So, our 2009 Tennessee Women’s Health Report Card came out last week and, needless to say, we didn’t do so well. We’ve been hoping to see some shift in our infant mortality rate, which remains abysmal. We have in five years lowered it from 9.4 per 1,000 to 8.3 per 1,000, but the African American community continues to suffer from an infant mortality rate of 16.4 per thousand.
There has been excellent coverage for the past year or so about the infant mortality rate in Memphis (though I feel I should warn you that, if you start Googling for it, you will see pictures of caskets so tiny that you will gasp out loud and want to cry), with the latest being this story in today’s Tennessean.
There’s a lot to unpack in that story, but I want to touch on just a few things. One, there seems to be no discussion about how our sex ed curriculum(s) have utterly failed a large segment of our population. Women have scarily little accurate information on how to experience our own bodies as for us and not for the pleasure and entertainment of others, we don’t know how to use birth control or even get hold of it, and, in the cases of young girls who end up pregnant, we don’t talk about the ages or character of the men who got them that way.
Two, look at how much blame is put on the women. If my math is right, and Judy Golden is 23 now, and her daughter died two years ago, that means Golden had four pregnancies (Brooklyn, the two miscarriages, and the living child she references) before she was 21. She lost at least one pregnancy because of domestic violence. And she feels to blame for losing Brooklyn because she didn’t eat right?
I mean, come the fuck on. Being able to eat right is way down on the list of problems Golden has. What about being able to be safe from violence in her own house? What about being able to control when she gets pregnant? What about not being blamed for her personal tragedies by the medical professionals who are supposed to help her?
Women in my state live in grinding poverty. We tolerate a lot of violence, often because we’ve been taught and have it reinforced every Sunday that violence is our lot. We’re not taught about our bodies or protected from predators because, again, if we don’t want to have kids, we should just keep our legs shut. It’s slut shaming and fat shaming and women blaming all in one ugly mess that results in our suffering the loss of our children.
And again, it’s that racism that bites white people in the butts. Because do I even have to tell you?
Once the face of infant mortality became Memphis, infant mortality in our state became a problem Black people have. Oh, those people in Memphis who just can’t get their acts together, those people in the projects in Nashville who just can’t get their acts together. You know how it works.
And so, as much as folks are working very hard to lower the infant mortality rate in this state, there’s a whole lot of passive resistance in the form of “eh, what can you do? You know how those people are.” So, you know, we’re pro-life, except when it’s hard or when we might help a lot of suffering black women.
I don’t even have to tell you the kicker, though, do I?
Here’s a map of infant mortality rates in the state of Tennessee by county. Memphis may have the most infant deaths in the state, but Memphis is also our most populated city. You take a look at those counties where the infant mortality rate is above 13 per 1,000 and you can see that the communities suffering the most are poor, rural, mostly white communities.
This kind of intersection of racism and classism is hard to talk about and I do a poor job (though I am of the school that says a poor job is better than no job at all). But I look at that map and I read what people say about infant mortality in our state and how they try to frame it as a Memphis problem. And I think about how that racism is hurting the white people in those counties.
I don’t know how you get that across to people, that, though they are often used as the poster-children of scary white racism–the Southern Redneck–,the racist power structure has no compunction about letting them suffer in order to make sure that black people also suffer. But it could not be clearer that this is the case, when you look at that map.
(Yes, cross posted to Feministe, hat tip to W. for the map.)
Tiny Cat Pants 
Pingback: Not Just A Memphis Problem : Post Politics: Political News and Views in Tennessee
Pro-life is only about punishing women for having sex. They don’t care about infants or children. Only that women are forced to bear the scarlet letter of their sin.
Betsy (& Cathy):
There IS a racial disparity in infant mortality rates – and it is deplorable. This does not mean that the cause is necessarily racist. As you point out, poverty and access to healthcare also appear to be closely correlated.
And we won’t make any progress in reducing infant mortality so long as you sneer at those who disagree with you and call names. (I’m pro-life and I’ve adopted two children – quit stereotyping!)
Suggestion: What specific steps that will have a positive effect on infant mortality could we work on together?
