Nice to find an uncracked pedestal

When I was a child, I had a book of Norman Rockwell’s illustrations art that I used to joyously pore over. I remember even doing a report on him for school, and I had to make sure he wasn’t too much of a commercial artist to qualify.

In my previous life before motherhood and medical school, I actually went to art school and was a portrait artist. I could never even begin to touch the hem of Normal Rockwell’s garment when it came to the emotional quality he could bring to his faces, much less his exquisite technical skill. I never, ever mentioned being inspired by him in art school, however. No one else mentioned him either. I was busy discovering other portrait artists like Francis Bacon and Sigmund Freud.

There is a Normal Rockwell exhibit at a nearby art museum, and I really want to go. I was listening to a story on it on my local NPR station (you guessed that I listed to a lot of NPR already, right?) and I was stunned and impressed by their coverage of his dedication to civil rights. I was also stunned and disgusted by their explanation why none of his pieces depicting civil rights for African Americans were ever in the Saturday Evening Post; they had an official policy that blacks could only be portrayed as servants: waiters, housekeepers, etc. This was in the 1960’s.

(Another example of very institutionalized racism, and why I had the “there is no such thing as a race card” this very morning. Before I heard this story.)

I am looking forward to seeing the exhibit, especially two pieces that I had never heard of until they were described on the radio this morning. It used to mildly annoy me when they did stories about art on NPR and tried to describe the works, but I am so happy they do, now. (Obviously, it is beneficial to the visually impaired, also). Here are internet versions of two of the pieces at the exhibit: (click to embiggen)

“The Problem We All Live With”

This piece depicts four federal marshals escorting a black six year old girl (SIX!) to school in Louisiana. All the white parents pulled their children out of the class, according to the coverage. There is a tomato smashed on the wall behind her, as if it just whizzed past her head. And, the N word is emblazoned, lightly, on the wall above her head.

The second piece they described: (click to embiggen)

“Southern Justice” (Murder in Mississippi)

This hair raising image depicts the shootings in Mississippi during the civil rights era. I am fairly sure they are the shootings that lead to the movie “Mississippi Burning”. Only the blood on one of the victims is in color, and the rest of the piece is in black and white. According to the radio story today, he actually purchased a pint of human blood to make sure his portrayal was accurate.

It’s nice to find out more about someone I love (and may have been a little embarrassed for loving) and be even more in love with them.

Reply turned post, heart heavy but not too heavy style

I replied on Los Angelista’s post “How Do We Talk Productively About Racism On Blogs?” (h/t What Tami Said). It seemed relevant, considering what has been happening on this blog lately.

Here it is:

Great post that I really needed to read today.

I have had difficult conversations about race on two of my blog posts this week. One wasn’t even about race! The other ended up spilling onto other posts.

After a lot of really emotionally draining arguments and being called a racist at the end of both conversations (I am a white woman and both commenters are white women, by the way), I was reeling. But, I couldn’t help but think, hey, I can walk away from this. I can pretend racism isn’t my problem and ignore it. I don’t have to write about race on my blog.

I can only imagine how hard this is for someone of color. Someone who can’t choose to ignore racism. Someone who is expected to a patient educator who always takes the high road and watches her “angry” tone.

So, then I signed on Facebook and saw that my little brother, chairman of the local Young Republicans club, thought this chart was oh so funny and accurate. I didn’t comment, yet. The chart was posted on a third party’s page, one that I am not friends with. So, I am in limbo, thinking I have the valid option of “staying out of it.” And, I am feeling sorry for myself for walking around with arguments against it in my head, and my fingers itching to type them, and my heart heavy for the hatred in America and my stomach in knots because some of this hatred is coming from my own family.

But still, I can, to a certain extent, still be separate from the fray by choice. And all of this frustration and unease I am feeling, it is not anything compared to what people of color must be feeling in this culture of racism denialism.

Reply turned post, reverse racism style

This is a reply turned post of one of my recent posts. When I posted my picture of a racist display mocking President Obama and the letter I wrote to my local paper, a commenter started talking about reverse racism that she experienced living in “the ghetto”. Here is my reply:

IMO, that was ugliness and prejudice. I am sure it felt awful and I am sorry.

