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

Translator: Cristina Marey Castro Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

Most of you can probably relate to what I'm feeling right now.

Coido que a maioría ides comprender o que estou a sentir.

My heart is racing in my chest.

O corazón latexa forte.

My palms are a little bit clammy.

As mans están un chisco pegañentas.

I'm sweating.

Súo.

And my breath is a little bit shallow.

Non respiro moi profundo.

Now, these familiar sensations are obviously the result

A causa destas sensacións familiares é estar fronte a miles de vós

of standing up in front of a thousand of you

and giving a talk that might be streamed online

e dar unha charla que quizais vexan na rede un millón máis.

to perhaps a million more.

But the physical sensations I'm experiencing right now

Mais isto físico que sinto deriva dun mecanismo mente-corpo

are actually the result of a much more basic mind-body mechanism.

moito máis básico.

My nervous system is sending a flood of hormones

O sistema nervioso envíalle unha morea de hormonas

like cortisol and adrenaline into my bloodstream.

á corrente sanguínea, coma cortisol e adrenalina.

It's a very old and very necessary response that sends blood and oxygen

Unha resposta ben antiga e necesaria para enviarlles aos órganos e músculos

to the organs and muscles that I might need

o sangue e o osíxeno precisos de ter que responder a unha ameaza.

to respond quickly to a potential threat.

But there's a problem with this response,

Mais a resposta ten un problema: podería activarse demais.

and that is, it can get over-activated.

If I face these kinds of stressors on a daily basis,

Se acotío teño que enfrontar estes estresantes

particularly over an extended period of time,

e isto se estende no tempo,

my system can get overloaded.

poderíase sobrecargar o sistema.

So basically, if this response happens infrequently: super-necessary

É dicir, que pase de cando en vez

é moi necesario para o benestar e a supervivencia.

for my well-being and survival.

But if it happens too much,

Porén, de darse decote, pode facerme mal.

it can actually make me sick.

There's a growing body of research examining the relationship

Cada vez se investiga máis a relación entre o estrés crónico e as doenzas,

between chronic stress and illness.

Things like heart disease and even cancer

demostrando a conexión deste coas doenzas cardíacas e mesmo co cancro,

are being shown to have a relationship to stress.

And that's because, over time, too much activation from stress

xa que, ao activarse demasiado, co tempo pode interferir

can interfere with my body's processes that keep me healthy.

cos procesos que nos manteñen sas.

Now, let's imagine for a moment that I was pregnant.

Imos imaxinar por un intre que estou embarazada.

What might this kind of stress,

Como podería impactar o estrés durante o embarazo

particularly over the length of my pregnancy,

what kind of impact might that have

na saúde do feto?

on the health of my developing fetus?

Acho que non vos vai sorprender que

You probably won't be surprised when I tell you

that this kind of stress during pregnancy is not good.

este estrés non sexa bo durante o embarazo.

It can even cause the body to initiate labor too early,

Mesmo pode provocar un parto prematuro,

because in a basic sense, the stress communicates

pois, basicamente, comunica que

that the womb is no longer a safe place for the child.

o útero xa non é un lugar seguro para o feto.

Stress during pregnancy is linked with things like high blood pressure

O estrés no embarazo está ligado

á tensión alta e ao déficit de peso do feto

and low infant birth weight,

and it can begin a cascade of health challenges

e pode derivar nun alude de problemas de saúde que volvan

that make birth much more dangerous

for both parent and child.

o parto moito máis perigoso para a nai e o bebé.

Now of course stress, particularly in our modern lifestyle,

Co estilo de vida moderno,

o estrés é case algo universal, non é?

is a somewhat universal experience, right?

Maybe you've never stood up to give a TED Talk,

Inda que non falarades en TED,

but you've faced a big presentation at work,

afrontastes unha exposición importante no traballo,

a sudden job loss,

a perda súbita de emprego,

a big test,

un exame crucial

a heated conflict with a family member or friend.

ou un conflito grave cun parente ou cunha amizade.

