Skepticism that black doulas will stop bad birth outcomes. Ohio's process for solving open records requests has some merit.
Skepticism that black doulas will stop bad birth outcomes.
There are some discrepancies in birth outcomes for black mothers. Among these are that black women are more likely to die from childbirth. They're more likely to miscarry. They're more likely to have preterm, and SGA (small for gestational age) babies.
Confoundingly, it doesn't seem that these are all an effect of socioeconomic factors. The patterns above persist despite changes in income and other factors that go into socioeconomic factors.
A persistent and maddeningly unanswered "Why?" is one of the few certainties here.
Theories abound, but it seems that progressives in this state feel they've a handle on it. To them the answer is, as it often is, tied up in racism. Per my earlier newsletter touching on this topic (linked first below), OBGYN's are racist and that racism leads directly to these kinds of poor outcomes.
Rewind back to 2019. A bill passed that year, linked second below, created a committee housed in CDPHE to study maternal mortality (not just black, but in general though the data are broken out by race of course). This committee was to, quoting the bill summary, "... review maternal deaths, identify the causes of maternal mortality, and develop recommendations to address preventable maternal deaths, including legislation, policies, rules, and best practices that will support the health and safety of the pregnant and postpartum population in Colorado and prevent maternal deaths."
The 2023 report from this committee spurred a CPR article which I link to third below.
A common thread running through these three links is the (either explicitly stated or implied) idea that doulas, in particular doulas that are black, will be a remedy for the ills I mention above.
If the system is racist and not "culturally competent", after all, then having someone who is black involved in helping the new black mother will fix the bad health outcomes.
As you will likely see if you read my first pass at this issue below, I am skeptical of that direct connection. I'm skeptical both because I don't think our healthcare system is inherently, systematically, or whatever other adjective you'd like to use, racist.
And I am also not sure that having a doula in the room is going to make an impact on maternal outcomes.
It's a thing we can try. I don't object to seeing. But I would call your attention to the following. Look at just how much time and attention are put to black doulas and racism in the Sun article (which I link to in my earlier post) and CPR article. The attention paid at both the individual and policy level.
This flies in the face of opportunity cost and a much more sane strategy (one that doesn't presume a cause and then spend all its time attacking that one potential, partial cause). While we spend time and money on chasing down systemic racism among OBGYNS and on training and certifying black doulas, we are ignoring other, equally plausible causes. How many other articles, how many other reports from CDPHE, how many other CPR articles and legislative efforts on poor black outcomes have you seen that DO NOT mention racism or doulas?
We ought to be casting our net wider and ought to enlarge the conversation on this issue. We're not going to help as many people as we might otherwise if we continue on this path.
https://coloradoaccountabilityproject.substack.com/p/how-does-colorado-pick-state-judges?utm_source=publication-search
https://leg.colorado.gov/bills/hb19-1122#:~:text=Maternal%20mortality%20review%20committee%20%2D%20creation,to%20this%20bill%20as%20enacted.)
https://www.cpr.org/2024/10/30/colorado-new-doula-program-challenges/
Ohio's process for solving open records requests has some merit.
Colorado Freedom of Information Coalition (CFOIC) recently put out an article describing how Ohio solves disputes about open records requests. I liked their ideas. Thought I would share.
Let's back up a bit though.
If you do a CORA (Colorado Open Records Act) request for public records there are some records or parts of records that can be denied. Some are a definite "NO" like personnel records. You cannot, for example, get the home address of the state's chief economist.
Fair enough.
Some things are more of a judgment call, however. One exception to CORA is any sort of record that would give away the "deliberative process". You cannot, for example, get the back and forth email discussion about how to advertise the newest changes to unemployment from the Department of Labor because the people making those decisions (and advising the ones who do) need to be confident that what they say is private so they can all be frank with each other.
I cannot count the number of times I've had a request denied because one or more things I wanted fell under the "deliberative process" exemption.
I also cannot tell you how many times I've wondered whether or not their denial was too strict--that the material they denied would not actually be covered under the exemption--but didn't have the resources of time and money to fight it.
CFOIC touches on that, quoting their article linked first below (links left intact):
"In Colorado, filing a lawsuit in district court is the only way for journalists and the public to challenge denials — there is no administrative appeal mechanism in the Colorado Open Records Act. Journalists here have some access to legal help for open-government matters because of the Colorado Freedom of Information Coalition and the Reporters Committee for Freedom of the Press’ Local Legal Initiative. But challenges from ordinary citizens aren’t all that common, perhaps because it can be intimidating to take on the government and the initial cost of a lawsuit — even though a prevailing plaintiff is entitled to attorney fees and court costs. So maybe that’s a reason to consider alternatives for dispute resolution such as the now-eight-year-old Ohio program."
CFOIC then goes on to detail Ohio's lower-bar-to-entry way of solving this program. I'll leave it to you to read up on that in more detail, but the essence is this.
In Ohio, if your records request is denied, a $25 fee lets you start an action in what the article calls a "Court of Claims" (this is a guess on my part, but by the context, I'd say this sounds like Small Claims Court here). You do not need a lawyer to proceed.
The first step is mediation and if that fails you can proceed to court, but at a lower cost if your action fails.
An intriguing idea. I was thinking to myself something similar not too long back. Long way 'round, but my idea relates to the anti-SLAPP law here in Colorado which shunts some defamation lawsuits to a quicker, lower-cost hearing. See the second link below for an earlier newsletter and context.
The Ohio law shares that essential feature and offers a way for citizen CORA requesters who lack the resources of a big news organization to pursue privilege claims that are dubious.
I like the idea. Given how difficult it's been to get solid reforms to CORA, I'm not expecting a reform like this in the near future, but a guy can dream can't he?
https://coloradofoic.org/taking-another-look-at-ohios-low-cost-process-for-resolving-open-records-disputes/
https://open.substack.com/pub/coloradoaccountabilityproject/p/free-speech-tuesday-a-triplet-of?r=15ij6n&utm_campaign=post&utm_medium=web
Related:
Complete Colorado has had quite a saga in their battle with the state over a records request that the state denied for "deliberative process".
I put the last article in the installment below. You should be able to link back from there if you'd like.
https://pagetwo.completecolorado.com/2024/06/13/complete-colorado-legal-costs-transparency-lawsuit-against-state/