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

譯者: Melody Tang 審譯者: Helen Chang

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

在座的大多數可能可以 體會我現在的感覺。

My heart is racing in my chest.

我的心臟跳很快。

My palms are a little bit clammy.

我的手掌有點黏。

I'm sweating.

我在流汗。

And my breath is a little bit shallow.

我的呼吸有點急促。

Now, these familiar sensations are obviously the result

很明顯，這些熟悉的感覺是因為

of standing up in front of a thousand of you

我站在你們無數人面前演講，

and giving a talk that might be streamed online

而且這個演講可能會放到網路上

to perhaps a million more.

供上百萬人觀看。

But the physical sensations I'm experiencing right now

但是我現在的這個身體反應

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

實際上是很基本的身心機制的結果。

My nervous system is sending a flood of hormones

我的神經系統正在輸送

許多如皮質醇和腎上腺素等荷爾蒙 到我的血液裡。

like cortisol and adrenaline into my bloodstream.

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

這是一個非常老且非常必要的反應。

它送我所需的血液和氧氣 到器官和肌肉裡

to the organs and muscles that I might need

to respond quickly to a potential threat.

讓我可以快速回應潛在的威脅。

但是這個回應有一個問題，

But there's a problem with this response,

and that is, it can get over-activated.

那就是，它可能反應過度。

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

如果我每天面對這些種種壓力，

particularly over an extended period of time,

持續一段時間後，

my system can get overloaded.

我的系統可能會不堪負荷。

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

基本上，如果這個反應不常發生，

那對於我的健康和生存是很必要的。

for my well-being and survival.

But if it happens too much,

但是如果它經常發生，

it can actually make me sick.

那就可能會讓我生病。

There's a growing body of research examining the relationship

有越來越多的研究檢視

慢性壓力和疾病之間的關係。

between chronic stress and illness.

Things like heart disease and even cancer

心臟病，甚至癌症等疾病

are being shown to have a relationship to stress.

顯然與壓力有關係。

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

那是因為，長時間 太多來自壓力的激活

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

會干擾我的身體保持健康的過程。

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

現在，我們想像一下 我現在懷孕了。

What might this kind of stress,

這種壓力，

particularly over the length of my pregnancy,

特別在整個懷孕期間，

what kind of impact might that have

對我體內正在發育的胎兒

on the health of my developing fetus?

可能造成什麼影響？

You probably won't be surprised when I tell you

你們可能不會驚訝 當我告訴你們

that this kind of stress during pregnancy is not good.

懷孕期間的這種壓力很不好。

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

它甚至可能導致身體太早生產，

because in a basic sense, the stress communicates

因為，基本上，壓力告知身體

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

子宮已經不是胎兒的安全所在了。

Stress during pregnancy is linked with things like high blood pressure

懷孕期間的壓力與高血壓

and low infant birth weight,

和嬰兒體重不足等有關聯，

and it can begin a cascade of health challenges

而這些啟動一連串的健康挑戰，

that make birth much more dangerous

使母親和胎兒在生產時更加危險。

for both parent and child.

Now of course stress, particularly in our modern lifestyle,

當然，特別是我們現代的生活方式，

壓力是相對普遍的經驗，對嗎？

is a somewhat universal experience, right?

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

或許你未曾在台上做 TED 的演講，

but you've faced a big presentation at work,

但是你曾在工作場合做過大型的發表，

a sudden job loss,

或是突然失去工作，

a big test,

面對一個大的考驗，

a heated conflict with a family member or friend.

甚至與家庭成員或朋友有熱烈的衝突。

But it turns out that the kind of stress we experience

但事實證明，我們經驗的那種壓力，

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

以及我們是否能夠 足夠長久地保持放鬆狀態，

to keep our bodies working properly

使我們的身體保持正常運作，

depends a lot on who we are.

基本上取決於我們是那種人。

There's also a growing body of research

有越來越多的研究顯示

showing that people who experience more discrimination

經歷更多的歧視的人

are more likely to have poor health.

更可能有比較差的健康狀態。

Even the threat of discrimination,

即使是歧視的威脅，

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

像是擔心你可能會在開車時 被警察攔下來，

can have a negative impact on your health.

