Q & A Media

Discrimination, Doxxing, and That ‘Louie’ Episode: A Q&A With the Filmmakers Behind ‘Fattitude’

Annamarya Scaccia

Rewire recently spoke to Lindsey Averill and Viridiana Lieberman, who are crowdsourcing funds for Fattitude, their documentary about fat prejudice. The filmmakers discuss the core principles of Fattitude, the harassment they've experienced while making the film, and much more.

So often in pop culture, fat is used as a symbol of immorality.

From Colin Farrell’s fat-hating boss in Horrible Bosses to “Fat Monica” on Friends to Ursula in Disney’s The Little Mermaid, fat bodies frequently are a substitute for something disturbing, something laughable, or something that’s villainous. Even if the fat-shaming is not overt, as in Lifetime’s series Drop Dead Diva, there is still an underlying message that fat equals impiety.

Yet, despite widespread acceptance that pop culture drives and defines how we feel about our bodies, there has yet to be much acknowledgement of how society is not only rife with fat discrimination, but is complacent about it.

That’s where Lindsey Averill and Viridiana Lieberman come in. Through their feature-length documentary, Fattitude, the Florida-based filmmakers and long-time friends are taking a concentrated look at the ubiquity of fat prejudice through media analyses and interviews with some well-known activists—like Marilyn Wann, author of Fat! So?, and Sony Renee Taylor, founder of global movement The Body is Not an Apology. They also plan to develop an educational activist campaign around the film, much like those related to the documentaries An Inconvenient Truth and Miss Representation, that centers on raising awareness of fat discrimination.

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“Our media tells a lot of lies about fat bodies and about the experience of living in fat bodies,” Averill told Rewire. The film project is “close to both of our hearts because we both have lived in bodies of changing sizes throughout our lives and we both battled how fat discrimination functions, how fat hatred functions, how fat-shaming functions.”

Fattitude is still in the production phase, though, and Averill and Lieberman have turned to the community to help fund their project through a Kickstarter campaign, which ends on Sunday, May 25. Funds raised through the drive will go toward travel costs for the crew and production team to shoot additional interviews, equipment purchases, revenue for an illustrator/animator and sound editor, and costs of film festival applications.

So far, their Kickstarter campaign has more than exceeded its goal, bringing in nearly $5,000 more than the original $38,050 they set out to raise. With only a few days left, the duo is now pushing for $50,000, hoping to raise enough for additional production items such as professional color correction, original music composition, and a fair use lawyer.

But the entire process has not gone smoothly. Earlier this year, Averill and Lieberman became the victims of a horrible online attack. Shortly after launching their Kickstarter, a YouTube user by the handle “GODBLESSADOLFHITLER” posted the Fattitude trailer under the title “Cakes: The New Comedy Hit,” which Averill immediately reported for copyright infringement, and YouTube removed it. Apparently angry about being reported, the YouTube user began to harass Averill, Lieberman, and their supporters on Twitter, posting their contact information online—or “doxxing” them—and soliciting his followers to also stalk and abuse the filmmakers. In a matter of days, Averill and Lieberman were receiving rape and death threats, hate mail, and frightening phone calls. The abuse continues to this day. (The incidents were reported to local police, which subpoenaed Google, YouTube’s parent company, but the filmmakers have yet to hear back.)

While the experience has left both Averill and Lieberman shaken, they say it’s validated the importance of both the film and their work in exposing fat hatred. “I feel more aggressively determined that this is an absolutely necessary film,” Averill said.

Rewire recently spoke with the filmmakers about the core principles of Fattitude, the latest episode of Louie, the importance of featuring diverse voices, and more.

Rewire: Fattitude aims to educate about “the harsh and very real realities of fat shaming and fat hatred.”  How so?

Lindsey Averill: We felt that there wasn’t a strong documentary that really looked at how popular culture intensifies fat discrimination in everyday life. For us, we believe representation plays a huge role in how we formulate our ideas about the culture we live in. What we did is really examine popular culture and say, “How is the everyday experience of media representing the fat body?” So our film [is] really delving into that. We’re saying, “In our culture, when we talk about fat bodies, it’s in a negative context, period.”

Viridiana Lieberman: And using pop culture as a lens is very accessible in conversation because everybody can relate or has seen one or all of the forms of media we’re discussing—whether it’s a show you really like or a story that you read about in the newspaper, or just reality television that is just in your ear all the time, even if you’re not watching it.

