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Web Bonus: Linda Villarosa on Black Maternal Health Crisis & America’s Hidden HIV Epidemic

Web ExclusiveApril 20, 2018
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Extended conversation with journalist Linda Villarosa about her two recent major pieces in The New York Times Magazine: “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis” and “America’s Hidden H.I.V. Epidemic,” looking at why America’s black gay and bisexual men have a higher HIV rate than any country in the world.

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, with Nermeen Shaikh. Today we bring you Part 2 of our discussion of an explosive report in The New York Times Magazine headlined “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis.” That’s the title of the piece. The answer to the disparity in death rates has everything to do with the lived experience of being black—a black woman in America. Its author, Linda Villarosa, directs the journalism program at the City College of New York. I’m Amy Goodman, with Nermeen Shaikh. Professor Villarosa, talk about the woman you begin your piece with, named Simone Landrum.

LINDA VILLAROSA: So, Simone Landrum, to me, is a hero. She has had a very hard life but is a very resilient person, really strong-willed, a good sense of humor, given what’s happened to her. So, she had two children, and then she got pregnant with a little girl, which she was really happy about. She really wanted to have a girl child. But she noticed that during this pregnancy, something was very different. So, first of all, she noticed swelling in her face and extreme headaches. So, every time she would tell her doctor that she had these headaches and they were worse than the usual headache, he would say, “Take Tylenol.” And she’d say, “No, my headache is quite bad.” And he’d say, “Take more.” So then she had a prenatal visit about six weeks before her due date, and the headache was extreme, and also her blood pressure spiked in the office. And so he said to her—she was, you know, upset. So he said to her, “You have two choices. Either we can take you upstairs to labor and delivery, and you can have this baby now”—which is not really feasible.

AMY GOODMAN: How many months pregnant was she?

LINDA VILLAROSA: She was six weeks away from her delivery date. And then, “Or you can sit down and calm down, and we can try to get your blood pressure down.” And so she felt that that was disrespectful to her, that it was more about his convenience and his schedule. And so, what happened was, so she sat there, she got her blood pressure down, but four days later, she went into a crisis. She was in her car, and she thought her water had broken. And she looked down, and it was blood. So she got herself in an ambulance to the hospital, and she was basically bleeding out.

And the nurse put a monitor to her stomach, and there was no heartbeat to the baby. And so she realized that her baby had passed away and that she was in a crisis. She was dying, because of extreme blood loss. So they took the baby with a C-section. She survived; the baby didn’t. She had named the baby Harmony, and she passed away. So, then she got pregnant the next year, and she was determined not to have this happen again. And she was afraid, and so she ended up getting attached to a doula, Latona Giwa, who is another hero of this story.

AMY GOODMAN: Explain what a doula is.

LINDA VILLAROSA: So, a doula is a professional person who is with a woman during pregnancy, during labor and delivery and in the weeks after the baby is born, just to make sure—to advocate, to make sure that everything goes well, to be a source of information and also to be a source of support and comfort. And studies show that women who have worked with doulas have better pregnancy outcomes. So she got with this doula. And the good thing about this doula collective—it’s called Birthmark Doula Collective—is that they’re social justice- and birth justice-oriented, so they worked with her for free.

And so, she—so I came. I went to one of their early sessions, and I saw the most beautiful interaction between these two women. They’re very different. Latona’s very mellow, and Simone was very afraid. And she calmed her down. She talked her through. She talked about her prenatal visits, and she made a birth plan for her.

So, then, I was actually there most—a lot of the time. And her baby was due. The doctor was going to induce her on Thursday, because the pregnancy was going post-term. So, on Monday, we went in for the prenatal visit, and you saw on the screen that something was wrong, that the baby’s heart rate looked like chicken scratching. And the doctor called down to where she was having the test, and said, “We need to get the baby tonight. We need to take the baby today.”

So she got induced. Latona, the doula, came. She was wearing these cute little purple scrubs and had lavender oil and was just very calm. And it wasn’t—you know, it was kind of dramatic, but, in the end, Simone had a healthy baby. His name is Kingston Blessed, which is the perfect name for this child. And she also got to introduce this baby to her other two sons, who lost their little sister. And that was the moment, for many of us, that just felt like complete, very complete, complete in this woman’s life and complete this family’s life.

