Under the Build Back Better Act, Congress can expand and strengthen Medicare and Medicaid, improving the lives of millions of seniors while also throwing a lifeline to folks living in states where GOP politicians are strangling public benefits.
But to win these popular reforms, we have to defeat the efforts of Big Pharma, their greedy lobbyists and the politicians who take their money.
It wasn’t enough for Democratic Representatives Kurt Schrader of Oregon, Scott Peters of California, Kathleen Rice of New York and Stephanie Murphy of Florida to vote against a robust bill that would allow Medicare to negotiate drug prices, the Lower Drug Costs Now Act (H.R. 3). These politicians — compelled by their unhappy corporate donors — tried to derail efforts to lower the cost of prescription drugs by introducing atoothless alternative in a pathetic public stunt to appease the industry. Their bill excludes most drugs, letting Big Pharma continue to price-gouge.
This was a coup for corporate interests. The savings from the Lower Drug Costs Now Act will provide funds to let Medicare cover dental, hearing and vision care, and to expand Medicaid. But by taking the side of greedy lobbyists, this handful of contrarians dealt a huge blow to President Joe Biden’s Build Back Better agenda and put the health and well-being of millions of working-class and poor people in jeopardy.
Representatives in the pockets of the corporations — which spent $18 million since July on ads opposing drug price negotiations — are trying to pit Medicaid against Medicare by saying we cannot afford to do both.
This is a false choice. We can and should expand both. Yet wealthy CEOs and greedy lobbyists are posing a false dilemma by trying to force Congress to choose one or the other.
But grassroots voices from across the country are fighting back.
A few weeks ago, my organization, People’s Action, held adirect action in front of Pharmaceutical Research & Manufacturers of America (PhRMA) headquarters in Washington, D.C. alongside Independent Vermont Sen. Bernie Sanders and our allies where we shared stories of real people in pain thanks to Big Pharma’s greed. PhRMA is the third-largest lobbying organization in the country, and represents companies like Gilead, Johnson & Johnson, Pfizer and Merck & Co., which place misleading ads and spend millions more in dark money and direct campaign contributions to keep drug prices high.
At the rally, we told Judy Cross’s story. Cross lives in Idaho and has worked as a nurse for 51 years. Now, at 74, she relies on an oxygen tank and is unable to travel or see her grandchildren because she cannot afford her $10,000 per month medications to treat pulmonary fibrosis. She has a life expectancy of three to five years without the medication that she can’t get.
We also shared Joey Izaguirre’s story. Facing health issues, Izaguirre lost his job and shortly after was diagnosed with diabetes. He couldn’t afford insulin, doctor’s visits and equipment to test his blood, and rather than continue to feel like a burden on his family, he took his own life.
These stories are horrific, and they are only two of so many others. Pain, suffering, further health complications and even death are the costs that people in our country pay for Big Pharma’s greed. So we aren’t stopping.
Recently, People’s Action released anew report with Dēmos that spells out the corporate sabotage of democracy and the plot to kill the Build Back Better agenda. It coincided with a day of action on which 13 of our member organizations held direct actions in states from Colorado to West Virginia, holding these same corporations or the entities that represent them to account and exposing their role in undermining the progressive agenda our communities need.
Corporate influence over Congress is no secret. Companies like JPMorgan Chase, Anthem Blue Cross Blue Shield and Exxon have spent millions in lobbying to derail popular, progressive investments in our communities.
For example, the American Dental Association recently pushed for means-testing as a way to restrict access for seniors to dental, hearing and vision benefits in Medicare.
Adding these benefits to Medicare, which is part of the Build Back Better plan, would be critical for millions of seniors. Carmen Betances could not afford the preventative dental visits she needed years ago. So today, she needs $8,000 tooth implants to prevent more pain, infections and lost teeth. She has no idea how or if she will afford the care she desperately needs. Her story is common: Almosthalf of all Medicare beneficiaries go without dental care, and those rates jump when it comes to seniors of color, like Betances.
Big Pharma is orchestrating this horror story. While PhRMA presses corporate Democrats to put profit before people and weaken Medicare drug price negotiations, organizations like the American Dental Association are squeezing the same elected officials to limit care. The result? It will be harder for seniors, particularly seniors of color, to stay healthy.
But these conservative Democratic sellouts are only considering cutting dental, vision and hearing because there wouldn’t be enough savings from the watered-down drug price negotiations to pay for them. Drug companies think they have us cornered, and they are gearing up to pounce.
That’s why our elected officials need to stand up to Big Pharma. The health and well-being of millions of people like Cross, Izaguirre, and Betances is at stake.
Group home workers in Connecticut went on strike on Tuesday morning after talks with their employer, Sunrise Northeast, broke down. The workers are demanding higher wages, affordable health benefits and pensions. Sunrise runs 28 group home and day care programs for the intellectually disabled throughout Connecticut. Workers formed picket lines in front of the company’s homes in New London, Hartford, Danielson and Columbia.
As weary health care workers across California enter the 19th month of the pandemic, thousands are walking off the job and onto the picket line, demanding more staffing. The strikes and rallies threaten to cripple hospital operations that have been inundated by the COVID-19 Delta surge as well as patients seeking long-delayed care. More than two dozen hospitals across the state have experienced strikes by engineers, janitorial staff, respiratory therapists, nurses, midwives, physical therapists and technicians over the past four months.
For me and many others in prison, COVID-19 has been an emotional roller coaster. The Delta variant wave is just one more ride. I made it through the first round, will I make it through this one?
I’m 53 years old and I’ve spent 35 years of life in prison. I’ve long since come to grips with the powerlessness that is every prisoner’s lot. But COVID has taken that powerlessness to another level.
Many of us don’t know if we are going to live long enough to finish our prison sentence no matter how short it is. The vaccine, for those of us who have gotten it, has reduced the risk of death drastically. Many haven’t gotten the vaccine due to lack of trust in the government. But I got it, because after what I have witnessed during the first wave, I felt it may be my only way to get out alive.
But that is not our only concern. An immediate concern now is how the New York Department of Corrections and Community Supervision (DOCCS) is going to respond to the new wave of the pandemic and what policies they are going to enact this time. Throughout the pandemic and long before that, DOCCS has lost trust through its actions. The pandemic only gave more proof of how cruel the prison system is.
COVID Exacerbates Abuse and Neglect of Incarcerated People
In prison, our medical care is subpar to begin with during the best of times. Since the pandemic started it has gotten much worse. The State of New York has used COVID-19 as an excuse to take away our rights and privileges as well as to abuse and assault prisoners. The state also refuses to provide necessary medical care, including in my own case.
I myself had two issues that needed addressing when the pandemic hit: a sebaceous cyst that was pushing against a nerve in my neck and was scheduled to be removed, as well as a molar tooth that broke off at the root. When the pandemic started, all outside appointments were canceled. Over 18 months later, I still have not received treatment for either issue despite multiple requests. I deal with constant untreated nerve pain and chewing my food is extremely difficult and painful.
My story is far from unique. Many people I have talked to have had their medical issues sidelined since the pandemic began. Since the Spring of 2020, all outside medical appointments and only the most immediate emergencies were seen in the prison hospital.
I am known as a guy who writes about what occurs in prison, so people talk to me about what is happening. In addition to medical issues, I hear about physical abuse at the hands of guards, which has increased as well. Neglect and physical assaults of prisoners by guards in New York State has been the worst that I’ve seen in the four states I’ve done time in over the past four decades.
In recent years, these assaults and deaths by lack of medical treatment have led to lawsuits and news stories that have brought attention to the issue. For example, in 2015, Samuel Harrell was killed in Fishkill Correctional Facility by guards known as the “beat up squad.” And more recently, Layleen Polanco died at Rikers while in solitary confinement, after the jail’s failure to treat her medical condition.
The state has placed more cameras in the facilities and mandated that body cameras be worn by some officers. The problem is that the guards know where the cameras’ blind spots are and who is wearing a body camera. They are then able to abuse people out of sight of the cameras, and I have witnessed this several times.
And I have also experienced abuse. I have been relocated to many different facilities throughout the state. The medium-security facilities are worse than the maximum-security ones. There are many more blind spots.
The main “beat down” spot in Franklin Correctional Facility is in the back of a van they use to take you to the box (solitary confinement). The driver takes the long way, and the guards in the back dump you on the floor (while you are handcuffed behind the back) and proceed to “tune you up.” This can include knees, feet, elbows and fists applied to your face, head and torso.
When it happened to me, they pulled my legs out from under me so I landed hard face first, taking most of the fall on my shoulder (by ducking my head and twisting), and then they kicked me once in the kidneys and left me there.
Maybe it was the gray in my beard and possibly my white skin that got me off light. I have heard about and witnessed the results of much worse attacks. When I was in Upstate Correctional, a special housing unit/restrictive housing facility, they put a kid in the cell next to me who had both eyes closed and what looked like a broken nose. He screamed when he used the bathroom to urinate.
As bad as you think you have it these days, try experiencing this crisis from a position where you had very little control to begin with, then having that stripped away entirely. There’s an old saying in prison: Shit runs downhill, and prisoners are at the bottom of that hill. At no time has that been clearer than now.
While things have gotten better since the vaccine was offered, DOCCS has continued to deny people basic rights and privileges. For a long time, there were no regular visits from family and friends or “family reunion visits,” which are overnight trailer visits with partners and kids. These are crucial for families to stay connected. As of September 2021, DOCCS has reinstated family reunion visits. But as a result of not having these visits for a year and a half, people had much less contact with loved ones, and this has led to increased tension, violence and mental health-related incidents.
