Ashish Premkumar

Connecting Police Violence With Reproductive Health.

Since the police-involved deaths of Michael Brown and Freddie Gray, activists have argued for connecting police violence with reproductive justice. We argue that systematic violence, including police violence, should be evaluated in relation to reproductive health outcomes of individual patients and communities. Beyond emphasizing the relationship between violence and health outcomes, both qualitative and epidemiologic data can be used by activists and caregivers to effectively care for individuals from socially marginalized communities.

Rethinking the social history in the era of biolegitimacy: global health and medical education in the care of Palestinian and Syrian refugees in Beirut, Lebanon

ABSTRACT The critiques leveled towards medical humanitarianism by the social sciences have yet to be felt in medical education. The elevation of biological suffering, at the detriment of sociopolitical contextualization, has been shown to clearly impact both acute and long-term care of individuals and communities. With many medical students spending a portion of their educational time in global learning experiences, exposure to humanitarianism and its consequences becomes a unique component of biomedical education. How does the medical field reconcile global health education with the critiques of humanitarianism? This paper argues that the medical response to humanitarian reason should begin at the level of a social history. Using experiential data culled from fieldwork with Palestinian and Syrian refugees in Lebanon, the authors argue that an expanded social history, combined with knowledge derived from the social sciences, can have significant clinical implications. The ability to contextualize an individuals disease and life within a complex sociopolitical framework means that students must draw on disciplines as varied as anthropology, sociology, and political history to further their knowledge base. Moreover, situating these educational goals within the framework of physician advocacy can build a strong base in medical education from both a biomedical and activist perspective.

Preterm Birth and Future Childbearing: More Questions Than Answers

Preterm birth, both from a medical and economic perspective, constitutes one of the greatest burdens in obstetrics.1 Alenius et al2 provide us with a unique analysis in which they seek to ascertain whether preterm birth is associated with additional, heretofore unappreciated social consequences: specifically, is there a relationship between the birth of a preterm infant and subsequent childbearing? In their analysis of data from Finland, they demonstrate that a lower gestational age at birth in 1 pregnancy was associated with a lower likelihood of having more children. The exception to this relationship was observed when a preterm infant died; in that case, a higher percentage of women had another child. Alenius et al2 ultimately conclude that because of the connection between preterm delivery and future childbearing, 1220 subsequent children (denoted as “missing siblings”) would not be born per 100 000 livebirths. The study and the authors’ ultimate conclusions are striking for a variety of reasons. First, the use of certain phrases (eg, “preterm birth has substantial consequences on the further reproductive behavior … Address correspondence to Ashish Premkumar, MD, Department of Obstetrics and Gynecology, Prentice Women’s Hospital, 250 E Superior St, Chicago, IL 60611. E-mail: ashish.premkumar{at}northwestern.edu

‘When language skews narratives’: Critical medical humanitarianism after Beirut, Paris, and Baghdad

The ISIS-led attacks on Paris, Beirut, and Baghdad in November 2015 were covered in a variety of ways by major news outlets globally. Coverage of the Paris attack was widespread, and layered with personal stories about those personally affected and analysis about the effects of terrorism on the French way of life. By comparison, little coverage was given to either the Beirut or Baghdad events, the experiences of those suffering on the ground, or the wider issue of the effects of terrorism within Lebanese and Iraqi communities. In this think piece, the bombings in Beirut are used as a lens for examining the politics and consequences of mediated silence or ‘forgetting’ of violence and suffering in the Middle East. We employ a critical humanitarianism, rooted in a social medicine analysis, to connect these media trends to the training of health professionals. Our approach helps build accountability for the inequalities present in the Western construction of suffering and the emotive aspects of global violence, and promotes a wider conversation about the long-term biomedical effects of violence.

Abortion and contemporary hip-hop: a thematic analysis of lyrics from 1990–2015

OBJECTIVE To evaluate the representation of abortion in contemporary hip-hop music, gaining insight into the myriad of attitudes of abortion in the black community. STUDY DESIGN We used Genius, an online storehouse for lyrical content, to identify songs by querying the database for search terms related to family planning, including slang terms. We then cross-referenced identified songs using an online list of songs about abortion. We analyzed eligible songs using grounded theory in order to identify key themes. RESULTS Of 6577 songs available, a total of 101 songs performed by 122 individual artists met inclusion criteria. The majority of artists were Black men; five artists were Black women. Key themes were: use of abortion as braggadocio; equating abortion with sin, genocide, or murder; male pressure for women to seek abortion; and the specific association of Planned Parenthood services with abortion. CONCLUSIONS The moral and ethical themes surrounding abortion in hip-hop lyrics reveal a unique perspective within a marginalized community. The overall negative context of abortion in hip-hop lyrics needs to be reconciled with the gendered, economic, historical, political, racial and ethnic background of hip-hop and rap music in America. IMPLICATIONS This study is the first to evaluate lyrical content from contemporary popular music in relation to abortion and family planning. Examining the intersection of reproductive rights and popular culture can provide a unique insight into the limited knowledge of the perspectives of abortion in the black community.

Opioid Use Disorder in Pregnancy: Health Policy and Practice in the Midst of an Epidemic

We applaud Drs. Krans and Patrick for bringing up the timely issue of opioid use disorder in pregnancy.1 Although the authors note the changing demographics of those seeking treatment— from primarily low-income, minority men to young, white women—they neglect to identify the role of race in opioid use disorder treatment.2 Officebased buprenorphine arose in part because of the problem of treating white, middle-class individuals within highly public, surveilled, and regulated methadone clinics.2 Buprenorphine certainly expands medication options and, as the authors note, “liberates patients from the stigma associated with many methadone clinics” in part because it is private, self-administered, and sequestered. However, this liberation is better seen as a form of (white) privilege, because access to buprenorphine is highly stratified by race and class.3 Whereas 53% of methadone patients are black, 92% of buprenorphine patients are white.4 Without acknowledging the racialization of opioid use disorder diagnosis and therapy, we as health care providers reinforce existing inequalities and contribute to a two-tiered system of care. Financial Disclosure: The authors did not report any potential conflicts of interest.