How racism harms pregnant women -- and what can help | Miriam Zoila Pérez

73,360 views ・ 2017-03-08

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00:12
Most of you can probably relate to what I'm feeling right now.
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My heart is racing in my chest.
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My palms are a little bit clammy.
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I'm sweating.
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And my breath is a little bit shallow.
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Now, these familiar sensations are obviously the result
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of standing up in front of a thousand of you
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and giving a talk that might be streamed online
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to perhaps a million more.
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But the physical sensations I'm experiencing right now
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are actually the result of a much more basic mind-body mechanism.
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My nervous system is sending a flood of hormones
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like cortisol and adrenaline into my bloodstream.
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It's a very old and very necessary response that sends blood and oxygen
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to the organs and muscles that I might need
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to respond quickly to a potential threat.
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But there's a problem with this response,
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and that is, it can get over-activated.
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If I face these kinds of stressors on a daily basis,
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particularly over an extended period of time,
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my system can get overloaded.
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So basically, if this response happens infrequently: super-necessary
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for my well-being and survival.
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But if it happens too much,
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it can actually make me sick.
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There's a growing body of research examining the relationship
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between chronic stress and illness.
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Things like heart disease and even cancer
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are being shown to have a relationship to stress.
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And that's because, over time, too much activation from stress
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can interfere with my body's processes that keep me healthy.
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Now, let's imagine for a moment that I was pregnant.
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What might this kind of stress,
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particularly over the length of my pregnancy,
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what kind of impact might that have
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on the health of my developing fetus?
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You probably won't be surprised when I tell you
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that this kind of stress during pregnancy is not good.
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It can even cause the body to initiate labor too early,
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because in a basic sense, the stress communicates
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that the womb is no longer a safe place for the child.
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Stress during pregnancy is linked with things like high blood pressure
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and low infant birth weight,
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and it can begin a cascade of health challenges
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that make birth much more dangerous
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for both parent and child.
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Now of course stress, particularly in our modern lifestyle,
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is a somewhat universal experience, right?
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Maybe you've never stood up to give a TED Talk,
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but you've faced a big presentation at work,
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a sudden job loss,
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a big test,
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a heated conflict with a family member or friend.
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But it turns out that the kind of stress we experience
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and whether we're able to stay in a relaxed state long enough
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to keep our bodies working properly
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depends a lot on who we are.
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There's also a growing body of research
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showing that people who experience more discrimination
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are more likely to have poor health.
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Even the threat of discrimination,
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like worrying you might be stopped by police while driving your car,
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can have a negative impact on your health.
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Harvard Professor Dr. David Williams,
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the person who pioneered the tools that have proven these linkages,
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says that the more marginalized groups in our society
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experience more discrimination and more impacts on their health.
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I've been interested in these issues for over a decade.
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I became interested in maternal health
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when a failed premed trajectory instead sent me down a path
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looking for other ways to help pregnant people.
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I became a doula,
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a lay person trained to provide support
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to people during pregnancy and childbirth.
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And because I'm Latina and a Spanish speaker,
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in my first volunteer doula gig at a public hospital in North Carolina,
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I saw clearly how race and class impacted the experiences
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of the women that I supported.
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If we take a look at the statistics about the rates of illness
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during pregnancy and childbirth,
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we see clearly the pattern outlined by Dr. Williams.
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African-American women in particular
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have an entirely different experience than white women
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when it comes to whether their babies are born healthy.
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In certain parts of the country, particularly the Deep South,
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the rates of mother and infant death for black women
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actually approximate those rates in Sub-Saharan African.
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In those same communities,
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the rates for white women are near zero.
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Even nationally, black women are four times more likely
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to die during pregnancy and childbirth
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than white women.
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Four times more likely to die.
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They're also twice as likely for their infants to die
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before the first year of life
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than white infants,
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and two to three times more likely
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to give birth too early or too skinny --
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a sign of insufficient development.
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Native women are also more likely to have higher rates of these problems
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than white women,
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as are some groups of Latinas.
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For the last decade as a doula turned journalist and blogger,
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I've been trying to raise the alarm
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about just how different the experiences of women of color,
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but particularly black women,
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are when it comes to pregnancy and birth in the US.
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But when I tell people about these appalling statistics,
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I'm usually met with an assumption that it's about either poverty
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or lack of access to care.
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But it turns out, neither of these things tell the whole story.
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Even middle-class black women still have much worse outcomes
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than their middle-class white counterparts.
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The gap actually widens among this group.
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And while access to care is definitely still a problem,
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even women of color who receive the recommended prenatal care
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still suffer from these high rates.
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And so we come back to the path
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from discrimination to stress to poor health,
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and it begins to paint a picture that many people of color know to be true:
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racism is actually making us sick.
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Still sound like a stretch?
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Consider this: immigrants, particularly black and Latina immigrants,
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actually have better health when they first arrive in the United States.
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But the longer they stay in this country, the worse their health becomes.
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People like me, born in the United States to Cuban immigrant parents,
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are actually more likely to have worse health than my grandparents did.