I am very concerned about what this new phase of COVID will bring. While the Delta variant is much less deadly for those who are vaccinated, we can still get very ill if we catch the virus. Add to that the fact that a large number of people in prison are not vaccinated, partly due to the mistrust generated by DOCCS since the pandemic began.
So we will see what the next round has in store. I’m not optimistic. Just like everyone else in the world, we wonder: Will it ever end? Will I survive? But in prison, we are even more powerless to protect ourselves, especially since COVID is only one of the threats we face. We also contend on a daily basis with abuse from correctional officers and lack of medical care. The pandemic has only exacerbated the poor conditions that I’ve experienced for 35 years in prison.
Today a People’s Peace Prize was awarded to Cuba’s Henry Reeve International Medical Brigade — not the Nobel Peace Prize, although more than 100 organizations and 40,000 individuals from the U.S. alone supported the Henry Reeve Brigade’s nomination.
The American Legislative Exchange Council (ALEC), a pay-to-play network of conservative state lawmakers and business lobbyists that writes model legislation, claims that it no longer works on social policy. But videos of ALEC-led events, obtained by the Center for Media and Democracy (CMD), tell a very different story.
The family of Henrietta Lacks has filed a lawsuit against biotech company Thermo Fisher Scientific for making billions in profit from the “HeLa” cell line. Henrietta Lacks was an African American patient at Johns Hopkins University Hospital. Doctors kept her tissue samples without her consent for experimental studies while treating her for cervical cancer in 1951. Benjamin Crump, one of the lawyers for the case, filed 70 years after her death, calls Henrietta Lacks a “cornerstone of modern medicine,” as her cells have since played a part in cancer research, the polio vaccine and even COVID-19 vaccines. Ron Lacks, author and grandson of Henrietta Lacks, laments the fact that the family was never notified when his grandmother died, and that part of what motivates the lawsuit is to ensure “no other family should ever go through this.”
More than 18 months into the COVID-19 pandemic, some states are once again facing shortages of medical resources needed to care for sick patients — leaving some to enter crisis mode or consider rationing vital resources, such as intensive care unit beds.
In Idaho a shortage of ICU beds is postponing non-emergency surgeries, while hospitals contend with fewer staffers to care for patients. As of Oct. 1, Idaho has the lowest percentage of people who’ve received one shot of a COVID-19 vaccine of any state.
In September, Idaho implemented statewide crisis standards of care, a plan for allocating resources amid shortages, in an attempt to save as many lives as possible and giving a lower priority for ICU beds to those less likely to survive.
Late last month, the legal advocacy group Justice in Aging asked the U.S. Department of Health and Human Services to investigate the state’s rationing plan, saying it discriminates based on age. Idaho’s crisis policy includes a scoring system for “tiebreakers” that prioritizes patients that have “lived through fewer lifecycles.”
Prioritizing certain groups of people over others was the subject of an April 2020 investigation by the Center for Public Integrity showing that in the early months of the pandemic, at least 25 states had crisis standards of care that could put people with disabilities at the back of the line for ventilators and other critical care.
Citing Public Integrity’s reporting, U.S. Senator Ben Sasse, R-Nebraska, announced proposed legislation that would deny states health-care resources from the federal government if their policies discriminated against people with disabilities. And a group of Democratic senators, including Elizabeth Warren of Massachusetts and Bob Casey Jr. of Pennsylvania, asked the Department of Health and Human Services to ensure patients received fair access to medical care.
Sasse’s proposal, the EQUAL Care Act, died at the end of the last Congress. He reintroduced it in June, but even as the delta variant and low vaccination rates have created shortages in some states, there has been no movement on the bill.
Sasse’s office did not respond to multiple requests for comment.
After The Arc, a nonprofit that advocates on behalf of people with intellectual and developmental disabilities, filed nine federal complaints last year to try to get HHS to step in, multiple states changed their policies, specifying that health care workers should not discriminate.
“Rather than making assumptions about a patient’s ability to respond to treatment based solely on stereotypes, doctors have to perform an individual assessment of each patient based on the best objective medical evidence,” said Shira Wakschlag, legal director of The Arc.
Multiple civil rights laws, including the Americans with Disabilities Act, already prohibit the denial of care on the basis of disability to an individual who would benefit from it. In March 2020, the AARP, which represents older Americans, released a statement opposing the use of age or disability to deny people access to treatments.
New Variant Prompts New Shortages
Earlier on in the pandemic, health care professionals worried they might run out of ventilators for all the patients who needed them. ProPublica reported last year that some doctors even considered putting two patients on one ventilator.
Now, hospitals continue to face shortages of ICU beds and staff, an issue leading to continued debate over delaying non-emergency surgeries for non-COVID-19 patients.
Govind Persad, a professor at the University of Denver’s Sturm College of Law, said rationing policies center around how much life doctors can save. However, they should not make stereotypical judgments about how long patients could live, Persad said.
Alaska recently implemented crisis standards of care for 20 healthcare facilities.
Hawaii’s crisis standards of care framework, released in September, came under criticism from AARP Hawai’i and other groups for including age as a “tie-breaker” criteria for deciding who gets care.
Bernard Lo, professor of medicine emeritus at the University of California, San Francisco, said the higher contagiousness and deadliness of the delta variant caused surges in hospitalizations, leading to strained resources.
Lo co-authored an article, published in February by the American Journal of Respiratory and Critical Care Medicine, that details recommendations for equitably allocating ICU beds when shortages occur during a crisis. Those recommendations include considering whether patients live in poorer neighborhoods, prioritizing people whose jobs put them at high risk of infection, and not using long-term life expectancy as a criterion for resource access.
“If you look at people who have multiple social vulnerabilities — they live in neighborhoods where there’s low income, people tend to have low educational status, a lot of unemployment — all these social factors that we know are associated with poor health outcomes,” Lo said. “Those people have had a disproportionate number of COVID deaths. Many of them are people of color as well.”
Role of Doctors
Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado School of Medicine, said individual doctors should not have to decide who might receive certain resources when they may not be as focused on how many resources are available more broadly.
“You want the doctor at the bedside to be able to serve as the advocate for their patient,” Wynia said. “You don’t want them being the judge deciding between their patients.”
A December 2020 NPRinvestigation found reports of Oregon “doctors and hospitals denying equipment like ventilators; insisting that an elderly or disabled person sign a DNR — maybe when they couldn’t understand it and in the middle of a crisis.”
Steven Joffe, a professor at the Perelman School of Medicine at the University of Pennsylvania, said another debate that’s gone on in the medical field is whether to prioritize vaccinated or unvaccinated patients when allocating monoclonal antibody treatments.
“We ought to actually be prioritizing the unvaccinated and immunocompromised, so that they don’t go on to get severe disease, and so that they don’t fill up the hospitals and we don’t need to use our crisis standards of care,” Joffe said.
Meanwhile, The Arc will keep watch on how rationing policies are implemented on the ground, Wakschlag said. “We’re going to be continuing to monitor that situation and advocate wherever we see discrimination happening.”
Now, organizers who have built power at the local level are beginning to unite nationally. Earlier in the pandemic, higher education workers had to struggle for survival mostly on their own. The battles, even when successful, took place in isolation; each group of workers in each separate institution, system, or state focused on its own specific setting, even though the problems are national phenomena demanding national solutions. In recent months, organizers have shifted their attention. They recognize that to reconstruct higher education as a public good—one that converts adjunct, outsourced, part-time, and precarious jobs into full-time, well-paid, dignified, stable positions at scale; one that ends the student and institutional debt crises; and one that rebuilds in the interests of students, workers, and communities—they must fight and win at a national scale.
Black women and their newborn babies are trapped in a public health crisis that is rooted in enslavement and perpetuated by systemic racism. Centuries of marginalization, exposure to environmental toxins, use of Black women’s bodies for scientific and pseudo-scientific experimentation, poor housing, substandard education, and the food apartheid that denies Black people self-determination in nutritional health have conspired over centuries to produce alarming health disparities and literally kill Black women and infants. These deaths are preventable, yet the numbers of the dead have risen. Looking forward, experts fear that the COVID-19 pandemic will only exacerbate racial disparities in maternal and infant health.
Across racial lines, the United States has the highest rates of maternal mortality than any other developed country in the world, with 17.4 deaths per 100,000 live births in 2018. According to the American Medical Association (AMA), this rate of maternal death was more than double the rates of maternal mortality in countries of comparable wealth. The following year, in 2019, the Centers for Disease Control and Prevention (CDC) found that the U.S. maternal mortality rate rose to 20.1 deaths per 100,000 live births.
Black maternal mortality ranks even worse. Maternal mortality rates for non-Hispanic African American women rose from 37.3 deaths per 100,000 live births in 2018 to 44.0 deaths per 100,000 live births in 2019. Black women’s maternal mortality exceeds that of other BIPOC women, including Latinx women, whose rates of maternal mortality (11.8 in 2018 and 12.6 in 2019) are lower than white women (17.4 in 2018 and 17.9 in 2019).
The CDC 2018 statistics on maternal mortality do not include data on Indigenous women, even though statistics on racial disparities were included in the report. (Indigenous women’s exclusion from the 2018 CDC report is consistent with their experience of marginalization in U.S. politics and policies, as well as silencing in the public discourse.) The CDC does have rates of maternal mortality for Indian and Alaska Native women for 2014-2017: 28.3 per 100,000 live births compared to 41.7 per 100,000 live births for African American women during that same period. During that period, white women and Asian and Pacific Islander women were statistically tied, at 13.4 per 100,000 live births and 13.8 per 100,000 live births respectively, while Latinx women had the lowest rates of maternal mortality, at 11.6 per 100,000 live births.
