vox--2020-08-10--America is failing Black moms during the pandemic

Ashlee Paisley was about 23 weeks pregnant when her doctor told her that her iron levels were so low , she would need regular infusion treatments .
But it was March , the coronavirus pandemic was sweeping the country , and the last thing she wanted to do was go to an emergency room .
Paisley was able to find an outpatient center to get the infusions , where staff members were scheduling only two patients at a time .
Still , with Covid-19 cases rising where she lived in Miami , going to a medical office regularly was “ @ @ @ @ @ @ @ Vox .
She had to wait two hours for the medication to be delivered , then two more hours for the treatment , all the while exposed to people in the center .
Then , when she called the center ahead of her fifth treatment , she was told it was closed due to the pandemic .
“ We ’ re just going to send everybody to the ER , ” a hospital staffer told her over the phone .
“ I was like ma ’ am , you don ’ t understand @ @ @ @ @ @ @ the ER , ” Paisley recalls .
“ That is putting me at high risk as a pregnant woman , to be in there , sitting with people who are coming in with symptoms of Covid.
” Instead of listening to her concerns , the staffer treated her like she had done something wrong , Paisley said , telling her she was “ refusing treatment ” and saying she would have to put a note in her file .
“ She was really being nasty to me , ” Paisley said .
Paisley @ @ @ @ @ @ @ staffer treated her differently because of her race .
“ I ’ m sure if her daughter was calling her , ” she would have warned her not to go the emergency room during a pandemic , Paisley said .
“ But it was okay for me to go to the ER.
” “ That was a really big turning point for me , ” Paisley said .
That night , she told her husband , “ we ’ re not having the baby in the hospital.
” Paisley ’ s story is @ @ @ @ @ @ @ before the pandemic hit , Black pregnant and birthing people around the country were reporting that doctors disregarded their concerns , ignored their wishes , and put them at risk .
Out of 10 similarly wealthy countries , the US had the highest number of maternal deaths per capita in 2018 .
Black women are disproportionately impacted , dying in childbirth at three to four times the rate of white women .
Now , birthing people and their advocates say the Covid-19 crisis is only exacerbating the discrimination that Black patients and other @ @ @ @ @ @ @ — one of the main drivers behind their higher rates of maternal mortality .
In response , some people are looking outside of hospitals , to midwives , home births , and birthing centers they feel are more likely to provide them with the care they deserve .
Increasing access to such out-of-hospital care is critical to making birth more equitable for Black Americans and others who have faced discrimination in medical settings .
But so is improving the health care system at all levels so that people who do give birth in @ @ @ @ @ @ @ too .
“ In the US we have dictated safety to mean the highest level of technology , ” Joia Crear-Perry , an OB-GYN and the president of the National Birth Equity Collaborative , told Vox .
“ But when it comes to birthing , the evidence shows us that what makes us safe is actually being heard and listened to and valued.
” Now , she said , the question is , “ how do we create a system that does that all the time ” — both during the pandemic and @ @ @ @ @ @ @ America goes back to the very beginning of gynecology Maternal mortality has been rising across the United States for decades .
Between 1987 and 2015 , the rate of women dying in childbirth more than doubled , even as it fell in other countries , according to US News & World Report .
And Black birthing people are dying at especially high rates — in 2018 , the maternal mortality rate for Black women stood at 37.1 deaths per 100,000 births , compared with 14.7 deaths per 100,000 births for white women .
@ @ @ @ @ @ @ in the US , from underlying conditions like diabetes to a lack of adequate health insurance .
All of these disproportionately impact Black women — Black Americans , for example , are 60 percent more likely than whites to be diagnosed with diabetes .
And 11.5 percent of Black Americans were uninsured as of 2018 , compared with just 7.5 percent of whites .
But differences in things like chronic illness , insurance , or socioeconomic status still don ’ t fully explain the gap between Black and white maternal mortality rates , @ @ @ @ @ @ @ “ even when we get prenatal care , ” Crear-Perry explained , “ even when we are normal weight and not obese , even when we have no underlying medical conditions , we are still more likely to die in childbirth than our white counterparts.
” In New York City , for example , a 2016 study found that Black patients with a college education were more likely to have pregnancy or childbirth complications than white patients who hadn ’ t graduated from high school .
The reason , Crear-Perry said , is @ @ @ @ @ @ @ have worse outcomes , it ’ s because of racism.
” Part of the issue is that providers treat Black patients differently from white ones .
Black women and other women of color often aren ’ t listened to when they express pain or discomfort , Jamila Taylor , director of health care reform at the Century Foundation , told Vox .
Racist beliefs about people ’ s bodies and their ability to experience pain are shockingly widespread : Half of the white medical students and residents surveyed in one 2016 study , @ @ @ @ @ @ @ myth about racial differences in pain perception , such as the idea that Black people ’ s nerve endings are less sensitive than white people ’ s .
The more myths someone believed , the more likely that person was to underestimate a Black patient ’ s pain .
The denial and dismissal of such pain are rooted in the history of obstetrics and gynecology in the United States .
In the 19th century , “ father of modern gynecology ” J. Marion Sims performed experimental surgeries on enslaved women without anesthesia .
@ @ @ @ @ @ @ fistulas — an injury that can occur after childbirth .
But he did so by experimenting , again and again , on Black women who were brought to him by their enslavers , as medical historian Vanessa Northington Gamble told NPR in 2016 .
He performed 30 surgeries on one woman , identified in his papers as Anarcha , who had developed a fistula after a traumatic birth at the age of 17 .
Sims allowed other physicians to watch his surgeries , which he performed while the women were naked .
“ @ @ @ @ @ @ @ think we think about pain , ” Gamble told NPR .
But “ we also need to think about how these women ’ s dignity were also taken away from them.
” The legacy of such abuse , and the perception that “ Black women don ’ t feel pain or they have thicker skin , ” persists today , Taylor said , and “ it ’ s also translating into the type of maternal health care that they receive.
” In a 2018 study in California , more than 10 percent of @ @ @ @ @ @ @ during the birth process because of their race .
Black mothers were almost twice as likely as white ones to say they felt pressured into getting a C-section .
And nearly one-third said hospital staff did not encourage them to make their own decisions about the birth , while only 20 percent of white mothers said the same .
Paisley experienced some of these issues with the birth of her first child , a daughter who is now 4 .
After she arrived at the hospital , staff said her labor wasn ’ @ @ @ @ @ @ @ needed an epidural .
When she said that wasn ’ t part of her birth plan , a nurse responded , “ I ’ m sure it ’ s not , but these things happen.
” Paisley said she was concerned about an epidural because she had a curvature of the spine that might make it difficult to place , but her concerns were waved off .
Her epidural ended up coming out multiple times , and she suffered a “ wet tap , ” a puncture in the lining of the spinal @ @ @ @ @ @ @ .
As a result , she suffered a severe migraine while still in labor .
After her daughter was born , doctors told her that she couldn ’ t nurse and that the baby would have to be transferred to the NICU , but didn ’ t tell her why .
She only learned the reason ( doctors were trying to rule out sepsis ) when her daughter was discharged , six days after she was born .
Paisley and her daughter are both healthy now — but , she says , “ @ @ @ @ @ @ @ Many say the discrimination Paisley and other Black birthing people face — alongside Indigenous and other patients of color — has only gotten worse as Covid-19 sweeps the country .
In April , for example , 26-year-old Amber Isaac , who was pregnant with her first child , was admitted to a hospital in the Bronx with a severely low platelet count , according to The City .
Doctors found she had HELLP syndrome , a type of preeclampsia that can be highly dangerous .
Her platelets had been falling since February , @ @ @ @ @ @ @ an in-person appointment , but she was only offered telehealth appointments due to the pandemic .
On April 17 , she tweeted that she couldn ’ t wait to share her experience “ dealing with incompetent doctors.
” But Isaac was unable to tell the world about what she went through — she died on April 21 , just after giving birth to her son .
“ Covid-19 did nothing except exacerbate the phenomenon of , Black people are not believed when we go in for health care , ” Monica McLemore , @ @ @ @ @ @ @ at the University of California San Francisco , told Vox .
“ We are not heard , we are not listened to.
” In some cases , the switch to telemedicine for prenatal care seems to be worsening disparities .
As the coronavirus spread this spring , many providers moved at least some prenatal appointments to phone or video chat to lessen transmission risk .
For some , telehealth has been a blessing , allowing them to see doctors without the need to travel or find child care .
And for some trans @ @ @ @ @ @ @ remote health care has the advantage of putting some distance between them and providers who might misgender or otherwise discriminate against them .
“ They don ’ t have to have the in-person conflict while they ’ re trying to receive care , ” McLemore said .
But in other cases , telemedicine has made it even harder for Black patients to get their concerns taken seriously , as some struggle to convince providers that they need to be seen in person .
“ If nobody ’ s believing you , ” McLemore @ @ @ @ @ @ @ just another barrier.
” And some patients — especially low-income people and those living in rural areas or on reservations — can not access telehealth at all because of a lack of internet access or the right device .
Telehealth “ is a great option for people , but there ’ s still a digital divide , ” Taylor said .
Meanwhile , the pandemic has also introduced a new risk factor for Black birthing people : isolation .
Several studies have shown that having a doula or other support person present during @ @ @ @ @ @ @ and their babies .
And doulas — coaches who assist people through birth and sometimes the prenatal and postpartum periods as well — are especially important for Black patients and others who experience discrimination during birth , Jamarah Amani , a midwife and the director of the Southern Birth Justice Network , told Vox .
