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Black Pregnancy Dangers, Deaths Seen as a ‘Completely Preventable’ Health Crisis_我的网站

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直播吧08月10日讯亚足联、欧足联、中北美及加勒比海足球协会发布联合声明，表示国际足联并未认识到此前的提案存在根本性错误，试图出售世界杯是对各机构间信任的背叛。

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.

“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.”

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. That means 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.

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 was 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.

Hill’s twins, though premature, are now preschoolers. “I believe God — and the high-risk doctor — saved my twins,” she says.(Brandon Thibodeaux/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.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF. It has been published with permission.

。联合声明：致足球大家庭的公开信亲爱的足球大家庭：足球是全世界最伟大的共同热爱。它不属于任何个人，也不属于任何机构。它属于球员、球迷、俱乐部、会员协会，以及每一个受委托守护其未来的机构。

二 | 正是本着这种精神，我们作为代表各自会员的联合会，今天共同发声。过去十年的发展是实实在在的。但这种进步从来不是某个人的功劳。它是国际足联、各大洲联合会、各会员协会以及成千上万为这项运动奉献一生的人们共同努力的成果。赛事规模的扩大、2030年和2034年国际足联世界杯主办权的授予、对各协会的资源分配——这些都是共同的成就，共同商议，共同落实。这与金钱无关。各大洲联合会已经呼吁对国际足联庞大的现有储备金进行负责任分配，以进一步加强对各会员协会发展的投入。这也不是关于某个会员协会会失去其应得的支持——尽管有人向我们的会员散布恐惧言论，暗示情况并非如此。这同样不是关于重新讨论赛事扩军、世界杯名额分配或其他任何集体作出的决定。这些决定是大家一起做出的，它们应当维持不变。

三 | 这关乎的是更根本的东西：这项运动的诚信，以及被选举出来领导这项运动的人们的诚信。足球领域的领导权不是一种占有物。它不是关于把持权力——或要求把持权力。它是对托付这份信任的足球大家庭的一种服务职责。当信任因欺骗而被打破，当一个人将自己凌驾于曾赋予他权力的集体之上时，这份职责就被抛弃了。国际足联最近致其副主席及211个会员协会的信函承认，在这一过程中犯了错误。

四 | 但它将此视为沟通上的失误，而足球界目睹的却是一次判断上的失败。在压缩的时间表下推进一项提案，未经有意义的协商，并在会员协会未能适当审查其条款之前就推向截止日期——这不是疏忽的产物，而是旨在限制审查的设计产物。该信函并未承认该提案本身在根本上是错误的。仍然没有人认识到，试图出售国际足联世界杯的权益是一次严重的判断失误——这不仅仅是程序上的失当，更是对国际足联本应服务的各机构之间信任的根本违背。国际足联还承诺将就这些事件向国际足联理事会提交一份全面报告，这再次未能认识到，面对如此严重的判断缺失，恰当的治理要求此类审查应由完全独立的第三方进行，而不是由国际足联自身、其工作人员或足球界的任何利益相关者来进行。国际足联行政部门在开展审查过程中不应发挥任何作用。根据此前的通信，所有相关文件和记录必须按照欧足联关于文件保存的通信要求予以保存。国际足联自己的信函还证实，在摩洛哥的领导层会议中，只有一位民选官员出席。没有国际足联理事会成员或会员协会受邀参加。只有由国际足联聘用高级职员组成的管理委员会在场。最近这次会议——只召集了国际足联管理委员会的少数成员（而非全体委员会）出国开会，而非领导层前往苏黎世面对国际足联的核心及其工作人员——只会加剧这些担忧，并且是导致我们走到今天这一步的那种行为模式的延续。