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It's what researchers call "the immigrant paradox,"
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and it further illustrates
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that there's something in the US environment
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that is making us sick.
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But here's the thing:
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this problem, that racism is making people of color,
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but especially black women and babies, sick, is vast.
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I could spend all of my time with you talking about it,
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but I won't, because I want to make sure to tell you about one solution.
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And the good news is, it's a solution that isn't particularly expensive,
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and doesn't require any fancy drug treatments
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or new technologies.
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The solution is called, "The JJ Way."
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Meet Jennie Joseph.
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She's a midwife in the Orlando, Florida area
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who has been serving pregnant women for over a decade.
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In what she calls her easy-access clinics,
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Jennie and her team provide prenatal care to over 600 women per year.
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Her clients, most of whom are black, Haitian and Latina,
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deliver at the local hospital.
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But by providing accessible and respectful prenatal care,
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Jennie has achieved something remarkable:
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almost all of her clients give birth to healthy, full-term babies.
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Her method is deceptively simple.
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Jennie says that all of her appointments start at the front desk.
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Every member of her team, and every moment a women is at her clinic,
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is as supportive as possible.
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No one is turned away due to lack of funds.
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The JJ Way is to make the finances work no matter what the hurdles.
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No one is chastised for showing up late to their appointments.
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No one is talked down to or belittled.
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Jennie's waiting room feels more like your aunt's living room than a clinic.
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She calls this space "a classroom in disguise."
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With the plush chairs arranged in a circle,
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women wait for their appointments in one-on-one chats
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with a staff educator,
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or in group prenatal classes.
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When you finally are called back to your appointment,
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you are greeted by Alexis or Trina,
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two of Jennie's medical assistants.
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Both are young, African-American and moms themselves.
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Their approach is casual and friendly.
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During one visit I observed,
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Trina chatted with a young soon-to-be mom
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while she took her blood pressure.
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This Latina mom was having trouble keeping food down due to nausea.
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As Trina deflated the blood pressure cuff,
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she said, "We'll see about changing your prescription, OK?
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We can't have you not eating."
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That "we" is actually a really crucial aspect of Jennie's model.
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She sees her staff as part of a team that, alongside the woman and her family,
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has one goal:
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get mom to term with a healthy baby.
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Jennie says that Trina and Alexis are actually the center of her care model,
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and that her role as a provider is just to support their work.
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Trina spends a lot of her day on her cell phone,
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texting with clients about all sorts of things.
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One woman texted to ask if a medication she was prescribed at the hospital
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was OK to take while pregnant.
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The answer was no.
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Another woman texted with pictures of an infant born under Jennie's care.
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Lastly, when you finally are called back to see the provider,
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you've already taken your own weight in the waiting room,
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and done your own pee test in the bathroom.
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This is a big departure from the traditional medical model,
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because it places responsibility and information
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back in the woman's hands.
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So rather than a medical setting where you might be chastised
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for not keeping up with provider recommendations --
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the kind of settings often available to low-income women --
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Jennie's model is to be as supportive as possible.
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And that support provides a crucial buffer
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to the stress of racism and discrimination facing these women every day.
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But here's the best thing about Jennie's model:
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it's been incredibly successful.
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Remember those statistics I told you,
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that black women are more likely to give birth too early,
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to give birth to low birth weight babies,
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to even die due to complications of pregnancy and childbirth?
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Well, The JJ Way has almost entirely eliminated those problems,
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starting with what Jennie calls "skinny babies."
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She's been able to get almost all her clients to term
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with healthy, chunky babies like this one.
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Audience: Aw!
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Miriam Zoila Pérez: This is a baby girl
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born to a client of Jennie's this past June.
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A similar demographic of women in Jennie's area
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who gave birth at the same hospital her clients did
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were three times more likely to give birth
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to a baby below a healthy weight.
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Jennie is making headway into what has been seen for decades
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as an almost intractable problem.
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Some of you might be thinking,
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all this one-on-one attention that The JJ Way requires
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must be too expensive to scale.
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Well, you'd be wrong.
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The visit with the provider is not the center of Jennie's model,
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and for good reason.
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Those visits are expensive, and in order to maintain her model,
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she's got to see a lot of clients to cover costs.
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But Jennie doesn't have to spend a ton of time with each woman,
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if all of the members of her team can provide the support, information
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and care that her clients need.
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The beauty of Jennie's model is that she actually believes
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it can be implemented in pretty much any health care setting.
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It's a revolution in care just waiting to happen.
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These problems I've been sharing with you are big.
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They come from long histories of racism, classism,
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a society based on race and class stratification.
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They involve elaborate physiological mechanisms
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meant to protect us,
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that, when overstimulated, actually make us sick.
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But if there's one thing I've learned from my work as a doula,
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it's that a little bit of unconditional support can go a really long way.
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History has shown that people are incredibly resilient,
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and while we can't eradicate racism
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or the stress that results from it overnight,
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we might just be able to create environments that provide a buffer
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to what people of color experience on a daily basis.
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And during pregnancy, that buffer can be an incredible tool
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towards shifting the impact of racism
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for generations to come.
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Thank you.
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(Applause)
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