“ Having an advocate there can be lifesaving , ” she said .
It can be instrumental in “ getting the right medication that you ’ re supposed to get , or being heard about the symptoms that @ @ @ @ @ @ @ pain level.
” “ Doulas , for many marginalized people , are essential , ” Amani said .
“ They ’ re essential workers.
” But as Covid-19 spread around the country , many hospitals instituted limits on the number of people who could accompany pregnant people into the delivery room , forcing patients to choose between a partner and a doula .
While some of those policies have been reversed , some hospitals around the country continue to limit birthing people to one support person , McLemore said .
The limits on @ @ @ @ @ @ @ equipment and slow the spread of Covid-19 , but when implementing them , hospitals didn ’ t consider the disproportionate impact they could have on Black patients .
“ To have that be universally applied when we know that risk of harm in hospitals and other health care institutions is not equally shared , is a problem , ” said McLemore .
And it ’ s not just what happens during birth — but also after .
To limit the spread of Covid-19 , some hospitals are separating birthing people from their infants @ @ @ @ @ @ @ medical experts advise against such a practice , even if the birthing parent tested positive for the virus , as newborns have not become severely ill in high numbers and separation can inhibit bonding and breastfeeding .
But some say hospitals are doing it anyway , sometimes without parents ’ permission — and families of color may be especially at risk .
Multiple birthing people and birth workers have reported such separation to Elephant Circle , a birth justice group that is collecting reports of mistreatment and abuse during the pandemic .
One @ @ @ @ @ @ @ not speak English was denied an interpreter , then “ coerced and bullied into agreeing to being separated from her newborn immediately at birth and indefinitely ” due to a positive Covid-19 test .
“ Scare tactics were used and she was not allowed to initiate breastfeeding , ” the witness reported .
In another case , a doula reported that since her client had a fever , her newborn “ was whisked away : no skin-to-skin no physical contact at all.
” Despite negative Covid-19 tests , the mother was not allowed @ @ @ @ @ @ @ of her hospital stay and “ there was no explanation nor support regarding what transpired.
” At one hospital in Albuquerque , New Mexico , clinicians say that some staffers are taking newborns away from birthing people if the families appear to be Native American , even in the absence of a Covid-19 test , ProPublica reported in June .
“ I believe this policy is racial profiling , ” a clinician told ProPublica .
“ We seem to be specifically picking out patients from Native communities as at-risk whether or not there @ @ @ @ @ @ @ reservation.
” Overall , many say that separating newborns from parents during a vulnerable time for establishing breastfeeding has no medical rationale , especially when they will be sent home together after the birth anyway .
“ Lactation has never been limited , even in pandemics , ” McLemore said .
Separation “ makes no sense.
” The pandemic also threatens to close hospitals and maternity wards around the country Beyond discrimination by providers , the pandemic is also exacerbating other inequities Black birthing people face , including the difficulty of even finding @ @ @ @ @ @ @ of redlining , the racist practice of denying mortgages to Black people and other communities of color , has left cities and towns segregated across America .
And communities with a high proportion of people of color don ’ t get the same investment as majority-white , suburban neighborhoods , Taylor said .
“ You go into those communities , you have state-of-the-art health facilities , the best technology , ” she said .
“ You just don ’ t see that in majority-minority neighborhoods.
” For example , Washington , DC ’ @ @ @ @ @ @ @ parts of the city , do not have maternity facilities .
In addition , obstetric services have been disappearing from rural counties around the country for years , Katy Kozhimannil , director of research at the University of Minnesota ’ s Rural Health Research Center , told Vox .
The cause is a combination of factors including declining revenues , a lack of trained doctors and nurses in rural areas , and clinician concerns about their own ability to handle higher-risk births , especially if they lack adequate training or resources .
And @ @ @ @ @ @ @ color are disproportionately affected .
Rural counties with a high percentage of Black residents were more likely to lack hospital maternity wards in the first place , and to have them close between 2004 and 2014 , according to research by Kozhimannil and her team .
The result of a lack of hospitals in communities is that pregnant people to travel far from where they live , and “ too often it means that women go without the health care that they need , ” Crear-Perry said .
“ There are times that @ @ @ @ @ @ @ , will show up to a hospital to give birth , [ and ] they haven ’ t had one prenatal care visit.
” And lack of prenatal care is associated with an increased risk of maternal mortality and morbidity , as well as a higher risk of infant mortality .
Now , with elective procedures postponed and fewer people coming for care — which means less revenue — hospitals around the country are under even more strain during the pandemic than they were before .
More than 250 hospitals have furloughed staff @ @ @ @ @ @ @ according to Becker ’ s Hospital Review .
Between early March and mid-April alone , at least two rural hospitals shut down and two more announced plans to do so , Becker ’ s reported .
“ Doulas , for many marginalized people , are essential .
They ’ re essential workers.
” Hospitals and clinics that see a large number of Medicaid and other low-income patients are at especially high risk , many say .
“ There are safety-net hospitals that aren ’ t going to make it out of this crisis @ @ @ @ @ @ @ of health care delivery system reform at the Commonwealth Fund , told Vox .
“ What does that mean for providing maternal health care when hospitals are closing and birth workers are not able to do their job ?
” Meanwhile , even hospitals that remain open have struggled to continue delivering babies as they treat rising numbers of Covid-19 patients .
St. Bernard Hospital on the South Side of Chicago actually stopped labor and delivery care earlier this year in order to focus on Covid-19 , as Kelly Glass reports at the @ @ @ @ @ @ @ Nobles County , Minnesota , cases skyrocketed earlier this year after an outbreak at a meatpacking plant , Kozhimannil said .
“ That small hospital is overwhelmed with this , ” she told Vox in June — and there aren ’ t very many other places nearby to give birth .
“ If you ’ re in that circumstance , there are limited resources available to you as a birthing person , ” she said .
“ Hospitals are really strained and very , very focused on immediately addressing the pandemic first.
” @ @ @ @ @ @ @ the pandemic for researchers to see the full impact of the crisis on maternal mortality and morbidity , McLemore said , and they haven ’ t seen an overall spike in the numbers yet .
But , she noted , many pregnancy-related deaths happen in the postpartum period , with about half occurring at least a day after birth and more than 30 percent happening at least a week afterward .
Postpartum follow-up with new parents was already spotty before the pandemic began .
Now , it ’ s sometimes nonexistent .
“ @ @ @ @ @ @ @ be missing things in the postpartum period , ” McLemore said .
And in the months and years to come , the situation is likely to get worse , not better , thanks to pandemic-related budget cuts that will further threaten hospitals , patients , and programs designed to address maternal mortality .
In Tennessee , for example , a proposed expansion of postpartum Medicaid coverage is likely to be scuttled due to budget cuts .
New York State ’ s latest budget legislation includes $ 138 million in cuts to New York @ @ @ @ @ @ @ Black and Latinx residents , as Emily Bobrow reports at the New York Times .
“ When we have fewer revenues , in many cases the programs for poor people are the first on the chopping block , ” Alina Salganicoff , director of women ’ s health policy at the Kaiser Family Foundation , told Vox .
Overall , an existing maternal mortality crisis has combined with the threat of the pandemic to leave pregnant and birthing people isolated , disregarded , and at risk .
But it doesn ’ t have @ @ @ @ @ @ @ Paisley was told she would need to visit the ER in the midst of a pandemic to get iron infusions , she started looking for alternatives to a hospital birth .
She found Magnolia Birth House , where Amani is one of the midwives .
Paisley “ instantly fell in love with her , ” she said .
“ When she speaks to you , she ’ s teaching you.
” Amani and the staff at Magnolia walked her through the rest of her pregnancy .
And on June 20 , at 41 @ @ @ @ @ @ @ her son with Amani and her husband by her side .
Her oldest daughter was allowed to come to the birthing center , and staff there cared for her during the birth .
“ When she came in after I had the baby , she had made him a birthday card , ” Paisley said .
Overall , Magnolia “ was so different from being in the hospital , ” Paisley said .
“ I could not believe the support that I could feel.
” Advocates have long been calling for greater access @ @ @ @ @ @ @ birthing center or at home , as a way to combat the discrimination Black patients and other patients of color can face in hospital settings .
“ Other countries that have better outcomes than we do create a system and a network of birth centers and home births that allow for people to make choices based upon their needs , ” Crear-Perry said .
In the UK , for example , where the rate of maternal mortality is less than half that in the US , midwife-led maternity units , similar to birthing @ @ @ @ @ @ @ the health care system , as Alice Callahan reports at Undark .
Midwives are responsible for most low-risk births in Britain , with OB-GYNs stepping in only for more complex cases .
In the US , only 8 percent of births are attended by a midwife , according to ProPublica .
But midwife care is all about listening to pregnant patients — exactly what birthing people in America need to be and feel safe , Crear-Perry said .
And expanding access to it is especially critical for Black patients , who have historically @ @ @ @ @ @ @ Our health care system was built with a belief that Black people were broken , ” Crear-Perry said .
“ The same negative assumptions that happen around Black men when it comes to interacting with police is what Black women feel inside of health care and hospitals.
” The pandemic has drawn enormous attention to home birth as many people search for alternatives to overstretched hospitals .
That includes white patients , who are now facing some of the same fears Black birthing people have long dealt with , Crear-Perry said , including @ @ @ @ @ @ @ .
Midwives and doulas around the country are seeing higher demand , and in some urban areas , like New York , home-birth midwives ’ calendars are fully booked , largely driven by a spike in requests from white women , Crear-Perry said .
