Reproductive Health Concerns in the Aftermath of the Gulf Oil Disaster

Lucinda Marshall

Should women trying to conceive, pregnant women and children living near the Gulf take special precautions due to the nature of the oil spill and its potential effects?

This piece was originally posted on Truthout and was used with permission.

Imagine that you are a woman living on or near the shores of the Gulf of Mexico. Perhaps, you are pregnant or hope to be soon. And, perhaps, your partner is one of the fishermen who has been helping to clean up from the BP oil disaster. He comes home at night coughing and barely able to breath and his skin is irritated from contact with the oil.

Will exposure to the toxic chemicals in the oil and/or in the dispersants damage his sperm or your eggs, perhaps making it difficult to conceive? Could the chemicals damage the embryo you already carry, cause a miscarriage or birth defects? Is your newborn baby or young child at particular risk? Should pregnant women and children living near the Gulf take special precautions? And what if you don’t even live near the gulf, could your reproductive health be impacted as well?

While all of these issues are valid concerns, there has been no substantive effort to address them in the aftermath of the Deepwater Horizon explosion. According to Dr. Riki Ott, a marine biologist who has worked extensively to study and raise awareness about the impact of oil spills on both the environment and on people, the ability to fight against toxics is not fully developed in the womb or in children and, as a result, these populations are particularly vulnerable. “Pregnant woman and children should not be anywhere near this,” she said in a phone interview.

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Of particular concern are ingredients in the oil and in the dispersants that may be endocrine disruptors which, according to the National Institutes of Health, “are chemicals that may interfere with the body’s endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in both humans and wildlife … Research shows that endocrine disruptors may pose the greatest risk during prenatal and early postnatal development when organ and neural systems are forming … Young children should not be allowed near the beach where they could come into direct contact with the oil.”

Further, “Some of the volatile chemicals in oil have been linked to miscarriage, preterm birth and low birth weight, so it is a good idea for pregnant women to avoid the areas where there are elevated levels of VOCs in the air. These are areas that include noticeable smells of oil or visible oil and also any areas where the EPA monitoring system detects elevated levels. The EPA air monitoring results are being updated regularly. To be cautious, pregnant women may choose to avoid any areas directly along the waterfront and beachfront, even when oil is not visible.”

To fully understand the danger that the oil and the dispersants pose, it is necessary to know what chemicals each contain. Unfortunately, Natural Resource Defense Council’s (NRDC) Gina Solomon points out that even BP doesn’t know what all of the ingredients in the dispersants are because the manufacturer is allowed to refer to them as proprietary ingredients, which as Solomon says, “means that the public has no access to the full ingredients lists of these products, or any ability to independently verify their safety.”

Dr. Ott also notes that very little research has been done on the long-term health repercussions of exposure to the ingredients in oil or dispersants. One of the few available studies looked at those exposed to oil during the cleanup of the Prestige oil spill. The study found significant cytogenetic impact and recommended further study.

There are a myriad of factors regarding exposure to toxins that impact the extent and type of damage they may wreak on the human body.

According to Dr. Ted Schettler M.D., M.P.H., the science director of the Science and Environmental Health Network, there are three ways in which toxins enter the human body: direct contact, inhalation and digestion. In an article about the Exxon Valdez spill, the Anchorage Daily News explained, “Whether a person’s health is damaged by exposure to a toxic substance also depends on the dose, the duration of exposure … Some scientists take it a step further and argue that exposure to multiple hazardous substances at the same time creates an unknown complex toxic reaction. They call it ‘multiple chemical sensitivity.'”

In terms of reproductive health, some of the known ingredients in the oil and dispersants should definitely be cause for alarm. According to the Material Data Safety Sheet for Benzene, an element of oil, “benzene is carcinogenic to humans. Chronic inhalation of certain levels of benzene causes disorders in the blood in humans, including leukemia (cancer of blood forming organs). Benzene specifically affects bone marrow (the tissues that produce blood cells). Aplastic anemia, excessive bleeding, and damage to the immune system (by changes in blood levels of antibodies and loss of white blood cells) may develop. Several occupational studies suggest that benzene may impair fertility in women exposed to high levels. However, these studies are limited due to lack of exposure history, simultaneous exposure to other substances, and lack of follow-up.”

