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

翻译人员: Conway Ye 校对人员: Wei Wu

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

你们肯定能想象我现在感受。

My heart is racing in my chest.

我的心脏砰砰直跳。

My palms are a little bit clammy.

我的手变得黏黏的。

I'm sweating.

我在出汗。

And my breath is a little bit shallow.

我的呼吸有一点急促。

Now, these familiar sensations are obviously the result

这些熟悉的感觉明显是因为

站在近千名观众的舞台上演讲，

of standing up in front of a thousand of you

and giving a talk that might be streamed online

而且演讲视频还可能放上网

to perhaps a million more.

向上百万人播放。

But the physical sensations I'm experiencing right now

但是我现在身体内正在进行的变化，

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

实际上比我们感受到的要复杂的多。

My nervous system is sending a flood of hormones

我的神经系统正在 向血管输送大量的荷尔蒙，

like cortisol and adrenaline into my bloodstream.

比如皮质醇和肾上腺素。

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

这是一个很古老且很重要的反应，

它令我在有潜在危险的情况下 能够快速反应，

to the organs and muscles that I might need

to respond quickly to a potential threat.

把所需的血和氧气送至器官和肌肉。

但是这个反应有一个问题，

But there's a problem with this response,

and that is, it can get over-activated.

它可能会反应过激。

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

如果每天我都面对这种压力，

particularly over an extended period of time,

特别是经过很长的一段时间后，

my system can get overloaded.

我的身体会超负荷。

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

所以简单来说， 如果这种反应只是偶尔发生——

对我的健康和生命就极为重要。

for my well-being and survival.

But if it happens too much,

但是如果这发生得过于频繁，

it can actually make me sick.

会使我生病。

There's a growing body of research examining the relationship

越来越多的研究开始调查

between chronic stress and illness.

长期压力与疾病的联系。

Things like heart disease and even cancer

像心脏病甚至癌症

are being shown to have a relationship to stress.

都被表明和压力有联系。

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

这是因为，久而久之， 由压力所导致的过度兴奋

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

会妨碍保持我健康的生理过程。

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

现在，让我们设想一下，我怀孕了。

What might this kind of stress,

这种压力，

particularly over the length of my pregnancy,

特别是在我怀孕的这段时间里，

what kind of impact might that have

会对胎儿的发育

on the health of my developing fetus?

有什么影响呢？

You probably won't be surprised when I tell you

当我告诉你时，这种怀孕期间的压力

that this kind of stress during pregnancy is not good.

是有害的，你可能不会感到惊讶。

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

这甚至会引起早产，

because in a basic sense, the stress communicates

原因很简单，压力会提示

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

子宫对孩子已经 不再是一个安全的地方了。

Stress during pregnancy is linked with things like high blood pressure

怀孕期间的压力和高血压、 婴儿体重过轻这样的

事情都有关系，

and low infant birth weight,

and it can begin a cascade of health challenges

而且它能够引发一系列的健康问题，

that make birth much more dangerous

让分娩对母亲和孩子

for both parent and child.

都变得更危险。

Now of course stress, particularly in our modern lifestyle,

当然压力，特别是在现代生活中，

是非常普遍的现象，对吧？

is a somewhat universal experience, right?

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

可能你没有做过TED演讲，

but you've faced a big presentation at work,

但是你可能做过重要的工作汇报，

a sudden job loss,

或是突然地被解雇，

a big test,

面临一场重要的考试，

a heated conflict with a family member or friend.

或是跟家庭成员或朋友 有过激烈的冲突。

But it turns out that the kind of stress we experience

但结果是我们所承受的那种压力

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

和我们是否能够在 足够的时间内保持放松状态，

来让我们的身体正常运行，

to keep our bodies working properly

depends a lot on who we are.

很大程度上，取决于我们是谁。

There's also a growing body of research

越来越多的研究表明，

showing that people who experience more discrimination

经历较多歧视的人

are more likely to have poor health.

身体更有可能不健康。

Even the threat of discrimination,

甚至可能潜存的歧视，

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

如开车时，你担心会被警察拦下，

can have a negative impact on your health.

