Bearing the Burden of Injustice: Black Maternal Mortality

Mother and babyWhen it comes to maternal mortality, American women don’t all live in the same country. While white women live in Qatar, black women live in Mongolia.

Maternal mortality is death related to complications from pregnancy or childbirth. Most of us don’t come from a time or place where the prospect of dying in childbirth is a tangible possibility — in the past century, as medicine has advanced, maternal mortality rates have plummeted.


To raise healthy families, we need access to general and reproductive health care, including preventive care, prenatal care, and maternity care.


The United States, though, hasn’t come as far as would be expected. Although its wealth should have put it on par with other developed nations like Canada, the United Kingdom, Australia, Japan, and those in Scandinavia, women in these countries fare far better than those in the United States. So do women in Libya, Bosnia and Herzogovina, Bulgaria, and Kazakhstan, indicating that national priorities — and not necessarily national wealth — are key to ensuring maternal health.

The United States’ high maternal mortality rate is heartbreaking no matter how you look at it, but is even worse for women of color. African-American women are 3.5 times more likely to die as a result of pregnancy or childbirth than white women. Between 2011 and 2013, the maternal mortality rate for white women was 12.7 deaths per 100,000 live births. Comparing that to 2015 data from the World Health Organization (WHO), that rate puts white women’s maternal mortality on par with mothers in Qatar and Bahrain, two wealthy Persian Gulf nations. African-American women, however, suffered 43.5 deaths per 100,000 live births, putting their maternal mortality on par with those of Turkmenistan, Brazil, and Mongolia. Continue reading

A Gun in the Oven

Last month, during an Arizona House debate on whether to ban bump stocks, which make semiautomatic rifles fire almost as fast as machine guns, Rep. Kelly Townsend (R-Mesa) blamed abortions for the epidemic of school shootings: “We are in a culture of death where it’s OK if you have an unwanted pregnancy to just go ahead and kill that child.”

This is not the first time a link between abortion access and school shootings has been suggested. In his commencement speech at the University of Maryland in 2013, U.S. Rep. Kevin Cramer (R-ND) proclaimed, “Forty years ago, the United States Supreme Court sanctioned abortion on demand. And we wonder why our culture sees school shootings so often.”

All morning, I’ve been trying to get inside the heads of these two legislators and follow the twisted reasoning behind their statements. Perhaps a Vulcan mind meld might work, though I suspect my brain could be permanently damaged. But, in the spirit of inquiry, I’ll take that risk.

OK, now that our minds are melded, I think I see a grand vision unfolding. Continue reading

What’s in a Name? Frances Oldham Kelsey and the Power of Skepticism

If Dr. Frances Oldham Kelsey had been named Mary, Helen, or Dorothy, it’s possible that thousands of babies would have died or been born with debilitating birth defects.

In the mid-1930s, after earning a master’s degree in pharmacology in her native Canada, Frances Oldham wrote to Eugene Geiling, a researcher at the University of Chicago, asking to work in his lab and study for a doctorate. Assuming Frances was a man, Dr. Geiling replied with an offer of a scholarship, addressing the letter to “Mr. Oldham.”


Dr. Kelsey upends the stereotype of the government bureaucrat. She saved lives by being a stickler for details.


Reflecting on the incident in an autobiography, she remembered Dr. Geiling as a “very conservative and old-fashioned” man who “did not hold too much with women as scientists.” His assumption that Frances Oldham was male might have played a role in her scholarship and subsequent education, which prepared her for a career that touched every American.

From an Early Victory in Chicago to a New Career in Washington, D.C.

After moving to Chicago, Frances Oldham earned a doctorate in pharmacology in 1938 and a medical degree in 1950. Along the way, she got married, becoming Dr. Frances Oldham Kelsey, and gave birth to two daughters.