Corexit, the dispersant that is being used by BP contains 2ButoxyEthanol, which “may damage the developing fetus. There is limited evidence that 2-Butoxy Ethanol may damage the male reproductive system (including decreasing the sperm count) in animals and may affect female fertility in animals,” according to the safety sheet.

Richard Dennison, a senior scientist for the Environmental Defense Fund says that Corexit is one of the most dangerous dispersants there is for shrimp and fish, according to the EPA.

“There’s no question the ongoing spill at Deepwater Horizon is a life-threatening condition, and emergency measures are in order. And BP has said it chose Corexit because of the large stockpile, though its cozy relationship with Nalco (the company that makes Corexit) has been invoked as a factor as well. Considering the massive public costs of this unfolding environmental disaster in the Gulf, we should seriously question why, despite the clear opportunity for foresight via the contingency plan, BP is being allowed to use dispersants that are neither the most effective nor the safest. And we should also question why EPA hasn’t used its emergency powers to force disclosure of all of the components of the Corexit dispersants. There couldn’t be a clearer case of the need for EPA to exercise its mandate to disclose proprietary information when necessary to protect public health and the environment.”

Environmental writer Elizabeth Grossman is also concerned because, “The toxicity of the combined oil and dispersants and their effect on human health has yet to be determined. (There are no existing consumption safety standards for these dispersants if they’re found in seafood.) There are also questions about health effects of combined exposure to the chemicals that make up crude oil and the strong UV light of the Gulf. Another area of concern is health risks posed by particulates resulting from surface oil burning and from volatile compounds – organic solvents and sulfides among them – emanating from the floating oil now making landfall. The National Institute of Environmental Health Sciences (NIEHS) warns that even at low levels there can be adverse health impacts from these airborne contaminants.”

While it seems clear that the most immediate and likely most serious risk to human reproductive health would take place among people living close to the Gulf of Mexico, harm for those who live further inland or even across the ocean cannot be completely discounted. In September, 2008, Hurricane Ike blew into the Midwestern United States. Given that we know from acid rain that chemicals can move far from their original locations, I asked Matt Milosevich, a meteorologist at WLKY-TV in Louisville, Kentucky, a city that was declared a disaster area after being severely damaged by Hurricane Ike, whether he thought it was possible for severe weather such as hurricanes to bring chemicals from the Gulf inland. “Since there is an evaporation process to the normal biodegrading of oil, you can assume that whatever the oil evaporate is, that some may get into rainwater from storms. Also, to what degree or amount? I would assume only trace amounts, but that is just an assumption,” Milosevich said. And given that dispersants are being used in unprecedented amounts and that at this time we do not yet know where the water currents will carry the oil or dispersants, there is a great deal that we do not yet know in terms of areas beyond the immediate Gulf area that will be impacted. In addition, a NOAA fact sheet points out that storms may indeed distribute the oil itself over a larger area or bring the oil further inland.

Congressman Ed Markey (D-Massachusetts) summed it up well in a written statement about the oil disaster, “The reality is we know almost nothing about the potential harm from the long-term use of any of these chemicals on the marine environment in the Gulf of Mexico, and even less about their potential to enter the food chain and ultimately harm humans,”

When I first began to ask questions about whether the oil or the dispersants used in the Gulf might be a threat to reproductive health, the people I spoke with responded by telling me that it was a good question. While the question might be good, unfortunately, the available answers are not.

Despite the fact that we know that some of the ingredients involved are toxic and can make people sick and have been identified as chemicals that may damage reproductive health, there are few studies and very little data available to provide answers. Although the National Institutes of Health has stated clearly that the oil spill poses a potential threat to pregnant women and young children, very little attention has been given to this warning and there is no reference to it on the Deepwater Horizon Response web site.

