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A social issue I care about is racial profiling, this is something that has been going on for years. And many people are getting racial profiled including many African Americans. Many people have been killed because of this, and were innocent civilians just living their everyday lives. This needs to definitely stop people shouldn't be getting pulled over, hurt or shot just because of how they look or portray themselves to be. Another social issue I care about is police brutality many people have been hurt and beaten by police officers, just for standing up for what they believe in, or protesting for their way to live right. This gives no one the right to beat or put their hands on believers. Both need to stop and as people we need more resources for those social issues.

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From school shootings to incidents on the street, gun violence is prominent throughout the country and the gun laws are absurd. There isn't consistency in the conviction of the criminals and the fact that practically anyone can get a gun and cause massacres is horrible. The amount of public shootings and school shootings is a reflection of how free some people in this country are. There are many accounts of white people of shooting and killing innocent people with large rifles without getting a stratch when they are being detained. The Parkland shooter is still in trial after 3 years after committing the crime.

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A social issue that I care about is gender equality because there are various amounts of differences between the fundamental human right of a man and woman. Women play a big role in the healthcare, labor markets, and the economy overall. Men get more benefits, income, freedom, and more which is why it is unfair to women who work just as hard. There are multiple unconscious acts of gender inequality and it shows at home, work, school, etc. When you think about it, the boy gets to stay out later than the girl, or the boy gets to help with manual labor or the boy gets paid more because he's a boy. It is the discrimination against women that make it hard for them to excel in the work that they are put in charge of. Like for instance, at work, men make it hard to speak up or get their point across because they feel more dominant and so forth. These things can mentally drain a female which is not including the force into marriages, lack of leadership positions, sexual violence, etc. The equality of genders can help stabilize women's rights which is necessary for the foundation of a unified and supporting world.

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A serious social issue that interests me is racial injustice. Not only is racial injustice something I am passionate about but something that affects me on a day to day basis. It seems that since this issue has been apparent for hundreds of years and has never been fully solved. It feels like POC and non-poc will never be equal. Life for POC especially African Americans shouldn't consist of being afraid to walk outside, go to the store, or going on a run. Being judged by the color of your skin. POC's actions, performance, or slightest movements judged usually by racially driven stereotypes. It is so normalized in today's society. The separation between everyone in this world is driven by race while we should all be united and treated equally. There is a difference in treatment by society and the government. POC tend to be charged harsher in the court of law or not given the justice they deserve, based on perception and judgement. This has gone on way to long engraved in our systems and is something I actively would like to be changed. I do not want to see another George Floyd, Breonna Taylor, or Gabriel Fernandez. We need better systems it is to the point of liberation.
POC= people of color

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A social issue that I care about is the health care system. I really do think it is a problem in America. There are many people who can not afford to pay for health care but need the medical attention. Many people suffer and stress about bills when health care should be totally free. You go to a hospital and come back with a big bill just for stepping in or a very minor incident. Why should we pay for healthcare when it is a basic human resource? (Adriana Hernandez)

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I think a very important social problem that I find urgent is the way education is shaped. The school system has been the same since it was founded. I think that with the evolution of education and intelligence, the way the education system works should adapt to this. I don't believe that everyone should be taught the same way because not everyone is the same. I believe that schools should focus on how capable their students are. All students should be taught basics but should also be taught in their strongest abilities.

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Racial injustice has been one of the biggest social issues ever since times of segregation and the current times we live in today. This social issue interest me the most because I feel like it is something that has been fought for countless amount of times and although sometimes action has been taken in some racial injustice cases, many situations have gone overlooked by those who are supposed to listen to our voices. As someone who has experienced racial injustice before I feel like it is something that will forever continue and all we ca do is make sure we keep fighting to make sure our voices our heard, because many people like me have expirienced such of an experience others have sadly died because of one thing racial injustice.

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A social issue that I find important is tampon taxing. To this day people all over the world who menstrual still have to pay tax for those products. I find it unfair that we have to pay in order to use products for something we can't stop from happening. Menstrual products should not have the same cost as mens razors. Many homeless people have no access to showers and private bathrooms, let alone menstrual products. I think menstrual products should be free to use since it is a necessity, and not a luxury. Almost 2/3's of low income families still cannot afford to use menstrual products to this day. States like Alabama and Texas and countries like Poland still tax menstrual products and its our job to stop it.

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A social issue that I care about would be the struggle immigrants go through. Many people decide to leave and find a better life for themselves and their kids. As parents, you would want to give your kids the best life they can possibly have. Half of the time, families begin to struggle more than they ever did before when families have broken apart because they have to find ways to maintain their loved ones. Most times these families are broken apart due to being deported, or when immigrants decide to become U.S. citizens, the process can take up to years to fully finish. Even if they work to become citizens, they are never truly safe and free of deportation.

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A social issue that I care about is mental health awareness and help in black and latinx communities. People in our communities don't really take mental health as a serious issue so they are not able to reach out for help. Even celebrities who are black and/or latinx, are not taken seriously but instead they are judge and called "dramatic" when they talk about being depressed or having anxiety. Children have to grow up not being able to express themselves fully because they are condemned for being sad or not feeling well. I've done presentations about this topic before and I've realized that black and latinx families should normalize saying they're not ok.

