BMHW24 – Reproductive Justice, Black Maternal Health, and the Supreme Court

April 11-17, 2024, marks Black Maternal Health week. Dr. Monica McLemore, Professor of Child, Family, and Population Health Nursing at the University of Washington and Director of the Manning Price Spratlen Center for Anti-Racism and Equity in Nursing sits down to talk with us about the state of maternal morbidity and mortality in the U.S., the upcoming Emergency Medical Treatment and Active Labor Act (EMTALA) Supreme Court case, and achieving comprehensive reproductive justice. 

Black women are three times more likely to die from a pregnancy related case than white women, with the CDC noting that 80% of pregnancy related deaths are preventable. As the Supreme Court gets ready to hear the EMTALA case, which could allow medical professionals to turn those in urgent or emergency need of an abortion away due to “conscience” concerns, maternal mortality and morbidity may increase as abortion becomes increasingly more difficult to access. As the wealthiest nation with the worst maternal health outcomes, the United States has the capacity to recognize the human right to choose if, when, and how to have children, access resources to plan one’s family, parent children in safe and sustainable communities, experience bodily autonomy and sexual pleasure, and provide holistic health care through a reproductive justice lens.

Links from this episode

Dr. Monica McLemore on Instagram
Dr. Monica McLemore on Threads
Black Maternal Health Week 2024
Black Mamas Matter Alliance
Black Maternal Health Caucus
Behind Closed Doors: Exposing and Addressing Harmful Gender-Based Practices in the United States

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice.

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Hi rePROs! How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, I don't know how it became April, all of a sudden, like it snuck up on me and it's just...and I know April showers bring may flowers and all that, but man, it has been raining here for several days in DC and I would like to see the blue sky again, feeling a little, like, bleh. But, you know, these things happen. But what I do have to mention is there was a really exciting report that came out with the overall organization I work for, the Population Institute, done by two amazing colleagues of mine, Maniza Habib and Amani Nelson. Y'all, this report is gorgeous. They did an outstanding job. I can't wait for one or both of them to come on the podcast and talk about it. It's called Behind Closed Doors, and it looks at gender-based practices in the United States. So, it really tackles the misperception that a lot of things like child marriage and FGM and femicide occur only in other countries. And so it takes a closer look at those things in the United States, and it's just one, it's a beautiful report. The artwork is gorgeous. It's wonderful to look at, but they did such an amazing job and y'all should definitely check it out. We'll make sure to include a link to it in the show notes for you to check out. But yeah, highly, highly recommend checking out Behind Closed Doors and just huge congratulations to Maniza and Amani. It is a wonderful report. Great job, y'all. And with that, I think we're just gonna turn to this week's interview. It was a little longer, again, not as long as last week's, but a little longer and just amazing. I'm so lucky to have had some amazing guests back-to-back. So, this week, we’re talking to the wonderful Dr. Monica McLemore, and she's with the University of Washington School of Nursing. It's a wonderful kind of far-ranging conversation, but we're doing it in honor of Black Maternal Health Week, which starts later this week on April 11th. And we'll make sure to include the toolkit of ways you can participate in Black Maternal Health Week in the show notes as well, because there are a lot of ways that you can take part and actions you can take over the next week kicking off on April 11th. So, make sure to check that out. And with that, let's go to the interview with Monica. Hi Monica! Thank you so much for being here today.

Monica: Hey! I'm so glad I get a chance to finally record this and talk to you.

Jennie: I know! Before we get started, do you wanna take a quick second and introduce yourself and include your pronouns?

Monica: Oh, yeah, absolutely. So, I'm Monica McLemore. I use she and her pronouns. They and them is fine and Doctor is okay too. I'm currently Professor of Child, Family, and Population Health Nursing at the University of Washington, and I serve as the Director of the Manning Price Spratlen Center for Anti-Racism and Equity in Nursing. I have adjunct appointments in the School of Public Health and Gender, Women and Sexuality studies, all at the University of Washington.

Jennie: I'm so excited to have you here. I've been following you your work for a long time and following you on social for a long time and have learned so much over that over the course of that. So, very excited to have you here to share your wisdom.