LA: For us, we feel that [the first step in] educating the populous about fat discrimination is opening people’s eyes to the reality of the fact that they already are complacent in fat discrimination because it’s so acceptable in the media that that message is imbedded in our lives. Our film is our first action item. It’s the first space in which we put forward, “Open your eyes. Realize that this is one of the invisible cultural assumptions that you’re not paying attention to, and you’re not realizing how cruel, how frugal, and how aggressive this assumption is when it plays out in everyday life.”

Rewire: You write on Fattitude‘s Kickstarter that, through this journey, a lot of your own views about fat prejudice and how it is to live in a fat body evolved. Can you talk about that?

LA: I became really conscious of where my failures of body acceptance were. Yes, I was already an activist saying everyone should love their bodies, but [being] in front of these people who so totally have taken on the reality of that, I realized I hadn’t yet. There were moments where even if I wasn’t saying something negative about my body, I was looking in the mirror and assessing it in my own mind. There were these very subconscious whispers that I was able to figure out how to dispel.

On top of that, an academic argument makes sense, but it’s very different seeing it crystalize in real life for you. A lot of the arguments I have seen people make, I hadn’t formulated my own opinions about, per se. Even with regards to “How do we manage this airplane [seat size] issue?” Through the process of listening to all these academics and talking with them, all of a sudden I was like, “No, no this is totally serious. The corporations need to be responsible for this. This is just flat-out discrimination.” Whereas I hadn’t thought deeply about it until I was listening to others really talking [about it].

VL: The pop culture reference we used to like to say [in women’s studies] is that you got unplugged from the matrix—the whole idea that all of a sudden you can see it everywhere, and in everything. That definitely happened to me right when we started working on the project with different aspects of fat activism. But the biggest thing for me, personally speaking, is when interviewing people, I remember walking out of those interviews and thinking, “How did they unplug [from the matrix]?”

I remember I used to wait to do things. I really gauged a lot of big moments in my life on the concept that I should wait until I reach a goal weight or I’m more fit or blah blah blah. And that was such a weird concept to sit back and be like, “Wait a minute, not only is this perhaps the way my body will be no matter what I do, but on top of that, you should never wait.”

What a terrible reason to wait to do things! [laughs]

I remember sitting back and I felt so much more free. [But I] also became very conscious of what people were saying around me from what they ingested in pop culture, and how they feel about their bodies—when we eat and they feel guilty.

LA: The other thing that was amazing to see was that a lot of the people we met [who] totally embraced body positivity and fat positivity have literally unplugged from popular culture. They said, “I’m no longer going to look at these images that tell me my body is not OK because that is totally detrimental to me.” And they had no television, didn’t see movies, just totally unplugged from the popular media because they felt popular media was constantly harassing and torturing them.

VL: We’d start rattling off the list of shows that we want to hear their input on, and they’ve never seen it. “Oh I’ve heard of that one, never seen it.” “I don’t own a television.” I mean every single person [laughs] and that was a huge revelation.

Rewire: In last week’s episode of Louie, the character Vanessa, played by Sarah Baker, made a speech about dating as a fat woman, which was praised by media outlets. Critics, however, like Willa Paskin at Slate, question the scene’s intent. How does that scene challenge or propagate the perception of fatness in pop culture? 

LA: That moment on Louie is rife with both the good and the bad. For example, it is amazing to see someone on television acknowledge the fact that the way we lie about the reality of a person’s body size is insulting and demeaning. Regularly when I refer to my body as fat, people try to tell me it’s not. Obviously, they are lying to me because they believe that being fat is something to be ashamed of, something ugly, something awful. Of course, in reality being fat is just a fact. It doesn’t have to have moral or aesthetic resonance—and the attempt to “hide” me from my fat points out that they believe that if I know I’m fat then I can’t possibly like myself. So I think the fact that this character is on television pointing out the ugliness that is intrinsic in dismissing the reality of a person’s body size is amazing and also really unheard of in mainstream media.

That said, [the speech] also relies on popular cultural lies—like the idea that fat women are not desired or that men are “ashamed” to be seen with fat women—and it makes some really limited assumptions about the issues that fat women struggle with and in turn obscures the systemic reality of fat discrimination. I think the conversation about fat discrimination is more concerned with the reality that fat people make less money than their thin counter parts, that they often receive sub-par medical care, and that they are assumed to be lazy or stupid. 

