Reposted with permission from Newsweek, where this article was first published on May 9, 2021

In our nation, babies are born into a system of well-child care—a series of planned health care visits designed to protect their health from day one through age six. But what about their mothers? No such system exists for them after the postpartum visit.

Our fragmented health care system offers no bridge across the chasm that separates maternity care and ongoing primary care. This chasm harms many mothers; for Black and Indigenous people, the gap in care too often means the difference between life and death. The U.S. maternal mortality rate is the highest among affluent nations, and Black and Indigenous mothers are 3.5 times more likely to die from pregnancy-related causes than are white mothers. One-third of these deaths occur between one week and one year postpartum (in the chasm); and for every maternal death, there are at least 100 near misses. When complications, such as hypertension and diabetes, are not followed by primary care after pregnancy, chronic illness can develop.

We write as scientists, clinicians and advocates to argue for an emergency plan to fill the gaping hole in women’s health care.

Pregnancy care should be conceptualized not as a singular event or series of events, but as a key source of information for women’s health care prevention and treatment needs across the life course. Creating a bridge to support such health care could also help to address the persistent disrespect and racism commonly experienced by Black mothers in health care settings.

Pregnancy is a stress test on women’s bodies, revealing clues about underlying and future health. Complications such as gestational diabetes, hypertensive disorders of pregnancy, pre-eclampsia, depression and substance use disorder affect up to a quarter of pregnant people. These conditions play an important role in women’s health in the year after birth and are harbingers of future chronic illness that can be prevented or ameliorated.

Gestational hypertension and preeclampsia, for example, double the risk for heart disease and stroke, the leading causes of death in women aged 35-54. Gestational diabetes, which occurs in about 10 percent of pregnancies in the U.S. annually, raises the likelihood of type 2 diabetes sevenfold in the decade after pregnancy. About one-third of the 10 million adult women with type 2 diabetes first had gestational diabetes, which could have opened the door to effective prevention. Yet for most the door does not open; only 20-50 percent receive the recommended testing and preventive care in the years following pregnancy. The physical, emotional and economic burden of type 2 diabetes (estimated at $327 billion per year) and all chronic illness over one’s life course is enormous for families and society.

What do we have to do to create a system of health care for mothers that mirrors well-child care?

The American Rescue Plan Act, with its child tax credit, investments in child care and allowance for states to choose to extend Medicaid coverage to pregnant mothers from 60 days to one year postpartum, is a step in the right direction. But there is much more that could be done.

Health systems could be held accountable to metrics that track the racism and disrespect in maternal health care. High-touch models of care (doulas, midwives) offered during pregnancy could be extended to the full postpartum year to assure follow up of complications and connection to primary care. Medicaid for pregnancy-eligible women could be extended to 365 days (instead of the current 60 days) and all insurers could manage integration between maternity and primary care providers. Reforms in electronic medical record systems could promote transfer of pregnancy experiences to future providers. Research funding could support the development of evidence-based approaches to assure that women stay connected to preventive care beyond pregnancy and the postpartum period, across their life course.

These and other changes are laid out in a recently released national agenda co-created by a collaboration of women with lived experience, clinicians, researchers, advocates, policy-makers and health system leaders.

Given that women bear the burdens of pregnancy and child birth, we would do well to honor mothers by establishing policies and practices that build a bridge between maternal care and well-coordinated primary care for mothers. Individuals, for their part, can voice support for legislation and funding initiatives that invest in insurance coverage and continuous, coordinated care that mothers, particularly Black and Indigenous mothers, need long after babies are born.

Lois McCloskey is associate professor of community health sciences and director of the Center of Excellence in Maternal and Child Health at Boston University School of Public Health. Ann Celi is associate physician at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School. Chloe Bird is a senior sociologist at the nonprofit, nonpartisan RAND Corporation.

By now it is well-known that Covid-19 exacerbates pre-existing economic and health inequities, something clearly shown in the disproportionate rates of mortality, unemployment, and food and housing insecurity in African American communities during this pandemic. This paper reports new research on another disparity that has been amplified by the pandemic — exposure of African American youths to community violence, often resulting in symptoms of Post-Traumatic Stress Disorder. Analysis of the behaviors that protect youth from experiencing such violence suggests that educators and psychologists need to rethink their understanding and treatment of PTSD in this population.

Even before the pandemic, as many as 97 percent of African American youth in some highly disinvested urban communities had witnessed at least one incident of community violence over the course of adolescence. But in 2020, the U.S. saw the largest single one-year surge in homicides since the government began compiling such records, with Chicago experiencing a 37 percent increase in murders during the first half of 2020 compared to the first half of 2019.  These increases have disproportionately impacted Black communities. Violence exposure, compounded by elevated levels of deaths and hospitalization of loved ones, economic loss, food insecurity, and residential instability, has placed Black children and adolescents at the epicenter of loss during the pandemic. As students begin to transition back to in-person learning, school officials must be ready to respond to the effects of loss and trauma by relying on trauma-informed and trauma-responsive practices, rather than punitive discipline practices.

For African American children and teens, the recent increase in community violence is compounded by the stress of the pandemic, rise in hate crimes, and disproportionate exposure to incidents of police violence towards African American men and women, diminishing their sense of safety.  This makes even more urgent the need for research that can help us understand and minimize the long-term negative effects of exposure to community violence on African American youth.

It is important to put this violence into perspective. Research with nationally representative samples of adolescents demonstrates that 85% of African American adolescents show little to no engagement in delinquent and risky behavior, with only 7% engaging in high levels of delinquent behavior and only 6% showing gang affiliation. Among all Americans, violent crime is clustered in areas of concentrated and severe poverty, but due to systemic racism and social stratification, African American Americans disproportionately reside in these areas. In some urban areas, for example, African Americans are almost four times more likely than other residents to live in neighborhoods where the poverty rate is 40% or higher.