But the growth in interest hasn ’ t necessarily translated into better access — Florida , where Paisley lives , is one of just five states where Medicaid and other insurance plans are required to cover out-of-hospital births .
And even there , insurance doesn ’ t cover all @ @ @ @ @ @ @ 300 to $ 1,000 out of pocket for a birth , Amani said , putting the option out of reach for many low-income patients .
The Southern Birth Justice Network and other groups focused on Black maternal health and rights are calling for comprehensive insurance coverage and other support for midwife care as one way to help Black Americans have better birth experiences .
“ We are about bringing midwifery care back to the community in a way that there ’ s access , in a way that families can feel supported and @ @ @ @ @ @ @ said .
“ Midwives have always offered that kind of protective factor within their communities , so that ’ s what we ’ re looking to restore.
” But birth at home or a birthing center is by no means for everyone — some underlying conditions , like diabetes , can make home birth more dangerous ; it ’ s also not an option when a baby needs to be delivered by C-section .
And plenty of people of all races would prefer to give birth in a hospital .
“ I don @ @ @ @ @ @ @ ” Crear-Perry said .
“ I had three children who were born in hospitals.
” That ’ s why in addition to greater access to out-of-hospital births , she and others are calling for a slate of reforms to keep Black birthing people and other patients of color safer regardless of where they deliver .
Access to Black practitioners and others who represent the communities they care for , whether they are midwives , nurses , or OB-GYNs , is critical , Crear-Perry said .
Indeed , a 2019 study found that Black @ @ @ @ @ @ @ Black doctors , and another study found that patient outcomes were better when hospitals specifically focused on the experiences of the communities they served , as Glass reported at the Times .
Some proposals already in Congress would address the crisis .
The Black Maternal Health Momnibus , for example , a legislative package introduced this year by Reps. Lauren Underwood and Alma Adams and Sen. Kamala Harris , would address the lack of providers in many majority-Black communities by funding the expansion and diversification of the maternal and birthing care workforce , @ @ @ @ @ @ @ doulas .
The legislation would also provide funding for community-based organizations working on Black maternal health , among other provisions .
However , “ we need the political will to pass something and to implement it if it does pass , ” Taylor said .
“ We wouldn ’ t have that under this administration.
” In other words , in order for change to happen , leadership has to come from the top .
In a recently released policy agenda , the National Birth Equity Collaborative calls for an Office of Reproductive @ @ @ @ @ @ @ address barriers to all aspects of reproductive autonomy , from maternal health to contraception to child care .
“ All of these things can happen if we have the highest levels of government invested in them , ” Crear-Perry said .
“ If we keep doing it on the margins , and trying to fix little tweaks here and there , and investing in structures that have been harmful , we will never get to this beloved community of birthing that we all want.
” Every day at Vox , we aim to @ @ @ @ @ @ @ you , and our audience around the world , with information that has the power to save lives .
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Ashlee Paisley was about 23 weeks pregnant when her doctor told her that her iron levels were so low, she would need regular infusion treatments. But it was March, the coronavirus pandemic was sweeping the country, and the last thing she wanted to do was go to an emergency room.
Paisley was able to find an outpatient center to get the infusions, where staff members were scheduling only two patients at a time. Still, with Covid-19 cases rising where she lived in Miami, going to a medical office regularly was “a nerve-wracking thing,” she told Vox. She had to wait two hours for the medication to be delivered, then two more hours for the treatment, all the while exposed to people in the center.
Then, when she called the center ahead of her fifth treatment, she was told it was closed due to the pandemic.
“We’re just going to send everybody to the ER,” a hospital staffer told her over the phone.
“I was like ma’am, you don’t understand, I’m not going to the ER,” Paisley recalls. “That is putting me at high risk as a pregnant woman, to be in there, sitting with people who are coming in with symptoms of Covid.”
Instead of listening to her concerns, the staffer treated her like she had done something wrong, Paisley said, telling her she was “refusing treatment” and saying she would have to put a note in her file. “She was really being nasty to me,” Paisley said.
Paisley, who is Black, believes the staffer treated her differently because of her race. “I’m sure if her daughter was calling her,” she would have warned her not to go the emergency room during a pandemic, Paisley said. “But it was okay for me to go to the ER.”
“That was a really big turning point for me,” Paisley said. That night, she told her husband, “We’re not having the baby in the hospital.”
Paisley’s story is one of many like it. Long before the pandemic hit, Black pregnant and birthing people around the country were reporting that doctors disregarded their concerns, ignored their wishes, and put them at risk. Out of 10 similarly wealthy countries, the US had the highest number of maternal deaths per capita in 2018. Black women are disproportionately impacted, dying in childbirth at three to four times the rate of white women.
Now, birthing people and their advocates say the Covid-19 crisis is only exacerbating the discrimination that Black patients and other patients of color already face from providers — one of the main drivers behind their higher rates of maternal mortality. In response, some people are looking outside of hospitals, to midwives, home births, and birthing centers they feel are more likely to provide them with the care they deserve.
Increasing access to such out-of-hospital care is critical to making birth more equitable for Black Americans and others who have faced discrimination in medical settings. But so is improving the health care system at all levels so that people who do give birth in a hospital receive good care there, too.
“In the US we have dictated safety to mean the highest level of technology,” Joia Crear-Perry, an OB-GYN and the president of the National Birth Equity Collaborative, told Vox. “But when it comes to birthing, the evidence shows us that what makes us safe is actually being heard and listened to and valued.”
Now, she said, the question is, “how do we create a system that does that all the time” — both during the pandemic and beyond?
The maternal mortality crisis in America goes back to the very beginning of gynecology
Maternal mortality has been rising across the United States for decades. Between 1987 and 2015, the rate of women dying in childbirth more than doubled, even as it fell in other countries, according to US News & World Report. And Black birthing people are dying at especially high rates — in 2018, the maternal mortality rate for Black women stood at 37.1 deaths per 100,000 births, compared with 14.7 deaths per 100,000 births for white women.
Many factors contribute to overall maternal mortality in the US, from underlying conditions like diabetes to a lack of adequate health insurance. All of these disproportionately impact Black women — Black Americans, for example, are 60 percent more likely than whites to be diagnosed with diabetes. And 11.5 percent of Black Americans were uninsured as of 2018, compared with just 7.5 percent of whites.
But differences in things like chronic illness, insurance, or socioeconomic status still don’t fully explain the gap between Black and white maternal mortality rates, experts say.
For Black women, “even when we get prenatal care,” Crear-Perry explained, “even when we are normal weight and not obese, even when we have no underlying medical conditions, we are still more likely to die in childbirth than our white counterparts.” In New York City, for example, a 2016 study found that Black patients with a college education were more likely to have pregnancy or childbirth complications than white patients who hadn’t graduated from high school.
The reason, Crear-Perry said, is simple: “When Black birthing people have worse outcomes, it’s because of racism.”
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Part of the issue is that providers treat Black patients differently from white ones. Black women and other women of color often aren’t listened to when they express pain or discomfort, Jamila Taylor, director of health care reform at the Century Foundation, told Vox.
Racist beliefs about people’s bodies and their ability to experience pain are shockingly widespread: Half of the white medical students and residents surveyed in one 2016 study, for example, believed at least one myth about racial differences in pain perception, such as the idea that Black people’s nerve endings are less sensitive than white people’s. The more myths someone believed, the more likely that person was to underestimate a Black patient’s pain.
The denial and dismissal of such pain are rooted in the history of obstetrics and gynecology in the United States. In the 19th century, “father of modern gynecology” J. Marion Sims performed experimental surgeries on enslaved women without anesthesia. Sims developed a technique for repairing vesicovaginal fistulas — an injury that can occur after childbirth. But he did so by experimenting, again and again, on Black women who were brought to him by their enslavers, as medical historian Vanessa Northington Gamble told NPR in 2016. He performed 30 surgeries on one woman, identified in his papers as Anarcha, who had developed a fistula after a traumatic birth at the age of 17.
Sims allowed other physicians to watch his surgeries, which he performed while the women were naked. “When we think about it, I think we think about pain,” Gamble told NPR. But “we also need to think about how these women’s dignity were also taken away from them.”
The legacy of such abuse, and the perception that “Black women don’t feel pain or they have thicker skin,” persists today, Taylor said, and “it’s also translating into the type of maternal health care that they receive.”
In a 2018 study in California, more than 10 percent of Black mothers said they were treated unfairly during the birth process because of their race. Black mothers were almost twice as likely as white ones to say they felt pressured into getting a C-section. And nearly one-third said hospital staff did not encourage them to make their own decisions about the birth, while only 20 percent of white mothers said the same.
Paisley experienced some of these issues with the birth of her first child, a daughter who is now 4. After she arrived at the hospital, staff said her labor wasn’t progressing quickly enough, so she needed an epidural. When she said that wasn’t part of her birth plan, a nurse responded, “I’m sure it’s not, but these things happen.” Paisley said she was concerned about an epidural because she had a curvature of the spine that might make it difficult to place, but her concerns were waved off.
Her epidural ended up coming out multiple times, and she suffered a “wet tap,” a puncture in the lining of the spinal cord causing spinal fluid to leak out. As a result, she suffered a severe migraine while still in labor. After her daughter was born, doctors told her that she couldn’t nurse and that the baby would have to be transferred to the NICU, but didn’t tell her why. She only learned the reason (doctors were trying to rule out sepsis) when her daughter was discharged, six days after she was born.