The bottom line is that we don’t know if the BP oil disaster in the Gulf of Mexico will impact reproductive health because, despite some anecdotal evidence, there is little data to go on in large part because the companies responsible have been allowed to keep that data from the public and, in the case of this particular spill, we don’t even know what all the chemicals involved are. It would seem that in light of that, we would be well advised to follow the Precautionary Principle, which states, “Where an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context the proponent of an activity, rather than the public bears the burden of proof. The process of applying the Precautionary Principle must be open, informed and democratic, and must include potentially affected parties. It must also involve an examination of the full range of alternatives, including no action.”

In practical terms of addressing the impact of the Deepwater Horizon disaster, we should insist that the EPA force the disclosure of the ingredients in the dispersants and that research be immediately commenced to study the full health impact of these chemicals, including reproductive health. BP should also be compelled to make fully available all health data of workers who have been exposed to the chemical soup that they have poured into the Gulf. And in the meantime, until proven otherwise, pregnant women and young children should take heed of Dr. Ott’s words and the National Institute of Health’s statements regarding these dangerous chemicals and do what they can to stay away from the oil and the dispersants.

Culture & Conversation Law and Policy

The Modern Struggle Over Anti-Trans Bathroom Laws Has Its Roots in Decades of Title VII Fights

Jessica Mason Pieklo

Because of Sex: One Law, Ten Cases, and Fifty Years That Changed American Women’s Lives at Work, written by Gillian Thomas, senior staff attorney with the American Civil Liberties Union Women’s Rights Project, goes beyond cases that helped shape workplace anti-discrimination policies. Rather, it focuses on ten key women whose own lives changed the law.

In 1966, Ida Phillips, a single mother working as a waitress, sat down at her kitchen table and wrote a letter to then-President Lyndon B. Johnson. She told him her story: Despite her qualifications, Phillips had been told by a Martin Marietta employee not to apply for an assembly-line position at one of the construction-material company’s manufacturing plant. The job would have paid more than double what she was making as a waitress. It included a pension plan and insurance, benefits unavailable in most female-dominated industries at the time (and which since have only marginally improved.) The reason Phillips was turned away? She was a woman with a preschool child.

That letter, Phillips’ subsequent lawsuit, and her Supreme Court win would help spark a civil rights revolution in the workplace—one with consequences that reverberate today.

So opens Because of Sex: One Law, Ten Cases, and Fifty Years That Changed American Women’s Lives at Workwritten by Gillian Thomas, senior staff attorney with the American Civil Liberties Union (ACLU) Women’s Rights Project. Despite its full title, though, Because of Sex goes beyond cases that helped shape workplace anti-discrimination policies, focusing on ten key women whose own lives changed the law.

Title VII of the Civil Rights Act of 1964 prohibits employment discrimination based on race, color, religion, sex, and national origin. And it was Phillips’ case, and the nine others profiled in the book, that would ultimately shape that law into one that, decades later, is an important tool in advancing gender and sex equality. As Thomas explained to Rewire in an interview, Title VII it is not just a foundational piece of civil rights legislation important for its historical effect on workplace equality. In the face of anti-transgender bathroom bills and statewide “religious liberties” legislation sweeping the country, it is a crucial tool for pushing equality forward.

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Thomas’ book is organized along three key themes in employment discrimination law: pregnancy-related workplace policies, gender stereotypes in the workplace, and sexual harassment. Those themes act as an inroad toward thinking more broadly about how, in Thomas’ words, we achieve “substantive equality” in the workplace. They illustrate how early fights over promotions and workplace policies that kept women out of certain jobs due to concerns of harming their potential fertility foreshadowed the legal showdowns over contraception coverage in employee health-care plans in cases like Burwell v. Hobby Lobby and Zubik v. Burwell.