都会对你的健康产生不良影响。

Harvard Professor Dr. David Williams,

哈佛教授大卫·威廉姆斯博士，

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

他研发了各种手段来证明这种联系，

says that the more marginalized groups in our society

他说社会上越被边缘化的人

experience more discrimination and more impacts on their health.

被歧视越多，对自身健康影响就越大。

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

我对这些问题的研究 已经有十年多了。

I became interested in maternal health

我开始对母婴健康感兴趣，

when a failed premed trajectory instead sent me down a path

虽然我考医学院的努力失败了，

looking for other ways to help pregnant people.

但我找到了帮助孕妇的另一种方式。

I became a doula,

我成为了一名“导乐”（孕妇保姆），

a lay person trained to provide support

一个接受过训练专门在孕期和分娩时

to people during pregnancy and childbirth.

帮助孕妇的女性。

And because I'm Latina and a Spanish speaker,

因为我是拉丁美洲裔， 而且会说西班牙语，

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

我第一个志愿孕妇保姆工作 是在北卡罗来纳州的一个公共医院，

I saw clearly how race and class impacted the experiences

我清楚地意识到种族和阶层是如何影响

of the women that I supported.

那些我帮助过的妇女们。

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

如果我们看看怀孕和分娩期间

during pregnancy and childbirth,

得病机率的统计数据，

we see clearly the pattern outlined by Dr. Williams.

我们可以清楚地印证威廉姆斯教授的概述。

African-American women in particular

当谈到她们的婴儿是否健康时，

have an entirely different experience than white women

特别是非裔美国人，和白人孕妇有着

when it comes to whether their babies are born healthy.

完全不同的经历。

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

这个国家的一些地方，特别是南部，

the rates of mother and infant death for black women

黑人孕妇和婴儿的死亡率

和撒哈拉以南非洲的死亡率差不多。

actually approximate those rates in Sub-Saharan African.

In those same communities,

在同样的社区里，

the rates for white women are near zero.

白人孕妇的死亡概率几乎为零。

Even nationally, black women are four times more likely

甚至从全国层面来说， 黑人孕妇比起白人孕妇，

to die during pregnancy and childbirth

在怀孕期及分娩时的死亡率

than white women.

要高出四倍。

近乎四倍的死亡率。

Four times more likely to die.

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

她们的婴儿在一岁之前

死亡的可能性

before the first year of life

than white infants,

是白人婴儿的两倍，

and two to three times more likely

并且有两到三倍的可能性

出现早产或体重过轻——

to give birth too early or too skinny --

这都是婴儿发育不良的信号。

a sign of insufficient development.

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

印第安女人也比白人更有可能

than white women,

遭遇这些问题，

as are some groups of Latinas.

拉丁裔女人也是这样的。

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

在过去十年来，作为导乐、记者和博主，

我一直尝试提高人们对

I've been trying to raise the alarm

about just how different the experiences of women of color,

有色人种非常不同的经历的注意，

but particularly black women,

特别是黑人妇女，

在美国的怀孕和分娩。

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

But when I tell people about these appalling statistics,

当我和人们提起这些 令人惊讶的数据时，

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

我经常假定这和贫困或者

or lack of access to care.

医疗系统不健全有关。

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

但结果是，这些不是全部的原因。

Even middle-class black women still have much worse outcomes

甚至中产阶级的黑人孕妇也比白人孕妇

than their middle-class white counterparts.

有更糟糕的健康状况。

The gap actually widens among this group.

差距在这个群组里变大。

And while access to care is definitely still a problem,

缺少基本医保肯定是问题之一，

even women of color who receive the recommended prenatal care

但是即使是那些进行产前护理的妇女

still suffer from these high rates.

也深受这些问题的困扰。

And so we come back to the path

所以总结一下就是

from discrimination to stress to poor health,

歧视导致压力，进而导致健康问题，

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

由此可以得出一件 很多有色人种都知道的事情：

racism is actually making us sick.

种族歧视真的在让我们生病。

Still sound like a stretch?