We can argue and disagree on this, but most people who study racism in a scholarly way say that the power differential occurs when you as a white person gets to go home, see the heroes and beautiful people in ads portrayed on TV who look like you, all of the pictures in magazines of people who are supposed to be beautiful who look like you, and go put money in the bank who most like has a white CEO who looks like you, and just live in a society in which you know that, regardless of your lower class upbringing, you have a lower maternal mortality rate than a rich black woman, you have a better chance at getting a job, and many, many other privileges.

When is the last time someone said a president or Supreme court justice who looked like you got their position did it only based on their race, not merit? See how ridiculous that sounds to a white person? Or that the health care plan that you’re proposing is really reparations?

Here is a great essay by a fellow white person, anti-racism activist Tim Wise, who discusses this:

The myth of reverse racism.

Here is an exercise that helps you look at this. I am sure many of these items, especially those in the beginning, you may be able to say …”See, we’re the same.” But wait until you dig a little further.

White privilege exercise.
(I have had trouble with this link. Right now it is set up for Firefox, since I can’t get to directly link to the .doc. If you do a google search on white privilege score, the exercise is the first link)

Once you leave that library or that situation with those black people and think about it, you know they are angry because of a LACK of power. They don’t think you’re lessor and use that to oppress you. They think you’re an oppressor and use that to attack you. They may make that judgment based on your race, but that does not give them racial power over you.

If an Iraqi soldier ends up alone and unarmed in a bunch of angry Iraqi insurgents and gets the crap beat out of him, that doesn’t change their power differential. Yes, the Iraqi soldier was “overpowered” by the Iraqis, but that doesn’t make it reverse racism.

I have lived in the “ghetto”, (that’s Racism Bingo card O2, by the way) and my husband grew up there. I did the white flight thing and moved from a neighborhood that was 90%+ African American in Miami Gardens Florida. If you want a trip in the police blotter, do a google search on “Miami Gardens” + the word “crime”. And, most of the crime is black on black. It’s unsafe to live there for them, too.

I felt afraid for my young, blond, pale white son there when I saw the kids at the playground glare at him and walk away when he asked to play, and was afraid of the gang bangers who tinkered on cars at the edge of the playground and jealously guarded their turf, cursing loudly enough for us to hear, every time we were there. I still feel extreme guilt for having the privilege and ability to move to a NICER neighborhood where more people look like me. I am proud of my multicultural neighborhood now.

But, can a black person do that? How often can a black person go to a safer place where more people look like them?

And, finally, the main problem I have with the term reverse racism is that it is used to deny that racism against people of color, especially African Americans, is a persistent, real problem with significant negative effects on a huge subpopulation of our country, and in the long run, negative effects on all of us. Your examples are a perfect illustration about how cultural and institutional racism against blacks can turn around and hurt white people. My last post linked to an article on how that racism denial, and I would like to add the competitiveness that lower class white people feel when people talk about racism, is what allows racism to thrive.

Edited to add: Kittywampus (with a little help from) Stephen Colbert does a great job discussing this here. Great minds think alike!

Race, race, race

I have had some frustrating encounters regarding race lately. First of all, there was racist display at a store at the touristy beach near my house. No word back from the newspaper about my letter to the editor. I may just have to write to the Ramada chain, since it is right outside their lobby and many people may associate it with the hotel.

Then, I got into it on a post on Alas, a Blog. It was a great post on many aspects of medical research, birth and race. Two commenters decided to take a whack at criticizing the research by taking random guesses about it without actually, you know, reading it.

A similar thing happened on Our Bodies, Our Blog. A link to an essay lamenting the shameful disparities between women of color and white, non Latino women in our country when it comes to perinatal outcomes prompted a commenter to say “But what about the white women?!” in the form of a weakly attempted criticism of a lack of inclusion of Caucasian women. It was an unfounded criticism of selection bias, and the essay wasn’t a study, it just referred to some epidemiological data. (Although I must say the comment was confusing in general. But, the “what about the white women?” part was crystal clear.)

These are two different types of issues. The first is the kind of situation that Jay Smooth so eloquently talks about here:

Someone, an individual, is doing something racist like putting up that display. This is what most people think of as classic racism. It’s also what many people would think may cause an ugly scene if someone wanted to talk about it. I took a quick photo and scampered out of that store.