“The subject matter areas that I saw [as a researcher and employment discrimination litigator] were, number one, women’s capacity for pregnancy, and then their subsequent roles as mothers, which, historically, has played a huge role in their second-class status legally,” Thomas told Rewire. “Women of color have always been seen as workers, irrespective of whether they had children, so that’s not an entirely universal stereotype. But I think it’s pretty safe to say that generally pregnancy and motherhood have proven to be enormous conflicts in terms of what equality looks like when you have these distinct differences” in how race and gender are perceived.

Take, for instance, the case of Peggy Young and the question whether an employer can refuse to make on-the-job accommodations for pregnant employees when it does so for nonpregnant employees. Young, another one of the women featured in Thomas’ book, was a United Parcel Service (UPS) “air driver” who became pregnant. When Young told her employer she was pregnant, UPS told her they couldn’t accommodate the light-lifting recommendation made by Young’s medical providers. Instead, UPS told Young, she would have to take unpaid medical leave for the remainder of her pregnancy.

In March 2015, the U.S. Supreme Court ruled against UPS, vacating the Fourth Circuit Court of Appeals ruling that had supported UPS’ policy. The decision produced a new test for assessing pregnancy discrimination claims and sent Young’s case back to the lower courts for another look. Not long after the Roberts Court’s decision, UPS and Young settled the lawsuit, bringing an end to Young’s case.

The decision was a qualified win for advocates. The Roberts Court had accepted Young’s argument that UPS had no legitimate business reason for failing to accommodate her particular request, but the decision went short of ruling businesses must accommodate any pregnancy request.

But Because of Sex doesn’t stop at unpacking overt discrimination like the kind detailed in Young’s 2015 case or Phillips’ one in 1966. The book also takes a look at what the law has described as more “benevolent” kinds of discrimination. These include employment policies designed to “protect” women from endangering possible future pregnancies, such as prohibiting women employees from working jobs where they may be exposed to hazardous chemicals.

“It really all boils down to two issues that we are talking about in all these things,” Thomas explained, when discussing workplace policies that, employers have argued, were put in place to protect their female employees from potentially endangering a pregnancy. “One is [employers] ignoring hazards that apply to men and making women into baby-making machines. And number two is [employers] treating health effects or health hazards on the job as reasons for diminishing women’s opportunities, instead of arming women with information and assuming that they will make the right choice for themselves.”

This disconnect is most apparent in the case of United Automobile Workers vJohnson Controls, Inc., another case Thomas highlights in her book. In 1982, the car battery manufacturer Johnson Controls sent a memorandum to all its employees that said “[w]omen who are pregnant or who are capable of bearing children will not be placed into jobs involving lead exposure or which would expose them to lead through the exercise of job bidding, bumping, transfer or promotion rights.”

The policy amounted to a demotion for many female employees and a closed door for others.

Title VII actually permits employers, in a limited context, to have employment policies that discriminate on their face, such as policies that permit churches to only hire members of the same faith. Johnson Controls argued its policy of keeping women out of certain positions due to employer concerns of health risks to future pregnancies fit within Title VII’s narrow window for permitting explicit discrimination.

The Supreme Court would eventually rule in 1991 that Johnson Controls’ policy violated Title VII because it forced female employees to have to choose “between having a child and having a job,” thereby rejecting the argument made by Johnson Control’s that a woman’s fertility—or infertility—can in most situations be considered a bona fide occupational qualification.

As Thomas noted in her book, “It was no coincidence that fetal protection politics were most prevalent in well-paid, unionized industries from which women historically had been excluded. Indeed they had been excluded precisely because they had been deemed physically unsuited for the dirty, sometimes strenuous work.”

But “in female-dominated fields, though, fetal protection policies made no business sense; they effectively would gut the workforce. That reality apparently trumped any hypothetical harm to employees’ future pregnancies,” Thomas wrote.

In other words, these policies didn’t exist in female-dominated fields.