Monica: Well, I'm glad to be here and I, you know, I wanna make sure people know, you know, I am myself on all socials except for the one formerly known as Twitter. I left Twitter on my birthday. I was so mad.

Jennie: Great present.

Monica: I was in New York City. Yeah, well, I was, you know, I had like 40-50,000 followers. I had to download my archive. But it's just become so toxic that I just decided I don't need that in my life. So, but I'm on everything else. So, my Threads, Facebook, Instagram, LinkedIn, YouTube. Tiktok. I'm myself everywhere at @mclemoremr.

Jennie: Awesome. Well, I feel like it's been a while since we've talked about Black maternal health on the podcast. So, I thought maybe we should do a little bit of a quick overview before we get too deep into it of maybe...

Monica: Well, we should start with that, like...

Jennie: A little history, right?

Monica: We should start with that anyway, because it's almost Black Maternal Awareness Week. So, for the people who Dunno, black Maternal Health Awareness Week was started around Easter slash Mother's Day to really be able to raise awareness around the maternal morbidity mortality crisis in the United States. It's April 11th through April 18th, and you'll see all sorts of activities and webinars, symposia. And what it was really meant to do was when the Centers for Disease Control and Prevention finally decided to go back to counting maternal deaths, because, you know, I mean, the way that pregnant capable people and people with reproductive capacity get treated in our country is really shameful in terms of not just clinical care that people have receive, but even how we count people in science. So annoying. Anyway, in 2017, the Centers for Disease Control and Prevention decided to again start to count maternal deaths in the United States. And what we found out is that regardless of race and ethnicity, are maternal morbidity and mortality statistics were increasing, right? And so, I always like to tell people that, you know, we are in a situation where between 1,275 and 1,400 deaths happen every year in the United States. It is still considered a rare event since we have, you know, 3.6 to 4 million births per year. But the, you know, significance around the statistics of this rare event is it's primarily born on the backs of Black and brown people. When we first figured out that Black women were three times, four times more likely to die from pregnancy-related complications, and these are preventable pregnancy-related complications, you know, the alarms went off. And so, we started Black Maternal Health Awareness Week, the Black Mamas Matter Alliance, and the Black Maternal Caucus within the Congress and the Senate to raise awareness and to hopefully be able to pass some legislation that would allow for us to improve health outcomes across the board. This shouldn't have been surprising to people because in the United States we've seen maternal morbidity, mortality increasing regardless of race or ethnicity. And it really has to do with several factors that are very complicated, right? Number one, and this was before for forced birth and fall of Roe and land of Dobbs, like before all this, we were having issues and, you know, if you would've left it up to the medical industrial complex of which I've been part of my entire adult life, you would think it was pregnant people's fault that they was dying from their own deaths. You know, the language and the research literature they- everybody wanted, they were looking at, oh, are people coming to pregnancy older? Are they coming to pregnancy sicker? Are they coming to pregnancy fatter? Are they coming to pregnancy? You know, uninformed, unprepared, like, you would think people were responsible for their own deaths. And I was just about done. So, I really shifted some of my work in 2015, 20 16, 2017, really trying to get people to understand that no, these are systems problems, how people are being treated, not listened to, not believed, disrespected the whole nine yards. And then we got a huge amount of help from the mediaNina Martin and Renee Montagne. So, Nina Martin was at ProPublica and Renee Montagne was at NPR at the time, and they both retired, but they were doing a journal project called the Lost Mother Series, where they were trying to really document maternal deaths in the United States. Then, we got help from Vogue because Serena Williams told her birth story, January of 2018, and then Beyonce turned around in September and told her story. So, we had also, me and my research group and a whole lot of other people had also been trying to look at what was the root cause of why we were seeing so much maternal death, you know, and it really had to do with teams being in conflict, not believing folks. And then poor, you know, Dr. Shalon Irving died, she was at the CDC running the maternal morbidity and mortality programs, right? Preventable maternal death. So I, you know, and we can fix this, that's the other thing, right? Throughout this entire conversation, the main thread is gonna be in reproductive health, rights, and justice, number one. I'm glad we're getting the kind of attention that we're getting. Number two, welcome to those of you who have not been around. Number three, if we wanted to fix this, we could, right? I've already alluded to the ridiculousness of the Dobbs leak and the overturning of Roe and all that weirdness, right? Okay. Congress could have fixed this. They still can. And so, if we decided we had enough votes and wanted to be able to pass the, you know, Women's Reproductive Health Protection Act, then we could actually fix all this right now. We could restore some of the protections of Roe including not criminalizing pregnant people for their outcomes, not criminalizing those of us who are trying to take care of them, right? So, everything, like, that's the through line of everything I'm gonna say. If we wanted a different future, we can make decisions now to make sure everything we wanna do is different in the future. I'm not gonna be your doom and gloom guest. I'm not gonna sit on here and talk about my fear and how scared I am, because that's just not true, right? We can fix all of this if we really had two things. Number one, the political will that's necessary in order to be able to make legislative change. Because we saw the non bipartisan, you know, Alabama Congress and Senate come together in 10 days to have a bipartisan bill about IVF, right? That can happen. And they hadn't had a bipartisan bill in 20 years. So, I'm just about done when people tell us, you know, we need the right. So number one, we need the right political will in order to be able to the right arms and right people to get the kind of legislation that we want. And then we need litigation. We gotta sue the hell outta everybody. It's one of the reasons why I'm one of the expert witnesses in a lot of the cases around the country, whether it's to expand midwifery practice or to sign on and allow for decriminalization, midwifery, or to expand abortion access in states where it's not banned because we can fix this.