Redhatrob, frankly, I don’t see how your side and our side would be able to work together to have a positive effect on infant mortality because many of the root causes are things many of the people on your side are never going to get behind.
We have, like I said, a situation in Tennessee where girls are taught little to nothing about how our bodies work. “Just don’t have sex” is not sex ed, it’s cruel. A lot of young women who are having sex are, at the least, being coerced into it. Not only do we need to teach girls that they have the right to say “no” without fear of reprisal, we need to be teaching boys and men that they need to get consent for sex and that they need to respect a woman’s “no,” immediately and in all circumstances.
Wearing your girl down is coercive, not romantic.
And all that is great, but that’s paradigm shifting. In the meantime, we need to make it incredibly easy for women to decide when and how many kids they have through the proper use of birth control.
That means your side is going to have to get its head out of its ass about birth control and stop pissing and moaning about how it “kills babies.”
If you cannot get your side to shut the fuck up about this, when it comes at the expense of women and children, you better suck it up and switch sides.
Y’all would also have to stop your war on Planned Parenthood and other women’s health centers, since these are the primary places many poor women in this state receive medical care (and birth control). The “pro-life” antics of standing outside of these places and trying to terrify women doesn’t do much to stop the woman determined to have an abortion, but it sure as hell can dissuade the woman who just wants a PAP smear or prenatal vitamins.
Your side’s vilification of Planned Parenthood keeps poor women from getting the help they need to carry babies to term. That, again, is something y’all are going to need to change if you want anyone on our side to believe that your commitment to reducing infant mortality is anything other than words.
The first part of your proposal provides quite a bit of common ground. Teaching young people that coercion is not a part of sex is a pretty elementary first principle. I was a college professor in an earlier life and did quite a bit of speaking to students in a variety of students. I usually read the young men the riot act about how they treated young ladies.
The opposition to Planned Parenthood focuses exclusively on their decision to be the McDonalds of the abortion industry. If they stopped doing abortions, there would be no protests at PP.
But even if all protests at PP were to end today, I doubt it would have any appreciable effect on the infant mortality rate in Tennessee.
There must be other things that can be done. . .
Well, we’ll never know, because you guys have to publicly indulge your “shame women you don’t know who have had sex” fetish. And those things are much more fun than funding programs to reduce domestic violence, putting more cops on the street, paying for programs that get doctors to go to women if women can’t or won’t go to doctors, improving education, funding more and better peer-helper programs, finding ways to lower the cost of healthy foods and making them as ubiquitous as crappy food, and so on and so on.
There are very few ways to lower our infant mortality rate without spending money. And we don’t particularly want to spend “taxpayer” money on people we’ve decided don’t deserve it.
And since your side has done such a good job vilifying women who have sex… Guess what? There’s not a lot of support for funding programs to help us.
I’m sorry to sound so bitter about it, but I am.
“There are very few ways to lower our infant mortality rate without spending money. And we don’t particularly want to spend “taxpayer” money on people we’ve decided don’t deserve it.”
It’s not very constructive dialogue to put words in my mouth and then denounce me for what I’ve never said.
Suggest, point to, link, propose something that works and I’ll support it.
I went to the legislature for many years to argue for legislative changes that would benefit the practice of midwifery. I know quite a bit about the entrenched interests of the medical community.
I’ll repeat my offer – propose something that could be done to lower infant mortality rates. It’s a worthy cause. I think lots of people would be willing to help.
A big basic step in lowering infant mortality rates is clear and unbiased sex education in schools. Especially beginning in Junior High (7th grade at least) and continuing yearly. Understand yourself, your body, how it works, what sex is and give people enough information to make their own reproductive choices no matter what those choices may be. Parents are free to re-inforce their own beliefs and preferences at home.
Ignorance is crippling, no matter what the subject. Ignorance in reproduction is deadly and the results are obvious in Tennessee.
Saraclark:
Your hypothesis is that “clear and unbiased sex education” would reduce the infant mortality rate.
Do you know of any studies that might confirm that?