A History of Medical Apartheid
In a stunning 2018 New York Times article, Linda Villarosa, journalist-in-residence at the Craig Newmark Graduate School of Journalism at CUNY, identified the stress related to Black life in the U.S. as one cause of the racial disparities in Black maternal health. The impact of racism on maternal health has specific expressions on women of African descent when compared to other BIPOC women, including Latinx, Asian and Pacific Islander, and Indigenous women.
“The racial disparity in maternal and infant mortality between Black and white women is stark — but Black women have the worst outcomes in America because we have been the targets of harm for so long,” Villarosa told Truthout. “Institutional and structural racism have affected our communities for centuries, beginning with slavery and continuing with Jim Crow, segregation in housing and education, redlining and the poisoning of our neighborhoods with pollution. Our bodies have also been studied closely, at first because of the commodification tied to enslavement, later as test subjects.”
Black babies are also locked in this death grip. According to the CDC, in 2018, the infant mortality rate in this country was 5.7 deaths per 1,000 live births. However, the rate of Black infant mortality was, alarmingly, double that, at 10.8 deaths per 1,000 live births.
“What is interesting about this question regarding the impact of poor maternal health on Black communities is that, despite education, income and employment, we are still dying,” Simone Toomer, a certified birth and postpartum doula, childbirth educator and international board-certified lactation consultant, says. “This shows it is beyond us and our efforts, although being informed and advocating for ourselves does make a difference.” Toomer adds that these disparities, despite wealth and education, impact Black families in ways maternal and infant mortality rates do not quantify when mother and baby survive but do not thrive. “Poor maternal health care trickles down into poor breastfeeding rates amongst our infants, higher percentage of Black mothers being readmitted to the hospital after delivery and higher rates of PMADs [perinatal or postpartum mood and anxiety disorder].” These health outcomes have reverberating impacts on Black communities across income levels and through U.S. society more broadly.
Villarosa, who is author of the forthcoming book on race and public health titled, Under the Skin: Racism, Inequality and the Health of a Nation, does have numbers to place poor maternal and infant care in perspective: “Racial disparity in maternal and infant mortality has led to tens of thousands of lost lives. For every woman that dies as a result of pregnancy, childbirth and the months after a birth, nearly 100 women almost die. This is traumatizing for individuals and families.”
The reasons for these racial disparities and the overwhelming trauma they cause across income and education levels are vast and complex, according to Chi Chi Okwu, executive director of EverThrive Illinois, a social services agency dedicated to achieving health equity. “What we do know is that the combination and crushing weight of racism and sexism has a profound impact on the health of BIPOC women,” Okwu says. “This is a complex issue that requires us to look at the entire health ecosystem in addition to dismantling the racist and sexist institutions in our society.” In a state where, according to a 2016-2017 report from the Illinois Department of Public Health, Black women are three times likely to die from pregnancy-related medical conditions as white women, Okwu and her colleagues at EverThrive are focused on changing policy to improve birth outcomes. At the state level, these policies include expanding Medicaid to provide doula, lactation consulting and home-visiting services.
Black Women Are Doing the Work
To produce healthier outcomes, African American women are working to disrupt the policies, systems and the inherent bias among health care workers that harm vulnerable Black mothers and their babies. Policymakers in the Biden administration seeking to improve Black maternal and infant health should listen to these women.
In addition to policy, EverThrive Illinois also supports initiatives developed through strategic partnerships that center women and babies most impacted by racial and economic inequalities in health. The Family Connects Chicago program is one initiative Okwu’s organization supports to promote positive health outcomes for Black women and their newborns. In a city where Black unemployment far outpaced other racial groups well before COVID, Family Connects provides a visiting nurse for parents who are having difficulty getting to doctor’s appointments. Okwu says a home visitation nurse can work with the parents to identify the barriers to care and obtain the support they need to overcome them.
To afford a baby nurse that comes into the home to support mother and child, wealthy families in the Chicago area must pay salaries averaging in the high-five to low-six figures. The median baby nurse salary in Chicago is nearly $80,000. Through Family Connects, parents who can’t afford to pay more than they make themselves receive the same privilege of in-home care. “Home visiting provides an opportunity for parents to conveniently receive additional support in their own home. This is not a substitute to going to their OB-GYN or pediatrician,” Okwu explains. “Parents need all the support they can get after giving birth, and home visiting is just one part of the support network to ensure both the parent and child are getting all of the help they need in the postpartum period.”
Improving the relationship between health care systems and African American homes requires shifts in both policy and the public conversation in order to address racism in medical settings. The AMA and The American College of Obstetrics and Gynecologists (ACOG) have identified racism as a public health crisis. To dismantle racism in health care and improve outcomes in Black maternal and infant health, professionals must focus on policies and systems that directly impact Black families. “Dismantling racism in health care will take a multi-pronged systemic and localized approach. We need to ensure that all people have access to high-quality, comprehensive health care,” Okwu says. “We also need to ensure that the care being provided is culturally competent and patient-centered.”
Reducing racial health disparities requires such significant change, but Black women like Okwu are already producing outcomes that health care professionals in ACOG and the AMA, as well as policymakers in Biden administration, should consider. In Okwu’s state, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program had declined, reducing the opportunities for Black women and babies to benefit from the breastfeeding support and healthy food WIC provides. In response, EverThrive Illinois convened a group of partners — those who run WIC sites and WIC program participants — to form the Making WIC Work Coalition and, in 2019, published a landmark Making WIC Work Report. In response to the coalition’s advocacy, the State of Illinois has made significant improvements to the way it runs WIC, including eliminating a discriminatory coupon system which has limited access to food for mostly Black and Brown families in Chicago for more than 20 years; offering more choices so people shopping with WIC can redeem their benefits for a wider variety of foods; providing updated guidance so that all WIC sites provide consistent services and implement streamlined application procedures; and adapting quickly to provide flexibility in WIC enrollment and redemption of benefits so families can care for themselves during the COVID-19 pandemic.
Though the data is not yet available, certainly the global pandemic has exacerbated racial disparities in health outcomes for Black women and babies. The California Health Care Foundation has documented these complications, but the problems of Black women’s access to quality maternal and infant care through the pandemic are national in scope.
Black-led organizations lead the efforts to fill COVID-related gaps. The Social Science Research Council (SSRC) is studying the work done in Cleveland, Ohio, by Birthing Beautiful Communities (BBC), a Black-owned and run perinatal support agency. By studying service shifts caused by the COVID pandemic, including the use of technology in infant mortality prevention programming, SSRC expects “the findings to have implications for healthcare service delivery for Black women and their families.”
Black Women and Doulas
One successful program initiative at BBC is the community-based doula program, which provides overnight postpartum care. Doulas can fill wide gaps created by racism in health care. According to Toomer, “The data is limited on how doulas reduce the Black maternal and infant mortality; however, across the board, we know continuous doula support increases positive outcomes for both the birthing person and infant through emotional and physical support, advocacy and preparation.”
Toomer, who works at New York Presbyterian Methodist Hospital in Brooklyn as a doula and lactation consultant providing prenatal education and support in the clinic and on the Mother Baby Unit, and who also has a thriving private practice, explains that doulas provide multiple beams of support for families. Depending on their training, birth doulas support families through pregnancy, with some trained to support people as they undergo the assisted reproductive technology known as in vitro fertilization (IVF), in which eggs and sperm are combined in a laboratory. Toomer explains that “Doulas provide resources, educate and empower families around their birth options before the baby is here and in the laboring room. We assist within that first hour with latching baby and ensuring a smooth transition once home.” Consistent with the efforts of organizations like EverThrive Illinois and the BBC, doulas also provide critical care to support mothers and give infants a better chance at surviving the first year after birth. Toomer says, “Postpartum doulas come into the home to support newborn feeding, assessing for PMADS, the need for sleep and food, newborn education and ensuring everyone continues to transition smoothly.”
Toomer says that doulas fill gaps that are the standard in maternal care throughout in the medical community. “All parents have to bring their infant to the pediatrician in the first 24-28 hours after discharge; however, oftentimes, no one is checking in on the parents. Many things can happen in those six weeks but unfortunately that is the next time most birthing people are seeing their care providers after delivery.”
Toomer worked with the Healthy Start Brooklyn’s By My Side Support Program for four years. She says that, as a doula, “at every monthly meeting we would hear how our support prenatally, through delivery and postpartum, affirmed families, empowered them and provided that continuity of care that is lacking from the American health care system.”
Systemic Change Is Needed
From her vantage point on the front lines of the Black maternal and infant mortality crisis, Toomer hears “in many stories regarding Black maternal death, accountability is lacking. Accountability of these providers.” She insists that the work she does will never be enough to save Black women and their babies, and that this country’s health care system needs significant institutional change. “It is nice to be on the radar; however, it is beyond providing a doula for every Black mom. We are a small piece in the big puzzle.”
Change needs to start at the top with establishments such as hospitals, Toomer asserts. “Anti-racism health professionals need to continue training in cultural humility. Black women need to be heard and listened to. Biases need to be erased. We need to be looked at as human and respected as such.”
Villarosa says California is providing a template to address the needs that Black women like she and Toomer have identified. “Our country should follow the lead of California, which made implicit bias training mandatory for all health care providers who work with pregnant and birthing people,” Villarosa says. “During the pandemic, the state became the first to make implicit bias training mandatory for all providers, which will go in effect in January. The U.S. should do the same.”