Arguably, this scene gives fat men an edge over fat women—which is debatable. It’s true that historic understandings of femininity have relegated women to the role of object and therefore “beauty,” and long-term relationships are understood as defining and significant factors in a woman’s life, but not a man’s. Of course this is an archaic idea, and yet popular culture still perpetuates these stereotypical gender concepts. That said, ultimately fat men and fat women suffer. We can’t sit around comparing oppressions. Instead we need to work on eliminating the causes of discrimination.

Rewire: What I find interesting, though, is that some outlets, like Flavorwire, are hailing it as this moment that’s given a voice to fat people, which seems dismissive of fat activists. How does that response play into what you’re discussing in Fattitude?

LA: One of the things we can always say is that on some level, anytime we’re having a conversation about fat discrimination—even if it’s problematic—we’re starting a conversation. I feel that the conversations are not being had enough in general, so while the conversation might be problematic, there’s a part of me that feels joy any time the conversation exists at all.

VL: I totally agree with that point.

LA: While there are activists on the ground, and there are amazing people out there saying amazing things, at the end of the day, the way our culture works—and the way it sort of worked for decades—is when you have someone famous as your spokesperson and you have someone famous start the conversation, the conversation is heard. Versus when you have activists having the conversation, it often gets relegated to, “Oh, those are activists talking. I don’t know if that’s important or not.”

And I say that with complete sarcasm, because while the activists are doing amazing and unbelievable things, they’re often shown as the far left or the far right. I’m saying that we can bring the conversation to center and enable it to happen.

VL: Right. You don’t need to mediate that, though. At the end of the day, if that person may have opened the door, it’s still giving access for people to finally be heard.

Rewire: As seen in Fattitude’s trailer, you feature a lot of diverse voices from cultural, wellness, and academic fields. How important was it to tackle this issue from those different viewpoints?

LA: We entered the sphere of making this film with the belief that diversity and diverse voices were extensively important, and one of the current flaws with the trailer—which will not be true of this film—is that it is all women’s voices. It is our goal, by the time we complete this film, that it is a film about fat men and fat women of every race, creed, sex, color, all of the above, because we believe only in that space can you truly have a conversation about what’s being experienced.

Rewire: Were there any issues that you were surprised to learned about as you conducted these interviews?

LA: The reality is that I was so well-informed before we even got to this because I am writing a dissertation of fat activist and fat-shaming. So most of the time, it was about the nuance of the argument, not that an argument popped that [we never thought about]. You look at an argument that you’ve defined for yourself, but then you start listening to [Fat! So? author] Marilynn Wann or [author and activist] Virgie Tovar explaining why they’ve come to the reasoning about a particular argument, and you think, “Oh, that’s incredible.” Then you talk to someone like [Seeking the Straight and Narrow author] Lynne Gerber, and you go, “Oh my God, holy, that’s incredible too.” 

You knew it was wrong that someone on the airplane was being kicked off for their body size, but you didn’t take the step forward to realize that the corporation must fix that. The fact that people didn’t think [about it as], “We’re telling you you deserve to be punished. You deserve to be kicked off this plane because your body size is too big,” the fact that people aren’t recognizing that’s prejudice—that was the kind of nuance that became blatantly clear.

VL: That’s why we love that quote where [Gerber] says, “We can land a person on the moon, but we can’t figure out how to get airplane seats for a human being,” because it’s true. Even “thin” people complain about those seats being too small [laughs]. There’s no relevance, there’s no acceptance of any form of spectrum in body size in the human body. Like Lindsey said, it’s just thought to be absolutely OK, undeniably OK, to discriminate and make that assumption.

Rewire: In the process of promoting Fattitude, you’ve also experienced incredible anti-fat abuse and harassment on- and offline. Tell us about that.

LA: It definitely happened to both of us. I think my household experienced the brunt of it, but I was not alone. [“GODBLESSADOLFHITLER”] got very angry and started harassing me on Twitter, initially. My reaction to his harassment on Twitter was, “This is someone who is ridiculous,” and I blocked him. Then he proceeded to go from there to calling my house and sending things to us in the mail, calling my parents’ house, calling my husband’s business, sending Mormon missionaries, having other people send horrible letters that said frightening things, death threats, rape threats. Viri got very aggressive rape threats. We got pizzas delivered to our house. Two days ago, I got a cola. It’s ongoing. It doesn’t go away. It has an anti-Semitic [element], which I think is just part of his online persona, but most of it is “fat bitch cunt” kind of stuff. It’s really anti-woman. It’s really anti-fat. It’s anti-gay, absolutely.