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a social problem i believe this world, or this country mainly has is immigrants. i think that when people come here from other countries they area usually not treated like everybody else. they see them as people less worthy or of less value then the standard so call american. people here treat others poorly and sometimes call them by names. coming to this country as a mexican can be hurtful sometimes because people can look at you in ways, treat you bad, tell you to go back where ever it is you're from. people can call ice or whatever it may be to make you leave and people can even abuse and hurt immigrants.

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Social Justice Issues - Jennifer Barragan 

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Social Justice Issues - Jennifer Barragan 

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A social justice issue that I care about is gender inequality. Gender inequality is a social process where women and men are not treated equally. I find it unfair since women are often viewed under men. Women especially in low classes are facing inequalities in education, workplaces, pay, harassment, marriage, violence, etc. This is important to me because I am a women and many women that I care about unfortunately are facing inequalities based on their gender. I find it unfair because both men and women are needed to make this world run and function. We are all human regardless of our gender, so why is one gender viewed more "superior" than the other?

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A social issue that I care about is missing or exploited children not being found around the world because lots of children get kidnapped and they don't get found. They become forgotten by society. The police do nothing about it and it becomes a closed case. A question I have is don't a child's life matter as much as yours and shouldn't you do whatever it takes to bring them back to their families?

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A social justice issue I care about is climate change and it's steady rise worldwide. Wild fires, abnormal climate changes in different areas, the melting of ice caps, and even straining human resources. These impact humans, animals, and the environment overall.
A second social justice issue I care about is racial injustice inside the country. BIPOC people still face unfair treatment by several different groups (including the authorities) simply because of their ethnicity/background and because of racial stereotypes already engraved into them.
A third social issue I care about would be gun violence and how there should be more laws that restrict certain factors. Many issues have allowed children to have a weapon on their hands, and releasing anger and frustration onto fellow classmates and teachers in many cases. There should be stricter laws on how to have a weapon out of a child's hand, as well as the accessibility to have one in other states where it is legal to carry one.

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A social issue that I care about is the fact that some countries around the world don't offer their people basic human rights. Countries like Burma, Equatorial Guinea, Eritrea, Libya, North Korea, and Sudan don't offer their people basic human rights and this has become normal for them when something like this shouldn't be allowed to happen. I think this is a huge problem and I understand that it can be very difficult to find a solution for something like this. However, I still think that we should at least try to do something about it instead of not acknowledging it.

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One social injustice that is important to me are school lunches because the lunches that are provided in the cafeteria aren't too good and barely give anything to the students that will give them energy that will last until school is over. Most students don't bother to even eat school lunches because of the lack of taste or are afraid to be seen eating it I feel like they should provide tasty foods and portions then so that it would actually satisfy students hunger and give them their second wind of energy to finish off the last hours of school strong. Only if the things I have mentioned came true maybe more students would eat lunch more often then have the energy to work harder in those last few classes.

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Ms. Guy Maternity Care for Black and Latinx Women/Medical Racism 

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Ms. Guy Maternity Care for Black and Latinx Women/Medical Racism 

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Black and Hispanic women are more likely to die in child birth than any other racial or ethnic group.

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Serena Williams knew her body well enough to listen when it told her something was wrong. Winner of 23 Grand Slam singles titles, she'd been playing tennis since age 3-as a professional since 14. Along the way, she'd survived a life-threatening blood clot in her lungs, bounced back from knee injuries, and drowned out the voices of sports commentators and fans who criticized her body and spewed racist epithets. At 36, Williams was as powerful as ever. She could still devastate opponents with the power of a serve once clocked at 128.6 miles per hour. But in September 2017, on the day after delivering her baby, Olympia, by emergency C-section, Williams lost her breath and recognized the warning signs of a serious condition.

She walked out of her hospital room and approached a nurse, Williams later told Vogue magazine. Gasping out her words, she said that she feared another blood clot and needed a CT scan and an IV of heparin, a blood thinner. The nurse suggested that Williams' pain medication must be making her confused. Williams insisted that something was wrong, and a test was ordered-an ultrasound on her legs to address swelling. When that turned up nothing, she was finally sent for the lung CT. It found several blood clots. And, just as Williams had suggested, heparin did the trick. She told Vogue, "I was like, listen to Dr. Williams!"

But her ordeal wasn't over. Severe coughing had opened her C-section incision, and a subsequent surgery revealed a hemorrhage at that site. When Williams was finally released from the hospital, she was confined to her bed for six weeks.

Like Williams, Shalon Irving, an African American woman, was 36 when she had her baby in 2017. An epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC), she wrote in her Twitter bio, "I see inequity wherever it exists, call it by name, and work to eliminate it."

Irving knew her pregnancy was risky. She had a clotting disorder and a history of high blood pressure, but she also had access to top-quality care and a strong support system of family and friends. She was doing so well after the C-section birth of her baby, Soleil, that her doctors consented to her request to leave the hospital after just two nights (three or four is typical). But after she returned home, things quickly went downhill.