Her work in Dr. Geiling’s lab provided early experience in unraveling medical mysteries. In 1937, more than 100 people, including 34 children, died after taking a liquid sulfa drug formulated with an artificial fruit flavor. Dr. Geiling’s team of scientists soon identified the problem: The medicine was composed primarily of antifreeze — along with the active ingredient, coloring, and flavorings. It was sent to market with no testing. Public outrage led to the 1938 passage of the Food, Drug, and Cosmetic Act, which required manufacturers to provide evidence to the FDA that their drugs were safe. Continue reading

Why Do Newborns Need the Hepatitis B Vaccine?

The first vaccine a baby receives — within hours or days of birth — protects them from hepatitis B virus (HBV). In a lot of people’s minds, HBV is associated with drug use and sexual activity — which stigmatizes people who have been infected with HBV or are carriers of the virus. Unfortunately, this stigma causes a lot of people to question why babies even need to be vaccinated against it, often pointing to “Big Pharma” conspiracy theories. A lot of other people are put off by the misconception that the HBV vaccine is made with human blood (it’s not).


May is Hepatitis Awareness Month, a time to learn about a childhood vaccine that’s saved millions of lives.


There are perfectly good reasons to vaccinate babies against HBV, mainly that HBV is the leading cause of liver cancer, itself one of the Top 10 types of cancer worldwide. Nine out of 10 infants born to a mother who is an HBV carrier will develop chronic infections and become carriers themselves — and a quarter of them will die prematurely of liver disease. Babies who develop chronic HBV infections are 63 times more likely to develop liver cancer than non-carriers, a connection that is 2 to 3 times stronger than the link between smoking and lung cancer.

When it comes to HBV, age at infection matters. Most people with chronic HBV infections are exposed at birth or in early childhood, when they are most likely to develop chronic, lifelong infections — whereas only 2 to 6 percent of infected adults will develop chronic infections, with only 15 percent of them eventually dying from liver disease. The fact that chronic infection risk is inversely correlated with age at infection means that birth is the time when a child is the most vulnerable to this virus — hence the importance of vaccinating as early as possible. Continue reading

STD Awareness: Sexual Transmission of Zika Virus

Zika

Zika virus. Image: Cynthia Goldsmith, CDC

I first heard of Zika virus in an epidemiology class, when another student made on offhand remark: “Did you know Zika virus can be transmitted sexually?” Ever vigilant for material for the STD Awareness column, I excitedly scribbled the name of the virus in my notes. But upon further investigation, I found that there were only a couple of documented cases of the sexual transmission of this virus that no one had heard of, and decided there was no reason to freak people out about yet another potential STD when rates of more common STDs, like chlamydia and gonorrhea, were on the upswing.

A year later, Zika virus was splashed across headlines on a daily basis, mostly for its newfound association with birth defects, but also in light of revelations that it could be transmitted by sex.


Access to condoms and reliable contraception is more vital than ever.


While Zika virus is usually transmitted by mosquito bites, the discovery that it can be sexually transmitted made it the only known virus that could be spread both sexually and by mosquitoes. It’s also the only known mosquito-borne virus that can cross the placenta to harm a fetus. Like several other viruses, including CMV and rubella, Zika is implicated in serious birth defects. But many health authorities worry that its potential as a sexually transmitted pathogen is dangerously underestimated. As of August 31, there have been 23 confirmed sexually transmitted cases of Zika virus in the United States — but sexual transmission will rise as the virus jumps into local mosquitoes, which will also make it difficult or impossible to tell if a sexually active Zika patient got the virus from sex or directly from a mosquito.

Earlier this year, sexually transmitted Zika virus in Texas made headlines, with many journalists incorrectly proclaiming it the first known case of sexual transmission. In fact, Zika’s sexual transmission was first documented in 2008, before “Zika” was a household name and the married couple who published their experience in a scientific paper thought they could share their STD status in relative obscurity. Despite referring to themselves as “Patient 1” and “Patient 3,” a science reporter quickly figured it out and (with their permission) revealed their identities in a 2011 article — still years before Zika-bearing mosquitoes would hit the Americas and trigger a microcephaly epidemic that propelled the virus to infamy. Continue reading

STD Awareness: What Does “Congenital Syphilis” Mean?