Paisley and her daughter are both healthy now — but, she says, “my first birth was a nightmare.”
Covid-19 has exacerbated the barriers Black birthing people face
Many say the discrimination Paisley and other Black birthing people face — alongside Indigenous and other patients of color — has only gotten worse as Covid-19 sweeps the country.
In April, for example, 26-year-old Amber Isaac, who was pregnant with her first child, was admitted to a hospital in the Bronx with a severely low platelet count, according to The City. Doctors found she had HELLP syndrome, a type of preeclampsia that can be highly dangerous. Her platelets had been falling since February, and she had been asking doctors for an in-person appointment, but she was only offered telehealth appointments due to the pandemic. On April 17, she tweeted that she couldn’t wait to share her experience “dealing with incompetent doctors.”
Can’t wait to write a tell all about my experience during my last two trimesters dealing with incompetent doctors at Montefiore — ✨ (@Radieux_Rose) April 17, 2020
But Isaac was unable to tell the world about what she went through — she died on April 21, just after giving birth to her son.
“Covid-19 did nothing except exacerbate the phenomenon of, Black people are not believed when we go in for health care,” Monica McLemore, a professor of family health care nursing at the University of California San Francisco, told Vox. “We are not heard, we are not listened to.”
In some cases, the switch to telemedicine for prenatal care seems to be worsening disparities. As the coronavirus spread this spring, many providers moved at least some prenatal appointments to phone or video chat to lessen transmission risk. For some, telehealth has been a blessing, allowing them to see doctors without the need to travel or find child care. And for some trans patients, especially those of color, remote health care has the advantage of putting some distance between them and providers who might misgender or otherwise discriminate against them. “They don’t have to have the in-person conflict while they’re trying to receive care,” McLemore said.
But in other cases, telemedicine has made it even harder for Black patients to get their concerns taken seriously, as some struggle to convince providers that they need to be seen in person. “If nobody’s believing you,” McLemore said, “then it’s just another barrier.”
And some patients — especially low-income people and those living in rural areas or on reservations — cannot access telehealth at all because of a lack of internet access or the right device. Telehealth “is a great option for people, but there’s still a digital divide,” Taylor said.
Meanwhile, the pandemic has also introduced a new risk factor for Black birthing people: isolation. Several studies have shown that having a doula or other support person present during birth can improve outcomes for birthing people and their babies. And doulas — coaches who assist people through birth and sometimes the prenatal and postpartum periods as well — are especially important for Black patients and others who experience discrimination during birth, Jamarah Amani, a midwife and the director of the Southern Birth Justice Network, told Vox. “Having an advocate there can be lifesaving,” she said. It can be instrumental in “getting the right medication that you’re supposed to get, or being heard about the symptoms that you’re experiencing or about your pain level.”
“Doulas, for many marginalized people, are essential,” Amani said. “They’re essential workers.”
But as Covid-19 spread around the country, many hospitals instituted limits on the number of people who could accompany pregnant people into the delivery room, forcing patients to choose between a partner and a doula. While some of those policies have been reversed, some hospitals around the country continue to limit birthing people to one support person, McLemore said. The limits on visitors were intended to conserve personal protective equipment and slow the spread of Covid-19, but when implementing them, hospitals didn’t consider the disproportionate impact they could have on Black patients. “To have that be universally applied when we know that risk of harm in hospitals and other health care institutions is not equally shared, is a problem,” said McLemore.
And it’s not just what happens during birth — but also after. To limit the spread of Covid-19, some hospitals are separating birthing people from their infants immediately after they are born. Many medical experts advise against such a practice, even if the birthing parent tested positive for the virus, as newborns have not become severely ill in high numbers and separation can inhibit bonding and breastfeeding. But some say hospitals are doing it anyway, sometimes without parents’ permission — and families of color may be especially at risk.
Multiple birthing people and birth workers have reported such separation to Elephant Circle, a birth justice group that is collecting reports of mistreatment and abuse during the pandemic. One witness reported that a mother who did not speak English was denied an interpreter, then “coerced and bullied into agreeing to being separated from her newborn immediately at birth and indefinitely” due to a positive Covid-19 test. “Scare tactics were used and she was not allowed to initiate breastfeeding,” the witness reported.
In another case, a doula reported that since her client had a fever, her newborn “was whisked away: no skin-to-skin, no physical contact at all.” Despite negative Covid-19 tests, the mother was not allowed to see her baby for the duration of her hospital stay and “there was no explanation nor support regarding what transpired.”
At one hospital in Albuquerque, New Mexico, clinicians say that some staffers are taking newborns away from birthing people if the families appear to be Native American, even in the absence of a Covid-19 test, ProPublica reported in June. “I believe this policy is racial profiling,” a clinician told ProPublica. “We seem to be specifically picking out patients from Native communities as at-risk whether or not there are outbreaks at their specific pueblo or reservation.”
Overall, many say that separating newborns from parents during a vulnerable time for establishing breastfeeding has no medical rationale, especially when they will be sent home together after the birth anyway. “Lactation has never been limited, even in pandemics,” McLemore said. Separation “makes no sense.”
The pandemic also threatens to close hospitals and maternity wards around the country
Beyond discrimination by providers, the pandemic is also exacerbating other inequities Black birthing people face, including the difficulty of even finding a doctor to treat them. Decades of redlining, the racist practice of denying mortgages to Black people and other communities of color, has left cities and towns segregated across America. And communities with a high proportion of people of color don’t get the same investment as majority-white, suburban neighborhoods, Taylor said.
“You go into those communities, you have state-of-the-art health facilities, the best technology,” she said. “You just don’t see that in majority-minority neighborhoods.” For example, Washington, DC’s Wards 7 and 8, majority-Black parts of the city, do not have maternity facilities.
In addition, obstetric services have been disappearing from rural counties around the country for years, Katy Kozhimannil, director of research at the University of Minnesota’s Rural Health Research Center, told Vox. The cause is a combination of factors including declining revenues, a lack of trained doctors and nurses in rural areas, and clinician concerns about their own ability to handle higher-risk births, especially if they lack adequate training or resources.
And like in urban areas, patients of color are disproportionately affected. Rural counties with a high percentage of Black residents were more likely to lack hospital maternity wards in the first place, and to have them close between 2004 and 2014, according to research by Kozhimannil and her team.
The result of a lack of hospitals in communities is that pregnant people have to travel far from where they live, and “too often it means that women go without the health care that they need,” Crear-Perry said. “There are times that women, particularly low-income women of color, will show up to a hospital to give birth, [and] they haven’t had one prenatal care visit.” And lack of prenatal care is associated with an increased risk of maternal mortality and morbidity, as well as a higher risk of infant mortality.
Now, with elective procedures postponed and fewer people coming for care — which means less revenue — hospitals around the country are under even more strain during the pandemic than they were before. More than 250 hospitals have furloughed staff as a result of the crisis, according to Becker’s Hospital Review. Between early March and mid-April alone, at least two rural hospitals shut down and two more announced plans to do so, Becker’s reported.
“Doulas, for many marginalized people, are essential. They’re essential workers.”
Hospitals and clinics that see a large number of Medicaid and other low-income patients are at especially high risk, many say. “There are safety-net hospitals that aren’t going to make it out of this crisis,” Laurie Zephyrin, vice president of health care delivery system reform at the Commonwealth Fund, told Vox. “What does that mean for providing maternal health care when hospitals are closing and birth workers are not able to do their job?”
Meanwhile, even hospitals that remain open have struggled to continue delivering babies as they treat rising numbers of Covid-19 patients. St. Bernard Hospital on the South Side of Chicago actually stopped labor and delivery care earlier this year in order to focus on Covid-19, as Kelly Glass reports at the New York Times.
And in rural Nobles County, Minnesota, cases skyrocketed earlier this year after an outbreak at a meatpacking plant, Kozhimannil said. “That small hospital is overwhelmed with this,” she told Vox in June — and there aren’t very many other places nearby to give birth. “If you’re in that circumstance, there are limited resources available to you as a birthing person,” she said. “Hospitals are really strained and very, very focused on immediately addressing the pandemic first.”
It’s likely too soon in the pandemic for researchers to see the full impact of the crisis on maternal mortality and morbidity, McLemore said, and they haven’t seen an overall spike in the numbers yet. But, she noted, many pregnancy-related deaths happen in the postpartum period, with about half occurring at least a day after birth and more than 30 percent happening at least a week afterward. Postpartum follow-up with new parents was already spotty before the pandemic began. Now, it’s sometimes nonexistent. “My worry would be that we would be missing things in the postpartum period,” McLemore said.
And in the months and years to come, the situation is likely to get worse, not better, thanks to pandemic-related budget cuts that will further threaten hospitals, patients, and programs designed to address maternal mortality. In Tennessee, for example, a proposed expansion of postpartum Medicaid coverage is likely to be scuttled due to budget cuts. New York state’s latest budget legislation includes $138 million in cuts to New York City public hospitals, which serve predominantly Black and Latinx residents, as Emily Bobrow reports at the New York Times.
“When we have fewer revenues, in many cases the programs for poor people are the first on the chopping block,” Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation, told Vox.
Overall, an existing maternal mortality crisis has combined with the threat of the pandemic to leave pregnant and birthing people isolated, disregarded, and at risk. But it doesn’t have to be this way.
Fixing the crisis starts with giving birthing people choices
After Ashlee Paisley was told she would need to visit the ER in the midst of a pandemic to get iron infusions, she started looking for alternatives to a hospital birth. She found Magnolia Birth House, where Amani is one of the midwives.