But it turns out that the kind of stress we experience

Mais o estrés que experimentamos

and whether we're able to stay in a relaxed state long enough

e ser quen de ficar relaxadas tempo dabondo

to keep our bodies working properly

para que o corpo traballe ben,

depends a lot on who we are.

depende moito de quen sexamos.

There's also a growing body of research

Tamén se está a investigar máis

showing that people who experience more discrimination

como é máis probábel que as persoas que experimentan máis discriminación

are more likely to have poor health.

teñan máis problemas de saúde.

Even the threat of discrimination,

Ata a ameaza de seren discriminadas,

like worrying you might be stopped by police while driving your car,

como a preocupación de que te pare a policía mentres conduces,

can have a negative impact on your health.

che pode afectar a saúde de xeito negativo.

Harvard Professor Dr. David Williams,

David Williams, profesor en Harvard,

doutor e pioneiro nas ferramentas que demostran estas conexións,

the person who pioneered the tools that have proven these linkages,

says that the more marginalized groups in our society

di que os grupos máis marxinalizados na sociedade

experience more discrimination and more impacts on their health.

experimentan máis discriminación e impactos na saúde.

I've been interested in these issues for over a decade.

Levo máis de dez anos interesada na saúde materna,

I became interested in maternal health

dende que me foi mal nos estudos preparatorios de medicina

when a failed premed trajectory instead sent me down a path

e decidín procurar alternativas para axudar persoas encintas.

looking for other ways to help pregnant people.

I became a doula,

Torneime doula, persoa non profesional, formada para dar apoio

a lay person trained to provide support

to people during pregnancy and childbirth.

no embarazo e no parto.

And because I'm Latina and a Spanish speaker,

Ao ser latina e falar español, no primeiro voluntariado

in my first volunteer doula gig at a public hospital in North Carolina,

nun hospital público de Carolina do Norte

I saw clearly how race and class impacted the experiences

vin ben claro como a raza e a clase afectaban as experiencias

of the women that I supported.

das mulleres ás que lles daba apoio.

If we take a look at the statistics about the rates of illness

As taxas de doenzas durante o embarazo e o parto

during pregnancy and childbirth,

we see clearly the pattern outlined by Dr. Williams.

evidencian o patrón do Dr. Williams.

African-American women in particular

No tocante á saúde dos bebés ao nacer, a experiencia das afroamericanas é

have an entirely different experience than white women

when it comes to whether their babies are born healthy.

completamente diferente á das brancas.

In certain parts of the country, particularly the Deep South,

Nalgúns lugares do país, sobre todo no sueste,

the rates of mother and infant death for black women

a taxa de mortalidade materna e infantil para as mulleres negras

actually approximate those rates in Sub-Saharan African.

achégase á taxa da África subsahariana.

In those same communities,

Nas mesmas zonas, esa taxa para as mulleres brancas é case nula.

the rates for white women are near zero.

Even nationally, black women are four times more likely

A nivel nacional, é catro veces máis probábel

to die during pregnancy and childbirth

que unha muller negra morra no embarazo ou no parto

than white women.

ca unha muller branca.

Four times more likely to die.

Catro veces.

They're also twice as likely for their infants to die

É o dobre de probábel

que os bebés delas morran antes do primeiro ano,

before the first year of life

than white infants,

and two to three times more likely

e entre dúas e tres veces máis probábel que nazan prematuros ou moi fracos,

to give birth too early or too skinny --

sinal de falta de desenvolvemento.

a sign of insufficient development.

Native women are also more likely to have higher rates of these problems

As indíxenas teñen tamén máis probabilidade cás mulleres brancas

than white women,

de seren afectadas por estes problemas, así coma algúns grupos de latinas.

as are some groups of Latinas.

For the last decade as a doula turned journalist and blogger,

Nos últimos dez anos, como doula e xornalista

I've been trying to raise the alarm

tentei chamar a atención no diferente das experiencias

about just how different the experiences of women of color,

das mulleres racializadas, sobre todo, negras,

but particularly black women,

are when it comes to pregnancy and birth in the US.

no embarazo e no parto nos EE.UU.