NERMEEN SHAIKH: Well, I want to go back to something that you point out in this piece, which is—you know, it’s such a dramatic figure that black infants now are more than twice as likely to die as white infants, which is a disparity that was greater than existed in 1850. So, could you explain why that is? I mean, even according to the term that you mentioned in the first part of our interview—”weathering”—what accounts for the fact that during slavery there was less infant mortality than there is today, in 2017?

LINDA VILLAROSA: There were certainly more raw deaths—I mean, deaths—then. But if you look at these numbers—so, I actually looked at the numbers, and I said, “What would it mean if there was no disparity? If there was no black-white disparity, what would happen? How many people would be saved?” Four thousand babies, black babies, would be saved per year, if the disparity was closed.

I am not sure exactly why this has happened, but I—this is happening—but I am thinking that we really need to look much more closely at both the lived experience of being a black woman in America and what it does to our bodies, as well as the treatment women get in the hospital system. I think doulas and other birth workers are a solution for right now, as we grapple with changing the system, that is unfair to people of color. But I think doulas connect the technology that we have, and some of the best medical technology in the world, with caring and really taking care of people and putting caring back in healthcare.

AMY GOODMAN: And what about the payment to doulas, who often work in low-income, high-risk communities?

LINDA VILLAROSA: And that is what is really unfair. And Latona Giwa only made $600 for everything she did. You know, I mean, it was from October until February, and they’re still in touch. And so, that really is wrong. And so we have to figure out how to pay doulas. We have to figure out how to incorporate them into the system and to make sure that it’s all woven together, because right now there’s a growing number of these kinds of social justice doulas, and it’s really beautiful to see this growing number of them and to see them trying to tackle these issues, but they’re kind of on their own. It’s a bit ad hoc. They’re not connected to systems. There are some that are connected to the medical systems in their city, here in New York City. We have a connection in some other cities, but it’s not national. It’s not nationalized.

AMY GOODMAN: I was at a birth a few years ago where there was a doula, and she was considered one of the guests, so they said she had to leave the hospital—the room—


AMY GOODMAN: —when the woman was giving birth.

LINDA VILLAROSA: Oh. So, that does happen sometimes, and certainly some doctors feel threatened, and, you know, there’s a conflict between doulas. But what I saw with Birthmark was a kind of sitting back, only taking action when necessary, being really by the birth mother’s side, and the focus was on her. But I also saw Latona take action, you know, when she needed to, but it was very calm and very nonthreatening, but it was firm.

AMY GOODMAN: What about doctors’ biases? How do they play into women and black women giving birth?

LINDA VILLAROSA: Well, the majority of physicians in this country, 75 percent, are white. And so, studies have shown that they do have biases. And how I look at it is, you know, not saying, “Oh, you went into the medical profession because you’re a big racist.” Everyone in this country has unconscious biases based on stereotypes that date back to slavery. But the solution is to really admit the biases, work on them, tackle them, say you have them, and how can you not bring those in to medical practices, to the medical setting. And that is what the key is, is to say, “Yes, these exist, but we’re going to work on that.”

And what I’ve seen is, in medical schools, you have younger medical students who are really trying to work on that. There’s this wonderful organization called White Coats for Black Justice, and there’s also groups around the country that are really trying. I received an email today about a young doctor who was saying, “I really want to get more woke and more organized about the kinds of inequities we see in healthcare.”

NERMEEN SHAIKH: Are doulas different? I mean, why wouldn’t doulas be equally prejudiced as the rest of the medical—or the formal medical community?

LINDA VILLAROSA: That’s interesting, but I do think that doulas go into this work that is not that well paid—doulas go into it for different reasons than doctors may go into it. From what I’ve seen, they are very into birth and very into women in a way, not the technology and not the medical part, but into the caring part.

AMY GOODMAN: So how do they get paid?

LINDA VILLAROSA: So, at Birthmark, what they do is they have some women pay full freight. OK? So they pay the whole—I think it’s $1,500 or something like that. But then they use the money for the people who pay full price, and let the other women go—not pay. As well as grants. And, you know, they’re applying for grants. They’re doing fundraisers. They’re doing a fundraiser today, just trying to make money so that they can keep doing the work for women who need it and can’t pay.