Paisley “instantly fell in love with her,” she said. “When she speaks to you, she’s teaching you.”
Amani and the staff at Magnolia walked her through the rest of her pregnancy. And on June 20, at 41 weeks pregnant, Paisley gave birth to her son with Amani and her husband by her side. Her oldest daughter was allowed to come to the birthing center, and staff there cared for her during the birth.
“When she came in after I had the baby, she had made him a birthday card,” Paisley said.
Overall, Magnolia “was so different from being in the hospital,” Paisley said. “I could not believe the support that I could feel.”
Advocates have long been calling for greater access to non-hospital births, whether at a birthing center or at home, as a way to combat the discrimination Black patients and other patients of color can face in hospital settings. “Other countries that have better outcomes than we do create a system and a network of birth centers and home births that allow for people to make choices based upon their needs,” Crear-Perry said.
In the UK, for example, where the rate of maternal mortality is less than half that in the US, midwife-led maternity units, similar to birthing centers, are an integrated part of the health care system, as Alice Callahan reports at Undark. Midwives are responsible for most low-risk births in Britain, with OB-GYNs stepping in only for more complex cases. In the US, only 8 percent of births are attended by a midwife, according to ProPublica.
But midwife care is all about listening to pregnant patients — exactly what birthing people in America need to be and feel safe, Crear-Perry said. And expanding access to it is especially critical for Black patients, who have historically been mistreated in hospital settings.
“Our health care system was built with a belief that Black people were broken,” Crear-Perry said. “The same negative assumptions that happen around Black men when it comes to interacting with police is what Black women feel inside of health care and hospitals.”
The pandemic has drawn enormous attention to home birth as many people search for alternatives to overstretched hospitals. That includes white patients, who are now facing some of the same fears Black birthing people have long dealt with, Crear-Perry said, including not being listened to by hospital staff. Midwives and doulas around the country are seeing higher demand, and in some urban areas, like New York, home-birth midwives’ calendars are fully booked, largely driven by a spike in requests from white women, Crear-Perry said.
But the growth in interest hasn’t necessarily translated into better access — Florida, where Paisley lives, is one of just five states where Medicaid and other insurance plans are required to cover out-of-hospital births. And even there, insurance doesn’t cover all costs, meaning patients typically pay $300 to $1,000 out of pocket for a birth, Amani said, putting the option out of reach for many low-income patients.
The Southern Birth Justice Network and other groups focused on Black maternal health and rights are calling for comprehensive insurance coverage and other support for midwife care as one way to help Black Americans have better birth experiences. “We are about bringing midwifery care back to the community in a way that there’s access, in a way that families can feel supported and held and cared for,” Amani said. “Midwives have always offered that kind of protective factor within their communities, so that’s what we’re looking to restore.”
But birth at home or a birthing center is by no means for everyone — some underlying conditions, like diabetes, can make home birth more dangerous; it’s also not an option when a baby needs to be delivered by C-section. And plenty of people of all races would prefer to give birth in a hospital. “I don’t want a home birth,” Crear-Perry said. “I had three children who were born in hospitals.”
That’s why in addition to greater access to out-of-hospital births, she and others are calling for a slate of reforms to keep Black birthing people and other patients of color safer regardless of where they deliver. Access to Black practitioners and others who represent the communities they care for, whether they are midwives, nurses, or OB-GYNs, is critical, Crear-Perry said. Indeed, a 2019 study found that Black patients got better care when they saw Black doctors, and another study found that patient outcomes were better when hospitals specifically focused on the experiences of the communities they served, as Glass reported at the Times.
Some proposals already in Congress would address the crisis. The Black Maternal Health Momnibus, for example, a legislative package introduced this year by Reps. Lauren Underwood and Alma Adams and Sen. Kamala Harris, would address the lack of providers in many majority-Black communities by funding the expansion and diversification of the maternal and birthing care workforce, including nurses, physician assistants, and doulas. The legislation would also provide funding for community-based organizations working on Black maternal health, among other provisions.
However, “we need the political will to pass something and to implement it if it does pass,” Taylor said. “We wouldn’t have that under this administration.”
In other words, in order for change to happen, leadership has to come from the top. In a recently released policy agenda, the National Birth Equity Collaborative calls for an Office of Reproductive Wellbeing in the White House that would address barriers to all aspects of reproductive autonomy, from maternal health to contraception to child care.
“All of these things can happen if we have the highest levels of government invested in them,” Crear-Perry said. “If we keep doing it on the margins, and trying to fix little tweaks here and there, and investing in structures that have been harmful, we will never get to this beloved community of birthing that we all want.”
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vox--2020-08-10--Performative masculinity is making American men sick

Fellas , is it gay to not die of a virus that turns your lungs into soggy shells of their former selves , drowning you from the inside out ?
Is wearing a mask to avoid death part of the feminization of America ?
Is it too emasculating to wear a mask to protect the others around you ?
Does staying alive make you feel weak ?
According to many American men , yeah .
Poll after poll , most recently a Gallup poll from July 13 , has found American men are more likely to not wear masks compared @ @ @ @ @ @ @ found that 34 percent of men compared to 54 percent of women responded they “ always ” wore a mask when outside their home and that 20 percent of men said they “ never ” wore a mask outside their home ( compared to just 8 percent of women ) .
What ’ s startling about these numbers is that it ’ s now been months since the US first implemented measures , including statewide lockdowns , in response to the coronavirus .
Since late April , health experts and medical professionals have @ @ @ @ @ @ @ as more and more research has found that the virus spreads through face-to-face close contact like talking , sneezing , and coughing .
US cases and deaths continue to rise ; at the same time , scientists are finding that men are more likely to die from Covid-19 and still do not know why .
With deaths and rising cases , it seems unclear what would convince more men to wear masks .
According to bias , behavior , and health experts , the reason is maddeningly simple : Masks aren ’ t @ @ @ @ @ @ @ make masks aesthetically more stylish , more age-appropriate , and more sustainable in a hope to appeal to the mask-less and change their ways .
Sports heroes like LeBron James and Mike Trout have been photographed playing with masks on .
And when President Trump finally wore one in public in July , his supporters rushed to praise him .
Still , some see masks as weakness , and men , regardless of politics or race or sexuality , don ’ t like being seen as weak .
This virus can ’ t @ @ @ @ @ @ @ the usual displays of dominance are meaningless .
Instead , it can best be battled by , of all things , putting on little cloth accessories .
The coronavirus has issued an undeniable taunt to American men on their home turf , and some have chosen to prove their virility through risk with no foreseeable reward .
It ’ s a narrow vision of manhood that ignores other tropes like self-sacrifice and being a protector ; performative masculinity for an audience of one that puts many more people at risk .
And the @ @ @ @ @ @ @ it weren ’ t left in the hands of the manliest men in the country .
Masks are caught in the eternal battle of men versus their own masculinity Americans can tell you how the coronavirus has completely changed their lives .
From buying habits to social gatherings to commuting ( or not ) to the way we work out , the pandemic has altered our day-to-day existence .
But not everyone ’ s behaviors have changed the same way .
The personal difference , as experts told me in July , comes @ @ @ @ @ @ @ and stress .
In crises , humans go into fight-or-flight mode , and we rely on our instincts .
Those instincts tell us whom to listen to , which messages are important , and whose behavior to emulate .
That notion about being sensitive to important messages and signals is central to why certain men are more likely to go against health directives and not wear a mask .
“ The notion is masculinity is a status that you constantly have to prove , ” Peter Glick , a Lawrence University professor and @ @ @ @ @ @ @ told me .
Glick specializes in overcoming biases and stereotyping .
“ Any sort of stumble is perceived [ as you losing your masculinity ] .
So if you do have a stumble , then you have to reestablish it .
And if you perceive a mask as ‘ Oh , I ’ m scared of this little virus ’ — that ’ s weakness.
” The term for this phenomenon is called “ precarious manhood , ” coined by Joseph A. Vandello and Jennifer K. Bosson , researchers from the University of @ @ @ @ @ @ @ they found that past studies show men experience anxiety when it comes to their manhood and masculinity , or masculine gender identity .
Vandello and Bossun posit that this is because masculinity , or what society thinks is “ manly , ” is something that ’ s hard to achieve and easily lost .
And when masculinity is slighted , men compensate by acting out in risky ways .
“ [ M ] en experience more anxiety over their gender status than women do , particularly when gender status is uncertain or challenged @ @ @ @ @ @ @ research paper .
“ This can motivate a variety of risky and maladaptive behaviors , as well as the avoidance of behaviors that might otherwise prove adaptive and beneficial.
” In the US specifically , American culture has a history of framing disease as an individual battle or competition in which there are victors and losers , triumph and defeat .
More recently , right-wing pundits and Republican lawmakers turned masks into a political issue , often framing masks as a slight on manliness .
Gestures like Vice President Mike Pence ’ s @ @ @ @ @ @ @ April and actions like Trump calling Dr. Anthony Fauci ’ s credibility into question strengthen the mask-is-weakness connection .
Especially among men who see Trump as a leader they want to emulate .
“ In those situations where your masculinity is called into question , the question is embarrassing ” “ Trump even kind of made fun of people who are wearing masks , right ?
” Glick said , referring to Trump ’ s mockery of Joe Biden wearing a mask in May .
“ In those situations where your masculinity is @ @ @ @ @ @ @ embarrassing .