However, the second and third example bug me on a different level. OK, maybe RonF on Alas has a history of making similar racism apologist arguments, as a commenter on here suggested. But why did the other commenter claim they were reluctantly jumping in to point out something they just had to correct me on, when they obviously didn’t have any actually knowledge about research or statistical analysis, and the point was just a random guess? Why did the commenter on Our Bodies, Our Blog feel the need to cry wolf about selection bias when the original post was talking about institutional racism and its effect on maternal and neonatal outcomes, not calling her a racist?

I am a pre-doctoral research fellow who researches birth. I am taking a Masters of Public Health class that involves analysis of the flaws of public health research studies with an M.D./Ph.D. who has been a reviewer for the CDC and worked for the government for decades conducting research and making public health decisions based on research. I am not trying to pull rank here. I am just saying it makes me really twitchy when people use baseless random hypothetical criticisms of research to justify denying the effects of racism. One of the most compelling issues for me when it comes to racism is the scary, overwhelming evidence of the pervasive negative health effects of institutional racism. (I could link to endless research here, so let’s just link to this and this. Their bibliographies offer a nice starting point if you’re hungry for more.)

There is a difference between the two situations. Obviously, I believe in calling out the former: blatant slurs or images or props that are symbols of racism.

But, the other is just as bad. Denying the very real effects of sometimes very subtle institutional and societal racism is just as bad, if not worse. The first study I link to above has this to say about denying institutional racism (emphasis mine):

Institutional racism occurs when seemingly innocuous policies and practices result in the disproportionate harm to particular race/ethnic groups. Institutional racism doesn’t require intent but is inherent in its outcome.13 Personal or individualized racism refers to personal prejudice resulting from negative attitudes and/or beliefs about a particular racial group’s motivations, abilities and intentions.14 It too does not require intent and as Jones states12 can be an act of either commission or omission. Internalized racism occurs when members of the stigmatized group accept or internalize the negative messages and stereotypes regarding their race/ethnic group that are perpetuated in society.12 This form of racism affects how one perceives himself/herself, including his or her self-worth and influences acceptance/tolerance of racially biased treatment or maltreatment by others.

Racism persists in American society because beliefs and attitudes that are not blatantly racist but result in racist behavior or outcomes are often not perceived to be racist. As Parks states, “racism thrives on denial“.15

People identify with these institutions. I am going to be a white obstetrician. Trust me, I am identifying with the people delivering the health care that is failing these women. It’s OK to have high standards. It’s OK to acknowledge where we are failing. It’s OK to admit that there are groups of people that many of us don’t belong to that have it worse than us in some ways. It is hard to discuss for some people, because they cannot admit that they have privilege. So they will make up imaginary flaws in statistical research to desperately deny there is institutional racism.

I write letters, racism style

I wrote a letter to the editor of my local newspaper. (Click to embiggen the picture)

It went a little something like this:

Jimmy Carter was right; there is confident, overt racism in much of the
opposition to Obama. It’s not just in isolated enclaves or in the Deep
South. I was using an ATM at a shop called “Sticks and Stones” in the
Ocenwalk Mall at the Ramada Inn in Hollywood Beach. The proprietor has a
display in a small enclave right inside the doorway, across from the ATM. I
attached a picture that I took with my iPhone. It has a cardboard cutout of
Obama, a stuffed baboon, and a book on Wild Chimapanzees.

I was disgusted, not only because this shop owner felt so confident in his
racism that he would put up a display like that, but also because there are
so many people who apologize for and deny similar situations and incidents.

Reply rurned post, pet peeve style

I get really annoyed when someone posts about some research, like this great post on Alas, a Blog on race and low birth weight, among other things, and someone who has no clue about research says “oh, but what about (insert obvious confounder that was obviously controlled for by the researchers here). Therefore, this study I didn’t even read must be total BS!”.

Some racism apologist commenter (RonF) decided to say that a study on the influence on racism on low birth weight is based on perceived racism, not real racism, and besides, he’d really like to see some research on poverty and low birth weight because that’s totally the real and only association with low birth weight.

Here is my reply:

Thanks for a great post.

Ron, you know, researchers who get published in major publications actually have to analyze their data for obvious confounders. (That’s a fancy statistics term for other variables that may be responsible for the outcome, like poverty instead of race being associated with low birth weight). I am sorry if I sound sarcastic, but this is a pet peeve of mine.