Johnson Controls may have helped grant women the agency to determine how and when they earned a paycheck with regard to policies targeting their potential fertility, but it hardly ended the debate around when and how employers attempt to diminish women’s opportunities related to their roles as potential mothers. This has played out in the hundreds of lawsuits over the contraception benefit, for example.

In other words, if Johnson Controls had settled the question of whether a woman’s fertility was an appropriate grounds for discrimination, we would not have Hobby Lobby.

Because of Sex draws another connection between the historical fight over Title VII and the contemporary one: How do employers adjust workplace policies around shifting gender norms, and when is it discriminatory if they don’t?

The law asks, “What are women supposed to want to do?” said Thomas in her interview with Rewire. “What work are they able to do? What work do they want to do? [Given] assumptions and stereotypes that are about their abilities, their preferences, their interests and how [they are] conforming to [those] in terms of stereotypes about what femininity is—what [are] women … supposed to look and act like?”

Gender nonconforming behavior, and the manner in which employees experience discrimination as a result of that behavior, is a key component over the debate around transgender rights. But it would take a “shrill” woman and the birth of the notion of “workplace harassment” to get us and the law there first.

By every measure, Ann Hopkins should have been made a partner in the global accounting firm Price Waterhouse. She was smart. Ambitious. Worked hard and constantly outperformed her peers. But it was those very attributes that her male partners deemed “too aggressive” or as evidence that she needed “charm school,” and ultimately used to deny her a partnership that by every objective measure she had earned.

The Supreme Court would ultimately disagree. In 1989, it ruled Hopkins should have been made a partner and that the comments relating to her demeanor amounted to improper gender stereotyping, a violation of Title VII’s sex discrimination provisions.

If Hopkins was initially shut out of workplace advancement due to her defiance of feminine stereotypes, so too are women subjected to on-the-job harassment, as Thomas draws out in Because of Sex. “Sexual harassment didn’t even have a name in 1974, but was such a prevalent force driving women out of the work force, driving them into different jobs [and] subjugating them just generally in terms of the identity as sexual objects on the job,” Thomas further explained in her interview.

1974 was the year Mechelle Vinson first hired a lawyer to represent her in a case against her boss, who was chronically sexually abusing her on the job. But at the time, courts largely wrote off those kinds of complaints as a kind of chasing-around-the-office, and not sexual harassment, or in Vinson’s case, on-the-job rape. As described by Thomas in her book, “throughout the 1970s, many courts responded to complaints about abusive bosses with a collective shrug that conveyed, ‘You can’t blame a guy for trying.'”

“Sexual harassment was such a prevalent force driving women out of the workforce, driving them into different jobs, and subjugating them just generally in terms of the identity as sexual objects on the job,” Thomas told Rewire.

That “you can’t blame a guy for trying” attitude hasn’t completely gone away as far as the federal courts are concerned. After all, in 2013 the Roberts Court in Vance v. Ball State made it even harder for employees to bring workplace harassment suits, and employees still face losing jobs for “being too cute” or having their sexuality be a perceived threat to their employer’s ability to remain professional in the workplace.

Which is why, in the fight over transgender bathroom access in 2016, Title VII should be a powerful force in defeating these latest attempts to stymie social progress. The idea that “you can’t blame a guy for trying” has morphed into “how the hell can we police gender roles if we don’t know where you pee.” That’s thanks almost entirely to the manner in which the law has wrestled with gender stereotypes under Title VII, Thomas explained.

In 2012, the Equal Employment Opportunity Commission (EEOC), the federal agency charged with enforcing workplace anti-discrimination laws, issued the landmark decision Macy v. Holder, which held that employment discrimination based on transgender status was a form of unlawful sex discrimination under Title VII. Then in 2015, it issued a ruling stating that denying employees access to restrooms consistent with their gender identity is also a violation of Title VII. Meanwhile several federal courts of appeals have ruled that Title VII protects against gender identity discrimination.

But the Roberts Court has yet to weigh in.

