By: Wes Nakour

Culture: the arts and other manifestation of human intellectual achievement regarded collectively (Oxford, 2020). In the matter of mental health, culture impacts a persons beliefs, norms and values, including how the person perceives ideas and behaviors which process through their minds in different ways with different emotions. Unfortunately, according to The Commonwealth  Fund, many minorities in the United States are less likely to get mental health treatment or will wait until symptoms are severe before doing so (CWF, 1997). This research was found in 1997, and we can assume with population growth and migration over the past decade that the matter has only gotten worse.

A part from minorities in the United States, the most severe mental health conditions come from cultures that encourage education heavily and dictates one's life based on their level of education. In China, there is a rising mental health crisis in China's education system. With rising competition due to the dense population, the academic stress in addition to the increasing competition is causing a mental health crises for youth and young adults. A study of 2,191 students ages 9-12 years old found that 81% of the children worried “a lot” about exams, 63% of them were afraid of punishment by teachers, and 73% of them were physically punished by their parents for lax academic effort (Hesketh et al, 2010). The culture plays a major role in these punishments, as it does similarly in my own middle eastern culture. Education plays a major role in many different cultures, and often punishment is associated with poor performance academically which plants the seed that will feed and grow on the stress students are facing through the many years spent in the education system.  

One reading that I found especially enlightening was Gender Differences & Mental Health. According to the WHO, The lifetime prevalence rate for alcohol dependence, a common disorder, is more than twice as high in men than women. In developed countries, approximately 1 in 5 men and 1 in 12 women develop alcohol dependence during their lives. In result, men are more than three times more likely to be diagnosed with antisocial personality disorder than women (WHO, 2013). This contributes heavily to the discussion of where the mental illnesses stem from and how they affect the different genders. The dependence for alcohol causes neurological damage to the brain and especially impacts mood and behavior. Most of the time, improper consumption can end a person up in jail which down the road contributes to even more mental illness because of the consequences of having a criminal record. The complexity of mental health reminds us that gender is not the only thing to factor into this discussion, there are personality/behavior altering substances in abundance for consumption that causes mental health problems on both sides, men more likely than women in this case. 

​Another reading that was especially enlightening was Facts About Women and Mental Health, specifically the fact that depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use affect women to a greater extent than men across different countries and different settings. According to the WHO, depression, anxiety, somatic symptoms and high rates of comorbidity are significantly related to interconnected and co-occurrent risk factors such as gender based roles, stressors and negative life experiences and events (WHO, 2013). Unfortunately in the world we live in gender inequality is significantly related to interconnected factors which determines the different power and control men and women have over their socioeconomic status which lead to specific mental health risks. This is an important conscious note for healthcare providers to go the extra mile and ask patients about their mental health. Ultimately, the truth is, most men and women are under diagnosed with mental health disorders, leading to permanent stressors that solidify the placement of gender based roles which ultimately accounts to the worlds leading burden of disease being depression. 
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​References: 


A Comparative Survey of Minority Health. (1997, July 1). Retrieved February 21, 2020, from
https://www.commonwealthfund.org/publications/publication/1997/jul/comparative-survey-minority-health
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Gender and women's mental health. (2013, June 24). Retrieved from https://www.who.int/mental_health/prevention/genderwomen/en/

Zhao, X., Harvard Graduate School of Education, & University of Calgary. (2010, March 3). Academic stress in Chinese schools and a proposed preventive intervention program. Retrieved from
https://www.tandfonline.com/doi/full/10.1080/2331186x.2014.1000477#

We have a number of readings this week that explain why it's important to look at gender in relation to mental health. Using at least 2 of the readings, provide a justification with at least 3 supporting points and examples.  

According to WHO "Gender  affects the power and control men and women have over socioeconomic determinants, their access to resources, and their status, roles, options and treatment in society." This shows that gender and mental health have a bigger role to play in our daily lives. 

Also according to WHO "Uni-polar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women". We can use gender to figure out what subgroup is more affected by certain mental health diseases and it will make it easier for us to get them the treatment they need. 

According to WHO "Despite these differences, most women and men experiencing emotional distress and /or psychological disorder are neither identified or treated by their doctor." This is a major problem because we should be identifying those suffering from such diseases and helping them but instead they can't be identified so they go without the proper treatments. 




​Choose 2 readings or media that you found to be especially enlightening this week and explain what they contribute to the discussion of gender, mental health, and human rights  and to your own learning/experiences. 