But when I tell people about these appalling statistics,

Malia estes datos abominábeis,

I'm usually met with an assumption that it's about either poverty

a xente adoita crer que se debe á pobreza ou

or lack of access to care.

á falla de acceso á saúde.

But it turns out, neither of these things tell the whole story.

Mais iso non abonda para comprender o problema.

Even middle-class black women still have much worse outcomes

As mulleres negras de clase media

teñen resultados moito peores cás brancas de clase media.

than their middle-class white counterparts.

The gap actually widens among this group.

De feito, a fenda é meirande.

And while access to care is definitely still a problem,

Aínda que o acceso á saúde segue a ser un problema,

even women of color who receive the recommended prenatal care

as mulleres racializadas que reciben o coidado prenatal recomendado

still suffer from these high rates.

padecen tamén estas taxas.

And so we come back to the path

Daquela, pasamos da discriminación ao estrés, á saúde feble,

from discrimination to stress to poor health,

and it begins to paint a picture that many people of color know to be true:

e desvélase unha realidade que coñecen ben moitas persoas racializadas:

racism is actually making us sick.

o racismo estanos a enfermar.

Still sound like a stretch?

Credes que esaxero?

Consider this: immigrants, particularly black and Latina immigrants,

Reparade: as persoas que migran, en especial, negras e latinas,

actually have better health when they first arrive in the United States.

están máis sas ao chegar.

But the longer they stay in this country, the worse their health becomes.

Porén, canto máis fican nos EE.UU. máis lles empeora a saúde.

People like me, born in the United States to Cuban immigrant parents,

Nós, nacidas nos EE.UU. de pais cubanos,

are actually more likely to have worse health than my grandparents did.

somos máis propensas a ter peor saúde cós nosos avós.

It's what researchers call "the immigrant paradox,"

Na academia chámeselle "paradoxo de quen migra",

and it further illustrates

e esclarece aínda máis que nos EE.UU. hai algo que nos fai dano.

that there's something in the US environment

that is making us sick.

But here's the thing:

Mais que o racismo estea a enfermar persoas racializadas,

this problem, that racism is making people of color,

sobre todo, mulleres e bebés negros, é un problema inmenso.

but especially black women and babies, sick, is vast.

I could spend all of my time with you talking about it,

Pasaría toda a charla con iso, mais non o farei,

but I won't, because I want to make sure to tell you about one solution.

porque vos quero falar dunha solución.

And the good news is, it's a solution that isn't particularly expensive,

O bo é que non é moi cara e non require fármacos sofisticados,

and doesn't require any fancy drug treatments

or new technologies.

nin tecnoloxía nova.

The solution is called, "The JJ Way."

A solución chámase "Fórmula JJ".

Meet Jennie Joseph.

Preséntovos a Jennie Joseph, unha matrona de Orlando, Florida,

She's a midwife in the Orlando, Florida area

who has been serving pregnant women for over a decade.

que leva máis dunha década acompañando embarazadas.

In what she calls her easy-access clinics,

Co seu equipo, nas chamadas clínicas de acceso doado,

Jennie and her team provide prenatal care to over 600 women per year.

ofrécelles coidado prenatal a máis de 600 mulleres ao ano.

Her clients, most of whom are black, Haitian and Latina,

As clientas, na maioría negras, haitianas e latinas,

deliver at the local hospital.

paren nos hospitais locais.

But by providing accessible and respectful prenatal care,

Mais ao ofrecer un coidado prenatal accesíbel e respectuoso,

Jennie has achieved something remarkable:

Jennie logrou algo excepcional:

almost all of her clients give birth to healthy, full-term babies.

case todos os bebés nacen a termo e están sans.

Her method is deceptively simple.

O método parece ben sinxelo.

Jennie says that all of her appointments start at the front desk.

Os compromisos comezan na recepción.