AMY GOODMAN: And then you have women in prison and how they’re treated when they give birth. I mean, we just did a big piece on a woman named Siwatu-Salama Ra. And Siwatu is in prison right now in Michigan, one women’s prison there. And it all depends on the law of the state. In some states, they allow the shackling of women even while they go through childbirth. In others, like in Michigan, the policy is they’re shackled to the hospital, then they are unshackled for the birth and then immediately shackled right afterwards. And then, when the infant is brought back to the prison, they can’t breastfeed them.

LINDA VILLAROSA: I think that birth is supposed to be this beautiful thing that happens. It’s supposed to be natural. But the way we’ve medicalized it, the way we’ve criminalized it, is tragic in this country.

AMY GOODMAN: So, after you did this study—what was your inspiration for doing it, and what surprised you most in your research?

LINDA VILLAROSA: I think what I—why I wanted to do it was because I knew about the numbers. So I had heard about the numbers, that it’s much more common in black women, maternal mortality and morbidity, the near death. So, for every woman who dies, a hundred women, like Simone Landrum, almost die. So I heard those statistics. But then I also knew about the statistics around infant mortality. So what I wanted to do was combine the two to say, “Wait, this is only one—you know, there’s one woman’s body who may die in childbirth, or her baby may die.” So it’s about her.

And so, I think the thing that surprised me most was when I went back to 1850, and I’m looking at that, and I was like, “Wait. How could this problem, the racial disparity, be greater during slavery, when black women were actually chattel, than it is now? And how could black women with an advanced degree have a higher incidence of either dying, almost dying in childbirth, or her baby dying, than a white woman with an eighth grade education?” So that was striking and startling.

But then you see it in what happens. I’ve gotten—since I’ve written this piece, I’ve gotten so many notes, letters, colleagues elbowing me, to tell me about what happened to them. Tearfully. And so, I was actually glad I shared my own story.

AMY GOODMAN: Can you talk about weathering? Who came up with this idea, what it is?

LINDA VILLAROSA: So, Arline Geronimus is a researcher at the University of Michigan, and she came up with the idea when she was a college student, undergraduate, at Princeton. So she was working at, I think, a school for unwed mothers, and she noticed that—she would go to their medical appointments with them, and she noticed that their bodies, when they took off their clothes, looked older than would be expected.

And then she started looking at infant mortality in those numbers, in those teens. Because what was interesting, at the time—and this is, I think, the '80s—the blame on black infant mortality was on teen pregnancy. It was like because these teens, they're irresponsible, they’re having babies, they are driving up the numbers of black infant mortality. What she found was actually the opposite, that it was slightly older black women who had higher rates of infant mortality. But the flip was true for white women, so white teens were driving up rates of infant mortality in whites.

So then she started thinking, “Oh, this is because they’ve lived longer. Black women have lived longer. They’ve had more access to stress, and it’s affecting their pregnancy outcomes.” And she has done—so that’s how she came up with the term “weathering.” But, you know, it’s real. It’s been well studied and been replicated. And I just love the term, because it really does say what it is. It’s your body is aging prematurely because of what’s happening to you.

And when you look at the, you know, sort of the questions, that—there’s a black women’s health study, and it added race questions in 1997. And the questions, it actually made me tear up, because the questions were like, “Oh, have you ever been treated differently because of your race?” “Do you think people think that they’re smarter than you?” “Have you had bad service at a restaurant because of your race?” And then there were hardcore questions like, “Have you been discriminated against at work, in housing and by the police?” And women who had higher rates of—reported rates of being discriminated against, whether it was big or small, had more preterm births.

AMY GOODMAN: Before we go on to another big piece you’ve just published, I wanted to ask you about the news this week, if you have any comment on the statue of the gynecologist J. Marion Sims being taken down in Central Park, 19th century gynecologist, known as “the father of gynecology,” who repeatedly performed painful, nonconsensual scientific experiments on enslaved black women without anesthesia. The removal of the statue coming after repeated protests last year amidst the nationwide wave of demonstrations against Confederate monuments and other racist statues.

LINDA VILLAROSA: I guess what I’ll say about that is, thank God for activists who rallied to get rid of that, and goodbye, good riddance. That is a memory we don’t need to have and we don’t need to celebrate.