Rewire: Are both of you OK?

LA: I think we’re OK. That’s the best I can say. Our alarm went off the other night, and you feel like cowering in a corner because for the first time in your life, it’s not your instinct to be like, “Oh, that’s our sensitive alarm [that goes off] all the time.” Instead, you’re like, “Oh my God, who’s outside my house?!” There’s definitely a certain level of paranoia I could do without.

VL: The day after my information got out on the Web, I remember getting really nervous, looking over my shoulder. Any time our phone buzzes when somebody would come to our apartment building, there was always a hesitation, even if it was our friends or someone randomly calling the wrong apartment. But it’s where your mind goes first, which is bad.

LA: You feel more cautious and more anxious. But we’re making this film for a reason. It’s an absolutely necessary conversation, because I have now not only experienced the bullying that was experienced by living in a fat body in the world, but I have also experienced this intense level of fat hatred in the culture that I haven’t felt. The reality is, activists like Amanda Levitt [of] Fat Body Politics get this kind of trolling on a regular basis. They get this kind of brutal ugliness coming at them as they try to fight this. I contacted all the people in our film right away when this started, and activist Substantia Jones was like, “Hey, this is my life. This happens to me all the time. We are human, we are strong, and we won’t be quieted.” There’s a huge part for me where I have to remind myself that the activists now, and who came before us, experienced this, and that’s a part of it. That’s what happens, because you’re striking a nerve and you’re having a conversation that is obviously compelling, but also important.

I think at the end of the day, are we OK? Yeah, we’re OK. Is it great? Not always, but we’re OK.

Rewire: What has this experience showed you about the work you’re doing with Fattitude?

LA: We’ve seen the ugliest version of fat discrimination. Fat discrimination is that someone thinks it’s perfectly acceptable to come up to me, and go, “Oh, I’m on this great new diet, I should tell you about it,” because that person is assuming that I want to know about a diet, that I’m interested, that I’m unhappy with my body as it is now. That’s a version of fat discrimination. And, obviously, so is someone sending me hate mail and threatening my life, and calling my documentary cancerous because I am trying to tell people it’s OK to live your life even if you’re fat.

That’s what it showed us: It’s not just something subtle. We know it’s systematic. But we just looked at the brutal version of the hatred.

VL: And the hatred that happens at a time of change.

LA: Absolutely.

Rewire: In the end, what is the number one thing we should know about Fattitude?

LA: That each person’s body belongs to them. One of the things we like to do in this world is to think we have the right to judge other’s choices, and that’s one of the ways we quickly justify body prejudice. Everyone’s body is their own, and everyone’s body deserves the right to live free, equally, and with love and acceptance in this world.

VL: I couldn’t have said it better.

This interview has been edited for length and clarity.

Commentary Politics

On Immigration, Major Political Parties Can’t Seem to Agree on What’s ‘Un-American’

Tina Vasquez

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other.

Read more of our coverage of the Democratic National Convention here.

Immigration has been one of the country’s most contentious political topics and, not surprisingly, is now a primary focus of this election. But no matter how you feel about the subject, this is a nation of immigrants in search of “el sueño Americano,” as Karla Ortiz reminded us on the first night of the Democratic National Convention (DNC). Ortiz, the 11-year-old daughter of two undocumented parents, appeared in a Hillary Clinton campaign ad earlier this year expressing fear that her parents would be deported. Standing next to her mother on the DNC stage, the young girl told the crowd that she is an American who wants to become a lawyer to help families like hers.

It was a powerful way to kick-start the week, suggesting to viewers Democrats were taking a radically different approach to immigration than the Republican National Convention (RNC). While the RNC made undocumented immigrants the scapegoats for a variety of social ills, from U.S. unemployment to terrorism, the DNC chose to highlight the contributions of immigrants: the U.S. citizen daughter of undocumented parents, the undocumented college graduate, the children of immigrants who went into politics. Yet, even the stories shared at the DNC were too tidy and palatable, focusing on “acceptable” immigrant narratives. There were no mixed-status families discussing their deported parents, for example.

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other. By the end of two weeks, viewers may not have known whether to blame immigrants for taking their jobs or to befriend their hardworking immigrant neighbors. For the undocumented immigrants watching the conventions, the message, however, was clear: Both parties have a lot of work to do when it comes to humanizing their communities.  

