Louisiana Illuminator

Dangers and deaths around Black pregnancies seen as a ‘completely preventable’ health crisis

Published

9 months ago

August 27, 2023

Staff Editor

lailluminator.com – Sandy West – 2023-08-27 10:00:58

Dangers and deaths around Black pregnancies seen as a ‘completely preventable' health crisis

by Sandy West, Louisiana Illuminator
August 27, 2023

HOUSTON — Tonjanic Hill was overjoyed in 2017 when she learned she was 14 weeks pregnant. Despite a history of uterine fibroids, she never lost faith that she would someday have a child.

But, just five weeks after confirming her pregnancy, and the day after a gender-reveal party where she announced she was having a girl, she seemed unable to stop urinating. She didn't realize her amniotic fluid was leaking. Then came the excruciating pain.

“I ended up going to the emergency room,” said Hill, now 35. “That's where I had the most traumatic, horrible experience ever.”

An ultrasound showed she had lost 90% of her amniotic fluid. Yet, over the angry protestations of her nurse, Hill said, the attending doctor insisted Hill be discharged and see her own OB-GYN the next day. The doctor brushed off her concerns, she said. The next morning, her OB-GYN's office rushed her back to the hospital. But she lost her baby, Tabitha Winnie Denkins.

Black women are less likely than women from other racial groups to carry a pregnancy to term — and in Harris County, where Houston is located, when they do, their infants are about twice as likely to die before their 1st birthday as those from other racial groups. Black fetal and infant deaths are part of a continuum of systemic failures that contribute to disproportionately high Black maternal mortality rates.

“This is a public health crisis as it relates to Black moms and babies that is completely preventable,” said Barbie Robinson, who took over as executive director of Harris County Public Health in March 2021. “When you look at the breakdown demographically — who's disproportionately impacted by the lack of access — we have a situation where we can expect these horrible outcomes.”

It kind of felt like I was watching myself lose everything.

– Kay Matthews, who miscarried 35 months into her pregnancy

In fact, Harris County ranks third, behind only Chicago's Cook County and Detroit's Wayne County, in what are known as excess Black infant deaths, according to the federal Health Resources and Services Administration. Those three counties, which also are among the nation's most populated counties, account for 7% of all Black births in the country and 9% of excess Black infant deaths, said Ashley Hirai, a senior scientist at HRSA. The counties have the largest number of Black births but also more deaths that would not occur if Black babies had the same chance of reaching their 1st birthdays as white infants.

No known genetic reasons exist for Black infants to die at higher rates than white infants. Such deaths are often called “deaths of disparity” because they are likely attributable to systemic racial disparities. Regardless of economic status or educational attainment, the stress from experiencing persistent systemic racism leads to adverse health consequences for Black women and their babies, according to a study published in the journal Women's Health Issues.

These miscarriages and deaths can occur even in communities that otherwise appear to have vast health resources. In Harris County, for example, home to two public hospitals and the Texas Medical Center — the largest medical complex in the world, with more than 54 medical-related institutions and 21 hospitals — mortality rates were 11.1 per 1,000 births for Black infants from 2014 through 2019, according to the March of Dimes, compared with 4.7 for white infants.

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The abundance of providers in Harris County hasn't reassured pregnant Black patients that they can find care that is timely, appropriate, or culturally competent — care that acknowledges a person's heritage, beliefs, and values during treatment.

Regardless of income or insurance status, studies show, medical providers often dismiss Black women's questions and concerns, minimize their physical complaints, and fail to offer appropriate care. By contrast, a study of 1.8 million hospital births spanning 23 years in Florida found that the gap in mortality rates between Black and white newborns were halved for Black babies when Black physicians cared for them.

In 2013, Houstonian Kay Matthews was running a successful catering business when she lost the daughter she'd named Troya eight months and three weeks into pregnancy.

Matthews hadn't felt well — she'd been sluggish and tired — for several days, but her doctor told her not to worry. Not long afterward, she woke up realizing something was terribly wrong. She passed out after calling 911. When she woke up, she was in the emergency room.

None of the medical staffers would talk to her, she said. She had no idea what was happening, no one was answering her questions, and she started having a panic attack.

“It kind of felt like I was watching myself lose everything,” she recalled. She said the nurse seemed annoyed with her questions and demeanor and gave her a sedative. “When I woke up, I did not have a baby.”

Matthews recalled one staffer insinuating that she and her partner couldn't afford to pay the bill, even though she was a financially stable business owner, and he had a well-paying job as a truck driver.

She said hospital staffers showed minimal compassion after she lost Troya. They seemed to dismiss her grief, she said. It was the first time she could remember feeling as if she was treated callously because she is Black.

“There was no respect at all, like zero respect or compassion,” said Matthews, who has since founded the Shades of Blue Project, a Houston nonprofit focused on improving maternal mental health, primarily for Black patients.