For the next three weeks, Irving made visit after visit to her primary care providers, first for a painful hematoma (blood trapped under layers of healing skin) at her incision, then for spiking blood pressure, headaches and blurred vision, swelling legs, and rapid weight gain. Her mother told ProPublica that at these appointments, clinicians repeatedly assured Irving that the symptoms were normal. She just needed to wait it out. But hours after her last medical appointment, Irving took a newly prescribed blood pressure medication, collapsed, and died soon after at the hospital when her family removed her from life support.

Viewed up close, the deaths of mothers like Irving are devastating, private tragedies. But pull back, and a picture emerges of a public health crisis that's been hiding in plain sight for the last 30 years.

Following decades of decline, maternal deaths began to rise in the United States around 1990-a significant departure from the world's other affluent countries. By 2013, rates had more than doubled. The CDC now estimates that 700 to 900 new and expectant mothers die in the U.S. each year, and an additional 500,000 women experience life-threatening postpartum complications. More than half of these deaths and near deaths are from preventable causes, and a disproportionate number of the women suffering are black.

Put simply, for black women far more than for white women, giving birth can amount to a death sentence. African American women are three to four times more likely to die during or after delivery than are white women. According to the World Health Organization, their odds of surviving childbirth are comparable to those of women in countries such as Mexico and Uzbekistan, where significant proportions of the population live in poverty.

Irving's friend Raegan McDonald-Mosley, chief medical director for Planned Parenthood Federation of America, told ProPublica, "You can't educate your way out of this problem. You can't health-care-access your way out of this problem. There's something inherently wrong with the system that's not valuing the lives of black women equally to white women."

Lost mothers

Speaking at a symposium hosted by the Maternal Health Task Force at the Harvard T.H. Chan School of Public Health in September 2018, investigative reporter Nina Martin noted telling commonalities in the stories she's gathered about mothers who died. Once a baby is born, he or she becomes the focus of medical attention. Mothers are monitored less, their concerns are often dismissed, and they tend to be sent home without adequate information about potentially concerning symptoms. For African American mothers, the risks jump at each stage of the labor, delivery, and postpartum process.

Neel Shah, an obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston and director of the Delivery Decisions Initiative at Ariadne Labs, recalls being struck by Martin's ProPublica-NPR series Lost Mothers, which delved into the issue. "The common thread is that when black women expressed concern about their symptoms, clinicians were more delayed and seemed to believe them less," he says. "It's forced me to think more deeply about my own approach. There is a very fine line between clinical intuition and unconscious bias."

For members of the public, the experiences of prominent black women may prove to be a teachable moment. When pop superstar Beyoncé developed the hypertensive disorder pre-eclampsia-which left untreated can kill a mother and her baby-after delivering her twins by emergency C-section in 2017, Google searches related to the condition spiked. According to the U.S. Agency for Healthcare Research and Quality, pre-eclampsia-one of the leading causes of maternal death-and eclampsia (seizures that develop after pre-eclampsia) are 60 percent more common in African American women than in white women, and also more severe. If it can happen to Beyoncé-an international star who presumably can afford the highest-quality medical care-it can happen to anyone.

Weathering report

Arline Geronimus, SD '85, has been talking about the effects of racism on health for decades, even when others haven't wanted to listen. Growing up in the 1960s in Brookline, Massachusetts, Geronimus, who is white, absorbed the messages of the Civil Rights movement and the harrowing stories of her Jewish family's experiences in czarist Russia. When she headed off to Princeton as an undergraduate, she resolved to find a way to fight against injustice. Her initial plan to become a civil rights lawyer gave way when she discovered the power and potential of public health research.

Geronimus worked as a research assistant for a professor studying teen pregnancy among poor urban residents, and, as a volunteer at a Planned Parenthood clinic, witnessed close-up the lives of pregnant black teens living in poverty in Trenton, New Jersey. She felt a chasm open up between what some of her white male professors were confidently explicating about the lives of these adolescents and how the young women themselves saw their lives.

According to the conventional wisdom at the time, Geronimus says, teen pregnancy was the primary driver of maternal and infant deaths and a host of multigenerational health and social problems among low-income African Americans. Researchers focused on this issue while ignoring broader systemic factors.

Geronimus sought to connect the dots between the health problems the girls experienced, like asthma and type 2 diabetes, and negative forces in their lives. She visited them in their crumbling apartments and accompanied them to medical appointments where doctors treated the girls like props, without agency in their own care. And she noticed that they seemed older, somehow, than girls the same age whom Geronimus knew.

"That's when I got the fire in my belly," she says, her voice rising. "These young women had real, immediate needs that those of us in the hallowed halls of Princeton could have helped address. But we weren't seeing those urgent needs. We just wanted to teach them about contraception."