The California Health Care Foundation says that exposing people to their unconscious bias and providing “a historical context for modern-day inequities in maternal health” can help professionals produce healthier outcomes as they “begin to understand how even well-meaning routine responses to patients can inadvertently cause harm and even death.”
Despite this promising commitment to dismantling racism in health care, Villarosa says that, in researching her book, the most surprising thing she discovered “is how well discrimination in our medical system has been documented — yet, there’s still a call for more ‘proof.’” This is more than unnerving as Black women and their babies continue to die at disproportionate rates, and experience poor health outcomes even when Black mothers survive the birthing process and Black babies survive the first year of life. These poor maternal and infant outcomes are the shame of a system that, as Toomer says, “is a broken system never meant to help us.”
Villarosa testifies to a consistent national truth: “Racial health disparities have been part of the American story since the founding of our country. Black mothers and babies should not be dying for reasons that are largely preventable. This isn’t how a just society treats a segment of its population.” The U.S. has the most advanced, expensive health care system in the world, she points out, “so why are we the only wealthy country where the overall rates of women dying or almost dying related to pregnancy are rising? And why do we have the highest rate of infant mortality of all the wealthy countries? These poor health outcomes are shameful, driven by the disproportionate death rates of Black mothers and babies, and are revealing that nation’s inequality.”
As state-level attacks on abortion rights intensify — not only in Texas but also in at least seven GOP-controlled states that are seeking to copy its draconian abortion ban — local abortion funds like the Texas-based Lilith Fund are serving as a locus of resistance.
These local abortion funds pair direct service (providing the resources to enable people to access an abortion) with an organizing effort to defend and expand access to abortion through collective action and consciousness raising. Erika Galindo, the Lilith Fund’s organizing program manager, spoke with Truthout about some of the reasons why organizing beyond service provision is important, as well as what is really necessary and at stake in the fight to preserve Roe.
As a Texas-based organization, the Lilith Fund is on the front lines of the fight to protect abortion rights in the U.S., contending with the state’s regressive new anti-abortion law that is part pre-viability ban and part vigilante justice.
The law, S.B. 8, prohibits free exercise to what should be an ordinary health care decision. Banning abortion after six weeks of pregnancy and providing a private cause of action for individuals to sue people who defy the law, S.B. 8 is an affront to the very spirit of Roe v. Wade. And yet the Supreme Court refused to stop the law from going into effect, claiming it was merely a procedural determination.
Galindo argues that even as we fight to defend Roe v. Wade from right-wing attacks, it shouldn’t be seen as an adequate standard for abortion access. Speaking in concert with a growing chorus of organizers of color across the country, she argues that beyond extreme six-week bans, many other restrictions prevent many people from accessing abortion — for example, restrictions involving multi-day visits before a procedure, prohibitions on using public funding or insurance for procedures, or even the various targeted restrictions on abortion providers (TRAP) laws. Despite the historic House vote protecting women’s health expressly prohibiting unnecessary restrictions on abortion access like S.B. 8, organizers like Galindo aren’t waiting for federal intervention.
Anoa Changa: How does the Lilith Fund engage in organizing, beyond the service of covering the costs of abortion for people?
Erika Galindo: We really think our work is like a two-pronged approach. There’s a direct service part, which is just like getting people to their abortions when you truly can’t afford them. But then there’s the organizing part because we know that, for one, there’s a lot of abortion policy being made right now, but hardly ever with people who’ve had abortions in the room, like an advocacy space, and just like spaces where these decisions are being made. And so, I think the idea was to get people who call our fund directly involved in the organizing to defend and expand abortion access.
We also know that because a lot of the funds that make up our hotline budget is through grassroots support. That is organizing when people are fundraising amongst their communities, and they’re talking to their friends about why it is that they are supporting the fund or why they support abortion funds. That in itself is like an educational moment.
Can you talk to me a little more about why looking at abortion as health care instead of some philosophically debated procedure is the better framing?
Yeah. Abortion is health care. Because, quite frankly, anything that you need to go see a doctor for is immediately health care. People need abortions, yes, because they don’t want to be pregnant anymore. But that can be for a plethora of reasons. And pregnancy itself is not just a super casual thing. It’s like the most dangerous thing that somebody can do. And I think we forget that. But in Texas, especially, it’s really dangerous for women — particularly Black women — to be pregnant, unfortunately, because we don’t have a health care system that isn’t anti-racist yet or fully just not without the biases or ills of the world.
What I mean when I say that abortion is health care is [that it is] a common procedure; it is safer than some dental procedures. People should be able to access it without having to pay out of pocket. And in Texas, you currently have to pay out of pocket for your abortion, because there’s not even private coverage for it. We do believe that all health care should be accessible to everyone. And that includes abortion.
It sounds like what you’re saying is we should be providing total coverage for the health care needs that people have, whether they’re choosing to have a baby or choosing to have an abortion whatever the case may be.
Exactly.
Much of the focus nationally has been on saving Roe. Is saving Roe enough to protect abortion access and rights for pregnant people in the communities y’all serve or in other parts of the country?
No. Saving Roe is crucial, but it’s not enough. And it’s never been enough. S.B. 8 is the latest anti-abortion restriction to go into effect. But it’s not the first abortion restriction to successfully be passed and implemented in Texas. We’ve had decades of anti-abortion restrictions like TRAP. We have had Roe eroded in states in the South for years, Texas in particular.
Roe has never guaranteed that there will be public coverage for abortion, and even in the two years after Roe, there were already attacks through the Hyde Amendment. Roe is like the baseline. It’s the floor, not the ceiling as a lot of people have described it, because it’s like the bare minimum that our country can do. But we need a whole lot more. Roe assumes that there’s a lot of things already functioning well. And there’s not, unfortunately. It’s operating obviously within capitalism.
When Roe was passed, it was focusing more on a doctor’s right to provide abortions, and that’s assuming that someone can get in front of a doctor, but that’s a huge assumption to make. Especially because health care is also just generally not accessible or a right in this country (or cheap). And because TRAP laws and coverage restrictions have only eroded Roe, it means that it has only gotten harder, because people have to pay out of pocket, take more time off work, find child care, etc. We need budgets that support people getting health care, including abortion.
What would you like people to understand about what’s actually happening in Texas and the work that people are doing?
I think people in Texas right now are being held hostage. And I say that because Texas is not a red state. Texas is a state that has so many things that are working against regular Texans — like gerrymandering, voter suppression, just like all sorts of things. Then I keep thinking about the fact that this extreme abortion ban was passed in a year where Texans were so bogged down and distracted. We had the winter storm happen. COVID is still happening. Our legislators made no effort to make the legislature accessible and pandemic-safe.
The legislature has never been accessible. But they really took advantage of the fact that people really can’t travel and go and drop things at a moment’s notice to go to a building where masks are not required. And try to intervene in this process. We had the cards stacked against us from the beginning. I think I just get very frustrated when people tend to write Texas off or the South off as like, a lost cause.
Texans do not want abortion restrictions. Texans wanted COVID relief and our legislators to fix the grid. That hasn’t happened. And we know that attacking abortion, attacking trans kids … it’s because they don’t want to give Texans or the South the legislation that could actually benefit us.
Is there anything else that you think is important for people to know?
I feel like if folks want to help Texas or get in coordination with Texas, I think folks need to of course donate to a fund and figure out how you can volunteer. But I think also getting involved in your own locality is super important.
Because even if you feel like maybe your state is in a better position, it could very easily not be. Also, even if your state doesn’t have harmful abortion restrictions, folks might still be struggling to pay for their care. So, I would encourage anybody to get involved with their local abortion fund and look to whoever’s been doing this work in your area because they will likely have so much expertise and can tell you exactly where you need to go to fight abortion restrictions.
This interview has been edited lightly for clarity.
Roughly 2,200 nurses, aides and health care staff walked off the job Friday morning in Buffalo, New York, to fight for better wages, staffing and working conditions at Mercy Hospital of Buffalo. Workers on the picket line describe horrific conditions at the hospital. Patients’ rooms, hallways, cafeterias and even medical equipment are filthy because the hospital refuses to hire enough workers.
“Since the return of the Sandinista government in 2007, the difference in medical care is stark. Today, the Hospitalito is a fully equipped hospital with emergency care and admitted patient beds. There is outpatient care – general medicine, pediatrics, gynecology, psychology, natural medicine, a rehabilitation center, and a maternal wait home.”
Activists gathered outside the homes of the White House chief of staff and the CEO of Moderna to demand the Biden administration and private drug companies do more to address the global vaccine shortage.
The term “race norming ” ought to be immediately suspected as having a nefarious intent. Anything referred to as norming in a racist society invariably ends with Black people getting the short end of the stick. The concept that Black bodies are anatomically different may be known as “race correction”, “ethnic adjustment”, or “race adjustment” and causes Black people to be undertreated for pain, undiagnosed for serious illness, and denied life saving treatments because of an idea which is inherently white supremacist and very much unscientific.
“Dear Mr. Ramalho, we are writing to you to urge Novo Banco to execute the transfer of a modest portion of the now technically unfrozen assets belonging to Bandes, the Venezuelan economic and social development bank, so they may be transferred directly to the Brazil-based Pan-American Health Organisation to pay for vaccines and medicines for infants in Venezuela.”
Rural health care leaders have begun offering sign-on bonuses and benefit packages to combat shortages during the pandemic. But they’ve found that even those perks aren’t enough to keep or attract skilled health professionals. Instead, they say, the focus needs to shift to boosting nursing school enrollment and getting workers into the field faster. “It’s just very difficult to compete with some of the size and scale that bigger systems have,” Pratt said.