Jennie: I think it's so important. So often these conversations happen in silos, and, like, this is the great thing about reproductive justice, is it brings it all together, like, maternal health and abortion are the same conversation.

Monica: Yeah.

Jennie: And like we talked about, you know, how the US' maternal mortality rate is increasing, that is putting them out of step with the rest of the world, particularly in other developed countries. And it's the same thing with abortion rights. We're one of only four countries that has restricted them in the last 30 years. So again, these are very much the same problem.

Monica: Well, and in my- okay, so now that you've brought that up, I need to, you know, make sure your readers or listeners understand this is the 30-year anniversary of reproductive justice, right? And if you are not familiar with the framework, it's very, very important that you completely understand. It's a very different way of talking about the reproductive health trajectory and rights that citizens should be able to expect because it's grounded in human rights. So, lemme break this down for the listeners, because sometimes people miss this, right? Folks forget in the United States that our origin story matters in terms of how we got where we currently are. So, number one, we have negative rights as citizens because we were fleeing a monarchy. Like, let's remember that, okay? So we don't ground our rights as citizens in human rights because the way our constitution is written, we were trying to flee a monarchy. So, we're free from control of a state, we're free from, right? Okay. So, reproductive justice was conceptualized in 1994 in Chicago by 12 Black women who came together and really thought that the pro-choice frame was too limiting specifically in the context of their lives. And if you don't know anything about reproductive justice, I'm gonna give you the resources of the names, who of the people who started it 'cause my understanding all but one are still alive and many are people that we know and love, like Dr. Toni Bond or soon to be Dr. Loretta Ross, right? I mean, we got MacArthur Genius Award winners and faculty members. And so anyway, they conceptualize that and they talk about it more simply than I do. So, when RJ founders talk about reproductive justice, they say it encompasses this notion that you have a human right to have a child, to not have a child, and to parent the children that you have in safe and healthy environments with all the supports that you need in order to be successful, that's the way they talk about it, right? The way I talk about it's because I use it not only as an organizing frame and an advocacy tool, a strategy as well as a research theory. I talk about it as: reproductive justice affords every citizen the human right to make family and kin and to birth in whatever way they see fit with all the supports and dignity that they need to be able to do so. Those same citizens have the human right to prevent and or end pregnancies with all of the supports that they need to be able to do that dignity in the ways that they see fit. Those same humans have a human right to parent the children they already have free from violence of any individual state or government. And they have the right to disassociate- the human right to disassociate sex from reproduction, so that we can have conversations about healthy sexuality, consent, pleasure, and being whole human beings as sexual and or asexual entities.

Jennie: I love that. I love that description.