Geronimus came to the Harvard Chan School to learn how to rigorously explore the ways that social disadvantage corrodes health-a concept for which she coined the term "weathering." Her adviser, Steven Gortmaker, professor of the practice of health sociology, provided data for her to correlate infant mortality by maternal age. While most such studies put mothers into broad categories of teen and not-teen, Geronimus looked at the risks they faced at every age. The results were surprising even to her.

White women in their 20s were more likely to give birth to a healthy baby than those in their teens. But among black women, the opposite was true: The older the mother, the greater the risk of maternal and newborn health complications and death. In public health, the condition of a baby is considered a reliable proxy for the health of the mother. Geronimus' data suggested that black women may be less healthy at 25 than at 17.

"Being able to see those stark numbers was essential for me," says Geronimus, who is now a professor of health behavior and health education at the University of Michigan School of Public Health and a member of the National Academy of Medicine. And the implications were staggering. If young black women were already showing signs of weathering, how would that play out over the rest of their lives-and what could be done to stop it?

Geronimus' questions were ahead of their time. The press and the public-even other scientists-misinterpreted her findings as a recommendation that black women have children in their teens, she says, recalling with a sigh such clueless headlines as, "Researcher says let them have babies."

In the 1970s, even researchers who broached the topic of racial differences in health outcomes-and few did-focused on small pieces of the puzzle. Some were looking at genetics, others at behavioral and cultural differences or health care access. "No one wanted to look at what was wrong with how our society works and how that can be expressed in the health of different groups," Geronimus says. Over time, her ideas would become harder to dismiss.

The tide began to turn in the early 1980s, when former Health and Human Services Secretary Margaret Heckler convened the first group of experts to conduct a comprehensive study of the health status of minority populations. As the field of social epidemiology took off, the Report of the Secretary's Task Force on Black and Minority Health (also known as the Heckler Report) brought Geronimus' animating questions into mainstream debate.

Then, in 1993, researchers identified a physiological mechanism that could finally explain weathering: allostatic load. "We as a species are designed to respond to threats to life by having a physiological stress response," Geronimus explains. "When you face a literal life-or-death threat, there is a short window of time during which you must escape or be killed by the predator." Stress hormones cascade through the body, sending blood flowing to the muscles and the heart to help the body run faster and fight harder. Molecules called pro-inflammatory cytokines are produced to help heal any wounds that result.

These processes siphon energy from other bodily systems that aren't enlisted in the fight-or-flight response, including those that support healthy pregnancies. That's not important if the threat is short term, because the body's biochemical homeostasis quickly returns to normal. But for people who face chronic threats and hardships-like struggling to make ends meet on a minimum wage job or witnessing racialized police brutality-the fight-or-flight response may never abate. "It's like facing tigers coming from several directions every day," Geronimus says, and the damage is compounded over time.

As a result, health risks rise at increasingly younger ages for chronic conditions like hypertension and type 2 diabetes. Depression and sleep deprivation become more common. People are also more likely to engage in risky coping behaviors, such as overeating, drinking, and smoking.

Geronimus' foundational work in the 1980s and 1990s has been cited by David R. Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health at the Harvard Chan School, an internationally recognized expert in the ways that racism and other social influences affect health. His Everyday Discrimination Scale is one of the most widely used measures of discrimination in health studies. It includes questions that measure experiences such as being treated with discourtesy, receiving poorer service than others in restaurants or stores, or witnessing people act as if they're afraid of you. As he explained in a 2016 TEDMED talk, "This scale captures ways in which the dignity and the respect of people who society does not value is chipped away on a daily basis."

Maternal Mortality in the U.S.: A Human Rights Crisis

Despite high-tech medical advances of the last century, women around the world are still dying in pregnancy and childbirth from age-old scourges such as hemorrhage and pre-eclampsia and, increasingly, from complications related to chronic diseases, obesity, and advanced maternal age.

In 2000, the global health and development community acknowledged the need for action in Goal 5 of the U.N. Millennium Development Goals, which aimed to reduce maternal deaths by three-quarters in 15 years (it declined by 45 percent). While press and publicity around the push offered harrowing stories, women reading these stories in the U.S. may well have come away believing that it was a problem for mothers in villages in Sierra Leone-but surely not in Atlanta or Washington, D.C.

Starting in 2008, human rights groups around the world began calling on the U.S. to do more to keep its mothers from dying. The United Nations Committee on the Elimination of Racial Discrimination (CERD) expressed concern about inequities in maternal mortality and recommended that steps be taken to improve access to maternal health care, family planning, and sexuality education and information.

A 2012 Amnesty International report declared that these steps weren't enough: "Preventable maternal mortality can result from or reflect violations of a variety of human rights, including the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health." Having ratified two key international treaties guaranteeing these rights, the authors wrote, the U.S. government should be held accountable.

Four years later, representatives from the advocacy organization SisterSong, the Center for Reproductive Rights, and National Latina Institute for Reproductive Health issued a report to CERD further exploring these issues. CERD adopted the groups' recommendations, including addressing stereotypes that promote discrimination in clinical settings and standardizing data collection on maternal deaths. In 2015, an advocacy organization called Black Mamas Matter emerged out of this effort to keep pushing the agenda forward.

