Who knew closing the gender and race gap could be so easy?

I thought this article on a 15 minute writing exercise that improved the performance of women in physics and students of color in high school was beautiful in its simplicity.

Think about the things that are important to you. Perhaps you care about creativity, family relationships, your career, or having a sense of humour. Pick two or three of these values and write a few sentences about why they are important to you. You have fifteen minutes. It could change your life.

This simple writing exercise may not seem like anything ground-breaking, but its effects speak for themselves. In a university physics class, Akira Miyake from the University of Colorado used it to close the gap between male and female performance. In the university’s physics course, men typically do better than women but Miyake’s study shows that this has nothing to do with innate ability. With nothing but his fifteen-minute exercise, performed twice at the beginning of the year, he virtually abolished the gender divide and allowed the female physicists to challenge their male peers.

The exercise is designed to affirm a person’s values, boosting their sense of self-worth and integrity, and reinforcing their belief in themselves. For people who suffer from negative stereotypes, this can make all the difference between success and failure.

People who are in the minority (and I mean a power minority, not a numerical one) – people of color, women in science classes, disabled people, etc. – often feel that their values and needs are invisible in an academic situation. This exercise simply affirms that this is not necessarily true.

I want to go into academics one day. I may need to do this exercise in my classes.

Nothing like bad news to drive a message home

(Trigger warning for poor obstetrical outcome)

Less than one week after I blogged about the maternal mortality crisis among black women in our country, I lost a friend. She was of Haitian descent, a fellow medical student, an aspiring ob/gyn, and a kind and wonderful person. She was eight months pregnant with her first baby, and newly married. We talked for a while last week about her taking time off, breastfeeding, and pumping when she got back to rotations. She was incredibly happy about becoming a mother.

She went into premature labor this weekend. She had a hemorrhagic stroke. She died. The baby is doing fine.

This was not an underprivileged woman by most definitions, at least not currently. She may have been raised in an impoverished home. The Haitian population in South Florida in general is devastatingly poor. She was well educated. She was not “advanced maternal age”. She was not a teen mother. She was not obese. She had good prenatal care and insurance. She had family support and was happy about her pregnancy. As far as I know, she had no health conditions, didn’t smoke, and didn’t do any drugs.

But, she was a black woman in America, which puts her at much higher risk of premature labor and death. In recent years, the maternal mortality rate for black women in Miami has been up to 10 times that of white women. We don’t completely understand why. Different delivery of care, early life malnutrition or lack of health care, the stress of racism, biological or genetic differences…these all may play a role.

But, right now what we do know is that a baby is born without a mother, and a husband is welcoming a new baby in his life with a dead wife, and no mother to help raise it. That is a horrible shame.

Proud to be an American

Happy birthday, USA!

When I say I am proud to be an American, (a USian, really, but I am quoting a song title), I am proud of what we have done that is progressive, such as women’s suffrage, and the civil rights movement. I am also optimistic of the potential we have to improve ourselves. I do not think that means we have to ignore problems that we have, or not admit mistakes, as many people mistakenly consider patriotism to be. I think having low standards and ignoring our issues is the opposite of patriotism.

Anyway, despite the partially successful civil rights movement of the 60′s, there is still glaring racism and racial inequalities in our country. Please check out this blog carnival at the Uneccesarean. It’s a round up of posts discussing the shockingly and depressingly high rates of infant and maternal mortality suffered by black women and infants in our country.

And, before someone goes there (which has happened before on this blog and on others so often it’s on racism bingo cards), it’s not a class issue. These inequalities still exist even when the mother is college educated, compared to white mothers who don’t even have a high school degree. This is more pervasive and deeper than class. Not that poverty isn’t important, but there is no quota for issues we should address to make this country even greater.

Crunch on these while I crunch numbers

I am working on getting my data analyzed by a friendly professor who knows more about that stuff than I do. Chi square mumble mumble. Then, I am going to be hunkering down and working on my paper and/or poster.

I also have other stuff going on in my personal life that is keeping me occupied, to say the least. I’ll try not to be so mysterious forever, but I am not ready to dump it all out on here just yet. Especially when I get comments calling me a broodsow, and wishing a fatal disease on my children and me. Nice. So, I pat myself on the back for keeping a lot of my personal life off this blog.

In the meantime, here is some stuff to check out:

Dr. Fogelson discusses cesarean closure at Academic Ob/Gyn

The Female Patient(pdf), which I just discovered. That particular paper is on estrogen pharmokinetics and delivery.