Furthermore, engagement in violent behavior is not widespread even among African American youth in such severely deprived neighborhoods. Sociological research shows that violent crime in urban communities is concentrated in a very small network of individuals linked to one another by co-engagement in violent crimes. In Chicago, for example, 70 percent of all non-fatal shootings occur in networks comprising less than 6 percent of Chicago’s total population. But the activity of this small network affects everyone living in the neighborhood, so the impact of violent crime by a small number of residents on African American youth’s well-being is widespread.

Individuals who have been exposed to community violence often develop symptoms of Post-Traumatic Stress Disorder (PTSD), including a cluster of symptoms that characterize physiological hyperarousal. Hyperarousal symptoms are rooted in the body’s neurophysiological response to stress, and an important component of a hyperarousal response is hypervigilance, which refers to a state of extreme alertness and awareness of one’s surroundings.  Hypervigilance enhances our ability to detect and react to threatening stimuli in our environment, while hyperarousal helps mobilize our body’s resources to maximize survival in the face of danger. Psychologists agree that these are appropriate and advantageous responses to an emergency.

However, hyperarousal and hypervigilance that persist after the emergency has passed have traditionally been considered to be debilitating and maladaptive. For youth exposed to community violence, posttraumatic hyperarousal can lead youth to overreact to perceived threats.  As such, educators and psychologists see such reactions as disruptive behaviors or hyperactivity that youths must be taught to overcome. But is it possible that maintaining a fairly constant level of hyperarousal and hypervigilance in the context of persistent community violence could actually be protective rather than maladaptive?

That is certainly how some young men see it themselves. For example, in 2012 and 2013, Smith and Patton (2016) conducted in-depth interviews with 37 young African American men in Baltimore, ages 18 –24, who had experienced the homicide death of a loved one. All the young men they interviewed were experiencing symptoms of PTSD, with hypervigilance the most frequently reported symptom.  However, the young men themselves described their constant hypervigilance as a potent coping strategy to stay safe in adverse and unpredictable contexts. They called it “being on point.” Is it possible that behaviors psychologists have found to be pathological or debilitating for middle-class patients in relatively secure situations may be adaptive ways of navigating dangerous and unpredictable environments? Could hyperarousal and hypervigilance actually reduce an individual’s exposure to community violence?

In a new study, my colleagues and I sought to answer these questions.  We collected survey data over a one-year period with a group of African American male high school students living in under-resourced urban communities in Chicago.  We wanted to know if physiological hyperarousal symptoms, particularly hypervigilance, predicted less exposure to community violence over time. We also wanted to examine the impact of aggressive vs. avoidant responses to threats. The boys in our study reported on how frequently they witnessed community violence or were direct victims of community violence, how frequently they experienced physiological hyperarousal symptoms, and how frequently they engaged in aggressive behavior.

Here is what we found: First, 85 percent of the boys in our study reported experiencing symptoms of physiological hyperarousal, with hypervigilance (being overly careful or frequently checking to see who and what is around you) being the most frequently reported symptom. These findings are consistent with research on African American adult men.

Second, we found that higher levels of hypervigilance predicted less likelihood of witnessing community violence one year later, after controlling for initial levels of witnessing violence.  Hypervigilance may help youth to pick up on clues that an area is unsafe or that a violent incident between others is imminent. For African American boys in the current study, being vigilant, or even overly careful may have allowed them to avoid potentially dangerous situations or locations where violence might occur in their communities.

Surprisingly, however, such cautious avoidance tactics, while lessening the amount of community violence the boys witnessed, did not necessarily protect them from experiencing violent victimization. We found that higher levels of physiological hyperarousal predicted lower levels of victimization over time only when boys also reported using high levels of physical aggression. Hyperarousal was protective only at high levels of physical aggression.

Earlier studies have shown that physiological hyperarousal leads some young adult men to utilize aggressive means of self-protection and proactive posturing to reduce perceptions of vulnerability.  Such behavior can be counter-productive in some settings, but our findings show that in unsafe and under-served communities, boys who are physiologically prepared via hyperarousal to respond to direct threats of violence, and who project a strong likelihood of responding aggressively to such threats, are more likely to avoid being victims of violence.

These findings raise an important question about the many interventions and treatment efforts that focus on reducing hyperarousal and other PTSD symptoms. Are we undermining or actually disabling needed survival strategies through our intervention efforts? And if so, will the young people we serve see our efforts as relevant for their daily life experiences?

It is important to note that the responses shown by boys in the current study are not unique to the African American experience, but rather are rooted in the context of traumatic stress.  Heightened, and even sustained, levels of physiological arousal and hypervigilance are shown by individuals exposed to other traumatic stressors, such as sexual assault, combat, and natural disasters.  What is different about community violence exposure is that the trauma exposure is an ongoing and recurring threat, as opposed to existing only in the past. In this context, “post” traumatic stress symptoms may be a realistic response to “continuous” traumatic threat.

To work towards more effective and contextually relevant solutions for African American boys exposed to community violence, we need interventions that are sensitive to our finding that hyperarousal, hypervigilance, and aggressive responses to perceived threats may be protective in contexts of traumatic and unpredictable stressors. Rather than trying to eliminate these symptoms altogether, we might do better to focus on increasing youths’ mindful awareness about what triggers these reactions and in what circumstances they are likely to be protective. Targeted interventions might help youths better distinguish between contexts where these symptoms and behaviors are adaptive (such as in interactions with potential threats in certain areas of their neighborhood) versus where they are not adaptive (such as in a work setting) and teach boys how to use them selectively. To ensure that interventions are relevant to the daily experiences of African American youth, intervention design efforts must utilize community-based participatory research strategies to enlist youth as active partners in a process where their voices and opinions are heard, valued, and honored.

At the systems level, we need a more carefully calibrated approach in settings such as schools, where responses to these behaviors are often punitive and harmful. For example, exclusionary discipline policies are direct predictors of academic underachievement, high school dropout rates, contact with the juvenile and criminal justice systems, and criminal victimization, as well as criminal activity.  Community violence exposure is a health issue, rather than a criminal justice issue.  Given the traumatic nature of exposure to such violence, we need to work to understand what young people have experienced rather than punishing them for how they react to what they have experienced.  And of course, a primary goal of those working to community violence exposure should be to implement racially just policies that focus on economic and social investment in under-resourced communities to eradicate the underlying conditions that heighten violent crime.