And ostracism is extremely powerful .
Embarrassment , ostracism — that ’ s what keeps us in line with social bonds.
” Glick ’ s analysis lines up with research that people with sexist attitudes are less likely to take precautions against the virus .
Tyler Reny , a postdoctoral research fellow at Washington University in St. Louis , found this by combing through data from the Democracy Fund + UCLA Nationscape project , a public opinion survey that ’ s been interviewing more than 6,000 Americans about the virus per @ @ @ @ @ @ @ who had more sexist attitudes were far less likely to report feeling concerned about the pandemic , less likely to support state and local coronavirus policies , less likely to take precautions like washing their hands or wearing masks , and more likely to get sick than those with less sexist attitudes , ” Reny told me .
“ What I found is that sexist attitudes are very predictive of all four sets of [ aforementioned ] outcomes , even after accounting for differences in partisanship , ideology , age , education , @ @ @ @ @ @ @ no set-in-stone rule that face masks are a sign of weakness .
Masks and masculinity existed separately long before the pandemic .
Health officials have also consistently said shame doesn ’ t work to get people to change their behavior for the better .
Yet the triggers of shame and slighted masculinity are so effective in getting people to abandon advice that could save their lives .
So why , then , does shame work to deter men from wearing masks ?
It could be that men are more invested in their own @ @ @ @ @ @ @ people who don ’ t wear masks “ doesn ’ t have the same power , ” Glick said .
“ Are those people really experiencing shame ?
I don ’ t think they ’ re ashamed about their behavior .
Shame is something you have to buy into.
” How we get men to wear masks There exists an entire industry to masculinize inanimate objects to make them worthy of man usage .
War Paint is makeup specifically branded for men .
So were Kleenex ’ s “ Man-Size ” boxes and @ @ @ @ @ @ @ bros , before being rebranded after public mockery .
And the Dude Wiper 1000 , according to its semi-ironic , tongue-in-cheek website , “ is not some ordinary bidet attachment , ” as it has “ blasters ” to clean even the manliest of buttholes .
Going by capitalism ’ s penchant for man-plifying objects and knowing about men ’ s fragile relationship to their masculinity , it would seem that the obvious way to get more men to wear masks would be to make the manliest version of a mask possible .
@ @ @ @ @ @ @ a football team , or make a mask that makes men feel like a super-soldier spliced from both Rambo and Captain America .
You can see the effect in sports and athletic wear , where companies like Nike and Under Armour are making masks that superheroes might don .
They ’ re sleeker , curved like shark fins .
In June , Under Armour launched its Sportsmask , which it promised would “ reinvent ” the face mask for athletes .
The Nike Strike Snood , which kind of makes the wearer look @ @ @ @ @ @ @ sold out .
GQ ’ s pick for masks includes one that makes you look like “ you ’ re in Mortal Kombat.
” Make a mask that makes men feel like a super-soldier spliced from both Rambo and Captain America For men concerned with masculinity , the appeal here is that these masks not only look cool but allow you to do masculine things like run faster , lift heavier , and be stronger .
At the same time , in Asia , designers are incorporating new tech and fashion into their @ @ @ @ @ @ @ , appealing to consumerist impulses isn ’ t the best way to change men ’ s , or anyone ’ s , behavior .
Glick and Reny echoed a sentiment that health experts I spoke to in July said : To get people to change behavior , masks have to become a socially accepted norm .
Once people start accepting masks as normal behavior , like they do wearing seat belts and not smoking indoors , the number of people going against the norm decreases .
Getting to that tipping point is a @ @ @ @ @ @ @ and mandates that the government used in the past in regards to seat belts and smoking took time for everyone to adjust to — time we don ’ t have due to how fast the coronavirus is spreading in the US .
And while experts say people are likely to emulate behavior they see from leaders , Republicans like Trump and Pence haven ’ t consistently modeled good mask behavior or messaged how important they are to our health .
“ So a good start would be to have stronger repeated signals from @ @ @ @ @ @ @ importance of mask-wearing as an easy and cheap way to slow the pandemic , ” Reny said .
“ Having publicly ‘ tough ’ men ( actors , athletes , some musicians ) and other Republican elites also join in and wear masks would help.
” There ’ s evidence of this working .
In late June , former Vice President Dick Cheney ’ s daughter posted a picture of him wearing a mask with the hashtag # RealMenWearMasks .
And Trump wore a mask in public for the first time in July @ @ @ @ @ @ @ Center .
He called himself “ patriotic.
” His supporters hailed him for looking “ intensely masculine ” and putting # AmericaFirst , and lauded how heroic he looked in a mask .
In May , Trump and conservatives had mocked Biden for wearing a mask , some saying it was a sign of weakness .
The abrupt turn is , of course , politically driven .
But it ’ s worth noting that the praise Trump received is about his manliness and heroism — the type of motivators that Glick and Reny @ @ @ @ @ @ @ gets more people , men specifically , to wear masks , that ’ s a positive for health officials .
The problem therein , though , is that there ’ s not enough consistent messaging or consistent visibility to really effect change — Trump and Pence need to wear masks consistently and visibly for it to make a difference .
That ’ s what makes Glick a little more skeptical .
“ It ’ s an uphill battle at this point , ” he said .
“ It ’ s going to be @ @ @ @ @ @ @ undermining the message.
” Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not @ @ @ @ @ @ @ enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

Fellas, is it gay to not die of a virus that turns your lungs into soggy shells of their former selves, drowning you from the inside out? Is wearing a mask to avoid death part of the feminization of America? Is it too emasculating to wear a mask to protect the others around you? Does staying alive make you feel weak?
According to many American men, yeah.
Poll after poll, most recently a Gallup poll from July 13, has found American men are more likely to not wear masks compared to women. Specifically, the survey found that 34 percent of men compared to 54 percent of women responded they “always” wore a mask when outside their home and that 20 percent of men said they “never” wore a mask outside their home (compared to just 8 percent of women).
What’s startling about these numbers is that it’s now been months since the US first implemented measures, including statewide lockdowns, in response to the coronavirus.
Since late April, health experts and medical professionals have stressed the importance of wearing masks, as more and more research has found that the virus spreads through face-to-face close contact like talking, sneezing, and coughing. US cases and deaths continue to rise; at the same time, scientists are finding that men are more likely to die from Covid-19 and still do not know why.
With deaths and rising cases, it seems unclear what would convince more men to wear masks. According to bias, behavior, and health experts, the reason is maddeningly simple: Masks aren’t manly.
Attempts have been made to make masks aesthetically more stylish, more age-appropriate, and more sustainable in a hope to appeal to the maskless and change their ways. Sports heroes like LeBron James and Mike Trout have been photographed playing with masks on. And when President Trump finally wore one in public in July, his supporters rushed to praise him.
Still, some see masks as weakness, and men, regardless of politics or race or sexuality, don’t like being seen as weak. This virus can’t do pushups or race cars, so the usual displays of dominance are meaningless. Instead, it can best be battled by, of all things, putting on little cloth accessories.
The coronavirus has issued an undeniable taunt to American men on their home turf, and some have chosen to prove their virility through risk with no foreseeable reward. It’s a narrow vision of manhood that ignores other tropes like self-sacrifice and being a protector; performative masculinity for an audience of one that puts many more people at risk. And the solution would be so easy, if it weren’t left in the hands of the manliest men in the country.
Masks are caught in the eternal battle of men versus their own masculinity
Americans can tell you how the coronavirus has completely changed their lives. From buying habits to social gatherings to commuting (or not) to the way we work out, the pandemic has altered our day-to-day existence. But not everyone’s behaviors have changed the same way.
The personal difference, as experts told me in July, comes down to how we respond to threats and stress. In crises, humans go into fight-or-flight mode, and we rely on our instincts. Those instincts tell us whom to listen to, which messages are important, and whose behavior to emulate. That notion about being sensitive to important messages and signals is central to why certain men are more likely to go against health directives and not wear a mask.
“The notion is masculinity is a status that you constantly have to prove,” Peter Glick, a Lawrence University professor and senior scientist at the Neuroleadership Institute, told me. Glick specializes in overcoming biases and stereotyping. “Any sort of stumble is perceived [as you losing your masculinity]. So if you do have a stumble, then you have to reestablish it. And if you perceive a mask as ‘Oh, I’m scared of this little virus’ — that’s weakness.”
The term for this phenomenon is called “precarious manhood,” coined by Joseph A. Vandello and Jennifer K. Bosson, researchers from the University of South Florida. In their research, they found that past studies show men experience anxiety when it comes to their manhood and masculinity, or masculine gender identity. Vandello and Bossun posit that this is because masculinity, or what society thinks is “manly,” is something that’s hard to achieve and easily lost. And when masculinity is slighted, men compensate by acting out in risky ways.
“[M]en experience more anxiety over their gender status than women do, particularly when gender status is uncertain or challenged,” they wrote in their 2012 research paper. “This can motivate a variety of risky and maladaptive behaviors, as well as the avoidance of behaviors that might otherwise prove adaptive and beneficial.”
In the US specifically, American culture has a history of framing disease as an individual battle or competition in which there are victors and losers, triumph and defeat. More recently, right-wing pundits and Republican lawmakers turned masks into a political issue, often framing masks as a slight on manliness. Gestures like Vice President Mike Pence’s maskless visit to the Mayo Clinic in April and actions like Trump calling Dr. Anthony Fauci’s credibility into question strengthen the mask-is-weakness connection. Especially among men who see Trump as a leader they want to emulate.