Monica: Yeah. Because for me, I'm tired of the- not, like, we need to call a thing a thing. So, listeners, this is gonna be very upsetting to you. It's kind of like in the matrix, but we have been lied to for the last, I don't know, I would say 400 years, but specifically for the purposes of this conversation. We have been lied to for the last 50 years, right? 50 years plus. Because we have been told that there are only two sides in conversations about sex and sexuality. You are either pro-life or pro-choice or pro-choice and anti-abortion. And quite frankly, that is a lie, right? It's complicated. Listen, I'm not the only research group. A whole lot of other people have looked at this as well. It's messy. And people's thoughts and feelings about abortion, whether you're a healthcare provider or you're a member of the public, are complicated. Why? Because the propagation of the human species is complicated. You talking about intimacy with another human? You talking about religion, you talk about family and transgenerational stuff. You talking about whether or not you even wanna be a parent, whether or not you even wanna be like a sexual person. We still live in a society where people figure out their sexual orientation by trial and error. So, that's a problem. Like it's all a mess. It's messy, right? And human beings are resilient. That's the other thing, right? Even if you do end up in a situation where you know you wanna be a parent, you're in a situation where you gotta make a decision about being a parent, most people don't figure that out. We saw that in Turnaway Study, right? When people are denying wanted abortions, they somehow figure it out, right? So it's messy, and those are not legally prudent arguments, but they are real human and scientific ones. And I'm so tired of lawyers and judges inappropriately and inaccurately trying to reduce this conversation to something very simple and very basic when it's not. So, that's why reproductive justice is very helpful. Let me give you some examples. Number one, the right to make family and kin in whatever ways see fit and to birth under situations, circumstances. That means you could have a home birth and a midwife and not be criminalized, but midwifery is currently criminalized in the state of Alabama, right? Or the right to end pregnancies with all the support that you need. Then we wouldn't be criminalized in self-managed abortion, or people who have miscarriages at home having to have grand juries and stuff, I mean hello Brittany Watts. Or to parent the children you already have free from violence, okay? Hello, you know, Haiti, Sudan, Gaza, Palestine, like, or how about you shouldn't have to relinquish your parental rights because you're disabled and you actually wanna get married and be in love, and start a family. Or how about you shouldn't have to relinquish your parental rights just 'cause you might have commit a crime? So, it widens the frame, it widens the temperature. Or how about you should be able to have the gender-affirming care that you need in order to operationalize your not only reproductive trajectory, but your whole existential being. How about that? But this notion that we get to allow bureaucracies to tell us what we can't and can't do, that is a lie. So as far as I'm concerned, the power of reproductive justice is, it blows apart the false binaries that we've been lied to about for the last 50 years. That there's only two sides of something. There are multiple sides of things. And in my mind, if you serve the public or you're a member of the health professions or you're a public health practitioner, the only side that really matters is the person sitting in front of you that we trying to serve. So I get real irritated when people, you know, when I hear anti-abortion talking points, or when I hear theocracy-driven very novice understandings of the complexity of human sexuality. Or when I see manuscripts that have been retracted because conflicts of interest being cited in the Supreme Court of the United States’, like, evidence, I get very angry about stuff like this because we've been intellectually lazy and we've been lied to for the last 50 years.

Jennie: This just makes me think of all the current mis- and disinformation that is floating around.

Monica: Let's get on that.

Jennie: Around reproductive health. It's real bad right now.

Monica: Well, again, I mean, not only is misinformation and disinformation part of that 50 year lie. It also is part of the erasure of history. That's why the origin story is so important, right? Like when I teach students, I always have to remind them that when the importing, the illegal importing of enslaved persons ended in the United States, that was not the end of enslavement in the United States. People never think about the fact that enslaved persons inherited the status of their mother, not their father, their mother. If you were enslaved and you were a slave person who had been sexually assaulted slash raped by the person who was enslaving you, because consent is not possible in the context of slavery, then that means your offspring, your progeny who are citizens, inherit your social status. We bred more enslaved persons because we could no longer import them here. So, when people always talk about why is reproductive health black women so complicated, look at the origin story, then you look at the workforce that has surrounded them, right? People always ask me, why do so much work around the discrediting of the grand midwives? And I wanna see more black midwifery because we birthed the whole nation. We used to take care of everybody before Sheppard-Towner in 1921 when the grand midwives were discredited. And then they stopped taking care of everybody because we were trying to professionalize obstetrics. So, they used, you know, abortionists and all sorts of other, you know, like untrue and deeply stigmatizing language to call them uncredential and dirty and unprofessional. So, misinformation and disinformation is part of the larger scheme. That's why we can't have comprehensive sex education in schools because it's misinformation and disinformation. They want that to run rampant so that nobody actually knows the physiological responses, the accurate scientific terms for body parts and biology. This is all purposes, right? If you have plausible deniability about the truth, then you can tell anybody anything and they might believe you.