To the women leading the charge, one central fact was clear: Racism is an undeniable thread running through the stories of black mothers who die. But as Elizabeth Dawes Gay, co-director of Black Mamas Matter and a public health professional, wrote in The Nation, providers and researchers often place "the onus for large-scale change on individuals rather than the systems that we know cause harm."

The telomere connection

In the early 2000s, research on telomeres-protective caps on chromosomes-provided further evidence that weathering is not merely a metaphor but a biological reality. Each time cells divide, telomeres get a little shorter. They eventually reach a point where they can't divide anymore and die. Allostatic load causes cells to divide faster to keep repairing themselves. The result is earlier deterioration of organs and tissues-essentially, premature aging.

"This is what I've been talking about all along," Geronimus says. "Weathering is a biological response to social factors-a product of your lived experience and how that impacts you physiologically. But now, I can describe this even more specifically, in terms of physiological mechanisms. The emerging science gives the concept of weathering a kind of substance or credibility, which has allowed more people to be open to it."

Geronimus has incorporated the study of allostatic load and telomere length into her own work. She recently led a study of telomere length in Detroit among low-income individuals of multiple races and ethnicities. The results suggested that community and kin networks may be more protective for health than income and education.

Indeed, in this study population, poor white individuals actually experienced more weathering than poor minority populations, and Hispanics with more education experienced more weathering than those with less education. Social isolation and feeling estranged from one's community, whether because of occupational or educational differences, along with everyday exposure to discrimination in new, predominantly white, middle-class contexts-in popular lingo, being "othered"-may explain these outcomes, Geronimus says.

She hopes to dig further into this line of inquiry, to find out which social stressors matter the most for health, how they can be disrupted, and how the scientific findings can be turned into policy. "If someone is experiencing weathering because of the discrimination they face in their lives," she says, "the solution is not just to tell them to get more exercise."

That Geronimus' ideas have become mainstream in the field was evident at the 23rd Annual HeLa Women's Health Symposium, held in September 2018 at Morehouse School of Medicine, in Atlanta. This year's event focused on maternal health disparities, and Geronimus' findings bubbled up in the talks of many speakers. Researchers and advocates said that a key part of reducing maternal deaths was addressing the societal conditions that affect women's health throughout their lives, like housing, air quality, and nutrition. One of those speakers was a fellow Harvard Chan alumna and a public health professional who was in a position to make a difference.

Finding stories in statistics

When she was growing up in a military family in California's San Fernando Valley, Wanda Barfield, MPH '90, a rear admiral in the U.S. Public Health Service and director of the Division of Reproductive Health at the CDC, was the kind of kid who would tend to an injured squirrel that fell out of a palm tree. She could never turn away a creature in distress, she says, and often had a stray dog or cat at home under her care. Veterinary medicine seemed like an obvious career path, but as an undergraduate at the University of California-Irvine, she learned about another vulnerable population in need of her big heart.

Black babies were twice as likely to die within their first year as white babies, Barfield read in the Heckler Report. That insight was life-changing.

Barfield, who is African American, had grown up largely protected from the harsh realities of U.S. health inequities. Her dad was in the Navy's submarine service, a job that came with secure housing and high-quality, accessible health care for his family. Reading the government report completely altered her perspective, and volunteering in a neonatal intensive care unit (NICU) sealed the deal. "I knew I wanted to care for babies and somehow close the gap," she says. "As I started learning more about working in the NICU, I realized that a baby's health is related to the health of the mother, and that the health of the mother is related to her community and to the circumstances of her life. I learned that the social determinants of health mattered in very real and concrete ways."

Barfield entered Harvard Medical School in 1985, one of just 24 students selected to participate in a new approach to medical education focused on problem solving and early patient interaction. Encouraged to take time off before her last year of medical school to earn an MPH at the Harvard Chan School, Barfield researched infant health outcomes in military families. Overall, African American babies in this population were healthier compared with babies in the general African American population, and their birth weights were higher.

One factor that may have made a difference: better access to care, which included more frequent prenatal visits. But Barfield notes that access is just a small piece of the overall health care women receive. More women are going into pregnancy with diabetes, hypertension, and overweight, she says, and these can threaten pregnancy.

But health care is not just a matter of scheduling an appointment. Mary Wesley, DrPH '18, an epidemiologist and health services consultant working with the Mississippi State Department of Health, organized data from a series of focus groups held with mothers across the state in 2013. Some women reported that they avoided prenatal care because of the way they were treated by providers. These women, many of whom were low-income or lived in rural areas, wanted more education about caring for themselves and their babies but were limited in their choice of providers. If they felt disrespected or unheard in the examining room, there was nowhere else to go.

The CDC currently collects the death certificates of all women who died during pregnancy or within a year of pregnancy. The information is voluntarily provided by the health departments in all 50 states, New York City, and Washington, D.C. But the information is limited, and there is no national standard.