One of the readings I enjoyed the most was "Gender differences and mental health" and the reason why I enjoyed this reading is because it sheds light on the important role gender plays in mental health and this is a huge importance because women and men are affected differently by mental health.
Another reading I enjoyed reading was "Stigma and discrimination" I enjoyed this because in Somalia there is a lot of stigmas that come with mental health, people are usually labeled "crazy" if they are seen seeking help and that will effect their lives so they stay quiet and never seek help because of fear of being unjustly labeled. I have a cousin that opened a clinic in Somalia and he doesn't really anybody to help because of this stigma placed on people. Also discrimination is huge, people with mental health problems are usually not married because the parents fear having their daughter face the same discrimination and stigma. 


Gender and women's mental health. (2013, June 24). Retrieved February 22, 2020, from https://www.who.int/mental_health/prevention/genderwomen/en/

         
​While watching Aspen Baker’s TED Talk, I began contemplating bias. Bias is something that has been brought up in several SNHS classes, most recently in my journal submission for Fieldwork in Health Studies. I did not discuss this particular bias in my journal submission, but I definitely have preconceived ideas about Christians and Christianity. Living in a country where much of the population is Christian, I have obviously come across many Christians of different denominations. And I know that they are not all the same. Still, when I think about Christians as a whole, I assume that as a group Christians tend to be narrow-minded and/or sheltered from the diversity of the real world. So, when Aspen Baker began talking about one of the volunteers at Exhale who was uncomfortable discussing God with women who had had abortions, it resonated with me.
 
 When I was nineteen, I had an abortion. A year or two later, one of my coworkers also had an abortion. We were discussing our own experiences – how I found my experience to be rather comical and how she found her experience to be a smaller deal than how abortion is usually portrayed. Even though my friend went to Catholic school her whole life, she wasn’t particularly religious, and I am definitely not. At the end of our discussion we agreed that we wouldn’t discuss our abortions with our mutual friend, who is Christian. A few months before I had my abortion, this mutual friend and I were discussing abortion. While she seemed okay with it in theory, she fully endorsed the idea of adoption as a solution for unplanned pregnancy. I was so concerned with how she might react to me having an abortion that I didn’t include her in the conversation or give her the chance to be supportive of my decision.
 
After getting my abortion, I remember the #ShoutYourAbortion movement igniting to protest defunding Planned Parenthood. My mom was also nineteen when she got pregnant with me. I appreciate everything she sacrificed by having me. But watching how my mom and dad struggled financially and how hard my mom worked to juggle work, school, and a kid, I knew from a young age that if I was ever in the same situation, I would get an abortion. And I did. And I don’t regret it. There might be some people who say that I made a selfish decision, but it’s okay for a nineteen-year-old to be selfish. It’s okay for anyone to be selfish once in a while. But the stigmatization of having an abortion kept me from shouting my own, even though it was the right choice for me.
 
 Aspen Baker stated that “Empathy gets created the moment we imagine ourselves in someone else’s shoes.” Civil discourse on abortion rights needs more empathy. Women who have abortions are often villainized, but their stories are not all the same. Aspen Baker’s Exhale organization and Twitter campaign #ShoutYourAbortion are examples of this. Women have abortions because they are sexually assaulted. Women have abortions because their pregnancy is dangerous to their own health. Women have abortions because they aren’t ready to be mothers. Polarization erases these women’s stories and promotes stigmatization. Women should be free to shout their abortion without judgement.
 
References
Baker, A. (2015, May). Retrieved January 29, 2020, from https://www.ted.com/talks/aspen_baker_a_better_way_to_talk_about_abortion
Shout Your Abortion. (n.d.). Retrieved February 18, 2020, from https://shoutyourabortion.com/about/

​Justice Kurihara

Nobody can force me to have a child
The journey from a lady to a mother is wild
The life coming in the world will be my responsibility
So, the future of this child will depend on my capability
Being a mother is not about giving birth
It’s about raising humans for the benefits of this earth
So, when I think about becoming a mother
I want all my attention towards the child and nothing other
I only plan to bring a life in this world when I’m ready
That is when I am mentally prepared, and everything is steady
 
