological, innate biological trait that black women have. And the crack baby, she was supposed to give birth to the so-called crack baby which was described in medical journals and in the media as children who were permanently damaged from crack use during pregnancy, a particular kind of damage that caused them not only to have health problems but to lack social consciousness and so they were predicted to all become criminals, drug addicts and welfare dependent. You all remember this literature, right? Okay, now these children have grown up and some researchers are finding they did not turn into a horde of monsters. Not only that, their health problems are no different from the health problems of other children in their neighborhood, neighborhoods whose mothers did not smoke crack cocaine. So now it's clear that whatever problems these children had as newborns was either completely attributed to or largely attributed to other structural inequalities that they faced in their neighborhoods. But again, another example, recent example where it's attributed to some kind of innate defect that black women have that causes them to produce problems in their offspring. Again, could that very common influential view have something to do with why this nation hasn't taken greater steps to end the racial gap in maternal mortality? I think we would be foolish to think it doesn't have an effect. At least we have to think about the racial gap in maternal mortality and mortality in the context of this long history and present, is I don't want to put it off on slavery. It continues to this day of devaluing black women's childbearing. It did have an effect, long lasting effect in policy of promoting massive sterilization of black women. Just one example is the operation of the North Carolina Eugenics Board into the 1970s where at that point its main victims were black women who relied on welfare. It has been suggested, this is just one example, but legislators have suggested this, other policy makers have suggested this, that the reason why black children are in poverty and have other forms of disadvantage is again because of their mothers having too many children, with the inquirers suggesting that Norplant was the answer to black poverty. And a recent revelation that in California, black and Latina women were subjected to a program of sterilization that sterilized at least 148 women, I would say unethically because they were incarcerated women, but at least we know that the doctors were violating California state law in performing these sterilizations without the proper ethical review. What we're seeing in this country arise in what was already happening as a result of these myths about crack babies, of prosecutions of black women, now it's spreading to women of other groups as well for fetal abuse, which I call punishing women for having children, blaming them for the horrendous rates of stillbirth and infant mortality by making them the scapegoats incarcerating women for giving birth. And all of this linked again, this is part of reproductive justice perspective that links all of these reproductive violations against black women in a single approach that this is a form of racial social injustice. The high rates of abortion among black women as well, which stem from higher rates of unwanted pregnancy, which stem from structural inequities in availability of contraception, also availability of sex education and other inequalities. At a time when we are seeing an assault on women's access to abortion in this country, who will be most affected by that? Again, the women who have higher rates and who are less likely to be able to get around all the state-imposed roadblocks to access. This is certainly going to lead to more maternal mortality. And there was a recent study that showed that Texas has had this huge leap. Now it's not clear that it comes from the abortion restrictions in Texas, but certainly they contribute to the increasing rates of maternal mortality in this country. Even though advocates against abortion use this very well-known image of black women as dangerous reproducers in their campaign. So across the country, billboards go up, this one was in Soho against a building in Soho, proclaiming the message that the most dangerous place for an African-American is in the womb. And so whether black women want to have a child or don't want to have a child, it's the same message. They are dangerous reproducers. But let's look at the family planning community as well. That as I just said, access to abortion and contraception, other forms of family planning, absolutely essential and life-saving and human right. But it is a human right because of the value of the women who should have access to, at all women, regardless of race and class, should have access to that. The idea that access to abortion is important because it saves America money by not having to support unwanted children is an unjust way of thinking about why there should be access. And it supports coercive family planning programs, which this country has had a long history of. Reproductive justice recognizes the injustice of population control policies, policies that advocate birth control for certain people because it benefits society versus birth control family planning policies that advocate equal access to all men and women because they are valuable human beings. They have a human right to control their reproductive lives. Do you see the difference between those two approaches? I hope you do. Because this kind of message is a dangerous one that has been used to control African-American women for centuries. Also, let me mention the recent advocacy for larks to be the first line, birth control for at-risk teens. Again, teenagers should have access to all forms of family planning. But to advocate that certain teenagers, Black and Latina teenagers, should be somehow encouraged, pressured only given this option because this is the solution to their lack of opportunities makes it seem as if the reason why they have lack of opportunities is because they're having children. Just like what has been revealed about the myth of the crack