Acknowledgments 

The study discussed in this briefing paper is part of the January/February 2021 special issue of the Journal of Applied Development Psychology devoted to highlighting how boys and young men of color successfully adapt to adverse environments, and in particular, how the unique demands of various inhibiting contexts may shape adaptive behaviors through conditional adaptation. I would like to thank the co-authors of the study, Jenny Phan, Suzanna So, and Alvin Thomas.  I would also like to thank Stephanie Coontz for her invaluable assistance and feedback on this briefing paper.

Noni Gaylord-Harden is a Professor of Psychology at Texas A & M University. 

Reprinted with permission from Ms.

The COVID-19 quarantine has been more than an involuntary lockdown for me: It has become an unexpected opportunity to weave memories, priceless recollections that have revealed the patchwork quilt that has been holding —all along—my feminist consciousness. Engaging in this active recollection of magnified moments has been validating and soothing as a feminist, and as a never-married woman living alone.

In her analysis of advice books for women, feminist sociologist Arlie Hochschild (1994) identifies magnified moments as:

“episodes of heightened importance, either epiphanies, moments of intense glee or unusual insight, or moments in which things go intensely but meaningfully wrong. In either case, the moment stands out; it is metaphorically rich, unusually elaborate and often echoes throughout the book.”

In the unwritten book of my own life story, these magnified moments have emerged through past conversations with my mother—which took place in the context of everyday life, from childhood to present.

In my memory work, I recall her words in Spanish and offer my most accurate and precise translation in English of these brief, but vivid recollections.

Late 1960s

“Listen, when you grow up you are going to go to school so you can have a good job and don’t have to depend on a man.”

I remember her giving me a stern warning, crying while washing the dishes and talking to me as I stood next to the sink listening attentively. Sobbing, she complained about not being able to go to school or have a paid job. I was 8 or 9, and I had my eyes wide open not knowing what to say or how to console her.

Early 1970s

“No, no, no. Do not put any makeup on her. I think that when she grows up, she going to be like those women who think and write.”

Her words stick with me. She was reacting to my older sister, who was telling me, with an animated voice, to get closer so she can put some makeup on me. I was probably 12 or so.

Mid 1970s

“So what do you think about today’s mass sermon?”

She surprisingly asked me as both of us walked back home after mass on a Saturday afternoon. I was totally clueless about what the readings or sermon was about—probably I was daydreaming in church— and lost in my shy silence I did not know what to say.

She then told me to remember that “the priest is a man; the priest is not God.” I was in secundaria, the equivalent to middle school.

Mid 1970s

“Why did you shave your armpit?! Why did you shave your legs?!”

She yelled at me while scolding me and giving me a warning: “Te vas a hacer esclava del rastrillo“—you are going to become a slave of the razor.

“See?” pointing to her arm pit, and showing me unshaved her legs, and explaining that if nature had given me all that hair, there was a reason for it to be there, and I needed to leave it alone.

“Guácala!“—gross! I recall feeling in silence while thinking that something was wrong with her.

Mid 1970s

“Soy una sirvienta sin sueldo“—I am a maid with no pay.

I remember my mother so well, complaining while cleaning the house. In my ignorance, I used to ask myself in silence, “But why does she want to get paid? Isn’t that what mothers do?”

Late 1970s

“Los esposos y los hijos se acaban a las mujeres“—Husbands and children wear out women.

I heard her say this at least once during casual conversations.

Late 1970s

“May I come with you?!” I animatedly asked her if I could join her as she announced that she was going downtown by herself on a Saturday afternoon.

“No, I want to be alone, I need take a break from all of you and your father.”

She was a full time housewife, raising five children. My father was a man of integrity who worked hard as a carpenter and made the minimum wage.

1980s

I left the family home, moved out of town, and eventually migrated to the United States in my attempts to figure out life. I had long distance communication with my mother and father.

Mid 1990s

“¡Tus maestras descubrieron el hilo negro!”—Your women teachers just reinvented the wheel!

She told me cracking up and with a playful tone of voice in response to my enthusiasm as I shared with her all of the wonderful things I was learning from my feminist professors in the doctoral program.

“So, how did you know that you were oppressed as a woman?!” I remember asking her with genuine curiosity. She explained that she always wanted to study and have a paid job and it was difficult “just because she I was I woman—sólo por ser mujer.”

2000s

“You may know a lot about women, but you know very little about old women.”

Upset, she told me this after I told her that she could no longer live alone and go to the supermarket by herself. She was in her late 80s.

2010s

She recalled stories of her adolescent years—in the mid 1940s— when she altered my grandfather’s pants and wore them with pride, without worrying about what others thought of her.

She loved race running and used to play volleyball back then as well—no wonder why her talent as a player of one of the teams in the nursing home where she lived in her late 80s was celebrated by other residents.

2019

“Cuando era joven, no me dejaba de los muchachos“—When I was young, I did not let young men mess with me.

With a soft smile, she made this random comment during one of my visits at the nursing home in San Antonio. She was already showing clear signs of dementia, and her comment touched me deeply.

Late February 2020

I can sense her warmth presence next to me, listening attentively and with so much devotion in her eyes. She is listening to a priest at a Catholic church in Austin; she wanted to go to Mass today. She is quiet, incredibly mellow, and shy these days, and she does not talk much, but she is very receptive to affection. She is fragile, walks very slowly and relies on a walker, and always gives me a fresh smile when I come to see her to the nursing home where she lives.

“Do I live here?!”

She asked me with surprise as I dropped her at her nursing home after Mass that day. I have been learning to go with her story.

I already forgot when I stopped identifying as Catholic, but her sign of the cross on my forehead means the world to me, so getting that today was especially meaningful. I expressed my gratitude to her for giving birth to me, today, 60 years ago. I cried tears of joy and gratitude as I walked away.