就可能對你的健康有負面影響。

Harvard Professor Dr. David Williams,

哈佛大學教授大衛 · 威廉斯博士

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

是開發能證明關連的工具的先驅。

says that the more marginalized groups in our society

他說在我們的社會， 越是被邊緣化的族群，

experience more discrimination and more impacts on their health.

經歷越多的歧視 和遭受越多對於健康的影響。

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

我十多年來一直對這些問題感興趣。

I became interested in maternal health

特別是有關孕婦的健康

when a failed premed trajectory instead sent me down a path

讀醫科的計劃的失敗， 反而把我送上了

looking for other ways to help pregnant people.

尋找其他方式幫助孕婦之路。

I became a doula,

我成了一個陪產婦，

a lay person trained to provide support

一位受訓練的非專業人士，

to people during pregnancy and childbirth.

為婦女在懷孕期間和生產時提供支持。

And because I'm Latina and a Spanish speaker,

而且因為我會講西班牙語， 是拉丁美洲裔，

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

當我在北卡羅來納州的 一家公立醫院擔任陪產婦志工時，

I saw clearly how race and class impacted the experiences

我清楚地看到了種族和階級 如何影響到

of the women that I supported.

我所陪產的婦女的經驗。

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

如果我們看看懷孕期間 和生產時的疾病的比率的統計資料，

during pregnancy and childbirth,

we see clearly the pattern outlined by Dr. Williams.

我們就會清楚地看到 由威廉姆斯博士概述的模式。

African-American women in particular

特別是非裔美國婦女，

have an entirely different experience than white women

她們的嬰兒出生時是否健康， 有著與白人婦女完全不同的經驗。

when it comes to whether their babies are born healthy.

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

特別是在美國的最南部地區，

the rates of mother and infant death for black women

黑人婦女中的母親和嬰兒的死亡率，

actually approximate those rates in Sub-Saharan African.

實際上與撒哈拉以南非洲人的 這些比率相似。

In those same communities,

在那些社區，

the rates for white women are near zero.

白人婦女的那些比率接近零。

Even nationally, black women are four times more likely

甚至在全國，黑人婦女

在懷孕和分娩期間死亡的比率

to die during pregnancy and childbirth

than white women.

是白人婦女的四倍。

Four times more likely to die.

四倍的死亡率。

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

黑人嬰兒在滿一歲前的死亡率 也是白人的兩倍。

before the first year of life

than white infants,

and two to three times more likely

黑人嬰兒早產和出生時重量太輕， 那是發展不足的跡象，

to give birth too early or too skinny --

a sign of insufficient development.

是白人嬰兒的兩三倍。

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

本土印第安婦女這些問題的比率

than white women,

也比白人婦女高，

as are some groups of Latinas.

有些拉丁美裔的族群也是如此。

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

在過去十年， 作為一個陪產婦轉業的記者和博主，

I've been trying to raise the alarm

我一直在試圖提出

about just how different the experiences of women of color,

關於美國有色人種婦女，

but particularly black women,

特別是黑人婦女，

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

在懷孕和生產的經驗 是如何不同的警報。

But when I tell people about these appalling statistics,

但是當我告訴人 關於這些令人震驚的統計，

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

我通常聽到的假設是

那是因為貧窮，或是得不到醫療照顧。

or lack of access to care.

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

但事實證明，這些不是全部的原因。

Even middle-class black women still have much worse outcomes

即使中產階級的黑人婦女， 比起中產階級的白人婦女，

than their middle-class white counterparts.

仍然有更不好的結果。

The gap actually widens among this group.

這個群組內的差距實際上更大。

And while access to care is definitely still a problem,

雖然是否得到醫療照顧 肯定還是個問題，

even women of color who receive the recommended prenatal care

即使有色人種的婦女 接受到推薦的產前保健，

still suffer from these high rates.

在前述比率上她們仍然偏高。

And so we come back to the path

所以我們回來追溯

from discrimination to stress to poor health,

從歧視到壓力， 到健康欠佳的過程，

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

這個許多有色人種 都相信的圖開始成形：

racism is actually making us sick.

種族歧視真的使我們生病。

Still sound like a stretch?

仍然聽起來過於誇張嗎？

Consider this: immigrants, particularly black and Latina immigrants,

請聽聽以下：移民， 特別是黑人和拉丁移民，

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

在剛抵達美國時， 他們實際上有比較好的健康狀態。

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

但當他們留在這個國家的時間越長， 他們的健康越惡化。

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

和我一樣出生在美國的 古巴移民家庭的人，

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

實際上更有可能 有比我的祖父母更差的健康狀態。

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

研究人員稱之為「移民者的矛盾」。

and it further illustrates

它並進一步說明了

that there's something in the US environment

美國的環境裡，

that is making us sick.