Last but not least, Drunk History, Vol. 3. This one is about President Washington’s runaway slave Oney Judge.

Exciting things a-brewin’

I am going to be in a production of Eve Ensler’s The Vagina Monologues tomorrow night. This is my third year being involved with our medical school V Day production. I was the narrator for the past two years. This year I am performing the poem at the end, a poem about birth called “I Was There in the Room”. It ends with:

The heart is capable of sacrifice
So is the vagina
The heart can forgive and repair
It can change its shape to let us in
It can expand to let us out
So can the vagina
It can ache for us and stretch for us, die for us
And bleed and bleed us into this difficult, wondrous world
I was there in the room
I remember

I also was selected to be a delegation coordinator for Amnesty International’s lobbying effort to bring attention to maternal mortality, including lack of prenatal care and racial disparities.

So, I know I am supposed to write up my cousin Susan’s birth story (which will probably be my first non guest post at Mothers in Medicine), and talk about the whole NIH VBAC conference thing, and recruit more doctors for my survey, but I’m a little busy right now. I’ll get to them soon, I swear.

Race, pregnancy and birth, link round up and reply turned post

There has been a lot of comprehensive, thoughtful discussion of race and its intersection with reproduction on the intertubes recently.

Do Black Women’s Reproductive Rights Matter? by Renee at Womanist Musings

Race and the Rights of Childbearing Women by Jill at the Unnecesarean

Women of Color and the Anti-Choice Focus on Eugenics by Pamela Merritt (aka Angry Black Bitch) at RH Reality Check

The Facts About Abortion Rates Among Women of Color by Susan Cohen on RH Reality Check

I wrote a reply on the last post, which I will reproduce here:

When I wrote about this on my own blog recently, a commenter mentioned the recently released movie Maafa 21, which was funded by an anti-choice group out of Texas not known for its civil rights history.

I hope this conversation continues, and the dominant voices aren’t the ones that use the horrible history of blacks in America and eugenics to try to deprive them of reproductive freedoms today. I was searching for a womanist, feminist and racially sensitive review (preferably by a woman of color) of the movie, but was only able to find copied and pasted press releases about how “well argued” it is. I don’t think it’s irrefutable at all, nor do I think laws banning or restricting legal and safe abortion help women of color. Rather, they would be the ones disproportionally getting unsafe abortions. I can only assume most people, including pro-choice and / or womanist women of color, don’t want to sit through the film in order to discuss it. I do think watching it is important, but considering all the important work I agree with that I don’t have time to watch, this film is low on my list. And, it doesn’t use my history to argue against my rights, (just the history of some of my ancestors’ enslavement and oppression of blacks) since I am white, so I can only guess that it wouldn’t be as difficult to watch for me as it would be for a woman of color.

That’s the problem when race and racism intersects with other social issues. And it does. With all of them. The fact that racism shows an effect in abortion rates doesn’t condemn abortion, it condemns racism. Racism is present in heart attack treatment in emergency rooms, but that doesn’t condemn treatment of heart attacks. It affects birth, mode of delivery, place of delivery, complication (morbidity) rates for the mom and the baby including preterm delivery, mortality rates, etc. That doesn’t condemn obstetrics in general, but it indicates that racism is pervasive, and is one of the many issues within obstetrics (and emergency care, and reproductive care) that needs to be examined and improved upon.

The billboard in Atlanta

The first time I had heard of turning abortion into a racial genocide issue was during the run up to the 2008 election. I was at an Obama event in Miami that was centered around Women’s Issues, and a small group of African Americans staged a disturbance / protest during the event, unfurling signs they had apparently hidden among their clothes and belongings, with slogans like “abortion is black genocide” and comparing Obama to the KKK due to his (lukewarm) support of a woman’s right to choose.

Renee at Womanist Musings wrote about billboards in Atlanta that is essentially blaming black women for aborting too many of their children. I find this troublesome on so many levels, not the least of all that I feel like the black community is being manipulated, and black women are being shamed and blamed.

I do understand that some White women may be reticent to enter this debate because it is framed as saving a Black child, who we know to be universally undereducated and invisible. Even when Black women place their children for adoption, they are less likely to be adopted and so it would appear that Black women are really reduced to two choices, abort or raise the child themselves. Even if we validate that point, there is still the issue of placing a priority on women’s agency when it comes to reproductive rights. We do not have the right to question these women on their decisions. No one chooses to abort without putting great thought into the matter and if we truly respect the right to choose, it must apply to ALL women.