“In those situations where your masculinity is called into question, the question is embarrassing”
“Trump even kind of made fun of people who are wearing masks, right?” Glick said, referring to Trump’s mockery of Joe Biden wearing a mask in May. “In those situations where your masculinity is called into question, the question is embarrassing. And ostracism is extremely powerful. Embarrassment, ostracism — that’s what keeps us in line with social bonds.”
Glick’s analysis lines up with research that people with sexist attitudes are less likely to take precautions against the virus. Tyler Reny, a postdoctoral research fellow at Washington University in St. Louis, found this by combing through data from the Democracy Fund + UCLA Nationscape project, a public opinion survey that’s been interviewing more than 6,000 Americans about the virus per week since March 19.
“Those who had more sexist attitudes were far less likely to report feeling concerned about the pandemic, less likely to support state and local coronavirus policies, less likely to take precautions like washing their hands or wearing masks, and more likely to get sick than those with less sexist attitudes,” Reny told me. “What I found is that sexist attitudes are very predictive of all four sets of [aforementioned] outcomes, even after accounting for differences in partisanship, ideology, age, education, and population density.”
There’s no set-in-stone rule that face masks are a sign of weakness. Masks and masculinity existed separately long before the pandemic. Health officials have also consistently said shame doesn’t work to get people to change their behavior for the better. Yet the triggers of shame and slighted masculinity are so effective in getting people to abandon advice that could save their lives. So why, then, does shame work to deter men from wearing masks?
It could be that men are more invested in their own masculinity than in their community.
Shaming people who don’t wear masks “doesn’t have the same power,” Glick said. “Are those people really experiencing shame? I don’t think they’re ashamed about their behavior. Shame is something you have to buy into.”
How we get men to wear masks
There exists an entire industry to masculinize inanimate objects to make them worthy of man usage. War Paint is makeup specifically branded for men. So were Kleenex’s “Man-Size” boxes and “Brogurt,” a yogurt for bros, before being rebranded after public mockery. And the Dude Wiper 1000, according to its semi-ironic, tongue-in-cheek website, “is not some ordinary bidet attachment,” as it has “blasters” to clean even the manliest of buttholes.
Going by capitalism’s penchant for man-plifying objects and knowing about men’s fragile relationship to their masculinity, it would seem that the obvious way to get more men to wear masks would be to make the manliest version of a mask possible. Maybe put guns on it, or a football team, or make a mask that makes men feel like a super-soldier spliced from Rambo and Captain America.
You can see the effect in sports and athletic wear, where companies like Nike and Under Armour are making masks that superheroes might don. They’re sleeker, curved like shark fins. In June, Under Armour launched its Sportsmask, which it promised would “reinvent” the face mask for athletes. The Nike Strike Snood, which kind of makes the wearer look like Bane or a ninja, is sold out. GQ’s pick for masks includes one that makes you look like “you’re in Mortal Kombat.”
There can be a double edge to the “cool-looking” mask, however. Gaiters, long face and neck coverings previously popular with runners and recently seen on MLB players like Texas Ranger Robinson Chirinos, have been proven to be worse than not wearing a mask, according to a study out of Duke University and reported on by the Washington Post. The problem lies with the porous material, which is designed to be breathable and in fact breaks up larger particles, allowing them to hang around in the air longer.
Make a mask that makes men feel like a super-soldier spliced from Rambo and Captain America
For men concerned with masculinity, the appeal here is that these masks not only look cool but allow you to do masculine things like run faster, lift heavier, and be stronger. At the same time, in Asia, designers are incorporating new tech and fashion into their masks. But according to health officials, appealing to consumerist impulses isn’t the best way to change men’s, or anyone’s, behavior.
Glick and Reny echoed a sentiment that health experts I spoke to in July said: To get people to change behavior, masks have to become a socially accepted norm. Once people start accepting masks as normal behavior, like they do wearing seat belts and not smoking indoors, the number of people going against the norm decreases.
Getting to that tipping point is a lot easier said than done.
Laws and mandates that the government used in the past in regard to seat belts and smoking took time for everyone to adjust to — time we don’t have due to how fast the coronavirus is spreading in the US. And while experts say people are likely to emulate behavior they see from leaders, Republicans like Trump and Pence haven’t consistently modeled good mask behavior or messaged how important they are to our health.
“So a good start would be to have stronger repeated signals from elites (particularly Trump) on the importance of mask-wearing as an easy and cheap way to slow the pandemic,” Reny said. “Having publicly ‘tough’ men (actors, athletes, some musicians) and other Republican elites also join in and wear masks would help.”
There’s evidence of this working. In late June, former Vice President Dick Cheney’s daughter posted a picture of him wearing a mask with the hashtag #RealMenWearMasks. And Trump wore a mask in public for the first time in July at a visit to Walter Reed Medical Center. He called himself “patriotic.” His supporters hailed him for looking “intensely masculine” and putting #AmericaFirst, and lauded how heroic he looked in a mask.
In May, Trump and conservatives had mocked Biden for wearing a mask, some saying it was a sign of weakness. The abrupt turn is, of course, politically driven. But it’s worth noting that the praise Trump received is about his manliness and heroism — the type of motivators that Glick and Reny mentioned.
If Trump wearing a mask gets more people, men specifically, to wear masks, that’s a positive for health officials.
The problem, though, is that there’s not enough consistent messaging or consistent visibility to really effect change; Trump and Pence need to wear masks consistently and visibly for it to make a difference. That’s what makes Glick a little more skeptical.
“It’s an uphill battle at this point,” he said. “It’s going to be hard as long as our leaders are undermining the message.”
Will you become our 20,000th supporter? When the economy took a downturn in the spring and we started asking readers for financial contributions, we weren’t sure how it would go. Today, we’re humbled to say that nearly 20,000 people have chipped in. The reason is both lovely and surprising: Readers told us that they contribute both because they value explanation and because they value that other people can access it, too. We have always believed that explanatory journalism is vital for a functioning democracy. That’s never been more important than today, during a public health crisis, racial justice protests, a recession, and a presidential election. But our distinctive explanatory journalism is expensive, and advertising alone won’t let us keep creating it at the quality and volume this moment requires. Your financial contribution will not constitute a donation, but it will help keep Vox free for all. Contribute today from as little as $3.


vox--2020-08-10--Ilhan Omar faces a fierce primary challenge in her first reelection bid

When Minnesotans go to the polls on Tuesday , the political futures of one of the state ’ s most progressive Democrats — as well as its most conservative — will be on the ballot .
In Minnesota ’ s Fifth District , voters will decide whether they want to return Rep. Ilhan Omar — a former Somali refugee and one of the first Muslim women ever to serve in Congress — to Washington .
And in the Seventh District , voters will pick a Republican challenger for Rep. Collin Peterson , a 15-term incumbent who has held on for @ @ @ @ @ @ @ in western Minnesota .
Elsewhere in Minnesota , general election matchups are already set — like in Minnesota ’ s Second Congressional District , where incumbent Rep. Angie Craig , who flipped the seat from GOP control in 2018 , is up against Marine Corps veteran Tyler Kistner — or aren ’ t expected to be competitive .
In Minnesota ’ s Fourth District , longtime Democratic Rep. Betty McCollum will face a handful of challengers , including political strategist and first-time candidate Alberder Gillespie , who co-founded the organization Black Women Rising @ @ @ @ @ @ @ more than 80 percent of the vote in 2018 .
The Minnesota Senate race is effectively locked in as well : Neither incumbent Sen. Tina Smith nor presumptive GOP challenger Jason Lewis , who previously represented Minnesota ’ s Second District in the House , have serious primaries to contend with on Tuesday , and their focus is on November .
The old Tip O ’ Neill aphorism holds that “ all politics is local.
” But in Minnesota ’ s Fifth District , which centers around Minneapolis , national politics has fueled @ @ @ @ @ @ @ lawyer Antone Melton-Meaux .
Melton-Meaux isn ’ t too far from Omar on the issues , and he brands himself as a “ lifelong progressive.
” But it ’ s not his position on Medicare-for-all or similar progressive policies that have buoyed his candidacy : Instead , it ’ s dislike of Omar , who serves as whip for the Congressional Progressive Caucus .
On the back of an ( arguably racist and sexist ) anti-Omar backlash , Melton-Meaux raised a staggering $ 3.2 million in the second quarter of 2020 alone .
@ @ @ @ @ @ @ last month , much of that money has come from large donations and pro-Israel bundlers .
And for both candidates , many of their donors are from out of state .
Melton-Meaux has criticized Omar on at least two fronts : One , her voting record — not what she ’ s voted for , but the number of votes she ’ s missed .
( Omar missed about 6 percent of votes in 2019 . )
“ I was hopeful that she would use her platform to do great work for the @ @ @ @ @ @ @ “ But what I ’ ve seen since then is someone that doesn ’ t show up for votes and someone that doesn ’ t show up for voters.
” And two , Israel : Omar supports the Boycott , Divest , Sanction , or BDS , movement ; Melton-Meaux , meanwhile , has the backing of several pro-Israel groups .
But for all the traction Melton-Meaux has gained in the race , it ’ s not too likely that Omar is going anywhere — a recent poll commissioned by her campaign found @ @ @ @ @ @ @ , with the other three challengers — journalist Les Lester , campaign strategist John Mason , and attorney Daniel McCarthy — relegated to single digits .
Omar has a long list of high-profile endorsements to her name , both in Minnesota and nationally .