To help combat these high mortality rates in Harris County, Robinson created a maternal child and health office and launched a home-visit pilot program to connect prenatal and postpartum patients with resources such as housing assistance, medical care, and social services. Limited access to healthy food and recreational activities are barriers to healthy pregnancy outcomes. Studies have also shown a connection between evictions and infant mortality.

For Hill, not having insurance was also likely a factor. While pregnant, Hill said, she had had just a single visit at a community health center before her miscarriage. She was working multiple jobs as a college student and did not have employer-provided medical coverage. She was not yet approved for Medicaid, the state-federal program for people with low incomes or disabilities.

Texas has the nation's highest uninsured rate, with nearly 5 million Texans — or 20% of those younger than 65 — lacking coverage, said Anne Dunkelberg, a senior fellow with Every Texan, a nonprofit research and advocacy institute focused on equity in public policy. While non-Hispanic Black Texans have a slightly better rate — 17% — than that overall state level, it's still higher than the 12% rate for non-Hispanic white Texans, according to census data. Health experts fear that many more people are losing insurance coverage as COVID-19 pandemic protections end for Medicaid.

Without full coverage, those who are pregnant may avoid seeking care, meaning they skip being seen in the critical first trimester, said Fatimah Lalani, medical director at Houston's Hope Clinic.

Texas had the lowest percentage of mothers receiving early prenatal care in the nation in 2020, according to the state's 2021 Healthy Texas Mothers and Babies Databook, and non-Hispanic Black moms and babies were less likely to receive first-trimester care than other racial and ethnic groups. Babies born without prenatal care were three times as likely to have a low birth weight and five times as likely to die as those whose mothers had care.

Tonjanic Hill's twins, though premature, are now preschoolers. “I believe God — and the high-risk doctor — saved my twins,” she says.(Brandon Thibodeaux for KFF Health News)

If Hill's miscarriage reflects how the system failed her, the birth of her twins two years later demonstrates how appropriate support has the potential to change outcomes.

With Medicaid coverage from the beginning of her second pregnancy, Hill saw a high-risk pregnancy specialist. Diagnosed early with what's called an incompetent cervix, Hill was consistently seen, monitored, and treated. She also was put on bed rest for her entire pregnancy.

She had an emergency cesarean section at 34 weeks, and both babies spent two weeks in neonatal intensive care. Today, her premature twins are 3 years old.

“I believe God — and the high-risk doctor — saved my twins,” she said.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Louisiana Illuminator is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Louisiana Illuminator maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and Twitter.

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Louisiana Illuminator

Gambling on a constitutional convention • Louisiana Illuminator

Published

18 hours ago

May 16, 2024

Staff Editor

lailluminator.com – Robert Collins – 2024-05-16 09:31:15

by Robert Collins, Louisiana Illuminator
May 16, 2024

Louisiana Gov. Jeff Landry recently requested that the Legislature call a constitutional convention. He says the current constitution is too restrictive, and forbids cuts to most agencies, resulting in most cuts falling on higher education and healthcare. He also says that most of the amendments in the constitution should be statutes that can be changed by the state Legislature.

The enabling legislation that made it out of the House proposes to hold a two-week convention starting Aug.1, with convention committees meeting prior to the convention to receive public comments.

The current Louisiana constitution is a flawed and excessively-amended document and should be rewritten at some point. However, the legislation being sent over to the Senate for debate is setting up a rushed, high-risk process that makes it difficult for ordinary citizens to have their voices heard. It would increase the influence of the governor by giving him more discretionary power over how state money is spent, but it's unclear how it would help ordinary citizens.

The first problem with current convention legislation is the lack of public input. The constitutional convention of 1973 had a long series of open meetings that stretched over an entire year. Meetings were not only held in Baton Rouge. Committee members traveled to all parts of the state to make sure that any citizen who wanted to participate in a public meeting received the opportunity.

The 1973 convention was composed primarily of elected delegates. Some were state lawmakers, some were local officeholders, but many were simply private citizens who chose to run for a delegate seat. The current legislation calls for a convention of strictly state legislators and gubernatorial appointees. It's not really a recipe for broad public participation.

This is especially problematic for the urban areas of the state. The main protection that a city such as New Orleans, a heavily Democratic city in a Republican state, has is a home rule charter. The central structure of city government is shielded from state interference by the home rule charter rights written into the constitution. A hostile group of delegates could weaken the home rule charter provisions in the document. They could choose to change the form of government of the city altogether, taking away the power of the mayor and City Council to appoint members of city boards and commissions, such as the City Planning Commission or Sewerage & Water Board, and give those powers to the state.

The governor's legislative floor leaders have responded to criticism that the time period allocated to write a new constitution is too short to allow broad public participation by describing the new constitution as a refresh or a streamlining. They argue that their goal is not to write a new constitution from scratch, but simply to remove all of the provisions that should be legislative statutes. Their stated plan is a “limited convention.”