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“No Business Being in This Country”

For context, Republican presidential nominee Donald Trump and his running mate Mike Pence are the decidedly anti-immigrant ticket. From the beginning, Trump’s campaign has been overrun by anti-immigrant rhetoric, from calling Mexicans “rapists” and “killers” to calling for a ban on Muslim immigration. And as of July 24, Trump’s proposed ban now includes people from countries “compromised by terrorism” who will not be allowed to enter the United States, including anyone from France.

So, it should come as no surprise that the first night of the RNC, which had the theme of “Make America Safe Again,” preyed on American fears of the “other.” In this case: undocumented immigrants who, as Julianne Hing wrote for the Nation, “aren’t just drug dealers and rapists anymorenow they’re murderers, too.”

Night one of the RNC featured not one but three speakers whose children were killed by undocumented immigrants. “They’re just three brave representatives of many thousands who have suffered so gravely,” Trump said at the convention. “Of all my travels in this country, nothing has affected me more, nothing even close I have to tell you, than the time I have spent with the mothers and fathers who have lost their children to violence spilling across our borders, which we can solve. We have to solve it.”

Billed as “immigration reform advocates,” grieving parents like Mary Ann Mendoza called her son’s killer, who had resided in the United States for 20 years before the drunk driving accident that ended her police officer son’s life, an “illegal immigrant” who “had no business being in this country.”

It seemed exploitative and felt all too common. Drunk driving deaths are tragically common and have nothing to do with immigration, but it is easier to demonize undocumented immigrants than it is to address the nation’s broken immigration system and the conditions that are separating people from their countries of originconditions to which the United States has contributed. Trump has spent months intentionally and disingenuously pushing narratives that undocumented immigrants are hurting and exploiting the United States, rather than attempting to get to the root of these issues. This was hammered home by Mendoza, who finished her speech saying that we have a system that cares more about “illegals” than Americans, and that a vote for Hillary “puts all of our children’s lives at risk.”

There was also Maricopa County Sheriff Joe Arpaio, a notorious racist whose department made a practice of racially profiling Latinos and was recently found to be in civil contempt of court for “repeatedly and knowingly” disobeying orders to cease policing tactics against Latinos, NPR reported.

Like Mendoza, Arpaio told the RNC crowd that the immigration system “puts the needs of other nations ahead of ours” and that “we are more concerned with the rights of ‘illegal aliens’ and criminals than we are with protecting our own country.” The sheriff asserted that he was at the RNC because he was distinctly qualified to discuss the “dangers of illegal immigration,” as someone who has lived on both sides of the border.

“We have terrorists coming in over our border, infiltrating our communities, and causing massive destruction and mayhem,” Arpaio said. “We have criminals penetrating our weak border security systems and committing serious crimes.”

Broadly, the takeaway from the RNC and the GOP nominee himself is that undocumented immigrants are terrorists who are taking American jobs and lives. “Trump leaned on a tragic story of a young woman’s murder to prop up a generalized depiction of immigrants as menacing, homicidal animals ‘roaming freely to threaten peaceful citizens,’” Hing wrote for the Nation.

When accepting the nomination, Trump highlighted the story of Sarah Root of Nebraska, a 21-year-old who was killed in a drunk-driving accident by a 19-year-old undocumented immigrant.

“To this administration, [the Root family’s] amazing daughter was just one more American life that wasn’t worth protecting,” Trump said. “One more child to sacrifice on the altar of open borders.”

It should be noted that the information related to immigration that Trump provided in his RNC speech, which included the assertion that the federal government enables crime by not deporting more undocumented immigrants (despite deporting more undocumented immigrants than ever before in recent years), came from groups founded by John Tanton, a well-known nativist whom the Southern Poverty Law center referred to as “the racist architect of the modern anti-immigrant movement.”

“The Border Crossed Us”

From the get-go, it seemed the DNC set out to counter the dangerous, anti-immigrant rhetoric pushed at the RNC. Over and over again, Democrats like Congressional Hispanic Caucus Chair Rep. Linda Sánchez (D-CA) hit back hard against Trump, citing him by name and quoting him directly.

“Donald Trump believes that Mexican immigrants are murderers and rapists. But what about my parents, Donald?” Sánchez asked the crowd, standing next to her sister, Rep. Loretta Sánchez (D-CA). “They are the only parents in our nation’s 265-year history to send not one but two daughters to the United States Congress!”