Saraclark you head the nail on the head. Ignorance really is crippling, even more so regarding reproduction.
that’s my hypothesis also. logic: such education would reduce the teen pregnancy rate and the unplanned pregnancy rate, both. teen and unplanned pregnancies are at higher than average risk of infant mortality (evidence pending, but should be easy to disprove if untrue). hence, reducing those pregnancy rates should reduce infant mortality. (as well as increase condom sales figures, improving the economy slightly, natch.)
I’m not sure that sex education and access to birth control is a solution for this *particular* problem (though I support those efforts 100% in all cases). It can certainly affect the number of infants born, but not necessarily the mortality of them after their birth.
Saving the babies means providing better pre-natal care overall to gestating mothers. Do any of those church-related pregnancy crisis centers provide the pre-natal care that Planned Parenthood does (in my state, they don’t)? Because if so, maybe protesters could provide that information to women outside of PP instead of just vilifying PP as an “abortion mill.” And if they don’t offer those services, maybe they could start.
Saving the babies also means better post-natal care – including automatic pediatric insurance coverage and prescription drug benefits. It means better educating women about the WIC program and overhauling their approval and requirements (for example, it’s crappy that non-breastfeeding women are eligible for less time than breastfeeding women – she can’t still take care of herself just because she’s no longer BF? Judgey much?). And expand WIC to cover all fresh fruits and vegetables (instead of just carrots).
States could make their maternal insurance programs faster at qualifying women. A freelancer friend of mine (whose independent insurance doesn’t cover pregnancy) has been waiting for two months to hear back from our state as to whether or not she’s going to be eligible for the pregnant women insurance program.
Maybe churches could also ease up a bit on degrading unwed mothers. This goes back to point number one about those church-related crisis centers. If more churches, especially in rural areas – were more supportive of those centers and spoke openly to their congregations, maybe the pregnant women wouldn’t be as afraid to announce a pregnancy and could feel better about taking care of herself and her baby from gestation through birth. Surely there is a way to condemn the sin but still help the sinner?
And better sex education does help prevent unwanted births. But if you aren’t going to teach the kids ways to prevent pregnancy, at *least* teach them how to handle one when it eventually happens (you know, because you were afraid to tell them about condoms). Emphasize better health care and frequent doctor visits. Talk about why infants can be born with low birth weights and fetal distress issues. I mean, geez, if you aren’t going to teach sex ed, maybe you can at least keep the kids from smoking and drinking (two major causes leading to poor fetal development).
Uh, sorry for that hijack… didn’t realize it was such a long comment…
It does seem to me that education about proper pre-natal care and newborn care would be more likely to affect infant mortality than a broad program of “sex ed.”
And I think you would find a broad consensus of people who would support that kind of targeted education program.
The opposition to Planned Parenthood focuses exclusively on their decision to be the McDonalds of the abortion industry. If they stopped doing abortions, there would be no protests at PP.
I call three-way bullshit. There would continue to be protests at PP, there is no exclusivity regarding abortion as a rationale to protest PP, and PP is hardly a “McDonald’s.”
There’s a lot of misinformation spread about contraceptive pills, as one example. Or did you not see “The Pill Kills” protests which targeted PP? See: http://thepillkills.org/
Contraceptive pills aren’t abortifacient drugs. Therefore, the protests at PP don’t focus “exclusively” on abortions. The mission of the protests is to prevent access to any reproductive information that isn’t first run through a Scriptural filter.
Then there’s the wholesale lie that the abortion procedure is a retail transaction as uncomplicated as ordering a Big Mac combo. That is a shrill, dismissive, and wholly unwarranted mis-characterization of the services that PP renders.
As long as the Catholic League and other activist groups remain staunchly anti-contraception, PP will be a target. They have been unabashed in their opposition to Griswold v. CT and until the day that the Supreme Court rules against the privacy rights enumerated thereto, these bullshit protests will continue to target PP specifically, and sex education generally.
Well, comprehensive sex education includes information about having healthy pregnancies as well as information about healthy ways to prevent pregnancies. But I agree with Peach that better access to health care generally would also be a good thing.
nm, that’s partly my point. People oppose comprehensive sex ed because it teaches prevention methods so they throw the baby out with the bathwater literally and kids don’t get prevention OR information about healthy pregnancies.