Jennie: Oh, yeah. Sex ed from a nun—definitely learned birth control didn't work, condoms didn't work, like-

Monica: Right? Like, I mean, it's-

Jennie: How is that helpful?

Monica: Right? And I mean, the other thing that I think also that we're gonna have to reckon with that I think is hella problematic is the supremacy of Judeo Christianism, right? I mean, I work as a nurse, right? And the idea that we have so much consolidation of our health services and health systems. Normally, I'd be talking to you from Washington State where I actually live currently in Philadelphia, Pennsylvania. But in Washington State, it's estimated that one in four hospital beds are run by religiously affiliated institutions. And so, as we consolidate more and more, I mean, Dr. Laurie Friedman's work has already taught us that one in six hospital beds in the United States is operated by religiously affiliated institutions.

Jennie: And you might not know.

Monica: Yeah. And the majority of those are the Catholic church, right? So, if I'm Hindu and I happen to be a medical assistant and I work at the religiously affiliated institution as a medical assistant, that means my employer decides the cafeteria menu of options that I have available to me as an employee. It's part of my health insurance. That's part of why the EMTALA case is so important at the end of this month. So, let's get on that. I am just about done with the Supreme Court case,

Jennie: Oh, I'm really stressed about this one.

Monica: Yeah, I didn't give a rat's ass about the Alliance for Hippocratic Medicine because I knew they ain't have no standings. And the justices actually read right through that too, right? Okay. Because hypothetical harms are not eligible for them turning around and saying everybody else in the country can't do something because you might hypothetically be harmed, right? Okay, so let's just cut that one out. Okay? I felt very good after the oral arguments in that case.

Jennie: Yes, same.

Monica: Okay? But this EMTALA situation is a problem, okay? So, for the people who don't know what EMTALA is—in 1984, we had an epidemic. And it was really spawned, interestingly enough, in my former home state of California where we had a couple of medical malfeasance cases that went down, some were in carceral systems in the jails, like three incarcerated persons had died at, like, San Quentin. But then we had this whole other situation where we had patient dumping on Skid row for unstably housed people in Los Angeles and greater Los Angeles area, those medical malfeasance cases got heard by the Supreme Court of the United States. And what came out of that was a law, and—I should probably look up with EMTALA means, and I'll do that at some point—but it is shortcut for being able to say that no person can be turned away from urgent care, emergency care without being stabilized regardless of their capacity or ability to pay. And this is a law that is being exploited in a case out of Idaho that is trying to overturn EMTALA on a conscience clause, basically saying that someone presents to an emergency department or urgent care under suspicion of a pregnancy-ending abortion, miscarriage, whatever, that people can evoke conscious claims and not have to care for those patients. And that the protections of EMTALA are gonna be removed, not just for pregnant capable people, but more broadly. And the reason this is very frustrating and scary, and in my opinion immoral is because, you know, pregnancies ending is always a time sensitive decision irrespective of how they're ending. Even birth is a time sensitive decision, right? I mean, so there's decisions that need to be made around care for pregnancies that are ending regardless of how they end. And so, this notion that we're gonna have to parse who can take care of these people who can't in real time without just caring for people is frustrating.

Jennie: And the next hospital might not be close, right?