Each speech from a Latino touched on immigration, glossing over the fact that immigration is not just a Latino issue. While the sentiments were positiveillustrating a community that is thriving, and providing a much-needed break from the RNC’s anti-immigrant rhetoricat the core of every speech were messages of assimilation and respectability politics.

Even in gutsier speeches from people like actress Eva Longoria, there was the need to assert that her family is American and that her father is a veteran. The actress said, “My family never crossed a border. The border crossed us.”

Whether intentional or not, the DNC divided immigrants into those who are acceptable, respectable, and worthy of citizenship, and those—invisible at the convention—who are not. “Border crossers” who do not identify as American, who do not learn English, who do not aspire to go to college or become an entrepreneur because basic survival is overwhelming enough, what about them? Do they deserve to be in detention? Do their families deserve to be ripped apart by deportation?

At the convention, Rep. Luis Gutiérrez (D-IL), a champion of immigration reform, said something seemingly innocuous that snapped into focus the problem with the Democrats’ immigration narrative.

“In her heart, Hillary Clinton’s dream for America is one where immigrants are allowed to come out of the shadows, get right with the law, pay their taxes, and not feel fear that their families are going to be ripped apart,” Gutiérrez said.

The Democratic Party is participating in an all-too-convenient erasure of the progress undocumented people have made through sheer force of will. Immigration has become a leading topic not because there are more people crossing the border (there aren’t) or because nativist Donald Trump decided to run for president, but because a segment of the population has been denied basic rights and has been fighting tooth and nail to save themselves, their families, and their communities.

Immigrants have been coming out of the shadows and as a result, are largely responsible for the few forms of relief undocumented communities now have, like Deferred Action for Childhood Arrivals, which allows certain undocumented immigrants who meet specific qualifications to receive a renewable two-year work permit and exemption from deportation. And “getting right with the law” is a joke at this point. The problem isn’t that immigrants are failing to adhere to immigration laws; the problem is immigration laws that are notoriously complicated and convoluted, and the system, which is so backlogged with cases that a judge sometimes has just seven minutes to determine an immigrant’s fate.

Becoming a U.S. citizen is also really expensive. There is a cap on how many people can immigrate from any given country in a year, and as Janell Ross explained at the Washington Post:

There are some countries, including Mexico, from where a worker with no special skills or a relative in the United States can apply and wait 23 years, according to the U.S. government’s own data. That’s right: There are people receiving visas right now in Mexico to immigrate to the United States who applied in 1993.

But getting back to Gutierrez’s quote: Undocumented immigrants do pay taxes, though their ability to contribute to our economy should not be the one point on which Democrats hang their hats in order to attract voters. And actually, undocumented people pay a lot of taxes—some $11.6 billion in state and local taxes last year, according to the Institute on Taxation and Economic Policy—while rarely benefiting from a majority of federal assistance programs since the administration of President Bill Clinton ended “welfare as we know it” in 1996.

If Democrats were being honest at their convention, we would have heard about their failure to end family detention, and they would have addressed that they too have a history of criminalizing undocumented immigrants.

The 1996 Antiterrorism and Effective Death Penalty Act and the 1996 Illegal Immigration Reform and Immigrant Responsibility Act, enacted under former President Clinton, have had the combined effect of dramatically increasing the number of immigrants in detention and expanding mandatory or indefinite detention of noncitizens ordered to be removed to countries that will not accept them, as the American Civil Liberties Union notes on its site. Clinton also passed the North American Free Trade Agreement, which economically devastated Mexican farmers, leading to their mass migration to the United States in search of work.

In 1990, then-Sen. Joe Biden introduced the Violence Against Women Act, which passed in 1994 and specifically excluded undocumented women for the first 19 of the law’s 22 years, and even now is only helpful if the victim of intimate partner abuse is a child, parent, or current/former spouse of a U.S. citizen or a permanent resident.

In addition, President Obama is called by immigrant rights advocates “deporter in chief,” having put into place a “deportation machine” that has sent more than two million migrants back to their country of origin, more than any president in history. New arrivals to the United States, such as the Central American asylum seekers coming to our border escaping gender-based violence, are treated with the same level of prioritization for removal as threats to our national security. The country’s approach to this humanitarian crisis has been raiding homes in the middle of the night and placing migrants in detention centers, which despite being rife with allegations of human rights abuses, are making private prison corporations millions in revenue.