还是有点牵强？

Consider this: immigrants, particularly black and Latina immigrants,

想想看，移民， 特别是黑人和拉丁美洲裔，

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

在初次到达美国前的健康状况更好。

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

但是他们呆的越久， 他们健康出现的问题越多。

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

像我一样的人，出生在美国， 父母是古巴移民，

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

比祖父母更有可能 拥有更多的健康问题。

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

这就是研究者所说的“移民的矛盾”，

and it further illustrates

这进一步解释了

that there's something in the US environment

美国环境里有些东西

让我们生病。

that is making us sick.

But here's the thing:

但是，

this problem, that racism is making people of color,

种族歧视让有色人种

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

特别是黑人女人和 婴儿生病的问题很普遍，

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

这个问题我可以讨论很久，但是

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

今天我想要跟大家 说的是一个解决方案。

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

好消息是，这是一个 低成本的解决方案，

and doesn't require any fancy drug treatments

而且不需要任何昂贵的药物治疗，

or new technologies.

或者新技术。

The solution is called, "The JJ Way."

这个方案被称作“简宁的方法”。

Meet Jennie Joseph.

简宁·乔瑟夫，

She's a midwife in the Orlando, Florida area

她是佛罗里达州奥兰多的一个助产士，

who has been serving pregnant women for over a decade.

服务怀孕女人超过十年。

In what she calls her easy-access clinics,

在她所说的便捷诊所中，

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

简宁和她的团队每年 向超过600名妇女提供产前护理。

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

她的客户，大多数都是黑人、 海地人和拉丁美洲裔，

deliver at the local hospital.

在当地医院分娩。

But by providing accessible and respectful prenatal care,

通过提供便宜和高质量的产前护理，

Jennie has achieved something remarkable:

简宁实现了一些非凡的成就：

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

几乎所有的客户都生出了健康的婴儿。

Her method is deceptively simple.

她的方法非常简单。

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

简宁说所有预约都从前台开始，

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

她团队中的每一个人， 从每位妇女到诊所的那个时刻

is as supportive as possible.

就会尽量的提供帮助。

No one is turned away due to lack of funds.

没人会因为经济原因被拒绝。

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

简宁的方法是抛开 任何经济障碍提供帮助。

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

没人因为预约迟到而被斥责。

No one is talked down to or belittled.

没人被嘲讽或者被蔑视。

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

简宁的等候室比起一个诊所 更像是你姑姑的客厅。

She calls this space "a classroom in disguise."

她称其为“有伪装的教室”。

With the plush chairs arranged in a circle,

舒适的椅子围成一圈，

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

孕妇们等候着跟医护人员

with a staff educator,

一对一的问诊，

or in group prenatal classes.

或接受产前小组培训。

When you finally are called back to your appointment,

当你的预约结束以后，

亚历克西斯和特瑞纳会向你问候，

you are greeted by Alexis or Trina,

two of Jennie's medical assistants.

她们是简宁的医疗助理。

Both are young, African-American and moms themselves.

她们都是年轻的非裔美籍母亲。

Their approach is casual and friendly.

她们所用的方式非常随意和友善。

During one visit I observed,

在一次拜访中，我注意到

Trina chatted with a young soon-to-be mom

特瑞纳在测量一位年轻准妈妈的

while she took her blood pressure.

血压的时候在跟她聊天。

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

这个拉丁美洲裔女人 因为恶心而无法进食。

As Trina deflated the blood pressure cuff,

当特瑞纳放开血压计的气闸时，

她说：“我们会看看如何 改善你的药方，好吗？

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

我们不能让你不吃东西。”

We can't have you not eating."

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

那个“我们”是简宁方法的核心。

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

她和她的员工组成的团队 与孕妇及其家庭紧密合作，

has one goal:

为了一个目标而努力：

get mom to term with a healthy baby.

让这位母亲生出一个健康的宝宝。

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

简宁说特瑞纳和亚历克西斯 其实是她方法的核心，

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

然而她的角色是支持她们的工作。

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

特瑞纳每天花很多时间在手机上，

texting with clients about all sorts of things.

她向客户发送各种短信。

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

一位妇女发短信问医院开出的药方

was OK to take while pregnant.

能否在她怀孕的时候服用。

The answer was no.