“I think sexual orientation in a way is the sort of a final frontier” in Title VII litigation, said Thomas. “The court seems really fixated on this idea of analogizing very precisely from Hopkins. In other words, if you look or act in a way that doesn’t conform to gender stereotypes then, OK, [the courts] can understand that’s sex discrimination,” said Thomas. “But if your identity is not conforming to stereotypes in that you, you know, are romantically attracted to someone of your sex, that is harder for [the courts] to get, even though it’s obviously the most obvious manifestation of stereotype.”

This is, in many ways, a fight that started in the workplace—one that eventually got the backing of the Obama administration before becoming a flashpoint of conservative election-cycle politics. Thomas’ book doesn’t close on a prediction of what the next big Title VII fight will be per se, but it is impossible to finish it and not see the narrative threads of the historical fight for workplace equality woven throughout the the contemporary one. Sex. Gender. How the law understands and navigates the two. All this is what makes Thomas’ Because of Sex the closest thing to an assigned reading I can make.

Analysis Human Rights

The Flint Water Emergency Is a Reproductive Health Crisis

Kanya D’Almeida

Today, the entire nation is aware of the disaster. But for well over a year, residents in this city of some 100,000 people fought a lonely battle to convince the authorities that they were drinking, bathing, and cooking with poisoned water.

Read more of our articles on Flint’s water emergency here.

At first the signs were subtle—a slight discoloration of the tap water, a strange smell lingering in the shower stall or bathtub. Then the symptoms became more severe. Adults started to lose clumps of their hair and children broke out in rashes. Suspicions grew into fears, which were subsequently confirmed by studies. Families waited anxiously for test results to trickle in.

It all began in April 2014 when the city of Flint, under a state official, switched its water source from Lake Huron to the highly corrosive Flint River in a cost-cutting scheme aimed at saving $5 million in a two-year period. The chloride-heavy water quickly ate away at Flint’s aging infrastructure, leaching lead from the pipes into the water supply. Today, the entire nation is aware of the disaster. But for well over a year, residents in this city of some 100,000 people fought a lonely battle to convince the authorities that they were drinking, bathing, and cooking with poisoned water.

From the very beginning, women were at the forefront of the movement to raise awareness about possible lead contamination, demanding answers from officials and teaming up with independent researchers to conduct their own water tests.

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As households continued to consume the murky, toxic water, mothers started noticing changes in their kids’ behavior, including slower cognitive capabilities, according to reports. Elderly people were developing lesions in their skin. Before long, local, women-led groups like Water You Fighting For and the Flint Democracy Defense League had begun to mobilize their communities to raise the issue as a public health crisis. Families came out to demonstrations holding samples of the discolored water and signs that said, “Stop Poisoning Our Children.”

“I remember one woman who would come out to some of the earliest protests—she was a senior citizen and each time she would show up with a bigger and bigger ball of her own hair,” Sylvia Orduño, an organizer with the Michigan Welfare Rights Organization, said in an interview with Rewire. “She had this really long hair but pretty soon, I was able to see her scalp because she was losing so much of it.”

She said other women were panicking about rashes breaking out in their children’s genital areas. “And one mother even told me her 4-year-old was having trouble speaking: Like, there were words he knew but he was struggling to communicate them.”

Health-care providers, too, began noticing how their patients became particularly anxious about what the water situation meant for their family’s health and well-being.

“Soon after the switch we started noticing a difference in the communities we serve and the patients who were seeking care,” Sabrina Boston, manager of the Planned Parenthood Health Center in Flint, told Rewire in a phone interview.

In June 2015, a full year after Flint residents had first begun to consume lead-contaminated water, the Michigan chapter of the American Civil Liberties Union released a mini-documentary titled Hard to Swallow: Toxic Water Under a Toxic System in Flint. It featured several Flint residents, including LeeAnne Walters, whose five children started falling ill shortly after the switch in 2014. Anxious about her kids’ “scaly skin,” rashes, and rapid hair loss, Walters summoned city officials to test her tap water. The test returned results that showed lead levels at 397 parts per billion (ppb). By comparison, the Environmental Protection Agency warns that anything over 15 ppb can cause “irreversible” damage to a child’s brain.