baby, it is a myth that teenagers who have children are so much, have so fewer opportunities than the same teenagers in their neighborhood who don't have children. None of them have equal opportunities. It's not because they're having children. It's because of structural inequities that are denying them opportunities, opportunities to go to college, opportunities to go to a high quality school, opportunities to stay out of juvenile detention. All of that isn't because they're having children. So yes, they're better off having access to contraception but don't blame their lack of opportunities on their bad reproductive decisions. That's not what's causing it. Okay, I'm gonna move ahead. Well, maybe I'll just add that another example because I was gonna say more about incarcerated women, another aspect of reproductive injustice that affects disproportionately black mothers. They are the highest, the fastest growing group incarcerated in the United States today and they are treated also in most states in the most dehumanizing way when they give birth, shackling them to the bed in the delivery room which I think all the OBGYNs here would know that that is a form and mothers in the room would know that is a form of torture and it causes physical injury, distress, trauma and is a emotionally dehumanizing way of treating a woman giving birth to a child, totally unnecessary. I could see of no purpose for it other than to dehumanize incarcerated women again to punish them for having children. So black women have been advocating for reproductive justice as I pointed out for decades using that term since 1994 but advocating the meaning of it for far longer and calling for all of us to change the perspective in the way we deal with these persistent, abominable gaps in health including maternal mortality and morbidity demanding that black women's dignity and humanity be recognized in protests that are calling out the United States' history and current practice of state violence against black people and issuing a counter message. This is a counter message specifically to those billboards that say the most dangerous place for an African American is in the womb but it speaks more broadly that black women should be trusted to make decisions for themselves, their families and their communities and it is essential not to treat black women's childbirth as a problem but to understand the structural inequities that are causing the problem is too mild a word of higher rates of death among black women for multiple outcomes but especially tragic and appalling deaths from pregnancy related causes. So I'll end there. I know I went a little bit over but I'm happy to engage in discussion with you. First of all, thank you so much for giving the talk today. I'm here. Oh, there you are. Okay. My name is Rachel Newhouse. I'm a PhD student at the University of Illinois at Chicago and I'm also a nurse midwife and my research is focused on disparities in maternal mortality for black women. But something that I've looked at that I just wonder how much you know about because I've been looking into it is the similarities and disparities in maternal mortality for Native American women and black women because they have very similar rates and I mean when I look at those two communities and look at the history, they're communities that have been systematically deconstructed over and over again and systematically disadvantaged and I feel like there's something to gain from I know that it's an African American problem but I think we're adding another variable to it to say that when we do this to a group of people this is what will happen and we've seen repeated examples. Yeah, yeah, I think that's absolutely right. My work focuses on African American women. I think there is that African American women have a particular position, political position in US structures of inequality so I think it's important to focus on black women but for me to focus, for many people to focus, we have certain ways of advocating for justice and there is a particular history of devaluation of black women in this country that shapes policy and law and practice institutions that's very important to recognize. It's also the case that other women of color have been subjected to state violence and structural inequities that produce similar kinds of horrible outcomes for them and certainly Native American women, many of the things I talked about, the statistics, the institutional devaluation. I mentioned the child welfare system. Native American children and black children have the highest rates of foster care placement in this country. Now that comes from a different kind of history, enslavement versus conquest, but both are histories of devaluation of the people, their families, the bonds between their families. There are differences I don't have time to go into but you're absolutely right, it's they're both examples of how state violence, structural inequality produce these very negative outcomes for health and other aspects of welfare and I think it also supports the view that this is not something innate that naturally produces these problems. It comes from these forms of inequality and so at some point, unless you believe that white people evolved to have superior genes to predispose them to better health, better education, lower rates of incarceration, unless you believe that, how do you explain that everybody else is these big groups of people have such negative outcomes? How do you explain it? And to me it's much more plausible to say it's because of structural inequality and that's what we need to focus on, that's what we need to end in order to solve these problems. And it's not to say this happened hundreds of years ago and the problems are just persisting. No, there are forms of structural inequality and violence that continue century after century, decade after decade, generation after generation, that's what we have to look at. And it's also not to say, I've heard these counter arguments so that's why I get so easily to spin them out. It's also not to say, oh, we have to end poverty, we have to end racism before we can do anything