Every member of her team, and every moment a women is at her clinic,

Cada integrante do equipo apoia o máximo posible

is as supportive as possible.

a cada muller que vaia á clínica.

No one is turned away due to lack of funds.

Non se rexeita por falla de recursos.

The JJ Way is to make the finances work no matter what the hurdles.

Malia as trabas, as contas dan.

No one is chastised for showing up late to their appointments.

Non se penaliza por chegar tarde.

No one is talked down to or belittled.

Non se menospreza nin denigra.

Jennie's waiting room feels more like your aunt's living room than a clinic.

A sala de espera semella o salón dunha tía de teu.

She calls this space "a classroom in disguise."

Chámalle "clase de disfraces".

With the plush chairs arranged in a circle,

Agardan en cadeiras nun círculo,

women wait for their appointments in one-on-one chats

falando de unha a unha cunha educadora,

with a staff educator,

or in group prenatal classes.

ou nunha clase prenatal grupal.

When you finally are called back to your appointment,

Cando te chaman,

you are greeted by Alexis or Trina,

Alexis ou Trina, asistentes médicas, danche a benvida.

two of Jennie's medical assistants.

Both are young, African-American and moms themselves.

As dúas son novas, afroamericanas e nais.

Their approach is casual and friendly.

Achéganse de xeito atento e relaxado.

During one visit I observed,

Nunha visita que observei,

Trina chatted with a young soon-to-be mom

Trina falaba cunha rapaza, a piques de ser nai,

while she took her blood pressure.

mentres lle miraba a tensión.

This Latina mom was having trouble keeping food down due to nausea.

Custáballe reter o alimento polas náuseas.

As Trina deflated the blood pressure cuff,

Trina, desinflando o aparello, dixo:

she said, "We'll see about changing your prescription, OK?

"Imos mudar a receita, si? Temos que lograr que comas".

We can't have you not eating."

That "we" is actually a really crucial aspect of Jennie's model.

Falar en plural, dun "nós", é crucial no modelo de Jennie.

She sees her staff as part of a team that, alongside the woman and her family,

Ve o persoal como parte dun equipo que, xunto coa clienta e a familia,

has one goal:

ten unha meta:

get mom to term with a healthy baby.

que chegue ao parto cun bebé san.

Jennie says that Trina and Alexis are actually the center of her care model,

Cre que Trina e Alexis son o piar do seu modelo de coidados

and that her role as a provider is just to support their work.

e que o seu rol como axente só consiste en apoialas.

Trina spends a lot of her day on her cell phone,

Trina está case sempre ao teléfono,

texting with clients about all sorts of things.

falando coas clientas de múltiples cousas.

One woman texted to ask if a medication she was prescribed at the hospital

Unha muller preguntoulle se o que lle receitaran no hospital

was OK to take while pregnant.

era axeitado no embarazo.

The answer was no.

Non o era.

Another woman texted with pictures of an infant born under Jennie's care.

Outra envioulle fotos dun bebé nacido baixo os coidados de Jennie.

Lastly, when you finally are called back to see the provider,

Cando te chaman para ver á especialista,

you've already taken your own weight in the waiting room,

xa te pesaches ti mesma e xa preparaches a proba de urina.

and done your own pee test in the bathroom.

This is a big departure from the traditional medical model,

Isto afástase do modelo tradicional,

because it places responsibility and information

pois volve pór a información e a responsabilidade

back in the woman's hands.

nas mans das mulleres.

So rather than a medical setting where you might be chastised

A diferenza das clínicas nas que quizais te reprenden

for not keeping up with provider recommendations --

por non seguir as recomendacións,

en xeral máis accesíbeis para mulleres con ingresos baixos,

the kind of settings often available to low-income women --

Jennie's model is to be as supportive as possible.

no modelo de Jennie dáse o máximo apoio posíbel.

And that support provides a crucial buffer

Ese apoio amortece de xeito crucial

to the stress of racism and discrimination facing these women every day.

o estrés que resulta do racismo e da discriminación que enfrontan acotío.