Sen. Tina Smith , House Speaker Nancy Pelosi , and Minnesota Gov .
Tim Walz have all backed her candidacy , though the Minneapolis Star-Tribune chose to endorse Melton-Meaux just last week .
Larry Jacobs , a professor of political science at the University of Minnesota , believes that @ @ @ @ @ @ @ and go on to win the reliably blue district come November .
“ Yes , she ’ s controversial , ” he said .
“ Yes , she ’ s alienated some Democrats and angered the Jewish community .
But she ’ s in a district where she ’ s progressive and voters are progressive .
And so she ’ s likely to , I think , win the primary and go on to being reelected.
” By some metrics , Rep. Collin Peterson is the most conservative member of the House Democrats @ @ @ @ @ @ @ s still more liberal than his district .
First elected to the House in 1990 , Peterson represents a district that went for Trump by 30 points in 2016 , which means that the National Republican Congressional Committee is champing at the bit for a chance to flip his seat this cycle .
Before the Minnesota GOP gets around to Peterson though , there ’ s still a five-way primary coming up on Tuesday .
Air Force veteran Dave Hughes is something of a perennial candidate in Minnesota ’ s 7th District , @ @ @ @ @ @ @ Republican nomination and gone on to lose to Peterson .
This year , former Minnesota Lieutenant Gov .
Michelle Fischbach looks to be his main challenger on the way to the nomination , but three other candidates — Dr. Noel Collis , pastor Jayesun Sherman , and farmer William Louwagie — are also in the running .
Though Hughes was the anointed candidate in 2018 , when he lost to Peterson by a bit more than 4 points , in 2020 Fischbach has won endorsements from President Donald Trump , the National Republican @ @ @ @ @ @ @ District Republican Party .
It ’ s already been a contentious race : According to MinnPost , Fischbach ’ s former campaign manager pleaded guilty to harassing Hughes just last month .
Nonetheless , most signs point to her being the favorite heading into Tuesday .
Not only does she hold the edge in terms of big-name endorsements , but she has a more than 10:1 fundraising advantage — MinnPost reports that she had more than $ 900,000 in the bank last month compared to just $ 66,000 for Hughes .
If Fischbach @ @ @ @ @ @ @ likely won ’ t have an easy time come November , despite how much the district favored Trump in 2016 .
Peterson has at least one major advantage : He chairs the influential House Agriculture Committee , a plum position for someone representing a rural district .
“ Donald Trump won by double digits in his district , ” Jacobs said .
“ It ’ s by the sheer power of Peterson ’ s name that he held on , though it ’ s worth saying that his last few elections have been @ @ @ @ @ @ @ large double digits.
” Currently , the Cook Political Report rates Minnesota ’ s Seventh District as a toss-up this November .
Jacobs , though , believes that Peterson , 76 , will pull off a win .
“ But , ” he adds , “ this could be his last election .
I mean , it ’ s not fun for him anymore .
This is like a fistfight.
” Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the @ @ @ @ @ @ @ power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider @ @ @ @ @ @ @

When Minnesotans go to the polls on Tuesday, the political futures of one of the state’s most progressive Democrats — as well as its most conservative — will be on the ballot.
In Minnesota’s Fifth District, voters will decide whether they want to return Rep. Ilhan Omar — a former Somali refugee and one of the first Muslim women ever to serve in Congress — to Washington. And in the Seventh District, voters will pick a Republican challenger for Rep. Collin Peterson, a 15-term incumbent who has held on for term after term in an ever-reddening district in western Minnesota.
Elsewhere in Minnesota, general election matchups are already set — like in Minnesota’s Second Congressional District, where incumbent Rep. Angie Craig, who flipped the seat from GOP control in 2018, is up against Marine Corps veteran Tyler Kistner — or aren’t expected to be competitive.
In Minnesota’s Fourth District, longtime Democratic Rep. Betty McCollum will face a handful of challengers, including political strategist and first-time candidate Alberder Gillespie, who co-founded the organization Black Women Rising. McCollum won her 2018 primary with more than 80 percent of the vote in 2018.
The Minnesota Senate race is effectively locked in as well: Neither incumbent Sen. Tina Smith nor presumptive GOP challenger Jason Lewis, who previously represented Minnesota’s Second District in the House, have serious primaries to contend with on Tuesday, and their focus is on November.
Minnesota’s Fifth District: A progressive luminary in a harsh spotlight
The old Tip O’Neill aphorism holds that “all politics is local.” But in Minnesota’s Fifth District, which centers around Minneapolis, national politics has fueled a challenge to Rep. Ilhan Omar from lawyer Antone Melton-Meaux.
Melton-Meaux isn’t too far from Omar on the issues, and he brands himself as a “lifelong progressive.” But it’s not his position on Medicare-for-all or similar progressive policies that have buoyed his candidacy: Instead, it’s dislike of Omar, who serves as whip for the Congressional Progressive Caucus. On the back of an (arguably racist and sexist) anti-Omar backlash, Melton-Meaux raised a staggering $3.2 million in the second quarter of 2020 alone.
As BuzzFeed’s Molly Hensley-Clancy reported last month, much of that money has come from large donations and pro-Israel bundlers. And for both candidates, many of their donors are from out of state.
Melton-Meaux has criticized Omar on at least two fronts: One, her voting record — not what she’s voted for, but the number of votes she’s missed. (Omar missed about 6 percent of votes in 2019.)
“I was hopeful that she would use her platform to do great work for the district,” he told MinnPost. “But what I’ve seen since then is someone that doesn’t show up for votes and someone that doesn’t show up for voters.”
And two, Israel: Omar supports the Boycott, Divest, Sanction, or BDS, movement; Melton-Meaux, meanwhile, has the backing of several pro-Israel groups.
But for all the traction Melton-Meaux has gained in the race, it’s not too likely that Omar is going anywhere — a recent poll commissioned by her campaign found her with a 37-point lead over Melton-Meaux, with the other three challengers — journalist Les Lester, campaign strategist John Mason, and attorney Daniel McCarthy — relegated to single digits.
Omar has a long list of high-profile endorsements to her name, both in Minnesota and nationally. Sen. Tina Smith, House Speaker Nancy Pelosi, and Minnesota Gov. Tim Walz have all backed her candidacy, though the Minneapolis Star-Tribune chose to endorse Melton-Meaux just last week.
Larry Jacobs, a professor of political science at the University of Minnesota, believes that Omar will win out on Tuesday — and go on to win the reliably blue district come November.
“Yes, she’s controversial,” he said. “Yes, she’s alienated some Democrats and angered the Jewish community. But she’s in a district where she’s progressive and voters are progressive. And so she’s likely to, I think, win the primary and go on to being reelected.”
Minnesota’s Seventh District: Third time’s the charm?
By some metrics, Rep. Collin Peterson is the most conservative member of the House Democrats’ 232-person majority — and he’s still more liberal than his district. First elected to the House in 1990, Peterson represents a district that went for Trump by 30 points in 2016, which means that the National Republican Congressional Committee is champing at the bit for a chance to flip his seat this cycle.
Before the Minnesota GOP gets around to Peterson though, there’s still a five-way primary coming up on Tuesday.
Air Force veteran Dave Hughes is something of a perennial candidate in Minnesota’s 7th District, where he has twice now won the Republican nomination and gone on to lose to Peterson. This year, former Minnesota Lieutenant Gov. Michelle Fischbach looks to be his main challenger on the way to the nomination, but three other candidates — Dr. Noel Collis, pastor Jayesun Sherman, and farmer William Louwagie — are also in the running.
Though Hughes was the anointed candidate in 2018, when he lost to Peterson by a bit more than 4 points, in 2020 Fischbach has won endorsements from President Donald Trump, the National Republican Congressional Committee, and the Minnesota Seventh District Republican Party.
It’s already been a contentious race: According to MinnPost, Fischbach’s former campaign manager pleaded guilty to harassing Hughes just last month. Nonetheless, most signs point to her being the favorite heading into Tuesday. Not only does she hold the edge in terms of big-name endorsements, but she has a more than 10:1 fundraising advantage — MinnPost reports that she had more than $900,000 in the bank last month compared to just $66,000 for Hughes.
If Fischbach wins on Tuesday, though, she likely won’t have an easy time come November, despite how much the district favored Trump in 2016. Peterson has at least one major advantage: He chairs the influential House Agriculture Committee, a plum position for someone representing a rural district.
“Donald Trump won by double digits in his district,” Jacobs said. “It’s by the sheer power of Peterson’s name that he held on, though it’s worth saying that his last few elections have been competitive. He used to win by large double digits.”
Currently, the Cook Political Report rates Minnesota’s Seventh District as a toss-up this November. Jacobs, though, believes that Peterson, 76, will pull off a win. “But,” he adds, “this could be his last election. I mean, it’s not fun for him anymore. This is like a fistfight.”
Will you become our 20,000th supporter? When the economy took a downturn in the spring and we started asking readers for financial contributions, we weren’t sure how it would go. Today, we’re humbled to say that nearly 20,000 people have chipped in. The reason is both lovely and surprising: Readers told us that they contribute both because they value explanation and because they value that other people can access it, too. We have always believed that explanatory journalism is vital for a functioning democracy. That’s never been more important than today, during a public health crisis, racial justice protests, a recession, and a presidential election. But our distinctive explanatory journalism is expensive, and advertising alone won’t let us keep creating it at the quality and volume this moment requires. Your financial contribution will not constitute a donation, but it will help keep Vox free for all. Contribute today from as little as $3.