答案是不能。

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

另一位妇女向简宁发送婴儿的照片， 是在简宁照料下的出生的婴儿。

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

最后，当你（孕妇）去见医生的时候，

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

你已经在等候室测好了体重，

and done your own pee test in the bathroom.

在卫生间做完了小便测试。

This is a big departure from the traditional medical model,

这和传统医疗模型很不一样，

because it places responsibility and information

因为它将责任和数据

back in the woman's hands.

都交还给了孕妇。

So rather than a medical setting where you might be chastised

所以当你没有能够遵守医生的医嘱时，

for not keeping up with provider recommendations --

在简宁这里你不会因此被斥责——

这在低收入女性中很常见——

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

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

简宁的模型是尽可能的支持。

And that support provides a crucial buffer

这种支持提供了一个关键性的缓冲，

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

减缓了这些妇女因每天面对的 种族歧视而获得的压力。

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

但是简宁模型最出色的部分是

it's been incredibly successful.

它出乎意料的非常成功。

Remember those statistics I told you,

还记得我告诉你的那些数据，

黑人妇女更有可能早产，

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

to give birth to low birth weight babies,

更有可能生出体重不达标的婴儿，

to even die due to complications of pregnancy and childbirth?

甚至更有可能因为怀孕与分娩而死亡？

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

简宁的方法几乎可以解决所有这些问题，

starting with what Jennie calls "skinny babies."

从简宁称之为“瘦弱的婴儿”开始。

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

她已经能够解决 几乎所有客户的健康问题

并生出像这样可爱的宝宝。

with healthy, chunky babies like this one.

Audience: Aw!

观众：噢！

Miriam Zoila Pérez: This is a baby girl

米里亚姆·佐伊拉·佩亚雷斯： 这一个女孩是

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

上个六月在简宁的诊所里出生。

A similar demographic of women in Jennie's area

在简宁所在地区的同样条件的女人，

who gave birth at the same hospital her clients did

在同一个医院里分娩，

were three times more likely to give birth

生出低于健康标准体重的 婴儿的可能性比

to a baby below a healthy weight.

简宁的诊所照料过的高出三倍。

Jennie is making headway into what has been seen for decades

简宁被认为是在几十年来最复杂的问题中

as an almost intractable problem.

找到了解决方法。

Some of you might be thinking,

你们可能会想，

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

简宁的这种一对一的关注

must be too expensive to scale.

一定太昂贵而不能大范围运用。

Well, you'd be wrong.

那你可错了。

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

一对一拜访并不是简宁模型的核心，

and for good reason.

原因很简单。

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

这些拜访很昂贵，为了维持她的模型，

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

她要见很多客户来平衡成本。

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

但是简宁并不需要在 每个女人上花很多时间，

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

如果她团队的所有人 都能够提供客户需要的

and care that her clients need.

支持、信息和照顾。

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

简宁模型的优势是她真的相信

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

这能够推广到所有医疗保健中。

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

这是一个未来医疗保健的革命。

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

我分享给你们的这些问题 复杂而又庞大。

They come from long histories of racism, classism,

这些源于历史中的种族歧视、阶级歧视，

一个基于种族和阶级的社会。

a society based on race and class stratification.

它们和用来保护我们的

They involve elaborate physiological mechanisms

meant to protect us,

系统有关，

that, when overstimulated, actually make us sick.

但过度情况下，会让我们生病。

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

但是我从当孕妇保姆中学到一件事，

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

微小的无条件的支持 可以带来巨大的改变。

History has shown that people are incredibly resilient,

历史告诉我们人类的适应能力很强，

and while we can't eradicate racism

当我们无法解决种族歧视，

or the stress that results from it overnight,

或者种族歧视产生的压力时，

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

我们也许能够创造一个缓冲的环境，

to what people of color experience on a daily basis.

缓冲有色人种每天面对的困境。

And during pregnancy, that buffer can be an incredible tool

在怀孕期间，这种缓冲可以非常有用，

towards shifting the impact of racism

能够有效的降低种族因素

对下一代的影响。

for generations to come.

Thank you.

谢谢。

(Applause)

（鼓掌）