Early March 2020

The COVID-19 crisis is starting to unfold and the social worker at the nursing home is asking me to stop visiting my mom. From my visits in person every other day, I went to not being allowed to see her, but my sisters and I talk with her via Zoom at least once a week. The coronavirus put some physical distance between us, but her presence feels closer than ever in my life.

My mother is now 94, has dementia and her nursing home in Austin is not far from my home. At times, she does not know if she lives in Mexico or the United States. And I do not know when or if I will ever see her soon, but there is one thing I know for sure: She was the first feminist who ever loved me.

Gloria González-López is a professor of sociology at the University of Texas-Austin and a Public Voices Fellow with the Op Ed Project.

In the past 30 years, the percentage of students at 4-year colleges who take out loans to finance their education has grown from less than half to a full two-thirds, and their average debt load – in constant dollars – has nearly doubled. In 2017, researchers asked students what they expected to get from college and how they thought college debt would affect them. In 2020, the researchers asked a subset of those who had graduated how their expectations had matched reality and how their lives would change if their loans were forgiven.

Their findings are summarized in a report, “The Difference Debt Makes: College Students and Grads on How Student Debt Affects Their Life Choices — and What They Would Do Differently if it Were Forgiven,” authored by Arielle Kuperberg of UNC Greensboro and Joan Maya Mazelis of Rutgers University-Camden. The report combines survey results published in Sociological Inquiry with follow-up surveys prepared especially for the Council on Contemporary Families

In some ways, the undergraduates surveyed in 2017 over-estimated the extent to which their college debts would burden them. But in other ways they gained less from the loans they took out than they had expected. Fewer reported being forced to work at jobs they did not like or having to live with parents or roommates to pay off their debts than had anticipated these outcomes back in 2017. But only 21 percent of graduates in the 2020 follow-up reported they had been able to get a better job because of their degree. Nearly one-fifth (18 percent) of graduates reported they could not buy a house because of their loans, while 22 percent said they had foregone or delayed graduate school because of their loan debt.

The combination of college debt and Covid-19 also affected the family decisions of graduates the authors surveyed. Almost one-fifth said they were delaying marriage until their loans were paid off, and 20 percent were delaying children.

Asked what they would do if their loans were forgiven, both the students surveyed in 2017 and the graduates surveyed in 2020 gave similar answers: Almost three-fourths said they would put the money in savings, and more than half said they would save up to buy a house. Among graduates, two-thirds said they would use that money to pay off other debt, and almost 53 percent would save for retirement. About 20 percent said they would get married or have children sooner.

For Further Information

Arielle Kuperberg, Associate Professor of Sociology and Women’s, Gender and Sexuality Studies, University of North Carolina at Greensboro atkuperb@uncg.edu @ATKuperberg

Joan Maya Mazelis, Associate Professor of Sociology, Rutgers University–Camden mazelis@camden.rutgers.edu @JoanieMazelis

Women have been far more likely to leave the labor force and to juggle working and child care than men have been over the past year. And women’s earnings, career prospects, and mental health are suffering. Of course, historically, women have done much more child care than men have. Inequality in the time fathers and mothers spend caring for children has persisted, though in recent decades, there’s been some movement—men have been doing more child care than they used to, often seen as an improvement for children and for their mothers. But the COVID pandemic has erased many of these gains.

In our research published last year using data from the Time, Love, and Cash in Couples with Children Study[1] (TLC3, connected to the Fragile Families & Child Wellbeing Study), Laryssa Mykyta and I found that some mothers described themselves as solely responsible for having and caring for their children, even to the exclusion of the children’s fathers. Some mothers spoke about their obligations related to their children in this way even when the fathers were involved in their children’s lives—in some cases, even when those men were sitting right next to them!

I have written for this blog before about people’s reluctance to ask for help from family members. Some participants believed that expenses related to parenthood are the parents’ responsibility—more specifically, the mothers’ responsibility.

Lanetta[2], a married Chicago mother, said during a couple interview with her husband Jerry, that she got no help for expenses from family, and “I try to take care of that by myself. My motto is, ‘I don’t take money for nothing’… Basically, I figure, [my son is] my responsibility . . . So basically I’ve been doing everything for him, by myself.” Lanetta was married to the man sitting beside her, the father of the son she spoke of.

Melissa also noted during a couple interview that she avoided asking for help from family members “Because it’s my responsibility, nobody else,” even while the father of her child, Mike, sat beside her.

Rosa said, “Like my kids are my responsibility, so for me to actually ask for something, for anything, for my kids, it has to be that I really have nowhere else to get it, and it’s my only choice.” Rosa also referred to the responsibility for her children being hers alone.

These mothers described sole responsibility for their children, even when married to the fathers of those children, and even when the children’s fathers sat next to them in the couple interviews. It may seem surprising that mothers would say this in front of their children’s fathers, but when we think about the context of long-held ideas about responsibility for care and supervision of children, it makes perfect sense.

U.S. society doesn’t value child care, a fact rooted in deeply entrenched sexism and racism. Americans tend to resist the notion of universal child care provided outside of the family unit, and inside the family unit, it’s mothers who people expect to provide care for their children. The reasoning centers in part on moral arguments and gendered expectations of what mothers should do, and in part on a pervasive individualistic ideology that is fundamental to United States society.

Women have internalized these notions about their obligations as mothers, and have found these ideas validated by economic realities. Center-based child care has long been prohibitively expensive, leading some parents—usually mothers—to leave the workforce as a result. During the pandemic, many school-age children have been learning at home, adding to parents’ need to provide care and supervision during the workday. And when child care is unavailable as it has been for many families over the last year, it’s been women who’ve juggled work responsibilities and parenting to care for their children. And it’s women who too often feel like failures when they can’t do it all.

All parents of young children struggle to balance work and family, and the COVID-19 pandemic has presented an additional challenge for working mothers. Those who cannot work from home have few if any child care options, while those who have been working from home while parenting full-time feel the competing pressures of career and family more intensely than they probably ever have. The situation is not tenable. But maybe these negative consequences can lead us to recognize that child care is an essential piece of the economy, and therefore lead to the meaningful structural policy changes we have long needed, to finally address enduring systemic inequalities and to help women—as caregivers and as workers.

