Via Kleinheider, we learn that The Tennessean had a big report about Tennessee’s infant mortality rate back in December. I am of many minds about the report. I think you should read and watch and listen to it, though. (And note that no one seems to be singling out drug or alcohol use as a primary contributor to the infant mortality rate.)
I have questions, though.
1. Why don’t we hear from the mothers? I mean, I know we hear from the mothers about what happened to them, but I mean, what do the women this is happening to identify as problems they have getting the healthcare they need? The healthcare professionals seem to have a lot of ideas, but what about the ideas of the women who live through this?
2. A great deal of attention was paid to obesity as a cause of our high infant mortality rates. And yet, the fact that we have a lot of fat people in this state who are malnourished was mentioned once. But I’ll repeat it–we have a lot of fat people in this state who are malnourished. Is being fat really a bigger contributor to infant mortality than the fact that these women aren’t getting enough vitamins and minerals for their bodies to function correctly? I mean, I know it seems really weird that someone could be fat and be malnourished, but it’s true, you can be.
3. I know I say this all the time, but I repeat it. Twelve year old girls who are “having sex” are almost always not having consensual sex. And yet, while they mention in the report that many of the fathers of these children are “long gone,” there’s no acknowledgment of the difficult circumstances under which some of these women are becoming pregnant. I mean, if a guy rapes you, who the fuck cares that he’s not there for the birth of the baby? The very least he can do is be long gone. He should be in jail.
4. I was glad the report brought up the stress of living in general in a racist society and specifically in shitty neighborhoods and the detriment stress can be to carrying a pregnancy to term or to keeping a child alive once it is born.
5. Again there was brief mention of the role of abuse in all this–one woman miscarried because the baby’s father pulled her down a flight of stairs, but otherwise, there’s very little attention paid to the effect violence (and talk about a stressful environment!) has on infant mortality.
6. Frankly, I thought the report let doctors off the hook. I know this is going to be unpopular, but, if there is indeed a crisis, which there is, doctors HAVE GOT TO rethink how they do things. This idea of sending an ambulance out to pick up women? Why don’t you get in your car and drive to a neighborhood and start knocking on doors and looking at kids? Kids cannot bring themselves to you. And yet, all healthcare in this country revolves around a model where the patient goes to the doctor. Maybe it’s time to rethink that model.
7. When you read something like this, doesn’t it make restricting sex ed in school seem cruel? How any Republican can look at those little caskets and sponsor legislation to make it harder for women to learn about our own bodies and how to control what happens with them is beyond me. That breastfeeding your baby is good for your baby should not be a secret you have to rely on your mom–who may not know it herself–to tell you. That using a condom when you have sex can prevent pregnancy should not be a secret. That you can use the Pill to keep from getting pregnant should not be a secret. That you don’t have to have sex with people of the opposite gender should not be a secret. That, if you do become pregnant, you need to go to the doctor should not be a secret. A baby dies every other day and we want to give parents the right to pull their kids out of class if they don’t want their kids to know about their own bodies. Are you kidding me?
8. Until we can have some honest discussions about how men treat women, we are going to be thwarted in our ability to confront this problem. You don’t have sex with children. Even if she’s precocious. And yet, I know that if you’re looking at the ages of the men who father children on 12 and 13 year old girls, you’re not finding a bunch of 12 and 13 year old boys. And at some point, we have to get the point across that your wanting to fuck does not trump a girl’s right to be a little girl. You don’t beat on the woman you’re fucking (I mean, I’d like it if we could agree to not beat on anyone but I’ll start small). There’s nothing the person you’re fucking could do that justifies you abusing them. Nothing. And we have to be honest that there are often cases when women and children are better off without the fathers of those children around.
It shouldn’t be that way, but we don’t live in a world where everyone’s great and if you just give them a little encouragement, things will turn out wonderfully.
And we need to work on teaching boys a definition of manhood that is not precipated on “do whatever the fuck you want to women; that’s what they’re for.”
9. Doctors need to decide if it’s more important for them to hector women about losing weight or if it’s more important for them to make sure that women continue to go to their appointments. Let me be clear with you, medical community–we don’t like you. The lectures about how we need to lose weight for our own good and about how fat we are? They make us not want to go to the doctor. When you go in for a cold and the doctor tells you you need to lose weight or when you break your wrist and the doctor tells you you need to lose weight? The lectures are grueling. And you’re going to have to decide whether having a patient to treat is more important than making your patients feel bad. Oh, I know. “Well, tough if they feel bad, they need to hear it.”
I’m telling you that we won’t hear it. We would rather not go to you than listen to you go on about how we need to lose weight. So, if you want your high-risk patients to continue to see you, you’re going to have to find some other way to frame it.
That’s part of the reason I think it’s so important to look at the issue of malnutrition. You can talk to your patients about whether they’re getting enough fruits and vegetables, about whether they need to cut back on their salt, about whether they’re getting enough exercise. All those things a woman can hear. But you start talking about fat and you’re bringing in a lot of cultural baggage that’s going to make women resistant to your ministrations.
