Suffer the Little Children

The Trump administration’s "zero tolerance" immigration policy has created a humanitarian crisis almost unprecedented in the history of our country. Desperate refugee families fleeing potentially life-threatening situations are being further victimized as they try to seek asylum in the United States.  We have witnessed images of crying children being systematically separated from their parents, held in detention centers, not knowing their fate.  How can we stand by as vulnerable children are further traumatized by this practice which can cause irreparable harm to innocents, affecting their intellectual, emotional and even physical health?  Where is our morality and compassion? 

The American Academy of Pediatrics, American College of Physicians and the American Psychiatric Association have all spoken out against this ruthless practice.   Former First Lady Laura Bush has stated that while she understands the need for border security, "This zero-tolerance policy is cruel. It is immoral. And it breaks my heart.  Our government should not be in the business of warehousing children in converted box stores or making plans to place them in tent cities in the desert outside of El Paso.  These images are eerily reminiscent of the Japanese American internment camps of World War II, now considered to have been one of the most shameful episodes in U.S. history."

In my opinion, to do nothing to right this wrong is to be complicit.  Each one of us needs to take action to stop this horrific and inhumane practice.  Call upon your elected officials to put decency above politics.  We can and must find a better solution.


Judith Wolf, MD
Associate Director, WHEP

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The Risks of Being Pregnant While Black

Many people may be shocked to learn that the United States has the highest maternal mortality rate in the developed world - a rate that is actually on the rise, driven primarily by mortality in minority women.  According to the Centers for Disease Control and Prevention (CDC), black women are 3-4 times more likely than white women to die from complications during pregnancy and childbirth: 43.5 deaths per 100,000 live births for black women compared to 12.7 deaths per 100,000 live births for white women.   And for every death, more than 100 women experience potentially life-threatening conditions like hemorrhage, pre-eclampsia, venous thromboembolic events and cardiomyopathy.  The question is why. The answer is at once complicated yet distressingly simple – racism. 

Previous research on racial and ethnic disparities in obstetrics focused on social and biologic/genetic factors and did not examine quality of care.  However, according to a more recent study examining severe maternal morbidity during childbirth in the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for 2010-2011*, it appears that racial differences in the site of care and delivery contribute to these disparities.  Strikingly, approximately 75% of black women receive care in 25% of all hospitals that provide lower quality of care.  These high and medium black serving hospitals are predominantly urban teaching hospitals in the South with high delivery volumes and higher proportions of Medicaid patients.  Women (of all races) who delivered in these hospitals had higher rates of severe morbidity compared to low black-serving hospitals, but black women had the highest rates. 

The Black Mammas Matter Alliance (BMMA) has called attention to racism in healthcare, including the experience of celebrities like Serena Williams whose complaints of shortness of breath post-delivery were initially dismissed.  She was subsequently diagnosed with pulmonary emboli.  Many African American women have experienced similar disrespect, bias and discrimination.  The time for action is now.  The only way health outcomes in our country will improve is for racism in health care to be recognized and rectified. 

* Howell et al.  Black-white differences in severe maternal morbidity and site of care.  Am J Obstet  Gynecol 2016; 214: 122.e1-7.

Judith Wolf, MD                              Associate Director, WHEP

 

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