Ask your liberal friends about Danny Glover. They will say – superstar actor featured in the Lethal Weapon film series. Civil rights activist. Democracy Now regular. Supporter of Bernie Sanders for President and for single payer national health insurance. But ask older Americans who watch a lot of cable television about Danny Glover, and they will tell you about Danny Glover – paid actor for big pharma and the insurance industry.
Organizations across the United States organized protests, cultural activities, community kitchens, teach-ins, and other actions about the issue of healthcare access in the US from September 13-20 as part of the Nonviolent Medicaid Army Week of Action. The diverse actions had the goal of uniting people directly impacted by healthcare denial and linking the different issues related to healthcare such as housing, police violence, access to clean water, and economic inequality.
The report released this week, which was conducted by advocacy group Worker’s Justice Project in partnership with Cornell University’s School of Industrial and Labor Relations, is a four-month-long survey (December 2020-April 2021) of 500 app-based workers throughout the five boroughs, many of whom work for the likes of Grubhub, Doordash and UberEats.
The WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury, 2000-2016, conducted before the outbreak of the global COVID-19 pandemic, gives a glimpse of the terrible toll taken on the international working class by the insatiable profit drive of the corporations. Globally, 34.3 out of every 100,000 people over age 15 die each year from work-related causes.
A Texas doctor has revealed that he recently performed an abortion in violation of the state’s new controversial law that prohibits nearly all abortions after roughly six weeks into a pregnancy, arguing that he “had a duty of care to this patient.” Alan Braid, a San Antonio-based physician, wrote in an op-ed published by The Washington Post Saturday that on Sept. 6, just five days after the Texas abortion ban went into effect, that he “provided an abortion to a woman who, though still in her first trimester, was beyond the state’s new limit.”
Republican legislators in more than half of U.S. states, spurred on by voters angry about lockdowns and mask mandates, are taking away the powers state and local officials use to protect the public against infectious diseases.
A KHN review of hundreds of pieces of legislation found that, in all 50 states, legislators have proposed bills to curb such public health powers since the covid-19 pandemic began. While some governors vetoed bills that passed, at least 26 states pushed through laws that permanently weaken government authority to protect public health. In three additional states, an executive order, ballot initiative or state Supreme Court ruling limited long-held public health powers. More bills are pending in a handful of states whose legislatures are still in session.
In Arkansas, legislators banned mask mandates except in private businesses or state-run health care settings, calling them “a burden on the public peace, health, and safety of the citizens of this state.” In Idaho, county commissioners, who typically have no public health expertise, can veto countywide public health orders. And in Kansas and Tennessee, school boards, rather than health officials, have the power to close schools.
President Joe Biden last Thursday announced sweeping vaccination mandates and other covid measures, saying he was forced to act partly because of such legislation: “My plan also takes on elected officials in states that are undermining you and these lifesaving actions.”
All told:
In at least 16 states, legislators have limited the power of public health officials to order mask mandates, or quarantines or isolation. In some cases, they gave themselves or local elected politicians the authority to prevent the spread of infectious disease.
At least 17 states passed laws banning covid vaccine mandates or passports, or made it easier to get around vaccine requirements.
At least nine states have new laws banning or limiting mask mandates. Executive orders or a court ruling limit mask requirements in five more.
Much of this legislation takes effect as covid hospitalizations in some areas are climbing to the highest numbers at any point in the pandemic, and children are back in school.
“We really could see more people sick, hurt, hospitalized or even die, depending on the extremity of the legislation and curtailing of the authority,” said Lori Tremmel Freeman, head of the National Association of County and City Health Officials.
Public health academics and officials are frustrated that they, instead of the virus, have become the enemy. They argue this will have consequences that last long beyond this pandemic, diminishing their ability to fight the latest covid surge and future disease outbreaks, such as being able to quarantine people during a measles outbreak.
“It’s kind of like having your hands tied in the middle of a boxing match,” said Kelley Vollmar, executive director of the Jefferson County Health Department in Missouri.
But proponents of the new limits say they are a necessary check on executive powers and give lawmakers a voice in prolonged emergencies. Arkansas state Sen. Trent Garner, a Republican who co-sponsored his state’s successful bill to ban mask mandates, said he was trying to reflect the will of the people.
“What the people of Arkansas want is the decision to be left in their hands, to them and their family,” Garner said. “It’s time to take the power away from the so-called experts, whose ideas have been woefully inadequate.”
After initially signing the bill, Republican Gov. Asa Hutchinson expressed regret, calling a special legislative session in early August to ask lawmakers to carve out an exception for schools. They declined. The law is currently blocked by an Arkansas judge who deemed it unconstitutional. Legal battles are ongoing in other states as well.
Legislators there also passed limits on local officials: If jurisdictions add public health rules stronger than state public health measures, they could lose 20% of some grants.
Losing the ability to order quarantines has left Karen Sullivan, health officer for Montana’s Butte-Silver Bow department, terrified about what’s to come — not only during the covid pandemic but for future measles and whooping cough outbreaks.
“In the midst of delta and other variants that are out there, we’re quite frankly a nervous wreck about it,” Sullivan said. “Relying on morality and goodwill is not a good public health practice.”
While some public health officials tried to fight the national wave of legislation, the underfunded public health workforce was consumed by trying to implement the largest vaccination campaign in U.S. history and had little time for political action.
Freeman said her city and county health officials’ group has meager influence and resources, especially in comparison with the American Legislative Exchange Council, a corporate-backed conservative group that promoted a model bill to restrict the emergency powers of governors and other officials. The draft legislation appears to have inspired dozens of state-level bills, according to the KHN review. At least 15 states passed laws limiting emergency powers. In some states, governors can no longer institute mask mandates or close businesses, and their executive orders can be overturned by legislators.
When North Dakota’s legislative session began in January, a long slate of bills sought to rein in public health powers, including one with language similar to ALEC’s. The state didn’t have a health director to argue against the new limits because three had resigned in 2020.
Fighting the bills not only took time, but also seemed dangerous, said Renae Moch, public health director for Bismarck, who testified against a measure prohibiting mask mandates. She then received an onslaught of hate mail and demands for her to be fired.
The new laws are meant to reduce the power of governors and restore the balance of power between states’ executive branches and legislatures, said Jonathon Hauenschild, director of the ALEC task force on communications and technology. “Governors are elected, but they were delegating a lot of authority to the public health official, often that they had appointed,” Hauenschild said.
“Like Turning Off a Light Switch”
When the Indiana legislature overrode the governor’s veto to pass a bill that gave county commissioners the power to review public health orders, it was devastating for Dr. David Welsh, the public health officer in rural Ripley County.
People immediately stopped calling him to report covid violations, because they knew the county commissioners could overturn his authority. It was “like turning off a light switch,” Welsh said.
Another county in Indiana has already seen its health department’s mask mandate overridden by the local commissioners, Welsh said.
He’s considering stepping down after more than a quarter century in the role. If he does, he’ll join at least 303 public health leaders who have retired, resigned or been fired since the pandemic began, according to an ongoing KHN and AP analysis. That means 1 in 5 Americans have lost a local health leader during the pandemic.
“This is a deathblow,” said Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health. He called the legislative assault the last straw for many seasoned public health officials who have battled the pandemic without sufficient resources, while also being vilified.
Public health groups expect further combative legislation. ALEC’s Hauenschild said the group is looking into a Michigan law that allowed the legislature to limit the governor’s emergency powers without Democratic Gov. Gretchen Whitmer’s signature.
Curbing the authority of public health officials has also become campaign fodder, particularly among Republican candidates running further on the right. While Republican Idaho Gov. Brad Little was traveling out of state, Lt. Gov. Janice McGeachin signed a surprise executive order banning mask mandates that she later promoted for her upcoming campaign against him. He later reversed the ban, tweeting, “I do not like petty politics. I do not like political stunts over the rule of law.”
Fawbush was a sponsor of 1989 legislation during the AIDS crisis. It banned employers from requiring health care workers, as a condition of employment, to get an HIV vaccine, if one became available.
But 32 years later, that means Oregon cannot require health care workers to be vaccinated against covid. Calling lawmaking a “messy business,” Fawbush said he certainly wouldn’t have pushed the bill through if he had known then what he does now.
“Legislators need to obviously deal with immediate situations,” Fawbush said. “But we have to look over the horizon. It’s part of the job responsibility to look at consequences.”
KHN data reporter Hannah Recht, Montana correspondent Katheryn Houghton and Associated Press writer Michelle R. Smith contributed to this report.
The U.S. health care system ranked last among 11 wealthy countries despite spending the highest percentage of its gross domestic product on health care, according to an analysis by the Commonwealth Fund. Researchers behind the report surveyed tens of thousands of patients and doctors in each country and used data from the Organization for Economic Cooperation and Development and the World Health Organization (WHO). The report considered 71 performance measures that fell under five categories: access to care, the care process, administrative efficiency, equity and health care outcomes.
On Sept. 1, the Supreme Court, without so much as a hearing on its constitutionality, let the most restrictive ban on abortion in the United States go into effect in Texas. Texas SB8 is a six-week abortion ban that will prevent legal abortions for almost all people seeking them. This ban is also well before the so-called viability test that Roe v. Wade has held in place since 1973, wherein abortions cannot be prohibited if they occur before the fetus could be considered viable.