Anyway, we have to do something and it needs to start with giving women the information we need to make good decisions, radically rethinking how we deliver healthcare to poor people in this state, figuring out how to make sure people are well-fed, and ceasing any tolerance for violence towards women.
So, get on that and we’ll meet back here in twenty minutes for a progress report.
Ha.
Heh.
Damn.
Tiny Cat Pants 
I know this is going to be unpopular, but, if there is indeed a crisis, which there is, doctors HAVE GOT TO rethink how they do things. This idea of sending an ambulance out to pick up women? Why don’t you get in your car and drive to a neighborhood and start knocking on doors and looking at kids? Kids cannot bring themselves to you. And yet, all healthcare in this country revolves around a model where the patient goes to the doctor. Maybe it’s time to rethink that model.
That’s a nice dream. But it will never happen. I was having a conversation with a friend who is a nurse that is married to a doctor. She said that there is a shortage of people going into internal medicine b/c of the high rates of insurance that doctors have to carry in order to deal with malpractice lawsuits.
Now, take the doctor out of the hospital where there are little, if any, regulations and see how the lawsuits skyrocket. It’s a nice thought, but has no ability to happen in the real world.
Anyway, we have to do something and it needs to start with giving women the information we need to make good decisions, radically rethinking how we deliver healthcare to poor people in this state, figuring out how to make sure people are well-fed, and ceasing any tolerance for violence towards women.
Amen.
i was old (35) and fat (210) when I had my boy. for the first time in my life i was told i had to eat (i was losing weight) I smoked (pot and cigarettes) too. i did not drink (the boy said nope i’m not having that) i had a 7lb 11 oz screaming indian :) to this day (20 years later) he has been the picture of health. me, not so much :) but i said all that to say this…Amen, sister, to everything you said.
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This is one of the most powerful pieces you’ve ever written, Aunt B. Damn.
Thanks, O.C., but any power it has is derived from the utter hopelessness I feel about the situation.
Teaspoons.
Beth, I think the problem you describe is another symptom of what B. is talking about, but I also think it is symptomatic of the miserable failure we have for a healthcare system. We have a situation where health insurance companies are abusing both doctors and patients and reaping massive profits, and they maintain that status quo partly by turning patients and health care providers against each other. So, in our litigious society* (which I prefer to a less litigious society like, say, Afghanistan), people are inclined to seek the only recourse they believe they have when the existing regulatory environment protects the real culprits (the health insurance companies**, in this case).
So a fundamental solution to the problem will be to do what B. suggests, which could be accomplished along with reforming (or revolutionizing) our health care system so that it respects the medical needs and dignity of both patient and health care provider without concern for profit. This would help remove the adversarial relationship between patient and provider that encourages and occasionally necessitates malpractice lawsuits.
Also I think all the issues B. describes are inextricably linked. We have a shitty health care ‘system’ because we have, in general, given ourselves over to people with shitty ideas about the nature of community (at all levels from local to national). Allowing backward people to set your policy agenda will result in backward policies and detrimental results. This comes from an environment where large numbers of people tolerate this shit, perhaps in the name of someone’s god, and it feeds back on itself and gets worse. If you want to see a more extreme example of this, look at the aforementioned Afghanistan; the Taliban isn’t much different from some of the more sanctimonious and reactionary among our own people (in both major political parties). The Talibs have just had free reign (they don’t have liberals and progressives to offer sustained opposition) and a shittier environment in which to operate.
In other words, if we want better health care as patients and a better, less combative work environment as providers, then we need to be willing to elect people who will construct a modern and civilized health care system. Before we can get to that step, we need to resolve to be better human beings, and understand that civilization requires making civilized choices outside the voting booth, too.
*Contrary to what some would have us believe, our national propensity for seeking redress in courts is nothing new. Edmund Burke noticed it way back in 1775 (scroll down to paragraph 35 if you don’t have time to read the whole thing). The problem, I believe, isn’t that people have the ability to sue, it’s who they choose to sue and why. I’m sure Bridgett can inform you about this topic way better than I can.
**Is it a coincidence that the other profiteers in this equation are also insurance companies? I think not. A nation of laws will always have too many lawyers, and of that we should be proud. However, we can’t have insurance companies exerting that much control over our life, death, and level of suffering.
> And yet, the fact that we have a lot of fat people in this state who are malnourished was mentioned once.
This might mean exactly what it seems to mean (vitamins and such), but I have recently been hearing healthcare providers talk about obesity itself as malnourishment. The idea is that “mal” doesn’t mean “under”; it means “bad”. If you get 800 calories/day, then you are malnourished. If you get 4000 calories/day, then you are malnourished.
> Why don’t you get in your car and drive to a neighborhood and start knocking on doors and looking at kids?
Maybe the answer isn’t doctors. Can’t 90% of what a doctor does for a well-child be done by a nurse? Nurses can draw blood (to send to a lab), check blood pressure, etc.
Damn, this is a terrific post. They’re always good, but this is really something else.
Allowing backward people to set your policy agenda will result in backward policies and detrimental results.
I would replace “backward” with “harmful”*. But, that aside, truer words were never written.