In fact, these same researchers wrote another entire study about poverty, race and low birth weight. You said you’d really like to see research on that topic. Do you actually believe you are the first person to consider this connection, and that you wouldn’t be able to find it? Or do you mean you’d like someone else to look it up for you, and in the meantime you’d just like to muse about the harms of racism being faked in published research by whiny black mothers who are mistakenly perceiving nonexistent racism and researchers with guilt and poor analysis skills?

It’s really frustrating when someone hasn’t bothered to read any of the abundant research that shows that race is an independent risk factor (independent from income and social economic status) for all sorts of health care outcomes, including low birth weight, but feels qualified to say the outcomes are incorrect and they have a much better theory, based on seeing no data and no research.

A simple search on the authors if you were trying to read the study before criticizing it, or on the topic of race, poverty and low birth weight before hypothesizing about it would find this:

Women’s Lifelong Exposure to Neighborhood Poverty and Low Birth Weight: A Population-Based Study

Here is the abstract:

Objective To determine whether women’s lifelong residential environment is associated with infant low birth weight. Methods We performed race-specific stratified and multivariate binomial regression analyses on an Illinois vital record dataset of non-Latino White and African-American infants (1989–1991) and their mothers (1956–1975) with appended United States census income information. Results Non-Latino White women (N = 267) with a lifelong residence in low-income neighborhoods had a low birth weight (< 2,500 g) incidence of 10.1% vs. 5.1% for White women (N = 10,647) with a lifelong residence in high-income neighborhoods; RR = 2.0 (1.4–2.9). African-American women (N = 18,297) with a lifelong residence in low-income neighborhoods had a low birth weight incidence of 17% vs. 11.7% for African-American women (N = 546) with a lifelong residence in high-income areas; RR = 1.5 (1.2–1.8). The adjusted population attributable risk (PAR) percent of LBW for lifelong residence in low-income neighborhoods was 1.6% for non-Latino White and 23.6% for African-American women. Conclusions Non-Latino White and African-American women’s lifelong residence in low-income neighborhoods is a risk factor for LBW; however, African-Americans experience a greater public health burden from this phenomenon.

Translation: African-American women who have lived in high-income neighborhoods had worse birth weight outcomes than white women who lived in low income neighborhoods.

There has been plenty of research that simply being a minority in this country is enough to affect you in many significant ways. It doesn’t matter if someone on a website hypothetically believes minorities have ever experienced “real” racism to make the measurable effects of racism true.

********

Edited with an update. The fool continues to defend institutional racism by grasping at straws in his effort to criticize the study, which he STILL HASN’T READ. Laughingly, he thinks there is a problem with the N (the number of subjects in the study.) I was forwarded research by a classmate yesterday of a gyn medical device that one of our professors is a fan of yesterday. The largest study had an N smaller than 30. The study I link to above? TENS OF THOUSANDS. Apparently this dipshit thinks researchers are supposed to misrepresent what happens in real life (like, more African American women live in persistent poverty in this sample, and lots more of them have low birth weight (LBW) infants) to make the numbers match exactly between groups (and therefore…prove nothing?) Then, Mr. Concern Troll says it is all well and good to talk about the lofty goals of eliminating racism, which he is not denying (except that he is) but realistically, what are we supposed to do about this?

Here is my reply:

RonF, you need to read more than an abstract to know what was controlled for. Also, in a multivariate analysis in which the researchers look for many risk factors, as this was, researchers may not even choose to publish risk factors that did not have clinical significance.

And, a disparity in the N numbers is not a problem with research, especially if one of the groups is a minority and is naturally present in lower numbers. In fact, the N numbers are NOT that disparate in this study, and just guessing that is true does not make it true. In fact, they clearly prove a higher prevalence of LBW in African Americans.

It’s amusing in a sick way, because the N is one of the strongest parts of this study. I am having a hard time having this discussion with you and not totally calling you out as a rabble rouser grasping at straws to apologize for and diminish racism.

If you want to discuss the fine points of statistical analysis, um, read a whole study first, and then take a biostats class.

What is important is the power of your N number. And, the power of this study is impressive. If you knew anything about research, or even read the full text of any of these studies, you would know that.