Monica: And it may not be close. And the truth of the matter is, the irony of all of this is, like, we get gunshot wounds and criminals in the emergency department all the time. And we ain't trying to really parse like who shot you, right? I remember when nurses got fired when the Boston Bombers got brought to the ED because they had a nerve to go on Good Morning America talking about, they wasn't gonna take care of them, which was a direct violation of the American Nurses Association code of ethics in our interpretive statement, right? Either innocent before proven guilty or not. We have due process or not, you don't parse that in emergency room before you decide to take your bullet wound out. So, you notice the irony that pregnancies ending is the place we're starting. Like, I can't even, so I'm real irritated. And that was one of the reasons why I signed onto the amicus brief of deans and scholars in the American Public Health Association and Robert Wood Johnson Foundation, a lot of other people explaining why EMTALA is such an important protection that citizens should expect to be able to save lives. So, I'm real irritated by that whole situation and that repro is the place, not gun violence, where crimes probably have been committed, right? I'm just about done with people continuing to allow themselves to be lied to.

Jennie: The thought of just turning someone away for needed care has always been one of those things that boggles my mind that that would be something that people would do.

Monica: And that's why I say as a faculty member and somebody who admits students and, you know, reviews applications and packets that we need to be more discerning of who is worthy of the gift to serve the public as a member of the health professions, right? Because if you wanna get into healthcare to pick and choose who you wanna take care of, maybe you need to do something else because that's not, that's not how I was trained. That is not how I conceptualize the gift of being able to care for the public, and I'm not gonna operationalize my personal beliefs around the care that they need regardless of what it is.

Jennie: It seems so basic. I like, I just, it just seems like the minimum.

Monica: Yeah. I mean, because I always tell people when we say that you're on service, did you miss what the word service means? I mean, when we bring our students onto the ward, that is the exact language we use. I am on service this week. Like, I don't know where people got it, that healthcare would become ground zero for operationalizing or foisting your beliefs onto other people. I don't know where that came from, but that really needs to go away. I also think that the other thing that has just sort of been driving me up a tree is the cruelty. And we need to call it that, right? I mean, I was in Alabama when Becerra visited and you know, the whole Supreme Court came down with their decision because I was at the Mothers of Gynecology Monument and the annual meeting for Anarcha and Betsy and Lucy that Dr. Michelle Browder puts for every year. And the cruelty of saying to in vitro fertilization and assisted reproductive technology people that you don't have a human right to attempt to create family and kin, a basic biological function for some humans, right? You don't, you're not worthy enough as a human being or a parent—the cruelty of that, seriously? Or the cruelty of saying that we don't trust trans youth to tell us who they are, that we're so controlling and so patriarchal that we're gonna tell another person what their lived experience is? Like, we have been lied to y'all. You don't have that kind of dominion over another sentient being, you just don't. Right? We have bodily autonomy in life and death, at least now we do. Legally, no, when you die, nobody can go dig up your organs and take them without your written consent. So, this notion that we think in life, we can tell people what the can and can't do is a real problem and it's cruel and we need to call it out as such, because I'll be damned if you're gonna tell me what I, as a sentient being on this planet can and cannot do, what risk I will or will not take on. I mean, when I think about the situation that young women are in right now, I always knew I wanted to be a childless-by-choice person. But we've known- people always, here's the other line that listeners need to understand. Pregnancy is not without risk. In fact, we know that pregnancy is more risky, 14 times more risky in the most recent data we have than a first trimester abortion. Why? Oh, hello. You're growing a whole ass human. You're doubling your blood volume in nine months. You are housing foreign DNA in your body. Under normal circumstances, your immune system would attack that and kill it. So, how dare you walk around and act like there is no risk in pregnancy, but abortion is some big risky thing. Life is not without risk, listeners, and that includes pregnancy. So, the idea that you would force pregnancy onto people, states where abortion is banned when we already know that pregnancy, especially for Black women, can be very risky because we're more likely to die from pregnancy related complications. Seriously?

Jennie: And they all are the same states, right? The ones with the highest maternal mortality rate, the ones that have abortion bans, the ones with the most Black people. It's the same. And banning gender affirming care, those are all the same states.