Abortion advocates have been bracing for the worst since the appointment of Amy Coney Barrett to the court after the death of Ruth Bader Ginsburg. The case Dobbs v. Jackson Women’s Health Organization, which the court agreed to hear last May, has long been considered the case that the court would likely use to overturn Roe. However, the actions of the Court last week regarding SB84 surprised many due to its willingness to ignore precedent and allow a law to stand that clearly violates previous rulings. Chief Justice Roberts, a reliable conservative, even joined the liberal justices in dissent, stating that he would “would grant preliminary relief to preserve the status quo ante—before the law went into effect.”
“For the people who want to abortions in Texas, they need to understand that they are not the target of this law, it is the people around them, and that there are resources online to help them, like needabortion.org, which will help them understand how they can continue to still get their needs met, because abortion is not a crime in Texas, or anywhere else.”
Sara Ainsworth, senior legal and policy director at If, When, How
The Texas law is different than many other laws which have been enacted around the country to challenge abortion rights because, while it bans abortion prior to six weeks, it does not create criminal penalties, and instead creates a civil liability of $10,000 for abortion providers or anyone who assists abortion providers. As has been pointed out, the law is so broad that it could even be used to sue Uber drivers who take a woman to a clinic.
Sara Ainsworth, senior legal and policy director at If, When, How, an organization that provides reproductive justice legal services, told TRNN that she wants people seeking abortions in Texas to understand that the law does not criminalize them.
“For the people who want to abortions in Texas, they need to understand that they are not the target of this law, it is the people around them, and that there are resources online to help them, like needabortion.org, which will help them understand how they can continue to still get their needs met, because abortion is not a crime in Texas, or anywhere else.”
While people seeking abortions are not being criminalized per se, they are are being pushed into self-managed abortions due to the lack of accessibility of other medical care.
“The definition of self-managed abortion is someone who is taking an abortion into their own hands outside of a medical setting [typically by using the most common prescribed “abortion pills” mifepristone and misoprostol]. It’s not really a medical risk; it’s very safe in the grand scheme of abortions especially. But the difference is you did that outside of a medical setting and that’s what can make it punishable,” said Rafa Kidvai, director of the Repro Legal Defense Fund, which covers bail and funds defenses for individuals who are investigated, arrested, or prosecuted for self-managed abortions.
“When you pass a law like this, that just basically deeply, deeply stigmatizes abortions and makes people believe that it is illegal, … a prosecutor will then cast around to find some kind of law to fit to the crime that they perceive, even in a state like Texas where criminalization is not on the books.”
Sara Ainsworth, senior legal and policy director at If, When, How
“Despite the fact that abortion is a constitutional right and a human right we have still been seeing since the year 2000 more than two dozen, possibly many more, prosecutions of people who are prosecuted under a range of laws, usually without legal authority,” said Ainsworth. “They are nonetheless arrested, jailed, prosecuted for having ended their own pregnancy or being accused of having done so.”
Ainsworth explains that laws like the one in Texas can lead to pregnant people being criminalized, no matter what the law says. “When you pass a law like this, that just basically deeply, deeply stigmatizes abortions and makes people believe that it is illegal, it casts abortion in a light of, ‘Well, if someone did it themselves, therefore it must be a crime.’ And a prosecutor will then cast around to find some kind of law to fit to the crime that they perceive, even in a state like Texas where criminalization is not on the books,” she said. “It’s the increase in self-managed care and then the stigma that attaches to anyone that manages their own abortion that increases the risk of criminalization.”
Kidvai agrees and points out that politics often heavily influence whether or not a person will get prosecuted for a self-managed abortion. “Prosecutions are about overarching culture, so prosecutors prosecute whatever is politically beneficial to them,” she said.
While most cases of people being criminally prosecuted due to this Texas law, or any other abortion restriction, will end up in dismissal, this does not change the impact that criminalization can have on the lives of the people charged. “So much about criminalization is all the stuff that comes along with it—like being under suspicion, threat of a potential prosecution, an open case can destroy your livelihood even if that case ends up being resolved in your favor,” says Kidvai.
Kidvai also points out that this criminalization is more likely to occur when marginalized people seek abortions than anyone else. “The same people [get prosecuted for self-managed abortions] as get prosecuted for all cases, BIPOC people and poor people,” she said. “Pregnancy makes you vulnerable to prosecution.”
As the Delta variant continues to rage in the United States, maxing out many of the nation’s intensive care units, we face a severe deficit in direct care nurses and caregivers in our hospitals. Since 2016, hospitals have turned over an average of 90.8 percent of their staff, including registered nurses (RNs). Some hospitals have annual RN vacancy rates hovering well beyond 20 percent. But the number actually needed to provide safe care is often double or even triple the number of budgeted vacant positions.
While there’s been no shortage of students wishing to study to become nurses, nursing programs across the country are closing, even as demand for nurses continues to rise. In New York State alone, more than 170 nursing programs closed over the past 50 years, with only 65 accredited nursing schools remaining.
What are the conditions driving RN turnover and vacancy rates, and what can we do to bring on and keep more qualified nurses in the field?
Salary and Pay
While salaries and benefits in “union-dense” regions of New York State have improved, they have still remained substandard in other areas. In nonunion and even some unionized hospitals in these areas, the cost of health benefits outweighs salaries, and nurses must resort to the taxpayer-funded state government system for their dependents. Ironically, these hospitals, which receive state subsidies, are relieved of the cost of insuring their employees, while additional state funds are expended for this purpose.
Defined benefit pensions have been discarded by many hospitals and replaced with defined contribution plans that are dependent upon the stock market and offer far less protection to retirees.
Travel nurses, on the other hand, can earn over $5,000 per week plus housing, transportation and food. When hospitals run out of enough nurses to keep patients alive, they resort to paying these costs as well as travel nurses’ lucrative agency fees. Nurses often choose to leave hospital staff and opt for these assignments in various locations in order to make more money, travel and avoid the torments of staff nurse positions in uncaring facilities.
In our nation’s hospitals, 23.9 percent of all new RNs leave within a year. Each percent change in RN turnover costs the average hospital an additional $270,800 each year.
Working Conditions
Ultimately, chronic understaffing and unacceptable working conditions are the main reason new nurses leave the bedside, senior nurses retire early and others “shop around” — or leave the profession entirely.
Nurses have been saying for years that we must have a standard of care that includes minimum nurse-to-patient ratios in order to deliver “the kind of care I would want for my mom.” Often, based on our professional judgment, we know that we can safely care for two, three or four patients, depending upon severity and complexity of illness. Yet we are told instead that we are responsible for double, triple and even quadruple that number of human beings, leading us to decompensate.
There is a mantra in the medical community: “Do no harm.” Forcing us to accept an assignment far beyond our capabilities, in volume or in competency (hospitals often demand we treat patients we’re untrained to care for) places us in a dizzying state of cognitive dissonance. We undoubtedly become accomplices in potentially harming the patients in our charge.
Yet, if we refuse to take on such an assignment, we’re threatened with termination. Adding to the stress, employers harass us with nitpicking details related to repetitive documentation via the electronic charting systems (EMR) — thus, making care of the patient secondary to its documentation. Why? The tedious checklists in the EMR generate billing, which enables the hospital to get paid.
This focus on documentation is the final straw in the pain nurses endure as we try to do our jobs. We have far less direct contact with our patients as a result, and are forced to “speed up,” and engage in rote, factory-like activities, rather than being able to develop meaningful relationships with our patients and their families, and utilize the critical thinking skills we cherish. Nurses are key in detecting and preventing complications and in creating a framework that most benefits our patients. That world is disappearing as we are dangerously understaffed and challenged without support and resources.
COVID
The SARS CoV-2 pandemic didn’t initiate the nursing shortage, but it did exacerbate the problem and made the public painfully aware of its seriousness. This “shortage” is manufactured by an inflated, top-heavy health care system built on profit-making rather than enhancing care. Dollars in hospitals are spent on consultants, marketers, information technology “streamliners,” and overpaid managers whose job it is to cut staff and work nurses beyond human capacity. That doesn’t even touch the money lining the pockets of insurers, Big Pharma, and other predators of the health care system — money that could otherwise be spent on staff, training and preventative care for our patients.
In addition, the frenzied competition and breakneck efforts of hospitals to make a buck result in overtreating the well-insured and undertreating the underinsured and the uninsured, leading to negative outcomes and complications. Nurses are pressured to reduce “length of stay” and often have to take on hospital and insurance administration to advocate for patients staying an extra day to recuperate.
As the pandemic continues to rage amid the Delta variants spread, patients in already overcrowded, understaffed and poorly prepared environments are still dying by the thousands. However, even in the face of this horrific medical nightmare, there was the potential to save so many more. The death toll and the conditions New York nurses faced in March and April 2020 left nurses numb. Many of us developed an almost collective amnesia about what occurred, just so we could continue on. Post-traumatic stress disorder is rampant among the medical community, and now, with numbers rising in intensive care units once again, it has become almost too much to bear.
What’s worse, the flip-flopping and crass abandonment of caregivers by the Centers for Disease Control and Prevention and our employers at the start of the pandemic resulted in a form of “trauma betrayal,” leaving people in caregiving professions skeptical about believing anything else the government promotes, including vaccines.
The Cure?
Without fundamentally altering the focus of the health care system away from the business model of profiteering and back to the social model of care facilitated by a Medicare for All system, our society will fail again to develop a reliable public health infrastructure. Without mandating standards for patient loads and without affording us respect as competent, thinking professionals, nurses will continue to “burn out” and abandon our beloved profession.
There are many idealistic youth who wish to give from their hearts, hands and minds to our society, but without making nursing school accessible and affordable to all, the nursing shortage will escalate — and there may not be anyone to care for you when you are most in need.