about the problem. No, there are ways in which very concretely today in policies and practices that are perpetuating these problems and we can address them if we have the desire to do it. But it requires a certain way of thinking about the problem. And this is why I think it's so important for people in biomedical research, in medical practice to engage with people who are in political activism and sociology and the humanities because often none of us has an unbiased perspective. We have to, it's important. I love being here to talk to you all as someone whose work is in sociology and law. And I hope I've shown you how my work relates to what you're doing. We need another way of approaching this. The way that these issues have been approached is fail, it's getting worse. It's getting worse so something has to change. You showed in one of your early slides that in 1980 the rate of maternal mortality was not very different between African-Americans and whites. Just that that slide was for breast cancer. I'm sorry, I'm sorry. But you did show that the doubling of maternal mortality in the last 23 years. Exactly, exactly. Which of these many aspects of social and racial inequality do you think contribute to that change? I think it's hard to say. I think that I guess the way I'd rather approach it is we know that there are many factors that do contribute. So because sometimes there's a, when not to say that people with certain interests and specialties shouldn't focus on particular aspects of it, but sometimes the focus, if it's too monolithic on one particular aspect of the structural inequality it ignores others. So one example is surely this has a lot to do with being able to access advances in medicine. I think Steve Whitman's explanation for why the gap increased white women's survival rate doubling but black women's remaining the same that has to have something to do with the fact that white women were able to take advantage of the advances in breast cancer detection and treatment. And similarly, the reason for the gaps in infant mortality, I mean, well, infant mortality too, but maternal mortality and morbidity surely have a lot to do, and this is demonstrated in the reports by the World Health Organization, others who've looked at this, lack of access to high quality care at various levels. But research is showing more and more that it's not just access to healthcare, it's also living conditions from birth to the time of giving birth and that these studies that are looking at maternal, the increase in maternal mortality and morbidity attribute at least some of it, a significant amount of it, to health related, poor health related complications. So the women's health when they become pregnant is important, it's not just whether they have access to prenatal care, their health is important. If you're already unhealthy and have a complicated pregnancy, that's a problem before you seek prenatal care. I mean, I know when I've had four children, my goal was to stay, no offense to the doctors here, stay away from the doctors as much as possible, I didn't want to be constantly going to the doctor and I had, my first three children, I had attended by midwives and I only saw midwives infrequently. I had problem free pregnancies. I'm not saying that to boast about it, but I think that was because I was privileged to grow up in a middle class home and to have access to good nutrition and low amounts of stress. My parents were teachers and I was privileged to be able to be pregnant in a healthy state. That's what you want. Now, yes, of course it's also important that if you are unhealthy, if you have complications, you have access to high quality medical care and as I pointed out, the report found that even when black and white women had similar complications, black women were more likely to survive if that's an important aspect, which also has to do with health, pre-existing health status, but again, if we just focus on access to healthcare, which believe me, I support universal, high quality healthcare for everybody. So I'm not saying it's not important, but if we just focus on that and don't also realize how racism is embodied throughout the life course, then we won't solve the problem that way either. I think we'll take, oh my gosh. It's all my fault. I think we'll take two more questions. Yes, and then we'll have in the back. Cindy. Hi, my name's Kudziah Sharif. I'm a second year in the college. My question is kind of, I guess like wondering what your opinion is on how like RJ movement can continue to be inclusive of like trans folks, gender non-conforming folks and also like sex workers. They're often not included in a movement that where we talk about women and like how to be inclusive in like a healthcare environment, but also in like more political settings. Like how, I guess like what your opinion is on how effective that is or if it is, I know some people might say it's distracting from like we just need to focus on black women or like how, I guess like yeah, what you're taking on that. So again, as I explained to the question about Native American women, my focus is on black women sort of broadly and on race and gender, the intersection of race, gender and class. But again, I am speaking from a reproductive justice approach which is an intersectional approach and that's why I always like to refer to the Combahee River Collective which their statement recognizes that race, gender, class aren't the only systems of oppression. So I think we need a way to, and maybe I don't do it perfectly either, but we need a way to be able to sometimes focus on particular forms of oppression, recognizing that they're all intersecting and also to be inclusive of the whole range of people in whatever category you're talking about. So if I talk about black women, I'm including trans women, including women who are sex workers, I'm including other groups who are marginalized in mainstream ways of thinking and also often in the black community as well. So I think that's a good point. I think that's important to state and to point out. I think that reproductive justice groups have been more inclusive