Tag: Race

Empty hospital bed.

Native Reproductive Justice: Practices and Policies from Relinquishment to Family Preservation

The Petrie-Flom Center Staff Leave a comment

By Lauren van Schilfgaarde

Adoption can be, and frequently is, a celebrated extension of kinship ties within Native communities. But we cannot ignore the historical context of adoption as a tool to empty tribal communities and delete tribal cultures. Nor can we ignore the historical context of the simultaneous deprivation and weaponization of reproductive health care, both of which deny Native women reproductive self-determination. 

It is these contexts in which anti-abortion proponents seek to ameliorate the further denial of health care through increased adoption. The proposal is eerily familiar. 

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Broken chain.

The Indian Child Welfare Act: Preserving Families Is in Children’s Best Interests

The Petrie-Flom Center Staff Leave a comment

By Kathryn E. Fort

On February 28, 2022, the Supreme Court accepted one of the most consequential federal Indian law cases in decades, a direct constitutional challenge to the Indian Child Welfare Act (ICWA). This challenge, brought by three states and three foster families, intends to not just dismantle a gold standard law in child protection, but all of federal Indian law. The plaintiffs who brought this case are not interested in improving the child protection system, or finding ways to support promising practices, or ensuring the resiliency for Native children affected by trauma. This case is about an attempt to dismantle the current federal protections for tribal governments, tribal citizenship, and tribal sovereignty. The case does so by ignoring the best interests of Native children and the voices of a uniquely unified Indian Country. 

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Baby feet in hands

Striving Towards Ethical Adoption Practice

The Petrie-Flom Center Staff Leave a comment

By Susan Dusza Guerra Leksander

In the United States, the practices of adoption are rarely oriented towards the goals of anti-racism, child-centeredness, and reproductive justice.

In this article, I present a model that strives to fulfill these goals. At Pact, an Adoption Alliance, the non-profit organization where I work as agency and clinical director, our mission is to serve adopted youth of color, and our approach to domestic infant adoption emerges from 30 years of serving Black, Latinx, Asian, and multiracial infants and their families. Based on our work with adopted children and adults of color, first/birth1 and adoptive parents, and adoption professionals, I will share our tenets of ethical adoption practice.

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Monarch Butterfly, pupae and cocoons are suspended. Concept transformation of Butterfly.

Understanding Transracial Adoption: Life-long Transformations, Not Frictionless Transactions 

The Petrie-Flom Center Staff Leave a comment

By April Dinwoodie

I took a long, slow, deep breath when I heard Amy Coney Barrett, the adoptive mother of Black children, describe adoption as a “frictionless alternative to abortion.” As a Black/bi-racial transracially adopted person in mid-life, adoption has been and continues to be many things, but “frictionless” isn’t one of them.  

On the contrary, being adopted into a white family and raised in a majority white community has been filled with the tension between the realities of what I was experiencing and feeling, and what others thought I should be. For me, Amy Coney Barrett ridiculously over-simplified the most intricate experience of identity one can have, being born into one family and raised by another. This is especially complex when the separation includes differences of race, ethnicity, and culture. 

What I have learned over time is that Amy Coney Barrett is not alone in her desire to categorize adoption as uncomplicated and a good solution for everyone connected to the experience. What I have also learned is that this kind of thinking more broadly is unrealistic and often results in gaps in services and support for all parents (expectant, birth, and adoptive) and leaves adopted persons without the tools they need to navigate this lifelong, transformational journey.  

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Female hand writing signature on the paper document.

How to Construct Better Organ Donation Policy and Achieve Health Equity

James Jolin Leave a comment

By James R. Jolin

The United States is facing an organ donation crisis, with massive gaps between supply and demand.

Per estimates from the Department of Health and Human Services (HHS), over 106,000 Americans are currently awaiting this life-saving medical treatment. Further, the burden of this shortage falls unequally:  in 2020, while approximately 48% of white patients in need of transplants received an organ, only 27% of Black patients secured one.

The stakes are too high to allow the organ donation crisis to proceed in the U.S. without bold intervention. But with many policy options on the table, unresolved ethical concerns, and a patchwork of organ donation laws across the country, the proper path forward is not immediately clear.

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Melbourne, Australia - 1st November 2021: A person wearing full PPE holds a vial of sotrovimab medicine covid-19 virus treatment. It is under an emergency use authorization to treat covid in Australia.