Andy Axel: you are so right about the protests at PP, in my neighborhood there is a PP office that is under siege several times a week. Lately I have seen many more anti-contraception signs including my favorite: “PLANNED PROMISCUITY”.
Peach, no apologies necessary. I don’t consider long comments that are on-topic to be thread-hijacking at all.
But yeah, we’re all kind of dancing around one of the points that I should articulate better. At some point, though, the problems aren’t individual. People aren’t just losing their babies because they don’t know better. They’re losing their babies because the circumstances we all live in are so bad for us and they can’t afford to negate the damage the way that some of us can.
I mean, I have never in my live knowingly had a rat in my house. There are women in Tennessee who have no way to get rid of all of the rats in their public housing. If your well is poisoned by a dump the state neglected to monitor and no one tells you, it’s not your fault if you inadvertently poison your baby by drinking that water. If you’re afraid of being turned over to the police and deported, who can blame you for not seeking prenatal care?
Rob, buck up. I’m not putting words in your specific mouth. I’m typifying what pro-lifers obviously believe. If that’s not what you believe, maybe you should reconsider associating with them.
@Kitty: Yep.
@B: Cross-referencing your map… I saw the Rhea County figures (18.1 infant mortality rate) and it struck me — as this is the home of the Scopes Trial & all, and seeing as how they tried to make homosexuality illegal by ordinance recently…
I went to look up some other facts & figures. Found here: http://www.tennessee.gov/tacir/County_Profile/rhea_profile.htm
Read ’em & weep:
95% caucasian, 2% af-am, 1.7% latino
$24,575 median income
65% w/ HS diploma, 9% w/ college degree
12.9% unemployment (Feb)
0.4 doctors per 1000 residents
0.8 hospital beds per 1000 residents
Wonder how strongly that access to competent medical care on a county-by-county basis tracks to the infant mortality rate. As it is, those stats are fairly breathtaking.
But, of course, there might be a homo or an evolutionist in their midst. So that’s what gets the attention.
Wonder how strongly that access to competent medical care on a county-by-county basis tracks to the infant mortality rate
Yep.
Yep indeed, and if we were having a rational discussion about our so-called “greatest health care system in the world,” maybe some people would start to reckon with rampant inequalities throughout said system — starting with the uninsured and ending with the 1,000 people in yon Rhea Counties being served by less than half of a doctor.
I further wonder how much that the for-profit medical model (see: HCA) have had an impact on already under-served areas. When there aren’t profits to be had, there’s little point in setting up shop.
Andy:
Does your plan include drafting doctors and ordering them into Rhea Co.?
Or did you have some other form of involuntary servitude in mind?
Do you think that having a 3rd world infant mortality rate is comports with a pro-life position, let alone a moral one?
(rather, “…mortality rate comports…”
The death of a single infant is tragic.
The 2007 statistics for TN by county are here:
Click to access IDRate_07.pdf
In 2007, there were 718 infant deaths (age less than 1 year) in all of Tennessee. 8 of those deaths were in Rhea Co., which given its small population and number of births, results in a rate of 18.1 per 1,000 births.
The 2006 statistics for TN by county are here:
Click to access IDRate_06.pdf
In 2006, there were 733 infant deaths in all of Tennessee. 4 of those deaths were in Rhea county, which gave it a rate in 2006 of 9.2.
Why were there 8 deaths in 2007 and only 4 in 2006? I don’t know. I do think that we ought to think about what could be done to reduce the infant deaths in Rhea county.
But the statistics do not break out by cause of death. We don’t know how many were SIDS, how many were accidents, or how many were illnesses.
Propose something specific and practical.
I thought that the free market could fix everything. So why hasn’t it?
Why isn’t the infant mortality rate in Cuba (or Canada, or Sweden) not zero?
What specifically shall we do to reduce the number of infant deaths in Rhea County? population 30,000, number of annual births roughly 440.
What can we do to reduce the number of infant deaths among those 440 infants from 8 back to 4 or lower?
brainstorm.
Move them to Cuba (or Canada or Sweden).
Statistically speaking, a baby born in those countries is more likely to see their first birthday (CB 5.1/1000, CA 4.8/1000, SW 3.2/1000, US 6.3/1000) and then their fifth (CB 6.5/1000, CA 5.9/1000, SW 4.0/1000, US 7.8/1000).