There is no such thing as a limited convention. There is nothing in Louisiana law that would stop delegates from immediately expanding the scope of the convention once they go into session. History indicates that governors and legislative floor leaders usually lose control of these conventions.

Veteran political journalist Jeremy Alford, in his book, “The Last Constitution,” said that the last time the state wrote a new constitution, in 1973, newly-elected Governor Edwin Edwards ran on a very specific set of constitutional reforms. Since Edwards was a popular and powerful governor, everyone expected the delegates to follow his charge. Alford said: “The delegates, however, ignored that charge and penned a plan for drafting their own constitution on the back of a cocktail napkin from Pastime Lounge, which in turn became one of the first official documents entered into the convention record.”

Given the high stakes of getting this convention wrong, it is time for the Senate to slow the process down, stretch it out, schedule public meetings across the state, and bring more private citizens into the process.

Ultimately, the voters will have the final say because a new constitution must be approved by a simple majority in a statewide vote. It would be preferable to bring broad public participation at the start of the process rather than waiting until the end. Rushing the process and excluding most of the voters runs the risk of dealing the state a losing hand in the end.

This article first appeared on Verite News and is republished here under a Creative Commons license.

Louisiana Illuminator is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Louisiana Illuminator maintains editorial independence. Contact Editor Greg LaRose for questions: info@lailluminator.com. Follow Louisiana Illuminator on Facebook and Twitter.

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Louisiana Illuminator

Ranked-choice voting close to being illegal in Louisiana • Louisiana Illuminator

Published

1 day ago

May 15, 2024

Staff Editor

lailluminator.com – Wesley Muller – 2024-05-15 18:28:24

by Wesley Muller, Louisiana Illuminator
May 15, 2024

Louisiana House lawmakers approved a bill Wednesday to outlaw ranked-choice voting, a method of elections they claim is too susceptible to fraud even though thousands of military members have used it for decades.

Senate Bill 101, sponsored by Sen. Blake Miguez, R-New Iberia, passed the House in a 74-22 vote and will return to the Senate for concurrence before heading to Gov. Jeff Landry, who is expected to sign it into law.

The vote fell mostly along party lines with every Republican voting in favor of the proposal and most Democrats voting against it except for Reps. Roy Daryl Adams of Jackson, Marcus Bryant of New Iberia, Robby Carter of Amite and Steven Jackson of Shreveport.

Miguez's bill prohibits local governments from holding ranked-choice elections, with an exception for out-of-state military members who have used it in Louisiana elections for decades.

Ranked-choice voting, also called “instant-runoff” voting, allows voters to list candidates in order of preference rather than select just one. It has grown increasingly popular across the country for its ability to temper extreme partisanship and give moderates and third-party candidates a better chance in elections.

When ballots are tallied on Election Day, the race is over if any candidate nets more than 50% of the first-place votes that are cast. If no candidate gets a majority in the first round, then the candidate with the fewest votes is eliminated. If a voter's first choice is eliminated, rather than his vote being wasted, it is applied to his second favorite candidate. The process continues with the lowest ranking candidates being tossed out until one candidate gets more than half of the votes.

During committee hearings on the bill, Miguez falsely claimed ranked-choice voting “guarantees that ballots are thrown in the trash.” It echoes national lobby groups that have blamed ranked-choice voting for helping defeat their preferred candidates and are now trying to get states to ban it.

Miguez's arguments against ranked-choice voting lean on misinformation

Military service members stationed out of state or overseas have used ranked choice to vote in Louisiana elections with no issues since the 1990s. There has never been evidence that their ballots have been disposed of without being counted as Miguez claimed.

Rep. Beau Beaullieu, R-New Iberia, presented the bill to the House floor Wednesday on behalf of Miguez, claiming ranked choice disenfranchises voters. He was unable to offer specifics when House Democrats pressed him on the claim and asked why, if the claim is true, has it never disenfranchised Louisiana's military voters.

Miguez's bill is part of Republican Secretary of State Nancy Landry's legislative agenda. Landry has argued ranked-choice voting can sometimes be complex and confusing, which is believed to have been the case in some elections.

An analysis of a 2004 ranked-choice election in San Francisco found that it might have led to lower engagement among African Americans, Latinos, less educated voters and those whose first language was not English, according to the Alaska Policy Forum.

However, other states and municipalities report success with ranked choice. Polling after the 2021 election in Utah found 86% of voters liked the system, and 81% said it was easy or somewhat easy to use, according to the Salt Lake Tribune.

Ranked-choice voting is used in more than 50 cities across 14 states. Colorado, Nevada and Oregon are on track to consider adopting it this year for statewide elections. It is even credited with helping Republicans break a decade-long losing streak in Virginia with the 2021 election of Gov. Glen Youngkin.

Like Miguez's bill, legislation in four other southern states seeking to ban ranked-choice voting includes exceptions for overseas military voters.

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