*because I don’t see this as an issue of lesser or greater personal/political development but as an issue of different developments, some of which cause damage
indifferent children, you’re assuming that the malnourished fat people are taking in more calories than the malnourished thin. Plenty of research shows that the dietary intake of fat and thin people is pretty much the same.
Can’t 90% of what a doctor does for a well-child be done by a nurse?
About half of the well-child appointments I’ve been to (and I’ve been to A LOT in the last year) have been with a LPN when we didn’t see the doctor at all. We actually prefer the nurse because the doctor always starts talking about obscure theoretical crap. The nurse always gives more practical advice.
The “mal” = “bad” idea was originally propounded by home economists trained in public health and nutrition as far back as the Progressive Era. Because they were “just” women talking about the relationship of food quality to public health and weren’t “real” scientists, the medical profession didn’t give that any play. Now we trivialize home ec teachers as the people who taught our moms to make florescent Jello, but they were much more than that.
Speaking of unacknowledged knowledge producers…
Okay. Wow. This was a powerful bit of writing, B. Awesome!
Lots brought up thoughts, but I most agree with your comments on boys and men. My husband and I are frantically trying to get that point across to our oldest son: people, particularly people you love, are NOT for hitting. He’s seen it from his mom/stepdad, and it’s a difficult image to contradict.
Men do make a difference in pregnancy outcomes. Good results can be helped by their solid support or their lack of presence, when they’re incapable of support.
I worry about that about my nephews so much. My oldest nephew finally got his step-dad to stop beating him by threatening to kill him if he touched him again and finally being a size where the bastard thought he might be able to pull it off.
Which, on the one hand, great. On the other hand, what better lesson that a credible threat of violence will get you your way?
And I love my brother, but I don’t know about his ability to convey to my nephew that violence in self-defense is one thing, but violence just because it works as a way to get your way is another thing. I mean, honestly, it’s not like we learned that at our house, so…
Sam, thank you for your long and thoughtful response.
I am not a medical professional – however, my mother is a nurse (RN with a desk job in a nursing home – she does a little of both because the need is there, therefore she keeps her RN license current). Since 1960, (save for the 13 years she was raising my brother and I as a stay at home mother) she has worked in almost every facet of medical care, except plastic surgery, as far as I can remember.
We were talking about the state of things the other night, and she was lamenting the hell that is running a nursing home. For example, do you have any idea of how many perfectly useful drugs are flushed down the toilets? You would think they would be able to reuse them, after they are accounted for. Nope. Flushed. Thrown away. That’s just one example of the waste – and this waste props up the financial statements of the drug companies.
When Christopher Reeve died, we had another conversation about nursing homes. Christopher Reeve essentially died of complications of a bed sore. Now, Reeve had the best medical care that money could buy and he still died. Now, think about all the nursing homes who have patients whose families sue b/c of bed sores claiming “abuse” – needless lawsuits clogging the courts & the word getting out to doctors who have to secure the malpractice insurance to operate – which eventually scares away very talented medical professionals. That’s just one example I can think of.
It’s just waste. I can’t stand waste.
Plenty of research shows that the dietary intake of fat and thin people is pretty much the same.
OC, I haven’t seen the research you’re speaking of, so I won’t refute your claim. However, on the same topic, but a slightly different point of view – I watched some program in the last year that touched on the subject. The program was focused on nutrition in the inner cities – I forget which one, perhaps Chicago (?) – the narrator visited several grocery stores within the inner city and the point was made that it was much more difficult to find fresh fruits and vegetables in an inner city grocery than in a grocery located in a more affluent area of a community.
Then, there was that 20/20 program last week or the week before on Appalachia – and showed how the citizens of those communities are addicted to Mountain Dew. I don’t know how all this ties in other than the poor are not making the nutritional choices that they should make. Regardless, I find it disturbing, and the only thing I can figure is that it all boils down on education which allows for better and more informed decisions to be made.
Thoughts?
Just a thought here…the people of colonial America seemed “addicted” to tea with a lot of sweetener in it after tea was introduced here in the 1720s. What historians now think is that they were using the heavily sweetened and highly caffeinated liquid as a means of staving off hunger pangs and as the cheapest source of calories that they could lay their hands on (since both tea and molasses/sugar were cheap, as colonial commodities went). The poorer the town, the greater its dependence on sweet tea as a food group.
The soda/obesity “epidemic” and the gallon-size McD sweet tea tankards? I speculate it’s an updated version of this.
I need to watch the 20/20 thing, because I have heard nothing but bad reviews and commentary that she “showed how the citizens of those communities are addicted to Mountain Dew” as a way of explaining away problems some people in Appalachia have with their teeth, instead of understanding the range of issues including poverty, and the lack of available providers in many areas. Speaking as someone who grew up in east Tennessee, an explanation that only encompasses “those poor hillbillies sure do like their soda” is pretty damn short-sighted and offensive.
I always figured that the continued dependence on sweet tea/soda in the south was more a function of hot weather and no air conditioning until relatively recently: that the sugar helped to replace nutrients lost through sweat, a sort of early version of Gatorade.
I wouldn’t be surprised if there’s an element of the water supply and historical slowness in extending municipal water throughout the southeast, either.
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