Indigenous and Chicanx/Latinx people, who comprise nearly 50% of New Mexico’s population, have been subjected to generational and current day racist reproductive policies under the United State’s federal- and state-funded legacy of forced sterilization and coercive reproductive control. Yet New Mexicans, including Indigenous people, Black people, people of color, and people of faith have built and fought for safe and legal access to reproductive health for centuries to protect our own loved ones.
On July 30, a Friday, Uganda’s President Yoweri Museveni partially lifted the 42-day lockdown order that had been implemented in June amid a surge of COVID-19 infections in the country.
Uganda’s total population is just over 45 million. The number of people in the target group prioritized for vaccination amounts to 21.9 million. At the time Museveni announced the partial lifting of the lockdown, less than 1.5% of those in that target group (only about 1.2 million) had received the recommended vaccines: According to Dr. Jane Ruth Aceng, minister of health, 902,293 had received the first jab, while only 232,742 people were fully vaccinated.
Uganda, however, has not effectively reached a state of suppressed transmission of the coronavirus, which would mean the positivity rate drops to 5% or below. Having reached a staggering 19.2% positivity rate as of June 8, Uganda was still experiencing 7-8% positivity by July 30—there was still active transmission happening at the community level.
This is the reality still facing many countries around the world, especially in Africa, due to the global vaccine apartheid and forced scarcity engendered by rich countries hoarding doses and protecting the profits and intellectual property rights of pharmaceutical companies over the lives of the world’s population.
But the government had to make a hard decision, opting to relax restrictions on trade, movement, and transport because the economy was bleeding and people had nothing to eat.
“Literally speaking, if the opening up during the first wave represented a training drill under a mixture of blank and live shots, what we have loosed Ugandans onto is an actively raging battlefield,” said Dr. Misaki Wayengera, the chair of Uganda’s Scientific Advisory Committee on COVID-19 for the Ministry of Health.
The “government of Uganda’s strategy is mass vaccination of the eligible population (22 million, representing 49.8% [of the total population]) as a means of optimal control of the pandemic and full opening up of the economy,” Dr. Aceng said.
Out of 80 million vaccine doses that the Biden administration has designated for global donations, the US government has committed to donating about 25 million doses to 49 countries in Africa. Uganda will certainly benefit from this donation, although the exact number of doses it will receive is still unknown.
“In the next coming weeks, we’ll continue to see additional deliveries to reach this 25 million,” according to Jessica Lapenn, US ambassador to the African Union.
Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said the vaccines donated by the US government will help to ensure that vaccination efforts will continue or resume in African countries that are either running out of doses or had already exhausted the doses they previously received. The fact remains, however, that only 1.7% of people in Africa have been fully immunized.
But the WHO has warned that, at the current pace of vaccine distribution, nearly 70% of African countries will not reach the 10% vaccination target by the end of September. Ministry of Health officials in Uganda said they expect another 11 million doses to arrive in the country by September.
Without enough vaccines, the governments of poor countries like Uganda are unlikely to hit that target. They will have to make the decision to lift lockdown restrictions and play a deadly game of “hide and seek” (imposing lockdowns when surges arise and health systems become overwhelmed, then opening back up when the devastation subsides).
This is the reality still facing many countries around the world, especially in Africa, due to the global vaccine apartheid and forced scarcity engengered by rich countries hoarding doses and protecting the profits and intellectual property rights of pharmaceutical companies over the lives of the world’s population.
Chinese Ambassador to Uganda Zhang Lizhong talks to a worker after handing over the Sinovac COVID-19 vaccine at National Medical Stores in Entebbe, Uganda, July 31, 2021. Hajarah Nalwadda/Xinhua via Getty Images
With few or no vaccines, many countries are still at peak risk and are experiencing faster and higher surges of cases. “We must all double down on prevention measures to build on these fragile gains,” said Dr. Matshidiso Moeti, WHO regional director for Africa.
“Vaccine inequity can fuel the epidemic through emergence of variants. It will also create social-economic impacts, particularly on education, and generate poverty—and all these will create a bad epidemic that will increase the inequity trap,” professor David Serwadda, head of the vaccine advisory committee in Uganda, told me. “We shall have a worldwide trap—if one region vaccinates and another does not …”
Vaccine inequity around the globe has resulted from a combination of factors, including rich countries hoarding vaccines, nationalist sentiments and fear overcoming global solidarity, and poorer countries relying on donations without being given a chance to purchase their own preferred vaccines (even if they are willing to purchase directly from manufacturers).
According to WHO Director-General Tedros Adhanom Ghebreyesus, one of the gravest threats and grimmest realities exposed during this pandemic has been the lack of international solidarity and sharing: the sharing of pathogen data, epidemiological information, specimens, resources, technology, and vaccines.
“What worries us is how the virus mutates, and we can only prevent it if we take this vaccine equity and implement it truly,” said Dr. Yonas Tegegn Woldemariam, WHO Representative in Uganda.
“The problem in Africa is vaccine famine, not vaccine hesitancy,” Dr. Nkengasong recently told Reuters. “It is very unfortunate, if you recognise that we have to immunize at least up to 70% of our population. That tells you we have an incredibly long journey to go where we have to be.”
Again, as of today, less than 2% of the 1.3 billion people living on the continent have been fully vaccinated.
Museveni worried about vaccine acquisition
“We are struggling with buying vaccines. We are talking to everybody—most importantly, we are developing a vaccine,” President Museveni reassured Ugandans during a presidential address on Saturday, Aug. 14.
To date, the government has only secured around 2 million vaccine doses, all in the form of donations, but authorities are looking to acquire more vaccines as richer countries immunize more of their populations.
“We must expand our manufacturing capacity on the continent, which will help us in public health and [provide] significant economic benefits because it will create jobs and ensure that things purchased out of Africa are bought locally, which will strengthen our economies,” Dr. Ahmed Ogwell Ouma, deputy director of the Africa CDC, told me.
Africa imports 99% of the vaccines it administers. “The gap is so big that our heads of state have stepped in and told us we must change the narrative,” said Ouma. “Our vision as Africa CDC is to see that vaccine manufacturing on the continent is 60% of what we need and [that we are only] importing 40% by 2030.”
Students attend an airing lesson in Kampala, Uganda, on Aug. 16, 2021. Uganda on Monday resumed airing lessons on radio for upper primary and secondary school levels as schools in the country remain closed. Nicholas Kajoba/Xinhua via Getty Images
Some countries, including South Africa, Senegal, Algeria, Egypt, and Rwanda, have started to build up their COVID-19 vaccine manufacturing capabilities.
“Vaccine equity cannot be guaranteed by goodwill alone. Africa needs to and should be capable of producing its own vaccines and medical products. Rwanda commits to working with member states and partners to make vaccine equity a reality,” said President Paul Kagame of Rwanda during the joint high-level meeting on vaccine manufacturing organized by the Africa CDC on April 12.
But before vaccine manufacturing takes off on the continent, many countries are still experiencing increased cases of COVID-19, especially with the emergence of new variants that are more transmissible and ensure every subsequent wave is more severe than the previous one.
As time passes and the pandemic wears on, the public tends to become less vigilant about following social safety measures and exposure increases—vaccines remain the most vital and effective tool in the arsenal to fight the virus.
Museveni adapted the HIV leadership strategy to COVID-19
Together with local leaders at all levels, Museveni spoke openly about HIV prevention, stressing the “ABCs”—(1) Abstinence, (2) Be faithful, (3) use a Condom—and encouraging “zero grazing” (i.e., monogamy). These efforts resulted in reducing HIV prevalence from 18% to 6%.
Now, with COVID-19, Museveni is once again speaking openly and publicly about prevention, using national addresses that are broadcast live on television and radio stations to enforce safety measures; this time, however, security forces are helping with the enforcement.
The first national address occurred on March 22, 2020, and a lockdown was called into effect from March 18-30, including the closure of public places such as churches, schools, and bars. Museveni also imposed curfews, halted public transport, and stopped passenger flights by March 25 (most of the cases initially recorded were from travelers). At the time, Uganda had 126 confirmed cases and no deaths.
Thereafter, Museveni took to using national addresses to call for donations from the public—the private sector donated UGX 21 billion (about $6 million USD)—which garnered much-needed supplies in the form of cash, food, and even vehicles to be used in the fight to mitigate the spread of the virus. Museveni even used these occasions to demonstrate how much food families should eat and ration, and how to exercise in their homes to stay healthy.
Uganda made significant achievements during the first lockdown. The government distributed food to the vulnerable and even promised distribution of radios for learners who were locked out of school so they could study “on air.”
[A] lockdown was called into effect from March 18-30, including the closure of public places such as churches, schools, and bars. [President] Museveni also imposed curfews, halted public transport, and stopped passenger flights by March 25 (most of the cases initially recorded were from travelers). At the time, Uganda had 126 confirmed cases and no deaths.
Registered cases dropped, obviously, but there were unanticipated benefits, too—on the wildlife front, for instance, the number of animals increased in game parks as a result of fewer poachers. In Queen Elizabeth National Park, the Uganda Wildlife Authority (UWA) said they recorded more than 90 mammal and 600 bird species, and the population of elephants surpassed the 3,953 mark registered before the lockdown. Records also showed increased numbers of buffaloes and kobs.
The public largely complied with the lockdown orders and stayed at home, which significantly reduced new COVID-19 cases, but there were other social catastrophes—within 14 days from the start of the national lockdown, Uganda police recorded 328 cases of domestic violence.
Other social calamities have been exacerbated during the lockdown period. Child neglect, malnutrition, and strains on mental health increased. No schools for the nation’s 15 million school-going children means a lack of access to the internet, computers, and phones. And teenage pregnancies have gone through the roof.