NERMEEN SHAIKH: Well, I want to ask about another piece you wrote last year for The New York Times Magazine, titled “America’s Hidden H.I.V Epidemic: Why do America’s black gay and bisexual men have a higher H.I.V rate than any country in the world?” I want to read from the piece a quote: “Last year [in 2016], the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of H.I.V. for several key populations, predicted that if current rates continue, one in two African-American gay and bisexual men will be infected with the virus. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. To offer more perspective: Swaziland, a tiny African nation, has the world’s highest rate of H.I.V., at 28.8 percent of the population. If gay and bisexual African-American men made up a country, its rate would surpass that of this impoverished African nation—and all other nations.” So could you talk about the research that went into that piece and how you found what you did?

LINDA VILLAROSA: Well, I have been reporting on HIV since the '80s. I was one of the first people to write for—excuse me—for an ethnic publication about HIV. So, at each point along this 30-year continuum, I kept thinking, “Oh my goodness, this is going to be over. This cannot—this epidemic”—and my focus is African Americans—”This will be over. This can't keep going on.” Each time, “It’ll be over. It’ll be over.” So when I saw this one in two, that half of all black gay men could be infected in their lifetime, I was shocked.

And then, shortly after was another study that named the areas where gay men, in general, had the highest infection rate. And Jackson, Mississippi, was the number-one place. So, I just revved up all my sources and said, “Please help me understand why this is still going on in 2016”—at that point—”and why it’s Jackson, Mississippi.” This is—you know, I know Jackson, Mississippi, from the movie The Help and the best barbecue ever. So, what is happening there?

And so, everyone said, “You need to go down and see for yourself.” So I went to a conference called Saving Ourselves Symposium, and it was this beautiful gathering of black gay men, who I had never met most of them. They were doing work under the radar, really trying to, as they said, save themselves. Then I just rented a car. I drove—that was in Memphis. I drove to Jackson, Mississippi. And my family’s from Mississippi, so it was a beautiful trip for me personally.

And I saw, again, another kind of heroic person, called Cedric Sturdevant, who was basically an AIDS doula. He was going around helping men, getting medication, taking them to the doctor, taking them to all their clinic visits, really helping them, because there was a crisis there. And even when I was there, I saw newly infected men. I said, “When did you get infected?” I was there in September. And one young man said, “Oh, I found out in July.” While I was there, a transgender woman said, “I found out yesterday.” And so, it was shocking.

I also saw people who lacked treatment, and it wasn’t because they couldn’t get treatment. It was because the stigma was so high that they were afraid to even go get the treatment that they needed. And I just flashed right back to the ’80s. I flashed back to the ’80s, where people were sick, dropping dead in the street, and I thought, “What is happening in America, present-day America? This is just wrong.”

AMY GOODMAN: Can you talk about the significance of the Centers for Disease Control’s Morbidity and Mortality Weekly Report from June 5th, 1981?

LINDA VILLAROSA: So, in that issue of that crazy, wonky newsletter—but it’s the voice of the CDC—it had five cases of men in Los Angeles, and they were previously healthy men who had contracted a very odd disease that was very much of a mystery. And that headline raced around, really, the country and, somewhat, the world.

But there were actually two other cases of men, and they were both black. So I went back to Dr. Michael Gottlieb, who I like a lot, and I said, “What is happening? Why didn’t you just report those last two cases?” And, you know, we had a really difficult but textured conversation. And he said, “They didn’t come in, in time. They came after the deadline for the publication.” And I said, “You know that could have made a difference.” And so then we really got into it.

And what he said was, “It was a hard time. It was a confusing time. Maybe I would have done something differently had I known what was going on, but people were dying. I was a doctor. I didn’t understand.” I celebrate this man now. He is still an HIV doctor in Los Angeles to this day. He still works with HIV-positive patients. So I don’t blame him. But that set the stage for a kind of erasure of the black experience in the epidemic.

NERMEEN SHAIKH: Well, you talk also in your piece about the impact of President Obama’s presidency and the renewed attention that was brought to the HIV epidemic. So could you explain what Obama did and what its effects were, in particular on the African-American gay and bisexual community?

LINDA VILLAROSA: Well, I think, symbolically, part of it was he and Michelle had AIDS tests, so that was very much of a symbol. He also created a strategy for the first time. There had been no coordinated AIDS strategy for the United States. And so that was really important.