Barfield and others in the field are pushing for wider adoption of Maternal Mortality Review Committees (MMRCs), now operating in about 30 states. Every time a mother dies, these volunteer expert panels meet to review official data as well as other information about the mother's life, such as media stories or her social media postings. The goal is to identify what went wrong and to develop guidelines for action. In Georgia, for example, where the country's maternal death rates are highest, the committee has found records of women who developed hypertension during pregnancy and didn't receive medication soon enough, women who died waiting for unavailable ambulances, and women whose providers didn't understand warning signs that led to a hemorrhage, just to name a few gaps in the system. "We need these stories to save women's lives," Barfield says.

Data that Barfield and her colleagues at the CDC are gathering through a new system called MMRIA (Maternal Mortality Review Information Application)-pronounced "Maria"-may help identify other under-recognized barriers to safe delivery. MMRIA pulls stories together and looks for trends. In its first report, published in January 2018, data from nine states found that the reasons women died varied by race. White mothers were less likely to have died from pre-eclampsia than black mothers, and more likely to have died from mental health issues, including postpartum depression and drug addiction. Barfield hopes to find out whether these results are true across a broader population and is working on expanding the system. Ideally, MMRCs will amass more fine-grained information about the conditions of lost mothers' lives, so that researchers can understand how to stop these untimely, heartbreaking-and largely preventable-deaths.

"A maternal death is more than just a number or part of a count," says Barfield. "It is a tragedy that leaves a hole in a family. It is a story that often includes missed opportunities, both inside and outside of the hospital. It's important to find out why women are dying so we can prevent the circumstances leading to their death."

The Black Women's Health Study

Every two years, participants in the Black Women's Health Study (BWHS), an ongoing cohort study of 59,000 black women, are sent questions about their health, their habits, and various experiences in their lives. Some of the questions, including several from the Everyday Discrimination Scale (developed by the Harvard Chan School's David Williams, see page 20), have focused on their perceptions of the discrimination they experience. Now in its 23rd year, the BWHS is the largest cohort study focused on black women's health.

The study was launched by Harvard Chan School alumnae Julie Palmer, ScD '88, and Lynn Rosenberg, SM '72, ScD '78, both professors at the Slone Epidemiology Center of Boston University. Noting that the scientifically productive Nurses' Health Studies included mostly white women, they felt it was important to gather similarly robust data on the health of African American women.

It took a few years before funding agencies were on board. "They weren't convinced of the value of a study that only included black women and didn't have a comparison group," Palmer says. "But we wanted the whole study population to be black women so that we would have as much statistical power as possible. We wanted to study exposure and disease relationships in black women, rather than using resources for a comparison with white women."

With the National Cancer Institute as a major sponsor, breast cancer emerged as an early area of focus. Researchers already recognized that while black women and white women have a similar chance of developing breast cancer, black women are 40 percent more likely to die from the disease. Today, they know that black women are more likely than white women to develop the most aggressive and less treatment-responsive form of breast cancer, known as estrogen-receptor-negative, or ER-. Exactly why remains a burning question and is being addressed in BWHS research. Palmer led a collaborative analysis of pregnancy data from the BWHS and three other large studies of breast cancer, finding that childbearing without breastfeeding leads to an increased risk of ER- breast cancer. For complicated reasons, breastfeeding is markedly less common among black mothers in the U.S. than in other mothers.

In a line of research separate from BWHS, Nancy Krieger, professor of social epidemiology at the Harvard Chan School, found that early-life exposure to Jim Crow laws-which legalized racial discrimination in Southern U.S. states from the late 1870s through the mid-1960s-was associated with negative health effects decades later. Among U.S. women currently diagnosed with breast cancer, being born in a Jim Crow state raised black women's risk of being diagnosed with ER- breast tumors.

BWHS investigators are also exploring other conditions that are uncommon in the general population but have emerged in striking numbers in black women, including sarcoidosis, a connective tissue disorder. "We didn't ask about it; none of us had heard of it," Palmer says. "On the first questionnaire, we had two write-in spots for other conditions, and a few hundred women wrote in sarcoidosis." A literature search showed it was more common in blacks than whites and in women than men. One researcher, Yvette Cozier, has made it one of her primary areas of investigation. As Palmer says, "That wouldn't have happened without 59,000 black women telling us about their health concerns."

She adds that an African American student working on the study had a preterm birth around the same time that several white women on the team had normal births. The team had already been looking into the effects of discrimination on health-but the student's unsettling experience was a striking reminder of why the research is important.

Saving mothers

Will this growing body of data attesting to black women's increased risk of death during and after childbirth shape policymaking? Researchers want to see a broad range of changes in health care culture, in public health information gathering, and in society at large. As Neel Shah and Boston University's Eugene Declercq noted in an August 2018 editorial in STAT, maternal deaths are a "canary in the coal mine for women's health." Shah added in a recent interview: "Efforts by clinicians and hospitals to improve maternity care are essential. But we can't solve the problem of maternal deaths unless we acknowledge that women's health isn't something to be concerned about only during pregnancy and then disregarded after the baby is born."