How Are We Defining “Un-American”?

When writing about the Democratic Party, community organizer Rosa Clemente, the 2008 Green Party vice president candidate, said that she is afraid of Trump, “but not enough to be distracted from what we must do, which is to break the two-party system for good.”

This is an election like we’ve never seen before, and it would be disingenuous to imply that the party advocating for the demise of the undocumented population is on equal footing with the party advocating for the rights of certain immigrants whose narratives it finds acceptable. But this is a country where Republicans loudly—and with no consequence—espouse racist, xenophobic, and nativist beliefs while Democrats publicly voice support of migrants while quietly standing by policies that criminalize undocumented communities and lead to record numbers of deportations.

During two weeks of conventions, both sides declared theirs was the party that encapsulated what America was supposed to be, adhering to morals and values handed down from our forefathers. But ours is a country comprised of stolen land and built by slave labor where today, undocumented immigrants, the population most affected by unjust immigration laws and violent anti-immigrant rhetoric, don’t have the right to vote. It is becoming increasingly hard to tell if that is indeed “un-American” or deeply American.

Culture & Conversation Maternity and Birthing

On ‘Commonsense Childbirth’: A Q&A With Midwife Jennie Joseph

Elizabeth Dawes Gay

Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Jennie Joseph’s philosophy is simple: Treat patients like the people they are. The British native has found this goes a long way when it comes to her midwifery practice and the health of Black mothers and babies.

In the United States, Black women are disproportionately affected by poor maternal and infant health outcomes. Black women are more likely to experience maternal and infant death, pregnancy-related illness, premature birth, low birth weight, and stillbirth. Beyond the data, personal accounts of Black women’s birthing experiences detail discrimination, mistreatment, and violation of basic human rights. Media like the new film, The American Dream, share the maternity experiences of Black women in their own voices.

A new generation of activists, advocates, and concerned medical professionals have mobilized across the country to improve Black maternal and infant health, including through the birth justice and reproductive justice movements.

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Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

At her clinics, which are located in central Florida, a welcoming smile and a conversation mark the start of each patient visit. Having a dialogue with patients about their unique needs, desires, and circumstances is a practice Joseph said has contributed to her patients having “chunky,” healthy, full-term babies. Dialogue and care that centers the patient costs nothing, Joseph told Rewire in an interview earlier this summer.

Joseph also offers training to midwives, doulas, community health workers, and other professionals in culturally competent, patient-centered care through her Commonsense Childbirth School of Midwifery, which launched in 2009. And in 2015, Joseph launched the National Perinatal Task Force, a network of perinatal health-care and service providers who are committed to working in underserved communities in order to transform maternal health outcomes in the United States.

Rewire spoke with Joseph about her tireless work to improve maternal and perinatal health in the Black community.

Rewire: What motivates and drives you each day?

Jennie Joseph: I moved to the United States in 1989 [from the United Kingdom], and each year it becomes more and more apparent that to address the issues I care deeply about, I have to put action behind all the talk.

I’m particularly concerned about maternal and infant morbidity and mortality that plague communities of color and specifically African Americans. Most people don’t know that three to four times as many Black women die during pregnancy and childbirth in the United States than their white counterparts.

When I arrived in the United States, I had to start a home birth practice to be able to practice at all, and it was during that time that I realized very few people of color were accessing care that way. I learned about the disparities in maternal health around the same time, and I felt compelled to do something about it.

My motivation is based on the fact that what we do [at my clinic] works so well it’s almost unconscionable not to continue doing it. I feel driven and personally responsible because I’ve figured out that there are some very simple things that anyone can do to make an impact. It’s such a win-win. Everybody wins: patients, staff, communities, health-care agencies.

There are only a few of us attacking this aggressively, with few resources and without support. I’ve experienced so much frustration, anger, and resignation about the situation because I feel like this is not something that people in the field don’t know about. I know there have been some efforts, but with little results. There are simple and cost-effective things that can be done. Even small interventions can make such a tremendous a difference, and I don’t understand why we can’t have more support and more interest in moving the needle in a more effective way.

I give up sometimes. I get so frustrated. Emotions vie for time and energy, but those very same emotions force me to keep going. I feel a constant drive to be in action and to be practical in achieving and getting results.

Rewire: In your opinion, what are some barriers to progress on maternal health and how can they be overcome?

