Old World Sexism

Last year I wrote about a bylaw requiring women and TBAs to pay a fine of a goat to the chief of their village each time they have a home birth. The other day I found out that when a young girl “falls pregnant*” her family also owes a fine to the chief as a penalty. I couldn’t help but ask “what about the boy or man’s family?” even though I knew the answer was that there is no accountability on the male’s part.

*So often the language alone says so much.

It’s bad enough when you know a culture facilitates victim blaming and double standards, but when the policies enforce them so blatantly, it gets to me. Don’t get me wrong—I’m aware of reproductive rights issues we have around the world including at home, but at least our policymakers have to try working a little more discreetly to write sexist legislation.

I also learned that medical students are taught just two categories for induced abortions: “inevitable” or “criminal.” The physicians had a dynamic conversation* about the appropriateness of putting that kind of language on a medical record. Their job is to treat people, not to get involved in legal disputes and criminal cases. The truth is abortions are still illegal here (pretty comprehensively), so technically calling it criminal is accurate. But the fact that stigmatizing language can even be found on your hospital chart demonstrates how pervasive the oppression of women really is.

*I was proud of the clinic leadership for even having the conversation—it was not easy or comfortable, as the Christian faith is a big part of this hospital. Ultimately, they were clear about wanting to do right by their patients.

Working on a research team connected to a clinic means it’s easy to see how these systemic issues touch individual lives.

The founder of CLI, Jeff, told me about a 12 year-old who was raped and impregnated by a local boy and ran away from her parents (no surprise given the environment I just described). She sought refuge with her uncle but was turned away, so was on her own until she came to deliver at CLI hospital. She is one of many cases to inspire the clinic’s new teen motherhood program. They’re working to offer nutritional and parenting support for the mother including a stipend for someone in her family to take time off of work so she can return to school.

It’s a needed service but it’s hard not to think ‘upstream’ about how we can prevent the pregnancies in the first place. Motivating cultural change is so complicated, resource- and time-intensive, so I’m happy to hear that the clinic staff is interested in using the community volunteers organized through my surveillance project as advocates for other initiatives driven by the clinic. These volunteers seem to really believe there is opportunity to improve their villages, and they are one thousand percent critical to driving sensitization efforts. You can’t be a mzungu running around insulting someone’s culture, but a respected champion who shares your vision (maybe an army of them) actually has a chance to incite change.

So, this is where the ‘less data, more doing’ pressure comes from. But evidence has shown time and time again that empowering girls and women promotes growth in all areas (econ/edu/health), arguably with more efficience than any other type of intervention. I hope CLI can learn from those cases and leverage data from Malawi and around the world to move the needle for girls and women right here.

Healthcare Exchange Enrollment – What March 31 might mean to you.

I get the idea behind the “Enroll before February 15th to make sure you’re covered on March 1st” campaign



(and these others)…










People are procrastinators. Focus on an earlier “deadline” that might actually inspire some action upon reading it. Also, the “OMG We built it and no one will come!” panic hasn’t fully subsided, and life will be easier if enrollees get it done sooner rather than later.

But I worry this tactic might cause some confusion over what the actual deadlines for enrollment in the health exchanges are. Just sticking to the March 31 date and considering all the exceptions and qualifiers along the way is complicated enough.

I made an interactive kind of brainstorming/discussion wall with Padlet and sadly it doesn’t embed here. =( But please consider dedicating your 30th new tab to my Health Exchange Enrollment Board. I started with some of the common questions I’ve been hearing, and welcome new posts and prompts. Add your own and let me dig up an answer for you! No account making, security question memorizing or lame list serve subscribing required.

Health Policy, F___ Yeah!

Ladies and gents, let’s talk Obamacare.

First as a communicator:

I am sad that Obama’s PR team tried to reclaim the term Obamacare, using it in all of their own materials in response to a long period of anti-Obamacare rhetoric, just to have it blown up in their face when the American people didn’t “get it” because they weren’t paying enough attention in the first place (as displayed by Jimmy Kimmel’s brilliant and gut-wrenching man-on-the-street poll). I thought it was a such a clever campaign trick when I first saw it. Sigh.


Second, as a Public Health student:

Things I see missing in the public discourse around the ACA.

NOTE: The rest of this entry assumes you’ve been following media of a high enough quality to know the basics. 1) that it’s not a government takeover, 2) that its primary function is to provide coverage to uninsured, and 3) how the insurance exchanges are supposed to work. Need some background info? Cue: The Kaiser Family Foundation’s Health Reform site. Fueled with good data and some serious medical/public health expertise.

I see the ACA as more than a list of offerings and regulations. The thing is, health services don’t really work in free-market economics. Not with today’s system. The ACA moves the needle on this.

Think about it. You can’t really shop around for health services. If you could call around and actually get prices to compare between providers, you are one seriously determined and free-time-having person. But it’s gotten so bad, so hard to predict actual patient costs per provider/insurer/plan, that we’ve become familiar with those forms at the doctor’s office. You know, the ones that say something along the lines of “We can’t tell you what this will cost, but you’re responsible for it regardless.” This would not be an acceptable payment method in almost any other market.

Now let’s talk about the person selling you your services. Your doctor. Who is paid more for selling you the most expensive services in the highest quantity (in a fee-for-service system, at least), even if a huge cost increase does not improve your outcomes. This incentive scheme is really the same as it is for salesman Pete at your nearest used car dealership. Except in healthcare, you’re supposed to trust your doctor. You don’t have hours (days) to spend reading the latest health journals, so you don’t know that your knee replacement has been decided, pretty much conclusively, to be of insignificant benefit over vastly cheaper rehab options.

Thanks to this buyer-seller relationship (and several other factors), there is also trouble in paradise when it comes to the conventional supply-demand-prices relationship.

Another thing about free markets: they’re supposed to be inclusive. With nearly 50 million people uninsured, this is clearly not the case.

So even if we can’t fix the doctor-patient relationship (yet), maybe we can help those uninsured participate in the market to bring things one step closer. What’s been prohibiting them from participating anyway? 1) Information (this time about the insurance options and prices rather than the actual health services) and 2) costs (if you could actually find those prices in a pre-ACA world, you’d run for cover).

Answer: An accessible marketplace providing layman’s terms information on insurance options that are easily compared, with regulated minimum coverage (like Safe Auto of health care but better), and subsidies so the poorest get some help and those who are just kinda broke still get a good deal, but pay their fair share into the system.

For any kind of coverage, insurance companies need a large pool to spread risk around. Now that healthy people (who can get by on a minute clinic visit and some DayQuils each year) are incentivized by a tax penalty to get real coverage, insurance companies are competing for them. That, along with transparency and an accessible marketplace, makes for economic activity that looks a little more like free markets for the people who haven’t been so fortunate to participate up until now.

I know there are issues. Web site probs, states being jerks about medicaid expansion, etc. I want to address those later, but let’s unpack this bigger picture concept first.

In an environment where liberals are seen as pro-imposing government and shoving communism down everyone’s throats, Obamacare seems to really try making healthcare work in a way that aligns better with free market principles. It’s nothing like a single payer “socialized” system that the most left would support if given the chance. And still, Obama is being blamed for our current political jam based on refusal to compromise?



Thoughts? Questions? I’m no expert but am nerding out over this stuff ATM and am happy to discuss/research with you.