In 2017, Shah started a national March for Moms to raise public awareness around maternal health. Through his work with Ariadne Labs, he is piloting new approaches to the birth process that ensure that mothers are empowered to make decisions about their care, including a labor and delivery planning whiteboard that helps track mothers' preferences, health conditions, and birth progress. He says that work is under way on a program to improve community support for mothers during the critical first year after childbirth by galvanizing city governments to coordinate and develop resources.

Along similar lines, the Mississippi State Department of Health offers programs that address issues of quality in care that moms referred to in the focus group discussions, says Mary Wesley. One example is the department's Perinatal High Risk Management/Infant Services System, a multidisciplinary case management program for Medicaid-eligible, high-risk pregnant and postpartum women and their babies less than 1 year old. The program includes enhanced services with home visits, health education, and psychosocial support for nutritional and mental health needs.

Arline Geronimus takes a wider view of the issue, arguing that the solution to racial inequities in maternal mortality is to change the way society works. In the near term, she says, race should regularly be taken into consideration during prenatal risk screenings, because even younger black women could be at increased risk of pregnancy complications. Risk status by maternal age should be reappraised in context, as well. While most women in their 20s and early 30s are considered low-risk, black women may be weathered and biologically older than their chronological age, she said, which makes them more subject to health complications at younger ages.

This is true even among highly educated or professional women, such as Serena Williams or Shalon Irving. The danger of failing to recognize the effects of weathering in black women of higher socioeconomic position can be compounded. That's because the U.S. lacks policies that support women who want both careers and parenthood, a gap that can lead professional women to postpone childbearing until their late 30s or 40s. According to Geronimus, "As a group, black mothers in their mid- to late 30s have five times the maternal mortality rate of black teen mothers, although the older mothers generally have greater educational or economic resources and access to health care."

Ana Langer, professor of the practice of public health and coordinator of the School's Women and Health Initiative, points out that the 2010 Amnesty International report Deadly Delivery: The Maternal Health Care Crisis in the USA, contained a shocking fact: Most women in the U.S. weren't dying during childbirth because of the complexity of their health conditions, but because of the barriers they faced in accessing high-quality maternal care-particularly those who were poor or faced racial discrimination.
Video: Black moms share their stories
In general, maternal mortality in the U.S. receives scant attention, Langer adds, in part because there are relatively few deaths each year compared with other conditions, and also because there are no important business opportunities related to conditions that don't require sophisticated drugs or technologies. But she bluntly suggests an additional reason: "Women-particularly those who are most vulnerable due to their race, age, or socioeconomic status-receive less attention overall for their health issues, compared to men. On a positive note, the attention on gender and sex gaps and social determinants of health in research and care is rapidly increasing. This is the time to build on this growing momentum to increase the efforts to improve maternal health in the U.S."

In an April 2018 Rewire News story, Elizabeth Dawes Gay, of Black Mamas Matter, directly addressed the racial disparities element in maternal mortality: "Those of us who want to stop black mamas from dying unnecessarily have to name racism as an important factor in black maternal health outcomes and address it through strategic policy change and culture shifts. This requires us to step outside of a framework that only looks at health care and consider the full scope of factors and policies that influence the black American experience. It requires us to examine and dismantle oppressive and discriminatory policies. And it requires us to acknowledge black people as fully human and deserving of fair and equal treatment and act on that belief."

As Linda Blount, of the Black Women's Health Imperative, noted during the Morehouse symposium, "Race is not a risk factor. It is the lived experience of being a black woman in this society that is the risk factor."

Serena Williams understands that. She told the BBC that she had received excellent care overall for her postpartum complications. But then she pulled back the lens. "Imagine all the other women," she said, who "go through that without the same health care, without the same response."

Amy Roeder is associate editor of Harvard Public Health.
Photos: Getty Images, Becky Harlan/NPR, Brian Lillie/University of Michigan, U.S. Centers for Disease Control and Prevention Illustrations: Benjamin S. Wallace/Harvard Chan School

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For decades, Harvard Chan alumni have shed light on high maternal mortality rates in African American women. Finally, policymakers are beginning to pay attention.

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A issue that I care about is the crisis that Yemen has been going through. A repeated cycle has been happening in Yemen and it's been consistent for years. Being born into a poor family, little to no food and water, education is declining and hospitals lack necessities. The war has been going on for a while and the children are being affected by it. Employment rates are at an all time low so many of the adults in Yemen are unemployed. People with a job don't have a steady source of income to provide for their families. I see Yemen in the news a lot but little to no action is being taken, more people need to become aware about the crisis that Yemen is in.

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A social issue that concerns me would be police brutality because of them feeling like they have the power to do whatever they believe is right, not knowing the full story. just because they have a badge and a gun they believe they're above anything else. Cops are human beings just like everyone else, they have good days and bad days. But you can't avoid them like you do any one else, they have the power to mess the rest of your life up.

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A social issue that interest me is Homelessness. Homelessness is an ongoing issue that has seemed to get no better, if anything has gotten worse because things continue to rise in price. Making minimum wage could not or could barely keep you off the streets with no financial assistance, there is a lack in affordable housing. A question I have about it is who would it take to make this change a community or higher end force?