[1] TLC3 consists of four waves of interviews with 150 parents in 75 couples (some married, some not married) in three cities, first interviewed shortly after the birth of a child. Both mothers and fathers participated in in-depth interviews individually and as a couple in each of the four waves from 2000-2005.

[2] All names used are pseudonyms.

Joan Maya Mazelis is the author of Surviving Poverty: Creating Sustainable Ties among the Poor (NYU Press 2017). She is an associate professor of sociology in the Department of Sociology, Anthropology and Criminal Justice at Rutgers University–Camden, an affiliated scholar at Rutgers–Camden’s Center for Urban Research and Education, a Faculty Affiliate at the University of Wisconsin’s Institute for Research on Poverty, and co-leader of the New Jersey/Philadelphia chapter of the Scholars Strategy Network, an organization of scholars that connect their research to legislatures, civic organizations, and the media. Follow her @JoanieMazelis.

As the United States becomes more accepting of interracial unions, multiracial individuals are a rapidly growing segment of our population.  Social scientists frequently tout the rising number of interracial unions as a sign that racial/ethnic distinctions are diminishing.  An implicit assumption behind such a view is that interracial couples live happily ever after.

The reality, however, is much more complicated. Although attitudes toward interracial unions have become much more favorable over time, some interracial couples continue to report ostracism from friends and families.  Family opposition may increase when interracial couples transition into more serious relationships. For example, transitions into marriage and/or childbearing often intensify opposition because they portend more permanent unions and changes to the racial/ethnic composition of the family line.

Such stigma may decrease the stability of interracial unions and increase the family instability experienced by multiracial children. For example, barriers to intermarriage may partially explain why relative to same-race couples, higher shares of interracial couples cohabit. Cohabitations are known to break up at higher rates than marriages. Stigma and lack of family support may also have adverse effects on the relationship quality of interracial couples. Because opposition tends to be most pronounced for White-Black interracial unions, reflecting the historic legacy of anti-miscegenation, the risk of union dissolution may be particularly high for multiracial children of White-Black descent. In general, whether or not multiracial children are more likely than their peers to experience family instability is largely unknown because existing studies focus on the family experiences of single-race children.

Our research

Our study, published in the Journal of Marriage and Family, examined multiracial children’s exposure to family instability through age 12.  We analyzed data from the 2006-2019 National Survey of Family Growth to investigate whether multiracial children’s experiences of family instability differ from their single-race peers, whether multiracial children’s exposure to family instability varies by their parents’ marital status at birth, and whether multiracial children of White and Black descent experience more family instability than children of White and Hispanic descent.

Findings

Our results show that how multiracial children’s risk of family instability compares with that of their single-race peers varies by their parent’s marital status at birth. Multiracial children born in cohabitations were more likely than their single-race peers to experience family instability. By contrast, the family instability experiences of multiracial children born to married parents tended to fall between those of their single-race White and single-race minority peers.

Multiracial children’s risk of union dissolution also differs according to both parents’ race and ethnicity, but how it differs continues to depend on parents’ marital status at birth.  Contrary to expectations, multiracial children of White-Black descent born in marriages were less likely than those of White-Hispanic descent to experience family dissolution.  This pattern likely arises because White-Black couples in intermarriages are a select group with extraordinary levels of commitment who overcame the formidable barriers to White-Black intermarriage. Differences between multiracial children born in cohabitation were minimal.  The lack of a difference may reflect two opposing forces at play. Parents of White-Black children experience more stigma than parents of White-Hispanic children, increasing their risk of union dissolution. Simultaneously, the more formidable barriers to interracial marriage mean that interracial cohabitations involving White-Black cohabitations may be more “marriage-like” than White-Hispanic cohabitations, and thus more stable.

Implications

Our findings underscore the importance of recognizing the heterogeneity of the multiracial population.  Their family contexts differ vastly depending on their parents’ marital status at birth and both parents’ race/ethnicity. Moreover, that higher shares of multiracial children are born to cohabitors suggests that the rise in interracial unions may not be blurring racial/ethnic distinctions. Rather, our results suggest that systemic racism and associated unfavorable attitudes towards interracial unions may be creating a disadvantaged group: multiracial children born in cohabiting unions.  These children are significantly more likely than their peers to experience family instability, which is linked to poorer outcomes.

Kate H. Choi is an Associate Professor in the Department of Sociology and Acting Director of the Centre for Research on Social Inequality at Western University in London, ON.  Rachel E. Goldberg is an Assistant Professor in the Department of Sociology in the University of California Irvine.  Their research explores the causes and consequences of inequalities within and across families.

The anniversary of the novel coronavirus pandemic in the US this March has brought many opportunities to reflect on where we were a year ago. For me, I distinctly remember just completing an invigorating keynote speech at the “Advancing the Village: Addressing disparities and connecting the dots in maternal mental health” conference hosted by Philadelphia Maternal and Infant Community Action Network. The talk was on the urgent need to address structural racism in perinatal health, and being in a multi-disciplinary, multi-sector space that centered the voices of Black birthing people and other birthing people of color, for me, signaled a much-needed shift in how to address this issue. Seeing birthing people in their entirety was a consistent thread throughout the day of speeches, panels, and networking opportunities. The connection between this work focusing on Philadelphia, PA and the work that I had been participating in through the Bridging the Chasm (BtC) collaborative at the national level was palpable and even with the uncertainty of the pandemic looming, I was excited about the way forward.