有使我們生病的東西。

But here's the thing:

但是事情是這樣的：

this problem, that racism is making people of color,

種族歧視使有色人種生病，

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

特別是黑人婦女和嬰兒， 是個很巨大的問題。

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

我可以花所有的時間 與你談論它，

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

但我不會如此做， 因為我想告訴你一個解決方案。

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

好消息是， 有一個不是特別昂貴解決方案。

and doesn't require any fancy drug treatments

它不需要任何昂貴的藥物治療，

or new technologies.

或是新的科技。

The solution is called, "The JJ Way."

這個解決方案叫做「JJ 方式」。

Meet Jennie Joseph.

這位是珍妮 · 喬瑟夫。

She's a midwife in the Orlando, Florida area

她是佛羅里達州奧蘭多市的助產士，

who has been serving pregnant women for over a decade.

服務孕婦十多年了。

In what she calls her easy-access clinics,

在她稱之為便利診所裡，

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

珍妮和她的團隊

每年為超過 600 名婦女 產前護理。

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

她的客戶，大多數是黑人、 海地裔，和拉丁裔婦女。

deliver at the local hospital.

她們在當地醫院分娩。

But by providing accessible and respectful prenatal care,

通過提供方便和尊重的產前保健，

Jennie has achieved something remarkable:

珍妮得到很不可思議的成就：

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

幾乎所有她的客戶 都生了健康、足月的嬰兒。

Her method is deceptively simple.

她的方法看起來很簡單。

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

珍妮說她所有的訪視 從櫃檯開始。

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

她的團隊中的每個成員 時時刻刻都對她診所的每個婦女

is as supportive as possible.

都盡可能提供支持。

No one is turned away due to lack of funds.

沒有人由於缺錢而被拒絕。

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

JJ 方式是無論有什麼障礙， 他們都不會讓財務成為問題。

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

沒有人會因為比預約時間晚到被責備。

No one is talked down to or belittled.

沒有人在言語上被貶低或輕視。

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

珍妮的候診室，比起診所， 感覺更像你的阿姨的客廳。

She calls this space "a classroom in disguise."

她稱這個空間是「變相的教室」。

With the plush chairs arranged in a circle,

坐在排列成一個圓圈的 鬆軟舒適的椅子上，

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

孕婦在等待她們的預約時，

與一位負責教育的工作人員 一對一聊天，

with a staff educator,

or in group prenatal classes.

或上團體產前課程。

When you finally are called back to your appointment,

當你終於被叫去做 你的預約檢查時，

你會見到阿里克斯或崔伊娜

you are greeted by Alexis or Trina,

two of Jennie's medical assistants.

她們是珍妮的醫療助理。

Both are young, African-American and moms themselves.

兩位都是年輕的黑人婦女， 她們本身也都是母親。

Their approach is casual and friendly.

她們的方法是非正式和友好的。

During one visit I observed,

在一次參訪時我觀察到，

Trina chatted with a young soon-to-be mom

崔伊娜和一位年輕的準媽媽聊天，

while she took her blood pressure.

一面量著她的血壓。

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

這個拉丁裔媽媽一直有孕吐的問題。

As Trina deflated the blood pressure cuff,

當崔伊娜在為血壓袖帶放氣時，

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

她說：「我們改改你的處方，好嗎？

We can't have you not eating."

我們不能任由你吃不下東西。」

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

那個「我們」在珍妮的模式裡 是一個非常關鍵的部分。

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

她將工作人員、孕婦和她的家人 都視為團隊的一份子，

has one goal:

有著共同的目標：

get mom to term with a healthy baby.

讓媽媽生出一個健康的嬰兒。

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

珍妮說崔伊娜和阿里克斯 實際上是她的護理模式的中心。

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

作為護理提供者的角色， 她只是支持他們的工作。

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

崔伊娜每天花很多時間在她的手機上，

texting with clients about all sorts of things.

向客戶發關於各種各樣事情的短信。

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

一位婦女發短信詢問 她在醫院治療時使用的處方藥物，

was OK to take while pregnant.