Treponema pallidum, the bacteria that causes syphilis

Treponema pallidum, the bacteria that causes syphilis

Congenital syphilis, for centuries a leading cause of infant mortality, is often thought of as an antique affliction, relegated to history books — but it is on the rise again. Between 2012 and 2014, there was a spike in congenital syphilis rates, which increased by 38 percent and are now the highest they’ve been in the United States since 2001. As of 2014, the last year for which we have data, more babies were born with syphilis than with HIV.

The word “congenital” simply means that the baby was born with syphilis after being infected in the womb. When an expecting mother has syphilis, the bacteria that cause the disease can cross the placenta to infect the fetus — and will do so 70 percent of the time. As many as 40 percent of babies infected with syphilis during pregnancy will be stillborn or will die soon after birth. It can also cause rashes, bone deformities, severe anemia, jaundice, blindness, and deafness. Congenital syphilis is especially tragic because it’s almost completely preventable, especially when expecting mothers have access to adequate prenatal care and antibiotics. Penicillin is 98 percent effective in preventing congenital syphilis when it is administered at the appropriate time and at the correct dosage.


More babies are being born with syphilis — but this trend can be reversed with wider access to prenatal care.


Incidence of congenital syphilis is growing across all regions of the country, but rates are highest in the South, followed by the West. Rates have also been increasing across ethnic groups, but, compared to white mothers, congenital syphilis rates are more than 10 times higher among African-American mothers and more than 3 times higher among Latina mothers, illustrating the need to increase access to prenatal care for all expecting mothers — and to ensure that this prenatal care is adequate.

Anyone receiving prenatal care should be screened for syphilis at their first visit, and some pregnant people — including those at increased risk or in areas where congenital syphilis rates are high — should be screened a second time at the beginning of the third trimester and again at delivery. Continue reading

STD Awareness: June Is National Congenital Cytomegalovirus Awareness Month

CMVPop quiz: Can you name the virus that most commonly infects developing fetuses when they are still in the womb?

Here’s a hint: June is National Congenital Cytomegalovirus Awareness Month.

In case that clue didn’t make it obvious enough, I’ll tell you the answer. The most common infection among developing fetuses is caused by a virus you might not have heard of: cytomegalovirus, or CMV. Around 30,000 children are born with this infection every year, and some of these babies will go on to develop serious problems because of it. National Congenital Cytomegalovirus Awareness Month is a time to learn about how CMV can affect pregnancy.


Cytomegalovirus can damage developing brain cells early in an embryo’s gestation.


This year, it might be of even greater interest, given the parallels that can be drawn between CMV and Zika virus, the emerging pathogen that has been dominating headlines lately. First of all, both CMV and Zika virus can be transmitted sexually, though they are not the first things you think of when the topic of STDs comes up, as they are overshadowed by more famous sexually transmitted viruses like herpes and human papillomavirus. While many of us are infected with CMV as children, we can also be infected as adults, often through sexual transmission — the virus can be found in cervical and vaginal secretions, saliva, and semen. The sexual transmission of Zika virus is not as well understood, but we know it can be found in semen, and there are documented cases of men passing the virus to sex partners through vaginal and anal intercourse. It might even be transmitted from a male to a partner by oral sex.

Second of all, both CMV and Zika virus are associated with birth defects. However, while the connection between CMV and birth defects has been known to us for decades, it was only in April that the Centers for Disease Control and Prevention concluded that Zika virus can cause fetal brain defects (though we’re still waiting for conclusive proof). Microcephaly is probably the most infamous of the birth defects associated with Zika virus, as well as CMV, but it’s not well defined. When you get down to it, though, microcephaly just refers to an abnormally small head, which itself might be indicative of a brain that has failed to develop fully. Continue reading