New from the ACNM

The ACNM has issued a brief:

In America the burden of disease and premature, preventable deaths is borne disproportionately by politically disfranchised and economically disadvantaged communities. In all leading public health mortality and morbidity indices, there is a persistent gap between the privileged and the deprived that is euphemistically referred to as “health disparities.” Health disparities are “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”1 Even when access-related factors are controlled, such as insurance status and income, minorities still receive a lesser quality of healthcare.2 For African American women, the lifetime and generational exposure to institutional and interpersonal racism have been shown to affect pregnancy outcomes such as birth weight,3 as well as other health conditions.4

Read it in its entirety.

According to my Pathophysiology textbook,

"A person experiences stress when a demand exceeds a person’s coping abilities, resulting in reactions such as disturbances of cognition, emotion, and behavior that can adversely affect well-being....In the past decade, for the first time in history, it has been demonstrated that the interactions among social, psychologic, biologic, and behavioral factors are inherent in the causes and courses of many diseases...Physiologic stress may cause or exacerbate several disease states, including many of the diseases implicated as leading causes of death in the United States."

Here are a few of the diseases listed in a chart as being “Stress-Related Diseases and Conditions:”

Coronary Artery Disease
Hypertension
Stroke
Asthma
Ulcers
Type II Diabetes
Amenorrhea
Fatigue and Lethargy
Depression

And not in the chart, but in the ACNM document, PREGNANCY OUTCOMES.

These are only a few of many listed. Why did I pick these? Do they look familiar? They should. A lot of them are diseases for which black people disproportionately suffer morbidity and mortality. This is not new information. In fact my professors are quick to point these stats out at the institution. They will show and quote power points like this one from the CDC which tells of all the disparities. But what's always missing is context. Well here’s some: STRESS. Why doesn’t anyone say this? Why don’t they/haven’t they made the connection? It’s right here in the same damn textbook that they have been making us memorize for everything else. I want to say it as plainly as possible:

Experiencing RACISM, whether, overt, internalized, institutionalized, forgotten, ignored, debated, denied, or otherwise, is STRESSFUL. That stress manifests itself in many ways, one of which is poor health outcomes. THIS is one reason why it is so damn frustrating to be sitting in a classroom where we are supposedly discussing these inequalities in health care, incidence of disease, and health outcomes and NOT ONCE discuss racism as a factor.

I’m screaming at this point. I can’t help it. I thought that the reason they weren’t providing context was because they couldn’t, and that’s why I was trying so hard to provide it myself. But maybe the reality is that they don’t want to. It’s here. They’ve read it. You mean to tell me that my professors who are leaders in the field of nursing and midwifery have not read the 1999 article implicating the lived experience of discrimination and racism as having a direct effect on health outcomes for black women? Seriously? Not one of 'em? I don’t buy it. They read it, and chose, at the time of delivering the statistics to our class, to not mention it. Why? Because it’s easier to say “it’s lifestyle choices…poverty…living in congested spaces without fresh air, parks to play in, or safe food in the grocery store” than it is to say it is our history of oppression, racism, discrimination, abuse, brainwashing, disregard, disrespect, denial of humaneness, and good old fashioned hatred that created/perpetuated this. The lack of parks, clean air, and fresh food sounds more like an external “that’s just the way it is” or “we all need more of that” or “commercialism has ruined our society” factor…on the other hand, you suffer more heart attacks, maternal mortality, and type II diabetes because I raped your mother, stole your father, and worked your child into the dirt is just too damn hard to come to terms with…especially for those who can’t even come to admit to themselves that white privilege exists.

For those who wnat more details (I would, too) here's an example of how, physiologically, this thing thing plays out:

Obesity and Type II Diabetes: Cortisol (aka hydrocortisone) is a hormone of the body that inhibits the uptake and oxidation of glucose so that one has more glucose in the blood. Why would we need that? Because glucose is energy...energy needed to combat stress...the more stress you have, the more cortisol you produce, the more glucose you hold on to which leads to obesity...specifically, "cortisol-induced obesity," which they now think leads to Type II Diabetes. (p317)

I remember on another post emjaybe (no blog) asked something to the effect of “now what?”

I’m sitting here thinking about that. OK. You read the brief, looked up some of the articles, and are outraged. I’m crying and typing and trying to make a point. Now what? “Now what” is that the ACNM claims it’s ”striving to increase now underrepresented racial and ethnic groups among the ranks of our Profession” (I'm glad they said "now") Yeah ok. So let’s tell the truth about that right quick. What kind of midwife do you have to be to belong to the ACNM? Bellytales talked about it here. Ok, now exactly how many people who look like me meet these requirements? We have to get our children through high school first. Then undergrad. Then a friggin master’s degree. Who in the hell are you kiddin? Yeah, we’re coming but it’s a mighty slooooooow process, and honestly, by the time you get done beating me up and robbing me of my mind, I might not even have anything constructive to contribute to your damn Midwives of Color Committee. And by the time I get done experiencing the profession at my place of learning, honestly, the ACNM is probably the last place I’m trying to go…hmmm…more like the ICTC. Furthermore I think it’s safe to say that a lot of people who meet the requirements are already members of the ACNM…but acknowledging that CNMs to do not = the profession, the real question is do you want us in the profession, or in your academy? And is just any brown face you're looking for, or one who has had certain life circumstances or one who is committed to working on these disparities or one who is willing to be the poster child for your campaign? What exactly do you want from me?

“Now what” is more people talking about the shit that somehow stays buried. Stress. Stress from racism. Stress from invisibility, or in the case of crime prevention and the so-called war on drugs, stress from microscopic monitoring and existing while black. Stress. Talk about it. That’s what’s next. But more than that, write about it. Leave behind some proof that you acknowledged it and thought about it. Then what? (cuz I already did that) Scream about it. Don’t stop. Work through the fatigue. Type through the cramping. Make it your thesis, loving pecola. Your fuckin dissertation if necessary. One of a million platforms.

Now what?

Sleep. Sweet release, at last.