What else must be done? Well, first of all, we have to get ignorant white men to stop denying facts about the extent of the problem on websites so we can have a productive conversation about this.
*******

Edited again to add:

Someone came on to defend RonF, albeit she claims it is a reluctant defense. She also didn’t bother to read the original research or the other study by the authors I linked to, but thinks she is qualified to comment on their flaws. She criticizes the N and the “statistical analysis” of the original qualitative study. Here is my answer:

The statistical rigor I was referring to was of the quantitative research done by the same authors, which I link to in my very first post and from which I pasted the abstract. There is only one “N” in the qualitative interview, since there is only one group of subjects, so I assume RonF was also referring to the quantitative study when he claimed that there was a “disparity” between numbers in multiple groups.

You don’t control for confounders or variables in a qualitative study with interviews. It is not appropriate, for obvious reasons, other than in your subject selection. The qualitative research was done with a typical number of subjects for qualitative research, a small group, and is not set to the same “rigor” standards as quantitative research.

In other words, there is absolutely no statistic analysis in a qualitative study, so criticizing a qualitative study for its statistical analysis when there isn’t any, is, well, a sign you have no idea what you’re talking about. In fact, a qualitative study that tries to assign quantitative values to open ended interview answers is seriously flawed and should be criticized for even attempting statistical analysis, since the study method is not suited for statistical analysis.

Qualitative research is usually open ended interviews with a small group of subjects to get more nuanced information about complicated, multi factorial topics. Like racism, which is obviously sadly lacking in nuance in much of the discussions of the topic. It is a common technique in health issues that also involve power balance questions, such as pregnancy and birth.

As for “racial discrimination”, I am really missing the finer point here. If you show me flaws in so called statistical analysis of all of their background literature review, including the excellent quantitative study with the huge N, that point to simply being African American as being a risk factor, one that is greater than genetics or poverty or whatever other risk factors are examined, then we can talk.

It seems to me, yet again, as you are linking to the layperson’s news article that discusses the scientific article, that you, like RonF, have not bothered to read any of the original research. I would really think twice about discussing “rigor” when that is your method of looking into a study’s quality.

I know I am coming across as really pissy, and I apologize, but I would never go on a website and pretend to criticize something as technical as statistical analysis of medical research if I didn’t have a pretty good idea that I had an accurate criticism. It would be like me going on a website on engineering and start telling people their blueprints are messed up because I read some other person’s paragraph about their blueprints. It’s more complicated than all of that, and this armchair amateur hypothetical musing is one of my pet peeves.

My head hurts

Today was a long day back under the fluorescent lights and in front of a computer screen. I like this fellowship because it allows me to do research, and I am confirming that I like academia. But, I definitely know I want to have a clinical practice. I am not liking being back in an office all day, every day.

So, after having to deal with defending Obama from being called a Nazi and a socialist, and helping with an ob/gyn interest club meeting, and being filmed for a promotional video for the medical school, I was trying to sit at my desk and fight my headache when I got a message from a friend of mine who is on his ob/gyn rotation.

He is rotating with a team of our professors, one of which I have already complained about. Well, everything he told me about what he has learned so far made my head explode message by message. I will give you a play by play:

He got to see a woman have a cesarean for a 4,300 g baby. He called the baby “macrosomic”. ACOG recommends that macrosomia should be defined as 4,500 g and up.

The physicians told him they cut episiotomies for every vaginal delivery. They told him “She’ll tear anyway.”

They do cesareans on whoever they can convince and then call it an “elective cesarean.”

The female ob/gyn told my classmate that in the 80’s the “trend” was toward cesarean section, and in the 90’s the “trend” was toward vaginal delivery because people wanted to get “back to nature.” Yeah, because anyone who wants to avoid major abdominal surgery with worse outcomes for the mother and the baby obviously is a crunchy hippie who is just following the latest trend. Evidenced based what?

She also told him that African American women (she is one, by the way) do not have adequate pelvises (pelvii?) to deliver vaginally. I know anthropoid pelvises (pelves?) are more likely in African American women, but they seem to have reproduced and delivered for millions of years without having a race wide dystocia.

That’s all I can remember. I better not have to do a rotation with them. I will switch, mainly because they have a very light practice and I want to see a lot more deliveries. But, I would also spend the entire time arguing with them or biting my tongue as my head exploded, and would probably fail the rotation when I need to pass my ob/gyn rotation with honors.

Did I mention that they’re brown?