I wrote this poem, because I know how hard it is for us women to be fully responsible for our pregnancy and after we give birth which not too many people understand that. As it was mentioned in 6.2 Reproductive Justice “the complete physical, mental, spiritual, political, social, and economic well-being of women and girls, based on the full achievement and protection of women's human rights”. And that’s how Loretta Ross defines Reproductive Justice which I fully support and agree.
Since I grew up in Egypt, which is considered as a developing country, infertility has always been an issue there. My father is a gynecologist in Egypt, and I remember him telling me how infertility can damage a marriage and a whole family’s life. It was a real issue there, because of many reasons. The first reason is if the couple got married and didn’t get pregnant within the first year, then they assume she is the one who has problems and they start to talk behind her back and how she is useless and not worthy enough to have a baby (primary infertility). Like it was mentioned in 6.4 Global Perception of Infertility article, “In developing countries, the % is a little higher, with 25% or 1 in 4 couples having reported being impacted by infertility (as reported on Demographic Health Surveys from 1990 and 2000)”. Which means the percentage of infertility is very high in developing countries like Egypt. Not only that, but if the woman didn’t have a baby boy, they think she is hated by God and it is a punishment from him to not have a baby boy who can carry the family’s name on (secondary infertility). And that was on of the psychosocial burdens of Infertility in Global Perceptions of Infertility. Many people in Egypt are not aware that men can be the reason why their women are not getting pregnant. So, they need to be aware of how fertility works and how it is not only the women’ responsibility. Moreover, women need to know how to seek an appropriate infertility care and how to stop to blame themselves when it happens to them. Because seeking infertility care is one of the women’ rights as humans.
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By Mariam Elias
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She is young, and alone in this great country.
Her native tongue washed away by the essence of what they call freedom.
Seventeen years of age and seven months pregnant.
Afraid of what is to come.
 
Nine months have passed, and the day has now arrived.
Mixed emotions wash over her body as she walks the hallway of the hospital.
She hears a newborn cry in the room next to hers.
Wishing her mother was beside her.
Her trial has begun.
 
All those birthing courses that she barely understood.
She starts to wonder if it is in her to succeed.
The pains become intense.
She holds her husband’s hand.
Five hours in, and her anxiety gets worse.
She feels that somethings wrong, but the staff ignore her cries.
What could a young girl like her know?
 
Ten hours have passed, and the pains have gotten worse.
She sees the doctors gaze.
Their expressions all seem worried.
Her world starts spiraling and they all start yelling.
She’s losing all sensation.
It’s a hemorrhage they say.
Everything goes black.
 
Five hours later she awakens.
Her body is in shock.
The pain is overwhelming. She hears a cry.
She suddenly remembers why she’s there.
Her daughter has arrived.
 
 
This poem was inspired by my mother and all she went through when she gave birth to me in the state of California at the age of seventeen. The readings that inspired this poem was Reproductive Justice by Loretta Ross “The universality of the reproductive justice framework means that everyone has the same human rights. Applying the theory of intersectionality accounts for what every person needs- based on individual and group identities- to have their human rights protected and respected. In other words, intersectionality is the process; human rights are the goal”.  The reason this quote inspired me is because my mother said she felt unheard by the medical staff because of her age, and because she knew so little English. The goal of human rights is to protect and respect everyone and their opinions no matter what their background may be. Vulnerable women are often overlooked because of systematic inequality. 
​-Karina H

There have been many different views in my life that have influenced how I view gender. Being 22 years old, and growing up in a household with two very different cultures I was always around people who had very strong views about gender. Growing up with a Iranian father and a Zambian mother there have always been certain gender roles that both my parents lived with. For example, women are the homemakers while men go out and make money to support the household. The same goes for my Zambian side, where women are supposed take control of the household but at the same time women are known for being the provider in the families as well. While I primarily grew up with my father who really instilled in me the idea that women should be at home taking care of the house, there has always been that other side of me who will not just let men control me but rather have my own identity not tied to anyone, which comes from my Zambian side.
            There are many different determinants of health, and I believe that they all equally play a role in the health status of people. When looking at education as a determinant of health it is hard not to be biased, coming from an institution of higher education. Because for me personally I believe that having a higher level of education means better access to health services. And for a majority of people they believe that having access to education allows individuals to create a voice in their own communities and allow them to create changes that they believe the community needs. China has recognized, “…literacy as the key to women’s full participation in societal decision-making and to improving the well-being of families. Education earns community respect, and being respected builds confidence and encourages participation” (“Outrage to Courage”, 42). This is very important in allowing social changes that will allow for rights and changes primarily focused on women. There are key rights that would have a large impact in the direction of women when education is taken into account. When education is given to women there is an awareness on women needs. For example, sex education awareness is increased therefore decreasing STD transmissions. “Studies link education with reduced child and maternal deaths, improved child health, and lower fertility. Women with at least some formal education are more likely than uneducated women to use contraception, marry later, have fewer children, and be better informed on the nutritional and other needs of children” (“The Effect of Girls’ Education on Health Outcomes: Fact Sheet”). This will lead to many changes if women are given the opportunity to create change.
 