Subsequent testing by volunteer researchers from Virginia Tech University showed Walters’ tap water to contain lead levels of over 13,000 ppb. According to this ACLU video, a lead-to-water ratio of 5,000 ppb is considered hazardous waste. Walters has since moved away from Flint, but her attempts to get to the bottom of her family’s sudden health problems have been widely recognized as instrumental in galvanizing national attention for the situation on the ground, which state and city officials had long sought to conceal.

Serious Consequences for Maternal and Child Health

Today, much of that cover-up is a matter of public record, with Michigan Gov. Rick Snyder (R) last week releasing official emails revealing his administration’s knowledge of the problem for well over a year.

On January 16 President Obama declared a federal state of emergency in the majority-Black city, days after Gov. Snyder had deployed the National Guard to assist in relief efforts, including distributing bottled water and filters to tens of thousands of households. Federal aid totaling $5 million—the maximum allocation possible under federal emergency laws—was recently made available to help mitigate the crisis. In addition, according to the New York Times, President Obama announced last Thursday Michigan could have immediate access to $80 million that had previously been earmarked for federal water infrastructure development. It is still unclear how this funding will be allocated.

Even as help pours in from around the nation, with big-name celebrities pledging tens of thousands of dollars in financial support, residents in Flint continue to suffer the health impacts of consuming and being in contact with lead-poisoned water, which has particularly serious consequences for maternal and child health.

According to the World Health Organization, there is no known “safe” blood-lead concentration, although the severity of symptoms and likelihood of longer-term impacts increase along with exposure. These include behavioral issues and reduced cognitive functioning in young children, as well as anemia, hypertension, and toxicity to their reproductive organs. WHO research also shows that high levels of lead exposure over a prolonged time period can severely damage a child’s brain and central nervous system, causing comas, convulsions, and in some cases death.

Data from the Centers for Disease Control and Prevention show that pregnant women and lactating mothers who are exposed to lead are at heightened risk of gestational hypertension. And since lead can persist in bones for decades, especially in pregnant and lactating women, mothers and their babies remain exposed to lead long after external sources of contamination have been eliminated.

“This is a reproductive health crisis of monumental proportions that you would not expect to see in a developed country and certainly not in a state … like Michigan, which ironically is surrounded by one of the largest bodies of fresh water in the world,” Dr. John Hebert, director of the Obstetrics and Gynecology Residency Program at the Hurley Medical Center, told Rewire.

By his estimates, based on his department’s observations of the unfolding crisis, between 9,000 and 10,000 children, and at least “a couple of thousand pregnant women” have likely been exposed to lead-contaminated water. For pregnant women this means “a heightened risk of pre-term delivery, increased rates of miscarriage, and low birth weight in infants,” he said.

In fact, one of the earliest notices warning residents to refrain from drinking Flint water, back in September of 2015, was directed at “senior citizens, children, and pregnant women,” after an independent study by the Hurley Medical Center found double the acceptable levels of lead in Flint water.

But simply issuing such an advisory in a city with a staggering poverty rate could not ensure compliance. In its Geography of Poverty article series, MSNBC reported that between 2009 and 2013, nearly half (41.5 percent) of Flint’s residents lived below the poverty line, far higher than the state’s 16.8 percent poverty rate. During the same period, about a quarter of Flint’s families lived on less than $15,000 per year, while the child poverty rate was 66.5 percent—nearly 10 percentage points higher than Detroit’s, which sits about 70 miles south.

“When you live in the affected zip codes you don’t have a choice,” Dr. Hebert explained. “You can’t simply stop drinking the water. Mothers have used this water to prepare formula for their infants; they may have been forced to drink contaminated water and then breastfeed their children. This crisis is absolutely not to be taken lightly.”