Yep. That’s a practical suggestion.
Let’s move all 440 babies born each year in Rhea county to Cuba or Canada or Sweden.
Try again.
No. Your turn, brainstormer.
And sure, it wasn’t a serious suggestion. But I want to hear how “the market” is going to salvage the infant mortality rate, not only in Rhea County, but throughout the country.
Because when we spend more per capita than any other country in the world, you’d think our metrics were quite a bit better. Ranking next to Slovenia isn’t a compliment for our way of doing neonatal care.
Ok, I will suggest a very practical program with specific benefits and redhatrob will tell me why it can’t possibly work.
Young doctors emerge from medical school with a ton of debt, so much so that they often wind up practicing dubious medicine because the financial incentives are on the side of pushing certain therapies, joining together in massive practices where every doctor is scheduled in 10-minute blocks for twelve hours of call at a time, etc. There is, moreover, no financial incentive to being a gp — you can get out of debt faster by going into a specialty (which is perhaps one reason for the unproductive blossoming of plastic surgeons). Why don’t we provide debt relief for these newly minted doctors if the relocate in underserved areas — I bet you’d get more doctors practicing in Rhea County if they could get $30k a year knocked off their student loans on a five-year hitch. I think this was the premise of a TV show a couple of years ago. Researchers in Canada have demonstrated that such programs, if well-funded, help to overcome the fears of young doctors who think that rural communities are culturally intolerant — specifically med students assume that rural communities will shun them on grounds of racial, religious, political, and sexual orientation. You have to put some money on the table to get them to try the waters.
The Frontier Nursing Service also offers a good and proven model of how to bring effective family-centered health education to rural populations. They’ve been at it for eighty years and their combination of nurse-practitioners, nurse-midwifes, and nurse-educators have been a godsend. The kind of health care and counseling that would make a huge difference need not be provided by a doctor, but it does need to be available and reliable.
That’s the crock about our discussion of health care rationing. We already ration it (obviously) because there’s not enough of it (obviously) and so some people get it and others don’t. If we were having an honest national conversation, it would start at that observation and then prompt a thoughtful discussion about how we can best increase access to health care as a public good everywhere, because in point of fact there is a shortage of providers throughout the Appalachians from Maine to Georgia.
Another idea is to do as the VA does in underserved areas: link them up by satellite with physicians elsewhere. A friend of mine in St. Louis who works for the VA spends at least one day a week having “office hours” with veterans in rural Missouri, and is able to deal with many of their problems at a distance (medical imaging is remarkable these days), refer them to regional medical centers, or tell them they have to come to St. Louis to see her personally. Of course, the VA funds as many such long-distance or in-person visits as are necessary.
Bridgett:
I think your ideas are excellent. I’m in favor of them. Debt relief in exchange for service in under-served areas, Frontier Nursing Service, and expansion of nurse-midwifery are all causes I believe in.
Alex: According to the CDC, the three leading causes of infant mortality are (in order) “congenital malformations, disorders related to short gestation and low birthweight, and sudden infant death syndrome”
I agree that our infant mortality rates are too high. But the reasons for infant mortality are not simple, they are complex and varied.
You seem to be implying that if we adopted a single-payer system (a la Cuba, Canada, or Sweden) that it would have a positive effect on infant mortality in places like Rhea County. I am not confident that it would make much of a difference. In fact, my fear is that it might actually erode the level of medical care in places like Rhea county.
I don’t think we’ve spent nearly enough time researching and thinking about the reasons for infant mortality to be able to confidently say that if we just appropriated money for this program or that program, we are sure it would cut the infant mortality rate in half.
I think we should be having a discussion about healthcare and what we can do that makes sense. I’m skeptical of all the utopians. I don’t think the free market solves all problems. I don’t think a single payer system would either.
I think the rush to implement huge sweeping changes is foolhardy.
I think the rush to implement huge sweeping changes is foolhardy.
What we are doing isn’t working.
Spending nearly twice per capita compared to Norway and on down…
Click to access 38980557.pdf
…you’d think we’d see far better results in life expectancy and infant mortality rates. 16% of our GDP is spent on health care.