BtC is a national collaborative convened to address the longstanding fragmentation of women’s health care that consistently prevents women and birthing people from maintaining the care needed between pregnancy and postpartum to avoid long-term chronic conditions. In a two-year, consensus building process, the BtC collaborative brought together women, providers, researchers, advocates, and other policymakers to develop a comprehensive agenda to address this fragmentation, which was published with an accompanying commentary on International Women’s Day this past March. The six points include:

1. Eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions
2. Providing infrastructure support for community based organizations,
3. Extending holistic team-based care to the postpartum year and beyond,
4. Extending Medicaid coverage in conjunction with new quality and pay-for-performance metrics to link maternity care to primary care
5. Developing systems to preserve maternal narratives and data across providers, and
6. Aligning research with women’s lived experience.

The release of the BtC policy agenda comes at an ideal moment. The tragedy of COVID-19’s impact on Black women amplifies the already disproportionate burden of adverse health that they bear, including 3-4x higher rates of maternal mortality and 20-70% higher rates of adverse cardiovascular events during and after pregnancy compared to their white counterparts. Evidence is clear: structural racism distributes disease across inequitable racial hierarchies. The agenda’s multi-pronged approach speaks to dismantling the key structures upholding these inequitable systems for Black women. However, the most important aspect of the BtC report and visioning process is how we explicitly center racism as a thread across action areas. Even beyond the first two strategic areas that explicitly address racism, all other priority areas center the role of racism in the design and discussion of recommendations. Given that structural racism is an emergent property arising from the interconnected relationships between institutions and the policies that guide them, addressing it requires a comprehensive approach that accounts for the implicit and explicit ways in which it exists.

Achieving the agenda laid out by the BtC Collective and dismantling the structural racism at the root of women’s health inequities over the life course is imperative and achievable. Initiatives such as this week’s Black Maternal Health Week (April 11-17, 2021) create a clear vision of how this work should be done. However, moving forward will also require us to bridge one more chasm. That is the chasm between our intentions and our impact. The coronavirus pandemic has been accompanied by racial uprisings in response to continued police brutality against Black Americans. The current moment of reflection has also turned an important lens toward how the intention to dismantle racism, especially for those at the intersection of multiple identities of privilege, does not always align with the impact needed to change the system. As researchers, providers, practitioners, and advocates doing we must do the work to bridge this chasm if we are to truly advance toward a society that allows Black women and women of color to thrive.

Dr. Irene Headen, Ph.D., M.S.,  is an Assistant Professor of Black Health in the Department of Community Health and Prevention at the Drexel Dornsife School of Public Health. Her research investigates the social and structural determinants of racial/ethnic disparities in adverse pregnancy outcomes, with a specific focus on neighborhood environment. She can be reached at ieh27@drexel.edu

Reposted with permission from the Gender & Society blog.

What do we miss when we don’t bring an intersectional lens to analyses of the pandemic?

The COVID-19 pandemic has revealed how we, as women of color, occupy crucial spaces and confront oppressive systems in multiple spheres of our lives on a daily basis.

Gendered and racialized inequities have unfolded in front of ours eyes, bringing to bare the harsh and unjust realities that many women of color experience. These challenges have not changed due to the current pandemic; many of these inequities have simply been amplified.  In our recent article in Gender and Society we suggest that we must look at racism and sexism in tandem to understand the root cause of health problems and inequities facing women of color in the pandemic. We focus on the impacts of COVID-19 on three (3) important settings occupied by women of color: home, health care, and work.

WOMEN OF COLOR AS DEVALUED IN THE HOME. 

With shelter in place orders starting in March 2020, home was presumed one of the safest places for people to be to avoid contracting the COVID-19 virus. Despite home being a safe place for many, this privilege did not apply to all. Reports of domestic violence increased dramatically, often in the presence of children and other family members. Talha Burki reports that “Some 243 million women are thought to have experienced sexual or physical abuse at the hands of an intimate partner at some point over the last 12 months”. These instances will have lasting impacts, introducing a number of public health implications. Even in homes without physical and mental abuse, home may not be a space of refuge. Since the beginning of the pandemic, women, especially women of color have reported higher levels of stress, anxiety and depression due to an overburden of labor in the home. This labor includes traditional household duties (i.e. cleaning) in addition to homeschooling responsibilities. These added expectations coupled with social isolation and resource insecurity foster an unhealthy living experience. Finally, women of color have also experienced increases in housing insecurity and homelessness due to financial constraints (i.e. loss of income) and abuse.

WOMEN OF COLOR AS DISPOSABLE IN WORK SETTINGS. 

It is evident that the pandemic has impacted jobs and employment. For example, we prioritized and encouraged workers in positions deemed essential to work outside of their homes. However, being essential was far less than equitable. For women of color, being essential did not mean increased pay, benefits, and respect; being essential often constituted increased risk of COVID-19 exposure and working under even more stressful conditions. Women of color in health care make up a large percentage of the COVID-19 deaths. For example, nurses of Filipino descent account for a shocking 31.5% of the workforce’s COVID-19 deaths, yet make up only 4% of the workforce. For women of color in non-essential positions, loss of job security, loss of income, and loss of health insurance were prominent concerns that have a direct impact on one’s physical and mental health.

WOMEN OF COLOR AS DISMISSED IN HEALTH CARE SETTINGS. 

There is a long history of women of color being mistreated, dismissed and ignored in health care settings. This has been no different during the pandemic, as we are presumed incompetent, even if we are in positions of perceived power and privilege. For example, many are again outraged after Dr. Susan Moore, a Black woman, filmed herself in the hospital and reporting on mistreatment and the rush to send her home: “This is how black people get killed when you send them home and they don’t know how to fight for themselves”. Sadly, she died at another hospital after advocates pushed for her transfer—though perhaps “murdered by the system” is a more accurate description. Unfortunately, this example is one of many and we continue to see occurrences of neglect and silencing of Black women in health care settings. Access to quality and equitable health care disparities are visible on a daily basis and have been brought to light during this pandemic with testing, treatment and now vaccines.

We as a community should continue to advocate for women of color in home, work, and health care environments. We challenge scholars, advocates, journalists, and wider publics worldwide to consider how we have embedded both gender and racial inequities into the very fabric of our society and the perpetually negative implications that has for women of color.  The COVID-19 pandemic has revealed already stark inequality… what’s our next move?