Tiffany Ghadamy
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Citations:
The Effect of Girls' Education on Health Outcomes: Fact Sheet. (n.d.). Retrieved from https://www.prb.org/girls-education-fact-sheet/
Murray, A. F. (2008). From outrage to courage: women taking action for health and justice. Monroe, Me.: Common Courage Press.

​​Respond to one of the video stories you watched about birth in America. Describe 3 factors that influence maternal mortality in America among women of color. Did you realize the U.S. had such a horrible maternal rate for a developing country? What are 2 things that could be done by our healthcare system to better support expectant mothers?  Be sure to credit your sources. 

In the “Birth in America” documentary, there were multiple factors that caused maternal mortality rate. Among those factors, we know that “while research into maternal health disparities seen among immigrant populations appears to be lacking, one disparity remains obvious: access to health care” (Howard, J. CNN. The stress pregnant immigrants face in America. 2018). Access to healthcare is one of the biggest issues that so many people face around the world, especially immigrants in America. This is one of the biggest influences of maternal mortality because they do not have the proper resources to get treatment or care during their pregnancy. They could live miles away from the nearest hospital and face childbirth complications. Some people just can’t afford healthcare. They don’t have insurance or money at all in some countries. Unprofessional procedures can cause serious health complications for the mother and the baby. With all the possible complications they could face, their stress levels increase and influence a lot of the more serious health disparities they come across. 

I was already aware that the United States had a horrible maternal mortality rate because of the lack of maternal care we provide. "All women should ideally have contact with a maternal care provider within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth” (MGH Center for Women's Mental Health.  2018). We fail to provide care for the one who just gave birth. There are many psychological factors that can impact a women’s life after giving birth and become more at risk for post-partum complications. In our healthcare system, since these kinds of complications aren’t normally monitored, let alone covered by insurance, we can start to educate mothers on how to cope with those psychological issues. There are resources that aim to help those mothers facing those issues. Another thing that we should do as a nation is expand the FMLA act by providing paid maternal leave. Right now, we offer a secure spot in our jobs for 12 works weeks of maternal leave. We found that “paid maternal leave brought in profits or had no effect at all” (CBSN. Why paid maternity leave is a smart business. 2016), so incorporating paid maternal leave would do more good for the company than bad.

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This week, we've examined infertility from a cultural relativist and universalist perspective. How is the issue of infertility seen in the culture and community in which you grew up?  How could one argue the right to have access to infertility care should be a human right?

In the community and culture that I grew up in, reproductive justice is not a common topic to discuss. It actually is one of those topics you don’t discuss at the dinner table. I was in vacation in the Philippines in December and remember having a talk with my little cousins about sexual education. They asked me about my experience with sexual education since it’s not talked about in school because everyone is expected to wait until marriage to avoid unwanted pregnancies. Philippines is a Christian-Catholic dominant country and I, myself, practice Catholicism. Religion plays a large role for the community and affects their accessibility to resources such as contraceptives. I asked them about the kinds of birth control they offer, and she couldn’t tell me what birth control was. Being an 18-year-old, uneducated but curious about sex and relationships was already a factor that influences unplanned pregnancies. The obvious, condoms, were the only thing that she knew about. She mentioned that the use of contraceptives can cause infertility and that’s why it’s not offered nor easily accessible for women. It’s NOT OKAY to be sexually educated because it goes against the concept of being holy. Having the right to access contraceptives and infertility care should be a human right especially in countries where it’s frowned upon because it prevents more than just unplanned pregnancies and birth complications. Having access to that care prevents it from happening through treatment, care and support. Young teens won’t know any better if they don’t know anything which is why education is so important. Different families can practice what they want, whether it be waiting for marriage or staying abstinent forever but knowing where to go without feeling like they’re going to hell for it can decrease the risk of psychological issues.