Shakesville tipped me to yet another article about single mothers that handles the race and ethnicity issue badly. The CNN article shows a beautiful picture of a pretty-enough-to-be-an-actress white woman with her dream wedding (which included her 10 month old child – gasp!) in the same idyllic intro with two of the mass media’s favorite single moms: Angelina Jolie and Bristol Palin. If you bother to click through to the second photo, you see a much less flattering picture of a black mother and her baby, whose boyfriend of five years and the father of the child is nowhere to be seen, although he is still involved, according to the article.

Experts wring their hands over the loss of stigma associated with so called “out-of-wedlock” birth. Brown, of the The National Campaign to Prevent Teen and Unplanned Pregnancy, says “I wish people spent as much time planning when to get pregnant, with whom, under what circumstances as they do planning their next vacation.” Yes, 50% of pregnancies in the United States are unplanned, regardless of the marital status of the participants. Is there any mention of what planning a pregnancy would entail? No, of course not.

Then, the article links to a breakdown of births to single mothers based on race and age. On the one hand, this information is significant when looking at the big picture of single parenting, since certain groups don’t seem to have a stigma associated with single parenting. The article horribly mishandles the statistics on these groups, saying, “While 28 percent of white women gave birth out of wedlock in 2007, nearly 72 percent of black women and more than 51 percent of Latinas did.”

Umm, no. Nearly 72% of black women weren’t even pregnant in 2007. This may seem like a minor detail to the author, but her denominator is wrong. Nearly 72% of women who GAVE BIRTH in the United States in 2007 who were identified as black were also identified as unmarried. Big difference than all black women. Anyone who is writing for CNN on epidemiological issues should know the importance of the correct denominator, which is key to discussing public health numbers.

My biggest question is, why is there so much focus on the racial and ethnic breakdown of the mothers in this particular article? Why is there no mention of contraception? If there was some analysis that was pertinent to the current statistics that had something to do with race or ethnicity, I would be interested. However, as the preliminary data from the National Center for Health Statistics suggests, the latest increases occurred over all racial and ethnic groups. So, while it is true that black women are much more likely in general to become single mothers, it has absolutely nothing to do with the most recent increase. A 20% increase in the ratio of births attributed to the unmarried in the past five or so years is a big deal, statistically. It apparently crosses all racial and ethnic lines, and is independent of age. So, why does this article, and others on similar topics, spend so much time (with interactive graphs!) on the racial and ethnic breakdown of the single mothers? It seems to be easier to point at the brown people than to wonder what is changing with everybody, regardless of brown-ness.

So, any discussion of abstinence only education, increasing contraception costs, loss of employer-paid insurance, refusal of insurance to cover contraception, the stigmatization of contraception by the religious right, decreased availability of abortion, increasing obstacles for minors to have access to abortion or other factors which may have actually had an influence on these new record breaking numbers are completely swept under the rug. The graphs and a few paragraphs tell us what we apparently already know – for generations, black culture in America has not emphasized the importance of marriage in parenting – and that racial disparity becomes the scapegoat of an article on the latest increase in single parenting, when it is nothing new and hardly relevant to the increase.

Any discussion of why children of single parents have higher rates of poverty or high school drop out rates is absent. Is it because their parents are unmarried? Or, as I am going to assume, are the 40% of babies born to single mothers more likely to face hardships if the single mother in question has darker skin, less income, less resources, and is younger? Where is this racial and ethnic analysis or the poor outcomes? Maybe the single parenting issue is simply a confounder of a greater societal problem. Maybe poor, brown, and ethnically disadvantaged children do worse, period. I don’t think Bristol Palin’s child is going to face the same problems as a child born to a teenager who isn’t white, rich, and the daughter of a governor.

The beautiful woman at the top of the page who had her dream wedding with her white now-husband and white child probably won’t have as bad outcomes as some of the teen mothers in the same article. Why was she chosen as the poster child for this article? Was it, as it seems to me, that her wedding photo was a stark contrast to the photo of the proud single black mother? If 72% of black women who gave birth last year were single and that is such an important point, why isn’t a black woman at the top of this article as the main photo? Is this white woman’s wedding on an organic farm 10 months after the birth of her first child really news worthy? Or is it just easier to gossip about her, Bristol and Angelina and how we wished a stronger stigma made them more shameful, lest they end up like those browner women who already just don’t seem to care if they are married?