Dr. Whitney Pirtle (sociology) and Tashelle Wright (public health) are researchers at the University of California, Merced (UCM). Their most recent work takes an intersectional approach to exploring and analyzing preventable health disparities among Black women and women of color. Pirtle and Wright address the implications of racism and sexism on women of color during the current COVID-19 pandemic. Dr. Whitney Pirtle was recently recognized as one of the newest John D. and Catherine T. MacArthur Foundation Chairs and Tashelle Wright was recently awarded a UCM Black Research Fellowship.  You can find Dr. Pirtle on Twitter at @thePhDandMe and Tashelle Wright @WrightTashelle.

Reposted with permission from the Gender & Society Blog

The closure of schools and childcare centers in response to the COVID-19 pandemic has intensified pressure on U.S. parents already struggling to balance employment and family caregiving in a country that provides little social support. The move of schooling and childcare into the home – along with the still-unfolding effects on women’s employment – has raised questions about the long-term consequences for gender equality in the U.S.

Some are optimistic that these large-scale disruptions – which, for some, have included new opportunities to work from home – offer a chance to increase gender equality in the division of care and domestic work. As remote work decreases the need for “face time” at the office, classic rationales justifying an unequal division of domestic labor may also recede. Others, however, remain skeptical, noting that if the increased unpaid work falls disproportionately on mothers, the loss of childcare and on-site schooling will only exacerbate existing gender inequalities, especially given women’s greater risk of job loss in the current “shesession.” Additionally, even if remote work offers an opportunity to increase gender equality for remote workers, access to this arrangement remains a largely white-collar privilege that limits such potential gains to a privileged few.

In our study, published in Gender & Society, we ask how families experienced and responded to sudden changes in paid and unpaid work in the early months of the pandemic, focusing in particular on how these experiences varied by parents’ ability to work remotely. Analyzing nationally representative survey data from 478 partnered parents, collected in April 2020, we examine how the loss of childcare and in-person schooling affected the division of housework, childcare, and children’s remote learning as well as how pressured parents felt about the sudden responsibility for their children’s schooling.

Findings

Our results indicate that among couples with children, the consequences of these pandemic-induced shifts in schooling and childcare largely depended not just on individuals’ own work circumstances but on their partners’ as well.

In families where both parents worked from home, the response to the increased domestic workload was generally egalitarian – mothers and fathers alike reported almost identical increases in housework and childcare and in responsibility for housework and child care as well.  Mothers and fathers in households with two teleworkers also reported feeling nearly equal amounts of pressure about their children’s schooling.  Even in the scenario where both parents worked from home, however, women still bore disproportionate responsibility for unpaid work since similar increases left pre-pandemic inequality intact. Mothers were thus more than twice as likely as fathers to say they were primarily responsible for housework and childcare during the pandemic and over 1.5 times more likely to report taking on the bulk of managing their children’s home learning.

Disparities in housework, childcare, and home education were even greater when only one spouse worked remotely. When mothers worked from home alone, they were more likely than mothers in dual remote-worker couples to have increased their housework time, absorbing the additional domestic work. In contrast, when fathers alone worked from home, they reported far less involvement in domestic work than either mothers working from home alone or fathers in dual-remote working couples.

When domestic workloads increased and neither parent worked from home, mothers mostly picked up the slack – especially when it came to housework and home learning. Among couples not working remotely, mothers were twice as likely as fathers to have increased their household time and were three times as likely to report being primarily responsible for housework. These mothers were also seven times as likely as fathers to say they did the majority of children’s home learning and, consequently, were twice as likely to report feeling pressure related to their children’s remote education.

The takeaway

We cannot yet know the longer-term consequences of the rise in remote work post-pandemic. Taken together, however, these findings suggest that gender remains a powerful force in organizing domestic work despite the greater flexibility that working remotely allows. In the most optimistic scenario, where both partners worked remotely, the gender division of labor remained relatively stable with both mothers and fathers contributing more to housework and childcare in the wake of school and childcare closures. In couples where neither parent worked from home or where mothers alone did so, mothers became the stopgap who absorbed most of the additional caring and schooling of children. For reasons that need greater exploration, fathers who work from home were generally better able to protect themselves from the incursions of unpaid care work. Going forward, our findings suggest that whether remote work fosters more equality or exacerbates preexisting inequalities will depend on the varied forms it takes in families.

Link to full article: Gender, Parenting, and The Rise of Remote Work During the Pandemic: Implications for Domestic Inequality in the United States – Allison Dunatchik, Kathleen Gerson, Jennifer Glass, Jerry A. Jacobs, Haley Stritzel, 2021 (sagepub.com)

Allison Dunatchik is a PhD student in Sociology and Demography at the University of Pennsylvania. Her research centers on gender, work and family, with a focus on how public policies affect gender and class inequalities inside and outside of the household.

Kathleen Gerson is Collegiate Professor of Arts & Science and Professor of Sociology at New York University. She is the author of “The Science and Art of Interviewing” and “The Unfinished Revolution: Coming of Age in a New Era of Gender, Work, and Family,” among other books. She is currently writing a book on the collision of work and caretaking in contemporary America.

Jennifer Glass is the Centennial Commission Professor of Liberal Arts in the Department of Sociology of the University of Texas–Austin, and Executive Director of the Council on Contemporary Families. Her recent research explores how work–family public policies improve family well-being, and why mothers continue to face a motherhood pay penalty as their income generating responsibility for their children grows.

Jerry A. Jacobs, Professor of Sociology at the University of Pennsylvania, is the co-founder and first president of the Work and Family Researchers Network. Jacobs has written extensively about women’s careers and work-family issues. His six books include The Time Divide: Work, Family and Gender Inequality (2004) with Kathleen Gerson and the Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America (2008) with Ann Boulis.

Haley Stritzel is a PhD candidate in Sociology and a graduate student trainee in the Population Research Center at the University of Texas at Austin. Haley uses a range of quantitative and demographic research methods to study the family and neighborhood contexts of child and adolescent health. Her dissertation focuses on the geographic distribution and correlates of foster care entries associated with parental substance use.