Litigation Challenges Prioritization of Race or Ethnicity in Allocating COVID-19 Therapies

James W. Lytle Leave a comment

By James Lytle

Recent guidance from the U.S. Food & Drug Administration (FDA) encouraged several states to adopt policies that prioritized race or ethnicity in the allocation of monoclonal antibody treatments and oral antivirals for the treatment of SARS-CoV-2.

The guidance proved to be highly controversial, prompting two states, Utah and Minnesota, to withdraw their guidance, and leading a third state, New York, to become the subject of two federal lawsuits that challenge the guidance’s legality: one (Jacobson v. Bassett) brought by a white, non-Hispanic Cornell Law Professor, William Jacobson, in the Northern District of New York (“Jacobson”) and a second (Roberts v. Bassett) initiated by Jonathan Roberts and Charles Vavruska, two white, non-Hispanic residents of New York City in the Eastern District (“Roberts”).

Public health and policy experts have published commentaries on the challenging issues underlying New York’s COVID treatment guidelines and others have offered more detailed guidance, including on this blog, on what criteria should be used in allocating scarce COVID treatments. What follows is focused on the litigation pending in New York and its potential impact on the broader issues at the intersection of the pandemic response and racial equity.

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umbrella covering home under heavy rain.

Weathering the Climate Crisis: The Health Benefits and Policy Challenges of Home Weatherization

James Jolin Leave a comment

By James R. Jolin

Weatherization serves as an important yet strikingly neglected tool not only to meet vulnerable communities’ energy needs, but also to combat the negative health effects associated with the climate crisis.

In the United States, households with lower gross income experience higher “energy burdens” — that is, the proportion of a household’s income that is expended to meet energy costs. Indeed, households earning 200% of the federal poverty line spend an estimated 8% of their income on meeting energy costs, as compared to the national median of 3%. Weatherization, the catch-all term for home improvements intended to improve the efficiency of home energy use, is a way to decrease disparate energy costs across socioeconomic classes.

Standard weatherization measures, which include (but are not limited to) repairing and modernizing temperature control systems and installing insulation, reduce the amount of money households need to spend on heating and cooling. In all, weatherization measures save over $280 on average per year, according to the U.S. Department of Energy — a modest but nonetheless important savings.

Crucially, however, weatherization also confers significant health benefits, which are not only ideal in their own right, but also result in further significant financial savings.

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New York, USA, November 2021: Pfizer Covid-19 Paxlovid treatment box isolated on a white background.

How to Fairly Allocate Scarce COVID-19 Therapies

Govind Persad Leave a comment

By Govind Persad, Monica Peek, and Seema Shah

Vaccines are no longer our only medical intervention for preventing severe COVID-19. Over the past few months, we have seen the arrival and wider availability of treatments such as monoclonal antibodies (mAbs), and more recently, of novel oral antiviral drugs like Paxlovid and molnupiravir.

The recent Delta and Omicron surges have made these therapies scarce. The Delta variant led the federal government to resume control over mAb supply and promulgate allocation guidelines. The Omicron variant exacerbated scarcity because only one of the currently available mAbs, sotrovimab, appears to be effective against it. While Paxlovid and molnupiravir are effective against Omicron, both will likely be in short supply for many months. Paxlovid is currently constrained by a lengthy manufacturing process. Molnupiravir — which is substantially less effective — is contraindicated for use in patients under 18 and not recommended for use during pregnancy.

To allocate COVID-19 vaccines, the CDC’s Advisory Committee on Immunization Practices, the National Academies of Sciences, Engineering and Medicine (NASEM), and the World Health Organization (WHO) identified ethical goals for prioritization, such as maximizing benefit and minimizing harm, mitigating health inequities, and reciprocity. These committees, particularly the NASEM and WHO committees, included ethics experts as well as experts in social science, biology, and medicine. Current federal guidelines for therapy allocation, in contrast, do not identify ethical objectives or involve ethics expertise.

In an open-access Viewpoint in Clinical Infectious Diseases, we identify ethical goals for the allocation of scarce therapies. We argue that the same ethical goals identified for vaccine allocation–in particular maximizing benefit, minimizing harm, and mitigating health inequities — are also relevant for therapy allocation. Because many people have now taken steps to mitigate pandemic scarcity, for instance by protecting themselves through vaccination, we argue that reciprocity is also relevant.

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