“The Damage Has Already Been Done”

Reproductive justice advocates say the situation in Flint not only represents a local public health emergency but also mirrors a larger crisis of reproductive justice for low-income women of color around the country.

“We are seeing so many intersecting issuesfrom economic justice to environmental justice to health-care accessmeeting right in the middle, and landing in a community that is overwhelmingly Black and where low-income communities of color are bearing the brunt of this collision in the most horrific ways,” Monica Simpson, executive director of SisterSong Women of Color Reproductive Justice Collective, told Rewire. A majority of Flint’s residents—about 52 percent—are Black.

Simpson stated, “This is a severe reproductive justice crisis that cannot be ignored.”

Referring to the fact that Michigan’s Republican-led legislature, which was complicit in the water crisis, has a long history of pushing a so-called pro-life agenda, Simpson said, “This is our opportunity to reclaim our language. For too long many of us within the reproductive justice movement have been forced into the ‘pro-choice’ category by default, because we support abortion access. In fact, I consider myself pro-life: I support every woman’s right to live her best and most healthy life possible. But I haven’t been able to embrace that label, which has been hijacked by people who call themselves pro-life but are really pro-privilege and pro-white supremacy. If they cared about life, they would not be hand-picking who gets access to water, they would be ensuring that every woman and child has that right and that access.”

For reproductive health-care providers, the decision to respond to calls from the community was an obvious one. Planned Parenthood’s Boston told Rewire that the Flint Health Center, which sees about 3,200 patients annually, amounting to close to 7,000 visits each year, initially distributed water filters in partnership with the Flint Health Department, and later began to hand out free bottled water.

Flint resident Tunde Olaniran, the outreach manager for Planned Parenthood of Mid and South Michigan, who first brought the crisis to the organization’s attention, said he took his cue from local organizers who’ve been mobilizing since the switch happened back in April 2014.

“I was listening to the voices of women of color and organizations like the Genesee County Healthy Sexuality Coalition and the Coalition for Clean Water, who were talking about the toxicity of water long before any reports were released,” he told Rewire. “There is a lesson here on the need to listen … to grassroots organizers and impacted community members on how to solve very serious issues.”

Boston said that many patients and visitors to the center are “still expressing fears, confusion, and anger.”

“They are looking for guidance on what this means for their children, their families, and their own health,” she explained, adding that the clinic continues to educate patients about possible health risks and steps they can take to mitigate the impacts of lead contamination. Staff at the Flint center are urging women to “pump and dump” their breast milk, especially if they haven’t been tested; advising men on the possibility of lead contamination reducing their sperm count; and handing out resources, including lists of where testing is being done.

As residents fret over their health, the city is continuing to issue bills and past-due notices for water that residents say is good for nothing but flushing the toilet. The Detroit Free Press reported Monday that some 100 residents protested outside the Flint city hall, ripping up their bills—as high as $100—and holding signs reading, “Why Pay for Poison?” According to some sources, Flint residents are saddled with some of the highest water bills in the country, often touching $150 per month.

While the political machine continues to grind on—with groups like the ACLU now pushing for several reforms including the immediate repeal of Public Act 436, which enabled a string of politically appointed emergency managers to override public concerns about the water—health-care providers are preparing for the long haul.

“A lot of the damage has already been done,” Dr. Hebert told Rewire. “There is no magic anecdote that can reverse it. Cognitive deficits and other neurological impacts on infants and unborn children will not become apparent for a long time. We are not talking about weeks or months here—these children are going to have to be monitored closely for several years.”

He said there is an urgent need for thorough follow-through and early childhood intervention programs to give a boost to those kids that wind up with developmental difficulties.

And even these steps, some say, will not be enough. “I think the families and the women who have come forward and put this issue on the map are very brave,” Michigan Welfare Rights Organization’s Orduño said. “But I don’t see how there can ever really be adequate solutions, or recourse, or reparations for any of this.”

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