Finally, as scared as White women may be to interact because of the racial undertones of this argument, I must ask don’t Black women matter?

Please read the entire post. And, please read Rachel’s post about it, which is where I saw it first.

My big fat reading list

I keep on accumulating things I am reading that I wanted to talk about. Well, it has turned into a link fest. So, here’s my linkaround for the week, mostly journal club style:

Maternal Obesity and Breast-feeding Practices Among White and Black Women (pdf) and abstract. I had many problems with this article. First of all, the associations seemed really inconclusive. I would have preferred this data looked at through another lens, not obesity, but, since it was published in Obesity, I guess that was the point. The only association in any of the groups with BMI and breastfeeding was in the very obese, and that was only in white women. How is this an examination of race and BMI, except to show there WASN’T much of an association. I am also dismayed but not surprised at the higher cesarean rate among overweight and obese women. And, considering those higher cesarean rates, why did the adjusted hazard ratio NOT adjust for mode of delivery, when cesarean section has (in some research, not all) been associated with less initiation and success in breastfeeding? They adjusted for: mothers’ age, education, marital status at birth or during the pregnancy, Medicaid status, and pregnancy complications; parity; and first trimester initiation of prenatal care, but not mode of delivery.

What the data (not the discussion) highlighted was the racial disparity, not much about obesity and breastfeeding, and doesn’t offer much in the way of offering solutions or explanations as to why black women have such poorer rates of breastfeeding initiation.

Also from Obesity, BMI and Mortality: Results From a National Longitudinal Study of Canadian Adults.

Although a clear risk of mortality is associated with obesity, the risk of mortality associated with overweight is equivocal. The objective of this study is to estimate the relationship between BMI and all-cause mortality in a nationally representative sample of Canadian adults. A sample of 11,326 respondents aged ≥25 in the 1994/1995 National Population Health Survey (Canada) was studied using Cox proportional hazards models. A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI <18.5; relative risk (RR) = 1.73, P 35; RR = 1.36, P <0.05). Overweight (BMI 25 to <30) was associated with a significantly decreased risk of death (RR = 0.83, P 0.05). Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality. Obesity class I was not associated with an increased risk of mortality.

Emphasis mine. As someone in the obesity class I, I am feeling a lot of harumphing about this right now. I am waiting to hear all the criticism of underweight people (not that I would or I want it) from the peanut gallery, and the admission that overweight and mild obesity isn’t going to kill us all with the fat. I want a big fat apology to Dr. Regina Benjamin. (Commenting note: Please notice I never said appropriate exercise or a healthy-for-you diet were bad. That is not the topic. The topic is whether overweight and obesity deserves the constant, relentless public shaming and association with lack of health that it does).

And, just to be balanced, CNN has some information on why being overweight may negatively affect your health: provider bias. Yes, I also agree that some diagnostic tests and techniques like a manual pelvic exam or Leopold’s maneuver can be more difficult with more tissue there. But, the misdiagnosing and over testing (and over sectioning) of overweight and obese women is due to provider bias as much as testing and maneuvering fail. (Hat tip to Shakesville for that last one).

Open call, please share and repost

I am busy reviewing and contributing to the second chapter of Our Bodies, Ourselves that was assigned to me. It is called “Unique to Women” and is about screening tests and medical procedures. I am trying to get through the technical side of writing this: checking on new screening guidelines, new screening tools, and such scientific type things. But, I really want to take into account the needs and points of view of many women, including disabled women, women of color, women from different cultural and religious backgrounds, women who are trans, men who are trans, women who are survivors of sexual abuse and/or assault, women who work in the sex industry, women who are polyamorous, women who are gay, women with piercings and tattoos, women of size, etc.

I am going to jot down items to look up. I already have some ideas. I know of many blogs out there for people with different disabilities, so I can search them for the easy to find encounters-with-medical-personnel horror stories. I know I can find plenty of health care practitioner bloggers out there (you know who you are) and submit something about a code green.

I am going to try to search out other stories on outlets available to me, but considering my short deadline, I would LOVE any voluntary submissions. The deadline is New Year’s Eve. I would love to continue the conversation past that point, but may not be able to submit anything to the publication. I am not a final decision maker editor, just a reviewer and contributor, but I will be happy to link to posts or publish them on here as comments, if people like. Or, you can email them to hilseb at gmail dot com.

Thank you, Shark fu

What she said.