Monica: Yep. And in the same way we have a clear understanding that the people who have birth and the people who have abortions are not different people. They just at different time points in their lives. Well, the same states that won't expand Medicaid, the same states who have rural obstetric hospital closures, because they didn't figure out that that was the only way expanding Medicaid was gonna be, that they would be able to stay open. Since half the births in the United States are covered by Medicaid, they clearly, there was nobody in the actuarial room that told them that. And now all of a sudden, we have an even more exacerbated crisis in terms of our workforce as well as places that actually serve people. This isn't some mystery out the sky and all of a sudden, we don't have services or that, you know, those populations are underserved. These are policy decisions that people have made to continue to harm citizens. And it's because we've been lied to for the last 50 years, if not longer, right? That we don't deserve good care. That it's not possible to both, you know, work with the federal government and be able to get citizens what they need, right? Or that somehow, we have to compromise, you know, the economy for human rights, right? These are all lies and we need to fire the people who keep lying to us. So, at some point, I'mma run for office, I said this on my Instagram live because I'm just about done of people who want jobs to represent folks when they're not doing their job of actually representing our interests. I'm done with that, right? Six physicians signed the Declaration of Independence. When people sit here and tell me that healthcare's not political, I'm like, okay, then why we caring about SCOTUS making decisions in healthcare. Like, I need people to wake up and appreciate the fact that we have been lied to. The other place that we're being lied to is the public's not with us. Nobody should have been surprised when Kansas and Minnesota and Ohio codified abortion rights into their state constitutions and or defeated bills, right? Nobody should be surprised by that. Either you believe the Pew Charitable Trust polls and [inaudible] polls and the KFF polls, or you didn't. Every time we've polled the public, they believe that a first trimester abortion should be available and accessible and their acceptability for abortion goes down with gestational limit increases, which makes no sense to me because it's not like the outcome is any different, but okay. Right? Again, folk getting lied to. And the real truth of the matter is people don't like later abortion because they don't like it when people come late to anything. Late to prenatal care, late to dinner, whatever. People don't like folk who come late, right? That's just a thing. But let's not act like somehow the physiological outcome for the fetus is different because it's not. So anyway, but this notion that we can't have a system of healthcare and social services that would allow for us to see better reproductive health outcomes is a lie. It would be helped along better if we had a robust social safety net. So, to your point, you know, the health outcomes of white people in the United States aren't even the best health outcomes we could get for white people in the world. Because when you look at other high income countries, right? The white people in those countries get better health outcomes than the white people in this country. And it's not because they're homogeneous. Like when you look at the Swedens, and the Norways and the Finlands and all that it's not because they European. You know why get they better health outcomes, the white people there? Because they have a robust social safety. Immortality is not an option for our species. You either gonna pay for it on the front end or the back end. You gonna have dignified life and or dignified death. So, you're either gonna protect your citizens and help them be as healthy as possible with a robust social safety net. Oh, what do I mean by that? Paid family leave. Like guarantee coverage, right? People get their teeth fixed, they get their eyes checked when they have preventative health insurance coverage. We already knew that insurance coverage was the number one intervention to improve health outcomes at the population level. Why do y'all think we cover all kids? That families are not bankrupted? Because we agreed as a society that all children with serious illness would be covered by Medicaid. What you think the children's health insurance program is, chip? So don't act like- or even like Medicare and Medicaid and people calling him entitlements. Don't you think citizens should be entitled to some stuff? Entitlement is a word you use for a customer or consumer, not a citizen. So, I'm just about done with people lying to us. I'm done. We need to call this shit out and I need everybody to understand, yeah, I'm entitled to some stuff. I'm a citizen. My ancestors came here and died for me to have the opportunity to make this world better. So yeah. But don't say entitlement like I'm some consumer asking for something I don't deserve.

Jennie: And, like, that happened when they started painting it as programs that were going to Black and brown people, right?

Monica: Exactly. I just wish people would just say, like, you know, "I feel entitled because I'm a white person and I don't wanna make any amends for what happened in history. Oh, and by the way, I don't really like Black people anyway. I believe every lie that I've been told about Black, brown, Latin, and Asian people in the world," and I just wish people would be more honest about this kind of stuff as opposed to this fake, aspirational, harmful, colorblind weirdness.

Jennie: Okay. This has been a really wide-ranging conversation and I've loved every minute of it.

Monica: Ha!