Mais velaquí vai o mellor:

But here's the best thing about Jennie's model:

hai moito que é un éxito total.

it's been incredibly successful.

Remember those statistics I told you,

Lembrades as estatísticas?

that black women are more likely to give birth too early,

É máis probábel que as mulleres negras teñan partos prematuros,

to give birth to low birth weight babies,

que os bebés nazan moi fracos,

to even die due to complications of pregnancy and childbirth?

que morran por complicacións no embarazo ou parto.

Well, The JJ Way has almost entirely eliminated those problems,

Ben, a Fórmula JJ case erradicou eses problemas,

starting with what Jennie calls "skinny babies."

comezando polo que ela chama "bebés fracos".

She's been able to get almost all her clients to term

Conseguiu que case todas as súas clientas teñan bebés sas e gordiñas coma esta.

with healthy, chunky babies like this one.

Audience: Aw!

(Público) Ah!

Miriam Zoila Pérez: This is a baby girl

(Miriam) É a filla dunha clienta de Jennie que naceu en xuño.

born to a client of Jennie's this past June.

A similar demographic of women in Jennie's area

As mulleres coma ela,

who gave birth at the same hospital her clients did

que parían nos mesmos hospitais cás clientas de Jennie,

were three times more likely to give birth

eran tres veces máis propensas a ter o bebé

to a baby below a healthy weight.

con menos peso do recomendábel.

Jennie is making headway into what has been seen for decades

Jennie está a avanzar no que durante décadas

as an almost intractable problem.

se considerou case irresolúbel.

Some of you might be thinking,

Se cadra pensades que esta atención persoal

all this one-on-one attention that The JJ Way requires

é demasiado custosa para expandirse.

must be too expensive to scale.

Well, you'd be wrong.

Estariades errados.

The visit with the provider is not the center of Jennie's model,

A visita coa especialista non é o piar do modelo,

and for good reason.

e con razón.

Those visits are expensive, and in order to maintain her model,

As visitas son caras, e para que o modelo continúe,

she's got to see a lot of clients to cover costs.

ten que ver moitas clientas para cubrir custos.

But Jennie doesn't have to spend a ton of time with each woman,

Mais non ten que pasar moito tempo con cada unha,

if all of the members of her team can provide the support, information

se todo o persoal lles pode dar o apoio, a información

and care that her clients need.

e o coidado que precisan.

The beauty of Jennie's model is that she actually believes

O fermoso é que cre que case se pode implementar

it can be implemented in pretty much any health care setting.

en calquera contorno médico.

It's a revolution in care just waiting to happen.

Unha revolución nos coidados que está no forno, agardando a saír.

Estes problemas son inmensos.

These problems I've been sharing with you are big.

They come from long histories of racism, classism,

Veñen de historias interminábeis de racismo e clasismo;

a society based on race and class stratification.

dunha sociedade estratificada segundo a raza e a clase.

They involve elaborate physiological mechanisms

Comprenden mecanismos fisiolóxicos que deberan protexernos,

meant to protect us,

that, when overstimulated, actually make us sick.

mais ao sobreestimularse, fannos mal.

But if there's one thing I've learned from my work as a doula,

Mais se algo aprendín de ser doula

it's that a little bit of unconditional support can go a really long way.

é que un pouquiño de apoio incondicional pode facer moito.

History has shown that people are incredibly resilient,

A historia ensinounos o moito que resisten as persoas.

and while we can't eradicate racism

Aínda que non podemos erradicar o racismo de socato,

or the stress that results from it overnight,

nin o estrés que causa,

we might just be able to create environments that provide a buffer

podemos crear contornos para amortecer

to what people of color experience on a daily basis.

o que as persoas racializadas experimentan decote.

And during pregnancy, that buffer can be an incredible tool

No embarazo, iso é unha ferramenta ben efectiva

towards shifting the impact of racism

para mudar o impacto do racismo nas xeracións futuras.

for generations to come.

Thank you.

Grazas.

(Applause)