Why are our results not better? Why does the dollar amount invested not accrue to better indices in terms of outcomes?
When you spend more and get less, that’s called inefficiency. Sounds like market failure to me.
Alex:
I agree that one’s first thought is that spending should correlate with outcomes. The fact that it doesn’t suggests a number of possibilities, but one possibility is that increasing spending may not improve outcomes.
We don’t really have a “market economy” in healthcare. Structurally it’s convoluted and byzantine.
What do you propose as a solution?
Check spelling on my name, please.
one possibility is that increasing spending may not improve outcomes.
Especially if that money is directly related to inflated profit margins for the stakeholders currently dissembling on the matter of reform.
As far as solutions? Get money out of government. Abolish corporate personhood by constitutional amendment. Abolish soft contributions and PACs. Stop treating campaign contributions as “association” and “speech.”
Then force all of our Congressmen and Senators, their families, and their staffs into a high deductible HMO (instead of the cushy, fully-funded, gold-plated Cadillac federal benefits plan that they currently enjoy because of our largesse) with +10-30% annual premium out-of-pocket adjustments. For extra mirth, assign each of them at least two disqualifying/pre-existing/exclusions for specific and chronic health problems that they have. Sign them up for a prescription drug plan equivalent to a medium sized company’s employee offer or to Medicare Part D. Harass them every couple of months with paperwork regarding their coverage, lose their paperwork on their kids. Force them to negotiate terms with their insurer like the hostage negotiations that they often turn out to be. Drop some of their doctors out of network at random. Then we’ll see how frickin’ motivated that they are to get the problems fixed.
then how about we CUT spending and get better outcomes? we might do this by adopting the British NHS, lock, stock and barrel. they spend LESS on their healthcare than we do, and by every measure that means a damn thing, they get better outcomes. why on earth are self-professed conservatives not jumping on that?
Alex:
Your suggestions for the congresscritters made me smile! I’d be much more inclined to take any proposal seriously if Congress adopted it for themselves.
Campaign finance reform has been a huge disappointment. Both sides game the rules seeking advantages. Artificial advantage via rule-making, lawsuits, & selective compliance have a corrosive effect on politics and public confidence. I think there should be complete disclosure of all financial gifts given & received by any office-holder and seeker. I think a ban on gifts by both corporations and unions makes sense.
I’d much rather see catastrophic health-care coverage for everyone, and individual policies and payments for ordinary care.
Please to check your spelling. You are referring to a person not participating in this discussion. No one named Alex is present.
why on earth are self-professed conservatives not jumping on that?
“Where’s the margin of profit?”
The Rhea County discussion brings up an interesting point about the statistics. They might be a bit skewed due to the low populations in the more rural areas that are at the top of the infant mortality list.
Have any of you been to Rhea County? It isn’t exactly secluded. There are lots of doctors within reach, they just aren’t necessarily inside the county line. Rhea County is just north of Hamilton County, which has Chattanooga.
I’ve been all over the state in some tiny rural areas and I don’t think physical access is that much of a problem in rural areas, with the possible exception of extreme NE TN. Now specialists are a different story.
Poverty is a key. I probably discounted physical access a little too soon because it’s a lot harder to get someone to give you a ride to the doctor if they have to drive 45 minutes and you don’t have a car of your own. Poverty has a lot of barriers beyond being able to pay the doctor.
Rob, it’s very impressive how you have everyone dancing to your tune here. You’re like a sub-par manager who just keeps shooting down things without proposing any of his own.
Ha, W., I have nothing more to add except to thank you for calling it like you see it.
I think sex education is an absolutely integral component of solving this particular. I don’t have the time to devote to looking up the hard numbers right now, but here’s my thought process on this: I suspect that comprehensive sex education is successful in reducing the number of pregnancies in two major demographics, the young (who just discovering sexuality) and the poor (who probably have limited avenues of quality information). I suspect that those same two demographics have the highest infant mortality rate (for a variety of reasons all of which should also be looked at as part of the larger solution). If those two suspicions are correct, then more comprehensive sex education would be certain to decrease the infant mortality rate, and I suspect the effect would be substantial.