In the year since lockdowns were first imposed, pregnancies among teenagers in Uganda have jumped from 24% to 35%, according to Reproductive Health Uganda. One district in northern Uganda, Gulu district, has reportedly registered 4,447 teenage pregnancies in a period of 18 months.
In other districts, underage marriages and sexual abuse have been a persistent concern. In Lyantonde district, according to one report that has left many speechless, parents are allegedly colluding with sex offenders to marry off girls as young as 13 years old.
Within just 35 days of the second lockdown, the sub-county of Amuru in Amuru district registered 170 cases of teenage pregnancies, according to a survey conducted by the African Medical and Research Foundation (AMREF) Uganda, a non-governmental organization working in partnership with Amuru sub-county through the Village Health Team (VHT).
Albert Ladaa, the assistant community development Officer in Amuru sub-county, said the most affected were teen girls aged between 15 and 17 years. However, David Ocira, chairperson of Amuru sub-county, posited that the number of teenage pregnancies are higher than what was recorded in the AMREF survey because many more cases are neither reported nor documented.
There are also reports in regions like Karamoja that female genital mutilation is relatedly on the rise.
Across the Sub-Saharan Africa region, UNICEF reported that over 32 million children are out of school as a result of pandemic closures due to second and third COVID-19 waves in some countries. That number, as the report states, “is in addition to an estimated 37 million children who were out of school before the pandemic.”
After the first lockdown
On May 4, 2020, Museveni extended the first nationwide lockdown while easing some restrictions. Some businesses, transport services, and essential health workers were allowed to move, but Ugandans were still required to wear masks, social distance, and abide by a nationwide curfew. At the time, Uganda had 89 confirmed COVID-19 cases, according to the Ministry of Health.
The public complied with these measures, even if the deaths from COVID-19 were minimal. After the second wave prompted a second lockdown, however, this one imposed for 42 days amid increased cases and deaths, the public was not taking it anymore. The only solution was (and is) mass vaccination.
As of August 2021, a total of 904,601 Ugandans had received the first jab, representing 79.4% of the total received doses, while only 250,664 had been fully vaccinated, according to the Ministry of Health.
The Ministry of Health has reported high vaccine uptake and low hesitancy among the public. I myself had to go to the local health facility five times, waking up early in the morning, to get my second jab—most health facilities would say they were out of stock. Eventually, I was able to get the second dose of the vaccine at a different facility from where I got the first one, and after a long wait.
Some officials attribute the high uptake to the second wave, which had a steady rise in cases, reaching a peak of 1,735 on June 10, 2021. As of June 30, 2021, cases started to decrease, but mortality still occurs.
On Aug. 14, there were 137 registered new cases out of the 3,372 tests conducted, and 11 new deaths. Predictions are that if standard operating procedures are not followed, within 28 days there will be an average of around 500 cases per day, with a weekly average of around 2,000.
A COVID-19 patient is treated at the Namboole Stadium, a makeshift COVID-19 treatment center, on July 09, 2021 in Kampala, Uganda. In June, Uganda’s President Yoweri Museveni tightened restrictions in the country following a rise in COVID-19 infections and deaths. The new stringent measures included a 42-day lockdown and restrictions on the movement of people. Uganda has seen over 85,000 COVID-19 cases, and just over 2000 deaths. Luke Dray/Getty Images
The Ministry of Health is seeking 9 million doses of the Johnson & Johnson vaccines, which it hopes to procure through the pool-purchasing entity Africa Vaccine Acquisition Task Team (AVATT), before the third wave hits.
As other countries push to “get back to normal,” Africa still has a long fight ahead. There is nothing luxurious about standing out of the queue. In fact, “people are yearning for vaccines. Africans have their arms stretched out waiting for vaccines—the situation has gone from people not interested to people protesting because there are no vaccines. There is no predictable supply of vaccines,” said Strive Masiyiwa, the African Union’s special envoy on COVID-19 and coordinator of AVATT.
Masiyiwa observed that hesitancy has apparently dropped and more people now want vaccines, especially after Africans have seen the devastation COVID-19 has wrought in other countries, including the United States.
“The third wave is raging in Africa and people are staying at home and not part of the crowds. While they remain locked up in their houses, they see what is happening in other countries. Ninety-nine percent of the people in US hospitals did not get a vaccine. They had a choice but they chose not to get them. They had a choice. They can get them anywhere, even on the subway,” he said.
It was 8:00PM on Tuesday when Marva Sadler looked at the patients waiting in the lobby, at the list of patients waiting to return, at even more patients waiting outside in cars surrounded by protesters—and realized they might not get to everyone. In four hours, a near total ban on abortions in Texas was set to take effect, and two dozen people were still waiting for the procedure at Whole Woman’s Health in Fort Worth, one of the largest abortion care clinics in the state.
“We are not the bad guys here,” [Sadler] told them. “We are doing everything right and we’re going to help everybody that we can.”
Sadler, the director of clinical services, and her colleagues did the math. They needed to perform eight abortions an hour with only one doctor on duty, an octogenarian who had been working since 7:00AM. It felt impossible.
Outside, chants came in through a bullhorn, protesters shouting prayer verses and arguing the clinic was too full. Already the police had been called. The fire marshal would come twice over capacity issues inside the clinic. Employees could see protesters through their security cameras and through windows of the small brick building.
They are watching us, Sadler thought, and they’re winning.
Inside, she looked at her team: eight people total between the techs and the front office staff, the doctor, and three staff members from a nearby clinic they brought in to help. She asked them to take a breath.
“We are not the bad guys here,” she told them. “We are doing everything right and we’re going to help everybody that we can. If there’s someone that we can’t help, it’s not our fault.”
At midnight Wednesday, Texas’ Senate Bill 8 became law, effectively banning abortions after six weeks of gestation—a time when most people aren’t even aware they are pregnant. Republican state lawmakers had fought to claw back abortion access before: In 2013, an anti-abortion bill banned the procedure in Texas 20 weeks post-fertilization and put a series of new regulations on abortion providers. Parts of the law were ultimately overturned in 2016 by the United States Supreme Court. It was Whole Woman’s Health, an abortion provider with clinics in five states, that sued to take that case to court. Sadler had been at the center of that fight, too.
SB 8 has also been appealed to the Supreme Court, with Whole Woman’s Health as the lead plaintiff in that case. But by Tuesday evening, with a full roster of patients to serve at the clinic in Fort Worth, it became clear that the high court would not step in before the law took effect.
The staff worked without stopping to eat, shifting patients in and out of rooms. In the lobby, people who had been waiting five hours or more asked when they would be called. They had to pick up other kids. Their ride was leaving. Their family members, who were outside because of coronavirus regulations, knocked on the front door to see what was happening. Would they be seen or turned away?
One young woman arrived at her first appointment to the clinic that same night. She was a drug user, she told Sadler, and set to begin serving a five-year prison sentence in a week. She already had three children at home. She didn’t want to deliver a baby in jail.
She dropped to her knees on the cold tile floor in front of Sadler, begging her to take her, to perform the abortion.
In Texas, patients have to wait 24 hours after their first appointment to get an abortion. The woman was 12 weeks pregnant, and on Wednesday, she’d be too far along to get the procedure.
It was that woman Sadler thought about later, as she drove away from the clinic, the adrenaline of the day washed away by waves of sadness and pain. The knowledge that, no matter what she did, she couldn’t help everyone.
Just before SB 8 took effect, at 11:56PM, the doctor walked out of his last procedure. Clinic workers got to everyone they were legally allowed to treat. In 17 hours, they’d performed 67 abortion procedures. They’d seen 60 people who had taken medication to abort at home to confirm that—yes, the process was complete, and they wouldn’t be left in limbo.
For a moment they were able to savor it. Sadler looked at the doctor and told him physicians half his age wouldn’t have been able to do what he did. Even if he only had performed one abortion, it would have been a victory, she said.
When they walked out of the clinic for the night, the protesters were still there, standing in the dark on the sidewalk, watching them. As part of the Texas law, private citizens can sue anyone they believe may have “aided or abetted” someone getting an abortion outside of the six-week window—and potentially win $10,000 or more in damages.
There were 77 people on their roster for the day—some of them real, some of them, Sadler suspects, protesters who called to make fake appointments to see if they could gain intel on what the clinic was telling its patients.
Protesters were still there Wednesday before Sadler arrived at 7:00AM.
Her staff was visibly drained from the day before, shuffling through the hallways and talking in low voices. There were 77 people on their roster for the day—some of them real, some of them, Sadler suspects, protesters who called to make fake appointments to see if they could gain intel on what the clinic was telling its patients.
Sadler knew she would have to go out and say something uplifting to her team, even as she knew this would be a day where she would have to deny people care.
“How unfair,” she kept thinking, “that those women yesterday were helped, and the women today don’t have any help.”
It was only 10:00AM, but she had already turned away four people—some as early in their pregnancies as five weeks and six days.
Donald Trump was the convenient scapegoat for the first year of the Covid-19 crisis. Austerity, low wage work, housing insecurity, and the profit driven health care system were problematic issues before anyone heard the word Covid-19 or indeed before Trump’s presidency. Every failing of the United States already in existence came into sharp relief when the pandemic struck.
Joe Biden has done nothing to alleviate these many crises. Temporary unemployment benefits end in September, and millions of people were denied these funds when republican state legislatures decreed that they wanted people back at work. The Supreme Court struck down the eviction moratorium and 90% of the funds allocated to pay for rent relief remain unspent. Millions of people face the prospect of becoming unhoused.
