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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.
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B | Europe’s leading hotelier Accor - a French international hospitality business with billions in revenue and more than 5,100 hotels - is now beginning “trials” to hire people with no experience in the hotel industry, the company’s chief executive Sebastien Bazin said, as it struggles to fill at least 35,000 vacancies.,“We tried in Lyon and Bordeaux 10 days ago and this weekend we're having people interviewed with no CV, no previous job experience and they are hired within 24 hours," Bazin said.,Since underpaid workers left the company, Accor is now filling those positions with those who are desperate for work such as students and/or expats.,Those who are practically hired on the spot by the multi-billion dollar company are trained in only six hours and are forced to learn on the job. The company will also limit their contact with customers as they struggle with staffing.,"It's students, people coming from North Africa," Bazin said, "and basically closing restaurants for lunch or [opening them] only five days a week. There's no other solution.",Some hoteliers will have to increase pay to find the help they need this tourist season. Spain’s tourism sector supported 13.5 percent of their workforce in 2018 - before the pandemic - and accounted for 11.8 percent of their gross domestic product in 2017. But Spain’s catering industry is at present short some 200,000 workers, and Portugal is fighting to increase staff at their hotels to keep pace with increasing demand.,"Many employees have decided to move to other sectors, so we are starting an industry from scratch and we have to fight for talent," said Gabriel Escarrer, chief executive of Spanish hotel group Melia which, along with other hospitality businesses, is reportedly offering higher wages than previously, health insurance, and free accommodation - though that last perk could be more a reflection of the shortage of housing near resorts.,However, hoteliers such as Hotel Mundial - located in Lisbon, Portugal - are facing the far from ideal decision of cutting services if they can’t find staff, and those who employ students will have to juggle rotas to accommodate their schedules.,“During the week we can't open because we have no hands - they are studying,” said Jose Carlos, who owns a bar in Madrid called Tabanco de Jerez.,Spain's hospitality industry is now paying 60 percent more than it did last year, on average, in an attempt to lure workers back to the force - however, those working in the tourism industry are still among the lowest-paid workers.,"Half of it is we've been blind, we've been not paying attention to a lot of people and probably underpaying some people for too long as well," said Bazin, who is worried his company won’t have enough staff when the summer rush, which is the height of the tourist season - arrives. "So it's a wake-up call.",One of the best documented reasons for people leaving their job during 'The Great Resignation' was because they were being paid too little. Another reason was the lack of professional advancement within the industry.,Other reasons people quit in 2021 included: feeling disrespected, lack of flexibility in scheduling, and a lack of benefits such as healthcare and paid holiday, according to a Pew Research Center survey. That same survey found that those who quit their job were able to find new places of employment that offered them better pay and more opportunities.。
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