在懷孕時是否可以服用。

The answer was no.

答案是不可以。

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

另一位婦女發短信附上 在珍妮的照顧下出生的嬰兒的相片。

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

最後，當你終於被叫去 見醫療提供者，

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

你已經在候診室量了體重，

and done your own pee test in the bathroom.

並在浴室做了尿液測試。

This is a big departure from the traditional medical model,

這和傳統醫學模式，有很大的不同。

because it places responsibility and information

因為它將責任和信息 放回到婦女的手中。

back in the woman's hands.

So rather than a medical setting where you might be chastised

在一般的醫療環境，

如果妳沒有遵從他們的推薦， 你可能會被譴責──

for not keeping up with provider recommendations --

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

那是低收入婦女經常接觸到的。

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

珍妮的模式是盡可能地支持孕婦。

And that support provides a crucial buffer

那個支持對於每天面對 種族主義和歧視壓力的婦女而言，

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

是個關鍵的緩衝。

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

珍妮的模式最好的是：

it's been incredibly successful.

它非常成功。

Remember those statistics I told you,

記得我告訴你們，

有關黑人婦女更有可能早產，

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

to give birth to low birth weight babies,

或者生出體重過低的嬰兒，

to even die due to complications of pregnancy and childbirth?

甚至死於懷孕和分娩併發症的 統計資料嗎？

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

JJ 方式幾乎完全 消除了這些問題，

starting with what Jennie calls "skinny babies."

從珍妮稱為「瘦小寶貝」開始。

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

她幾乎讓所有她的客戶

with healthy, chunky babies like this one.

生出像這個的健康和大塊頭的嬰兒。

Audience: Aw!

（聽眾）噢！

Miriam Zoila Pérez: This is a baby girl

（米里亞姆·柔依拉·佩雷斯） 這是一位女嬰，

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

珍妮的一位客戶在六月生產的。

A similar demographic of women in Jennie's area

在珍妮服務的地區， 一位有類似背景的的婦女，

who gave birth at the same hospital her clients did

在和她的客戶同一家醫院生產，

were three times more likely to give birth

有三倍的機率

to a baby below a healthy weight.

會生出低於正常體重的嬰兒。

Jennie is making headway into what has been seen for decades

珍妮突破了一個幾十年來 幾乎無法解決的問題。

as an almost intractable problem.

Some of you might be thinking,

你們有些人可能會想，

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

JJ 方式所需要的一對一的關注，

must be too expensive to scale.

要擴展的話，可能成本會很高。

Well, you'd be wrong.

但你們的想法是錯的。

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

與醫療提供者見面 不是珍妮模型的中心，

and for good reason.

這是有好理由的。

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

與醫療提供者見面是很貴的，

為了維持她的模式， 她必須看很多客戶才能打平。

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

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

但是珍妮對每一位婦女 不需要花很多時間，

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

如果她的團隊成員可以提供 客戶所需要的支持、資訊和照顧。

and care that her clients need.

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

珍妮模式的美是她實際上相信

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

這個模式在幾乎任何衛生保健機構 都可以做到的。

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

這是等待發生的一個醫療照顧的革命。

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

那些我與你們分享的問題是很大的。

They come from long histories of racism, classism,

它們來自悠久歷史

基於種族和階級分層的社會裡的 種族和階級歧視。

a society based on race and class stratification.

They involve elaborate physiological mechanisms

它涉及為了要保護我們所產生的 複雜生理機制。

meant to protect us,

that, when overstimulated, actually make us sick.

當這個機制被過度刺激時， 反而讓我們生病。

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

從我作為一個陪產婦的工作， 我至少學到了一件事，

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

那就是一點點無條件的支持 是很有效的。

History has shown that people are incredibly resilient,

歷史證明人們有令人難以置信的韌性，

and while we can't eradicate racism

雖然我們無法一夜之間消除種族歧視，

or the stress that results from it overnight,

以及它造成的壓力，

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

我們或許能夠為每天承受壓力的 有色人種提供一個緩衝的環境。

to what people of color experience on a daily basis.

And during pregnancy, that buffer can be an incredible tool

在懷孕期間，

那個緩衝可以長長久久

towards shifting the impact of racism

成為轉移種族主義的影響的 一個不可思議的工具。

for generations to come.

Thank you.

謝謝！

(Applause)

（掌聲）