On Sunday April 7, Homeland Security Secretary Kirstjen Nielsen resigned. Nielsen oversaw the implementation of controversial U.S. child separation policies at the U.S.-Mexican border. She stepped down when the Trump Administration asked her to violate a court order against the practice to resume such family separations. Nielsen’s departure will not deter the Trump Administration, nor can it heal the traumas accrued from years of forced family separation policies and politics.
The perfect mother is a ubiquitous, if impossible, part of American life. We see her in spandex at the gym, working out—self-care!—a week after delivering twins. She’s at center-stage when internet experts opine about how mothers can prevent teenagers’ opioid addictions. In the shadow of this unattainable, idealized vision of a mother as a virtual guarantor of their children’s health and happiness, actual mothers berate themselves for falling short of perfection, feeling ashamed and inadequate. In the American legal system, the pervasive stereotype of the perfect mother can lead to serious consequences, dramatically distorting the judgments of police, prosecutors, judges, and jurors.
Title X of the Public Health Service Act is the only federal program devoted exclusively to family planning and reproductive health care. Title X is symbolic of the mid-20th century’s widespread and bipartisan support for policies aimed at increasing access to affordable contraception. More recently, the once-separate politics of abortion and contraception have converged. Just as we see a growing number of “abortion-free zones,” we are witnessing the growth of contraception deserts, or geographic areas with inequitable access to affordable family planning due to states’ broad discretion in Title X implementation. New and proposed reforms to Title X at the state and federal levels may expand contraception deserts. This inequality isn’t trivial. Two-thirds of reproductive age women in the U.S. use contraception, and more than 20 million women require the assistance of public programs to afford that contraception.
As the nation swings from one polarizing policy debate to another – from health care to taxes to immigration – the connections among these issues can get lost in the rhetoric. The common impacts of those three particular issues are, however, nowhere more visible than in Latina health care access and outcomes. We’re talking about millions of Americans: children, the elderly, low and middle income, citizen and noncitizen alike. Latinas, a sizeable demographic within each of these populations, are especially vulnerable because of the ways in which ethnicity, gender, income, documentation status, and age intersect. Latinas’ lives and livelihoods are on the line.
In the world’s richest country, maternal mortality rates are rising steadily. A 2016 study revealed a drastic increase in U.S. deaths during childbirth from 2000 to 2014, while worldwide rates were dropping. Advanced industrialized countries overall have an average maternal mortality rate of 12 deaths per 100,000 live births, while the U.S. has a rate of 19.9. Measuring up to 42 days after birth, the current rate for the U.K. is 8.9 deaths per 100,000 live births. There are a number of factors that play into maternal death rates, but given that the vast majority of pregnancy-related deaths are preventable, it is reasonable to conclude that greater availability of medical care could reduce this elevated death rate (and, conversely, a contraction of such care may well lead to higher mortality). This conclusion is borne out in a comparison of two states, Texas and California. Beyond their differences in the expansion of insurance to low-income residents, these states also differed in their attention to maternal medical care.
The Gender Policy Report is pleased to welcome Professor Zobeida Bonilla as a new curator to our health page. A medical anthropologist and public health practitioner, Zobeida Bonilla brings expertise to the Gender Policy Report on issues of maternal child health, global health and the health of the Latino community in the United States and the Spanish-speaking Caribbean. In addition to her role as Assistant Professor in the Division of Epidemiology and Community Health at the School of Public Health at the University of Minnesota, Bonilla has over 15 years of practice experience in public health working with state and local departments of health and in the non-profit sector working with the women’s health group Our Bodies Ourselves. Bonilla looks forward to creating conversation among practitioners, activists and researchers in the Gender Policy Report.