 
Jennyna Golveo
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Resources
CBSN. Why paid maternity leave is a smart business. 2016. Retrieved from https://www.cbsnews.com/video/why-paid-maternity-leave-is-a-smart-business-move/
Howard, J. CNN. The stress pregnant immigrants face in America. 2018. Retrieved from https://www.cnn.com/2018/10/23/health/pregnant-immigrant-women-every-mother-counts/index.html
MGH Center for Women's Mental Health. Postpartum Care in the United States: Some Progress But Still So Far to Go. 2018. Retrieved from https://womensmentalhealth.org/posts/postpartum-care-progress-but-still-far-to-go/

​Respond to one of the video stories you watched about birth in America. Describe 3 factors that influence maternal mortality in America among women of color. Did you realize the U.S. had such a horrible maternal rate for a developing country? What are 2 things that could be done by our healthcare system to better support expectant mothers?  Be sure to credit your sources. 
One of the video stories that I watched about birth in America that stuck out to me the most was on California. It occurred to me that undocumented immigrants have trouble accessing hospitals or clinics because of how scared there are about being deported. And I understand that this should be a no brainer, but it never occurred to me that one would be questioned on their immigration status to be seen at these places? I felt that as a physician or staff, their only business is on their patient’s health. It’s quite unfortunate seeing that there are mothers who are constantly on edge while bearing a child because that causes an immense amount of stress. I am just glad though that in California, they are able to offer insurance, Medi-Cal, for all expecting mothers regardless of what their immigration status may be. This is great, but I don’t understand why one’s immigration status matters over just basic human rights. All people deserve to be seen and taken care of professionally by physicians. And I think this is what is so wrong with America, our healthcare system seems to be coming a privilege rather than a right. Everyone should be entitled to proper healthcare regardless of any immigration status or socioeconomic factors.
One of the factors that influence maternal mortality in America is insurance coverage. A woman’s insurance status can impact their health and the type of care she receives before, during, and after pregnancy, which affects her likelihood of having a healthy pregnancy and delivery and of receiving necessary care after birth (Hayes). Another factor would be racial/ethnic disparities. It has been shown that those of colored have greater maternal mortality prevalence among those of noncolored. African American and Native American women are more likely to die from pregnancy related issues than Hispanic and white non-Hispanic women. Social Determinants of Health contribute to these rates because black women with a college degree were still 2.4 times more likely to suffer severe maternal morbidity and 1.6 times more likely to die from a pregnancy-related complication than a white woman with less than a high school education (Hayes). The third factor would be the accessibility to quality healthcare that is offered. There are 2.4 million women of reproductive age, have no hospital obstetric services and also face primary-care physician shortages (Hayes). All three factors affect women of color because racism and discrimination still exist. I thought that the U.S. wouldn’t be this bad, but after seeing all of the mortality and morbidity rates as well as care for women after, it just shocks me at how developed of a country we are, and we have issues like this. And to be honest, I don’t even know if we could fix this because even if you put laws out to provide for all women, there will still be racism and discrimination within the healthcare. I feel like if we all offered something similar to Medi-Cal, it would have to be a hospital or clinic where all different races/ethnicities are offered one with a familiar background or race. As shallow as it sounds, people of similar race will treat you better than a different race because they share connection and something in common; they are able to understand each other.

Spotlight a local or global non-profit or activist group that is working to improve maternal health in the U.S. (EXCLUDING; Planned Parenthood and Groundswell). What is the name of the organization, its mission, and its services that it provides? 
A global non-profit group that is working to improve maternal health in the U.S. is Commonsense Childbirth. Their mission is to ensure access to maternal healthcare particularly for minority, low-income, and uninsured/underinsured women. They claim that they turn no one away regardless as they want to ensure all women have healthy pregnancy. So, I assume they don’t mind a women’s immigration status. They provide prenatal, labor and delivery, and postpartum services. They also offer programs for those who want to become a midwife and other paraprofessional courses in the maternal child health field.
 
 References: 
About. (n.d.). Retrieved from https://commonsensechildbirth.org/about/
 
Hayes, T. O. N., Huddleston, J., & Gray, G. (2019, September 9). Maternal Mortality in the United States. Retrieved from https://www.americanactionforum.org/insight/maternal-mortality-in-the-united-states/

Impact of Obesity on Maternal and Fetal Health. (n.d.). Retrieved from https://faculty.sites.uci.edu/messaoudilab/maternal-obesity/ (PHOTO)