Reposted with permission from the UT Austin Population Research Center.

Children’s health disparities have been well-documented across wealthy nations, including in the United States. Children in well-off families experience better health than those in economically disadvantaged families. These disparities widen between infancy and adolescence and if not substantially improved, they might compound to even larger inequalities in adulthood. However, the rates at which health disparities widen as children grow up vary substantially across societies, including rich countries.

Work-family conflict is consistently linked to declines in parental health and well-being, which in turn can deteriorate well-being throughout the family. In contrast, workers with ample paid time off for parenting, illness and/or vacation are better able to attend to their children’s needs. Indeed, flexible work arrangements and paid time off help to reduce parents’ daily stress. Workers who control their own schedules are better able to mesh their children’s school, sleep, and play time with their own work schedule, enabling closer supervision of children’s schoolwork, friends, and leisure activities.

While policy mandates that support reconciling conflicts between the demands of work and those of family – also known as work-family reconciliation policies – cannot eliminate all the financial difficulties of economic disadvantage, they can quite possibly provide more opportunities for quality parenting, reduce family or marital strain, and lessen economic burdens by reducing the need to take unpaid time off.

These work-family reconciliation policies – specifically parental leave, work schedule flexibility or control, and combined paid sick and vacation leave – are likely to reduce children’s health disparities. However, existing evidence is focused on workplace interventions or single countries such as the United States or Norway, leaving unclear whether national work-family policy mandates might make a difference. In many countries, including the United States, policy mandates are limited or completely absent. This makes families rely on their employers to deliver work-family support. Because these benefits are market-driven, they tend to go to advantaged families, thus widening gaps in children’s health in the absence of policy intervention.

National policy mandates may serve to benefit disadvantaged families the most by “leveling the playing field” among working parents. Paid leaves and work flexibility enable parents to continue working and supporting their children both financially and emotionally. Conversely, when mandated work-family reconciliation support is absent, families must draw on their own economic resources to parent effectively, leaving disadvantaged families behind.

State subsidization of childcare is a cash transfer policy lever that might also impact health disparities between rich and poor children. However, because parents utilize childcare in such differing ways depending on center quality, proximity, availability, and other factors, cost subsidies alone may not make a significant difference in narrowing children’s health disparities across developed nations. Moreover, while cash transfers may lower family economic strain in the short-term, they do not impact parental working conditions or hours, nor are they likely to facilitate bonds between parents and children in the same way that extended time off work might allow.

For these reasons, the authors hypothesize that children’s health disparities between disadvantaged and advantaged families will be lessened significantly in countries with more generous work-family reconciliation policies whereas cash transfer policies will not be associated with reduced disparities in children’s health.

In order to estimate the impacts of work-family reconciliation and cash transfer mandates in reducing children’s health disparities, the authors analyze child-level data from the 2006 and 2010 rounds of the World Health Organization Health Behaviour in School-Aged Children (HBSC) study. The HBSC is a crossnational, representative survey focused on the health and well-being of early adolescent girls and boys ages 11, 13, and 15 in 20 industrialized nations: Belgium, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Netherlands, Norway, Poland, Portugal, Russia, Spain, Sweden, Switzerland, United Kingdom, and the United States. Policy data are gathered from a variety of sources including the Organisation for Economic Co-operation and Development (OECD) database.

The authors analyze the impact of three policies on inequalities in young adolescents’ psychological health complaints, life satisfaction, and general health: 1) paid vacation and sick leave, 2) work flexibility, and 3) paid maternity leave. Based on the assumption that policies may operate more effectively as a complementary package of resources that consistently increase time and resources for parenting across childhood, the authors also analyze a comprehensive policy index based on the three policies listed above.

KEY FINDINGS
► Across 20 OECD countries, economically disadvantaged children report more psychological health complaints, lower life satisfaction, and worse general health compared to their more advantaged peers.

• This inequality in children’s health and well-being may be linked to national work-family policy. For example, the United States scores lowest on work-family reconciliation mandates and shows the greatest inequality in children’s self-rated health.

► Across all levels of disadvantage, higher amounts of paid vacation and sick leave, work flexibility, and a comprehensive work-family policy index are all associated with better self-rated health for children. Work flexibility is also associated with higher life satisfaction.

► At the same time, these country-level policies show stronger links to the health of children within disadvantaged families, thereby reducing inequalities in children’s health and well-being.

• For paid vacation/sick leave, the disadvantage gap in self-rated health is reduced by 69%. See Figure, below.
• For the country policy index, the gap is reduced by 60%.
• For work flexibility, the gap is reduced by 59%.

► Similar though weaker trends for life satisfaction were found, with the gap in children’s life satisfaction reduced by 25% in countries with the most generous work-family reconciliation policies.

► Notably, cash transfer programs, including family benefits spending and childcare costs, were not associated with the size of children’s health disparities across OECD nations, suggesting the unique importance of work-family reconciliation policies.

POLICY IMPLICATIONS
Taken together, these results suggest the singular value of better national work-family accommodations, rather than any generic cash allowances, for lessening inequalities in children’s health and human capital development. Because disadvantaged adolescents gain more well-being linked to work-family reconciliation than do advantaged adolescents, national work-family policies may be especially beneficial for children whose parents have less power to bargain for paid time off and consistent work schedules and hours. These policies, in turn, help to level the playing field among working parents and reduce the negative impact of economic disadvantage on children’s health.

ACKNOWLEDGEMENTS
This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849) and T32HD007081, Training Program in Population Studies, both awarded to the Population Research Center at The University of Texas at Austin. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Matthew A. Andersson (Matthew_Andersson@baylor.edu) is an assistant professor of sociology at Baylor University; Michael A. Garcia is a PhD student in sociology and a graduate student trainee in the Population Research Center at The University of Texas at Austin; and Jennifer Glass is the Barbara Bush Professor of Liberal Arts in the Department of Sociology and a faculty research associate in the Population Research Center, The University of Texas at Austin.