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Immigration is a social issue that I care about. Having relatives who are illegal immigrants and that arrived here at a young age, having the mentality that to be on their toes from I.C.E is serious. Many people live in fear not because of ICE, but more on if I leave who will maintain my family or single parent families if the parent is deported what about their children. Personally my father was deported so my mom had to find a way to get a job and bring food to the table. It shows how much immigration affects many households and demonstrates the impact of what the person left behind. This topic should have more attention when it comes to how can we minimize deportations or to come to a certain agreement.

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I really care about gender roles.  I already know that in some ways many traditional gender roles are out of the window and I am happy about this.  But what I also notice is that women seem to assume so many roles--roles of sexy siren, snapback mom, supportive colleague, beautiful wife, "boss b". Women are achieving, leading, believing, holding it down, but what are men doing? I do know that there has been a change in what it means to be a man in terms of it being acceptable to show feelings and be vulnerable, but I wonder how are men, young and old being groomed to be better and more supportive partners and to also "live their best lives" reach multiple dreams and be as amazing as the women they love, marry, relate to or seek. 

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I really care about gender roles.  I already know that in some ways many traditional gender roles are out of the window and I am happy about this.  But what I also notice is that women seem to assume so many roles--roles of sexy siren, snapback mom, supportive colleague, beautiful wife, "boss b". Women are achieving, leading, believing, holding it down, but what are men doing? I do know that there has been a change in what it means to be a man in terms of it being acceptable to show feelings and be vulnerable, but I wonder how are men, young and old being groomed to be better and more supportive partners and to also "live their best lives" reach multiple dreams and be as amazing as the women they love, marry, relate to or seek. 

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A social issue I care about is global warming since it affects me and everyone else the same. The worlds weather is also turning upside down due to global warming causing there to be more unnatural weather. If we do not take action against global warming the human race is not going to be able to survive. Its also very sad to see us destroy the world slowly but surely since its our only home. We need to cut down our pollution and Co2 rates quickly its the only way to make a difference! A question I have is which countries are doing the most to cut their pollution and creation of Co2?

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Social Issues Alessandra Ortega Period 5 

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Social Issues Alessandra Ortega Period 5 

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A social issue I care about is unequal opportunities because, in workplaces and other places with power dynamics, there are no equal opportunities between men and women, or POC and white people, and those who grew up in poverty versus those who grew up well off. This should not be the case because time and time again we've seen people who are seen as inferior in society, doing a good job and working hard in whatever they do. Opportunities should not be based on gender or race or social status. Because more often than not, in a hiring process, those who are capable of a certain job are passed up for the job and instead the job is given to someone who may not be as capable but went to a reputable school or they may be of an opposite gender, which makes them more favorable for the wrong reasons.

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A social issue that I believe to be important is suicide rates and suicide attempts throughout the world. People deal with a lot of negativity that people don't see and this destroys them. In 2019 men were 3.5 times more likely to kill themselves then women were. Suicide affects the person and all the people around them due to blame, guilt and grief. It should be something one could talk about without having to feel ashamed or even looked down upon.

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The reason this is a Social Justice Issue that I care about is because there are people from all over the world who wish to come here to better their lives and the lives of their children but can not. The way they are treated when in detention centers is unfair and inhumane, as well as how the world perceives people who come from outside the country.  One question I have is how we can stop people from fearing that they don't know.

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A social issue that interests me is the struggle immigrants have to go through to become a U.S citizen. Many immigrants decide to come to the United States, but can't get citizenship. When they do start the process, there are so many factors that delay that citizenship process. Often times they just want to give their children & family a better future, but struggle with that as well, since getting good paying jobs requires you to have a green card, which most immigrants do not have. A question I have about that issue is why are immigrants so frowned upon, and why isn't U.S citizenship offered to them when they arrive to the United States?

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A social issue that I care about is how divided the people who live in America are. Since the Trump Presidency, The world was able to see white supremacy true colors again. Since the riots at the Capitol, the American Society has only been going down hill especially since we're still in a pandemic. They gun down people of color for protesting against injustice but let white supremacy triumph when they riot on government grounds. It shows how divided this country is how the hope for unity seems to become pushed back further and further.

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Gentrification and Healthcare systems-Jessica 

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Gentrification and Healthcare systems-Jessica 

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One social issue that is important is the healthcare system especially for low-income and immigrant families. A lot of families are not being taken care of because of their status and so they die and there is no one coming back to investigate the cause of death. if they could give them equal attention the people with powers are given, Black mothers wouldn't be dying off like withered flowers.
Another issue that should be explored is gentrification. I say this because when black neighborhoods are being gentrified, there usually end up being homeless because they don't have a plan for the community they seem to be getting kicking out of the homes they have known or lived in for years.  Both social issues are aligned together because of the collective involvement of the black and brown communities when it comes to their well-being.

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A social issue that I care about is inflation because everything is getting more and more expensive for example gas prices have been sky rocketing, houses and properties are more expensive as well. I care about this because this is stopping me in the lower class to start growing and making more money so that my future will be brighter