than mainstream reproductive rights groups, but there's still work to be done and not every organization is as important as inclusive as others. Also, it's also important for queer trans people to have their own advocacy as well and for there to be collaborations across movements. This is another aspect of reproductive justice that because it's intersectional and you recognize that these are social justice issues, you have to also recognize that to achieve anything, you have to have movement intersectionality as well. So you see the even just reproductive justice, either it has to collaborate with advocates for economic justice, criminal justice, environmental justice, or somehow bring those issues within reproductive justice. I think there's a question of strategy of what's the better way to do it, but it's essential for advocacy, activism to see that the activism itself has to be intersectional. Reproductive justice isn't just about intersecting identities. It's about an approach to how to make the world a more just place. And so it's not just about recognizing, oh, these are my different identities. It's what does that mean for how I am gonna work to end injustice? And that has to include working with people who might be focusing on some other aspect of the interlocking systems, but all along recognizing that they are all interlocking, you can't separate one from the other. I think everything I've been thinking about answering the answer to your question about what's the main cause, well, they're all important. Now, obviously we can't all, no human being can work on every single issue and every single cause, but we can, as we're working, recognize that we are linked in values, in mission, in worldview to others who are also working for the similar end of ending these oppressive hierarchies, ending state violence, ending unjust institutions in this country and around the world. We could add the whole global question as well, so it could get very complicated, but that's the only way that we're going to make a change. We're gonna take one more brief question. Yes, I already have the microphone. My name is Samantha Liu. I have my master's in public policy and I focused my capstone research on how access to comprehensive sex education could decrease a woman's likelihood to depend on welfare later in life. And so there were a couple things you talked about. I thought your talk was very thought provoking, so thank you for that. I guess it's more commentary, but for instance, when you were talking about when TANF was implemented, signed by Clinton, and there's certain policies in that that just don't make any sense to me and they continue where they're trying to prevent women on welfare from having more children, but they also threw an abstinence-only sex education into that bill. So then if a woman had a child and then was on welfare, then she was provided with useless information that maybe led her to have more unintended pregnancies and then because of other policies, she couldn't do anything but have those children. So it's like these perpetuated things, these policies that don't make any sense and they just actually make issues worse. And so if they actually wanna solve the problem of people not wanting to have, not getting pregnant when they don't intend to get pregnant, then they should approach it differently from the beginning, not just address, well, look at abortion now and how to handle this pregnant woman now. Like how do we help this woman not get pregnant when she didn't mean to? So that's just frustrating to me. Yes, yes, the policies do seem irrational unless you understand them as all being dehumanizing policies that are directed toward controlling these women based on stereotypes, again, devaluing stereotypes about them. I mean, we could add to all that you said, not only do the policies provide useless information and not support a woman's control over her reproductive life, including providing access to abortion and family planning, but they also then punish her when she has a child while on welfare by denying her in many states, it's decreasing in many states, and increase in benefits to help support the child. So, which is also a contradiction between the supposed concern for the fetus and then when the baby's born, you're going to deny the woman any extra money. It's already a piddly amount of money that's inadequate to care for the additional child. So, yes, it seems irrational, except for the logic of not respecting the human dignity of these women, devaluing their bonds with their children, not believing that they should have any control over their lives, reproductive or otherwise, and another thing that all of it pushes women towards sterilization, that would, for many of these legislators, that would be a fine solution, and they in fact said that, many of them said it during the debates about welfare restructuring. The answer is that these women should all be encouraged to be sterilized. So, they're punished for their childbearing, their autonomy, their decision making, their own control of the lives is not being respected, and the upshot of it is, all of this leads to greater rates of maternal mortality and morbidity. So, that's how I look at it. Now, what should our view be? Again, I will reiterate that a reproductive justice view would recognize how this fits into the devaluation of these women into other forms of structural inequality, and how ending those structural inequalities would support these women and children and make their, improve their health, and improve the well-being of their children, give them greater control over their lives, and value them more, but it cannot be, we have to reject, though, the view that the purpose for family planning is to control them because they're problems to society. That is not the answer. That is closer, to me, that's closer to that conservative view. Unfortunately, many liberal people espouse that view, but it's closer to that liberal view, to me, a reproductive justice approach puts aside both the liberal view that supports population control and the conservative view that supports valuing the fetus over.