And one thing—when I went to Mississippi, I sat in on their statewide meeting of HIV providers and people involved, and they were using that AIDS strategy, created by President Obama and his team, to really sort of figure out what they were doing in their state. And I saw them. They had a copy. They were underlining things. And to have that kind of national guidance, guidance from the top, was wonderful.

The other thing President Obama did was he referenced the one in two, and he talked very openly about what was going on with black gay and bisexual men, and he said it was wrong. So, to have that kind of public address, you know, that issue being addressed by the president, was really important symbolically.

AMY GOODMAN: You know, Barbara Bush has just died, and one of the stories they tell about her was, in 1989, holding babies with AIDS to show the world that it’s not like you can get it, it’s contagious, that she was making that statement. But the U.S. policy, I’m wondering if you could comment on. I mean, Reagan didn’t mention the word ”AIDS” for—we were just talking about the CDC report from '81—until, I think it was, seven years into his presidency. And then, what was George H.W. Bush's policy, moving into Clinton and then Bush Jr.?

LINDA VILLAROSA: Well, oh, my goodness. There was such a—I mean, I interviewed a lot of people, old-timers at the CDC and NIH. And what they said was it was just very difficult to even talk about HIV and AIDS, because it was so highly stigmatized by the government. And so people were trying to figure out how to talk about it without actually talking about sex.

AMY GOODMAN: And this really matters, because you’re talking about money going into research.


AMY GOODMAN: That’s where the federal government comes in.

LINDA VILLAROSA: And if scientists can’t talk openly about what they’re doing, then we really can’t get real information, and you really can’t get real data. And so, that was very strange. And then, George Bush II, what he did was he—I mean, he’s celebrated for this, and it’s wonderful that he focused on PEPFAR. So, PEPFAR was looking at the countries that were most infected around the world, and giving money to them, earmarking money to these countries. However, in the United States, the black community was saying, “Wait, where’s our PEPFAR? What is happening here? Why aren’t we getting money and attention? Where’s our AIDS strategy?” So, even though it was heroic and good that we looked out at what was happening in Africa, where the numbers were huge, we were forgotten here in the United States.

AMY GOODMAN: PEPFAR being President’s Emergency Plan for AIDS Relief. So, this discussion of the comparison of the U.S. to Swaziland, can you elaborate on that?

LINDA VILLAROSA: So, I mean, the infection rate in black communities is so high, it does rival a place that is very poor, very small. They don’t have any of the same resources, most of the same resources we have.

AMY GOODMAN: The highest rate of AIDS in the world, in Swaziland.

LINDA VILLAROSA: Yeah, yes. And that was, admittedly, two years ago, so that might have changed. But still, at the time, that is crazy. That is wrong. What is—I mean, black gay men do not deserve this.

AMY GOODMAN: And can you talk about the advocacy groups of black gay and bisexual men here? Which groups are they? How successful are they? And what is their message?

LINDA VILLAROSA: I think that what struck me about the groups is that they have names that say, “We have given up on help from the country.” So, the Saving Ourselves Symposium says it all. My Brother’s Keeper was one of the groups that I followed down south. Cedric Sturdevant’s work was the SPOT; Safe Place Over Time is his new organization. So, he’s looking for a safe place. The Black AIDS Institute is—”Our People, Our Problem, Our Solution” is the tagline. Us Helping Us is an organization in Washington, D.C. And so, those names are saying, “We have given up. We have to wrap our arms around each other. We have to support each other. We’re doing this on our own and by ourselves.” But also there have been some initiatives, and there has been more money going toward HIV/AIDS in the South. Probably in the last year, you have seen an uptick in funding, because the funding is so mismatched that, I mean, really something had to change.

AMY GOODMAN: And under Trump?

LINDA VILLAROSA: Under Trump. Under the radar, under Trump.

AMY GOODMAN: Well, I want to thank you very much, Linda Villarosa, for joining us. These two very important pieces, we’re going to link to. “America’s Hidden H.I.V Epidemic: Why do America’s black gay and bisexual men have a higher H.I.V rate than any country in the world?” as well as your piece “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis.” I’m Amy Goodman, with Nermeen Shaikh. Thanks so much for joining us.

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