Jennie: But maybe let's talk real quick before we wrap up about what solutions, right? Like what-

Monica: Oh yeah, let's do this.

Jennie: Let's talk solutions. What can we do to fix this?

Monica: Well, okay everybody, and I know this is real unpopular right now because our options are limited. However, if you're a citizen and I'm, and not a consumer and not a customer, guess what your rent is on this planet. You need to participate in the political process and you need to vote number one. And yes, I'm with you. Our options are limited. I wish we had a deeper bench too, but you know, there's a reason that the president's title is commander-in-chief. So, I get the frustration and feeling complicit and all the decisions and all that stuff, but the seriousness of these times, we need to recognize that not participating in the process is not helpful. Number two, if we really wanted to improve health outcomes—and I need everybody to understand this at the population level—two interventions that we would do have nothing directly to do with health services provision. If we wanted to improve health outcomes at the population level in the United States, we would cancel student loan debt and we would have high quality, affordable childcare for everyone. If we did those two things, we would transform our society. Why Dr. Mclemore, why do you say that? Well, if people were not beholden to working in careers, because we have continued to tie employer sponsor health insurance to where people work and they didn't have student loan debt, they would choose to work somewhere else, they would probably start new businesses, do all sorts of things if they wasn't saddled with debt—and I say this is a person who has no student loan debt—but I think we could unleash the creativity of humanity if we cancel student loan debt. If everybody had high quality, affordable, and accessible childcare, whether you are a medical assistant or a janitor or a physician, we would completely transform how we work. And that would again, spawn a whole new set. That's what people are afraid of. Why do you think we got all these abortion bills, but we still don't have no jobs bills? Why do you think we have all these like, you know, different healthcare tweaks of SCOTUS, but nobody's talking about how to transform our society? Or when are we gonna have a basic minimum income because our artificial intelligent overlords are gonna get rid of all the jobs in the service industry. And yet consumer spending drives our economy. So, I need people to write and call their representatives. They forget they represent us because we don't tell them what to do. I call them up every day. I be emailing them all because that's their job. Fund reproductive justice organizations make a donation. All of them gotta donate button on front page. It's the 30-year anniversary of reproductive justice. Get them 30 dollars. Teach a student about reproductive justice. Teach students how to detect the lies we've been told. Talk to young people, listen to them. Hire them. Right? It's not rocket science, y'all Sign on amicus brief, agree to write expert testimony. Continue to push, push, push. We need also, at some point, I'm hoping that somebody gonna coordinate some marches, or sit ins or some kind of civil disobedience in June because if we lucky we gonna have an election in November and we have somebody already calling for a blood bath and violence. How about some sit-ins? How about some civil disobedience? How about showing some collective? We're not gonna take your threats. So, as far as I'm concerned, there's a ton- that look, that's just, and that's just not even active things that require you to spend money or to be harmed. Well, except for maybe the RJ donation part, y'all should do that because 30th anniversary right? Go back to school, advance your education, get involved in the process. Remind people that working in repro is satisfying. It's not all doom and gloom and chicken little and I hate my job and oh my God, no. It's some of the most satisfying work I've ever done in my life. Stand on the side of the people that we serve and bring back dignity to their experiences. Pass the mic to them. How do you think we got where we got so far in Texas and Alabama? Because people with lived experience have stood up and been like, no, this is not a thing. Right? Tell the truth and change the future. That's what I was.

Jennie: Oh my God, that's the perfect place to end.

Monica: Boom.

Jennie: Monica, thank you so much for doing this. I had a wonderful time talking to you.

Monica: Same. And you know, I love the podcast. I'm glad that you're documenting these moments and allowing us to be MythBusters because I'm just about done with being lied to and I hope other people will appreciate that they're being lied to and act and behave different.

Jennie: Okay, y’all, that was such a wonderful conversation. I am feeling extra blessed and lucky to have had just two outstanding conversations these last two weeks. Like I am always so grateful to all of my guests and think I get really lucky and having wonderful people on, but these last two have just been like above and beyond for me and I'm just so happy to have had all three of them behind. So, yes, just so thankful. I hope you all have enjoyed them. And I will see y'all next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!