JJ: The solutions that have been generated are the same, year in and year out, but are not really solutions. [Health-care professionals and the industry] keep pushing money into a broken system, without recognizing where there are gaps and barriers, and we keep doing the same thing.

One solution that has not worked is the approach of hiring practitioners without a thought to whether the practitioner is really a match for the community that they are looking to serve. Additionally, there is the fact that the practitioner alone is not going to be able make much difference. There has to be a concerted effort to have the entire health-care team be willing to support the work. If the front desk and access points are not in tune with why we need to address this issue in a specific way, what happens typically is that people do not necessarily feel welcomed or supported or respected.

The world’s best practitioner could be sitting down the hall, but never actually see the patient because the patient leaves before they get assistance or before they even get to make an appointment. People get tired of being looked down upon, shamed, ignored, or perhaps not treated well. And people know which hospitals and practitioners provide competent care and which practices are culturally safe.

I would like to convince people to try something different, for real. One of those things is an open-door triage at all OB-GYN facilities, similar to an emergency room, so that all patients seeking maternity care are seen for a first visit no matter what.

Another thing would be for practitioners to provide patient-centered care for all patients regardless of their ability to pay.  You don’t have to have cultural competency training, you just have to listen and believe what the patients are telling you—period.

Practitioners also have a role in dismantling the institutionalized racism that is causing such harm. You don’t have to speak a specific language to be kind. You just have to think a little bit and put yourself in that person’s shoes. You have to understand she might be in fear for her baby’s health or her own health. You can smile. You can touch respectfully. You can make eye contact. You can find a real translator. You can do things if you choose to. Or you can stay in place in a system you know is broken, doing business as usual, and continue to feel bad doing the work you once loved.

Rewire: You emphasize patient-centered care. Why aren’t other providers doing the same, and how can they be convinced to provide this type of care?

JJ: I think that is the crux of the matter: the convincing part. One, it’s a shame that I have to go around convincing anyone about the benefits of patient-centered care. And two, the typical response from medical staff is “Yeah, but the cost. It’s expensive. The bureaucracy, the system …” There is no disagreement that this should be the gold standard of care but providers say their setup doesn’t allow for it or that it really wouldn’t work. Keep in mind that patient-centered care also means equitable care—the kind of care we all want for ourselves and our families.

One of the things we do at my practice (and that providers have the most resistance to) is that we see everyone for that initial visit. We’ve created a triage entry point to medical care but also to social support, financial triage, actual emotional support, and recognition and understanding for the patient that yes, you have a problem, but we are here to work with you to solve it.

All of those things get to happen because we offer the first visit, regardless of their ability to pay. In the absence of that opportunity, the barrier to quality care itself is so detrimental: It’s literally a matter of life and death.

Rewire: How do you cover the cost of the first visit if someone cannot pay?

JJ: If we have a grant, we use those funds to help us pay our overhead. If we don’t, we wait until we have the women on Medicaid and try to do back-billing on those visits. If the patient doesn’t have Medicaid, we use the funds we earn from delivering babies of mothers who do have insurance and can pay the full price.

Rewire: You’ve talked about ensuring that expecting mothers have accessible, patient-centered maternity care. How exactly are you working to achieve that?

JJ: I want to empower community-based perinatal health workers (such as nurse practitioners) who are interested in providing care to communities in need, and encourage them to become entrepreneurial. As long as people have the credentials or license to provide prenatal, post-partum, and women’s health care and are interested in independent practice, then my vision is that they build a private practice for themselves. Based on the concept that to get real change in maternal health outcomes in the United States, women need access to specific kinds of health care—not just any old health care, but the kind that is humane, patient-centered, woman-centered, family-centered, and culturally-safe, and where providers believe that the patients matter. That kind of care will transform outcomes instantly.

I coined the phrase “Easy Access Clinics” to describe retail women’s health clinics like a CVS MinuteClinic that serve as a first entry point to care in a community, rather than in a big health-care system. At the Orlando Easy Access Clinic, women receive their first appointment regardless of their ability to pay. People find out about us via word of mouth; they know what we do before they get here.

We are at the point where even the local government agencies send patients to us. They know that even while someone’s Medicaid application is in pending status, we will still see them and start their care, as well as help them access their Medicaid benefits as part of our commitment to their overall well-being.

Others are already replicating this model across the country and we are doing research as we go along. We have created a system that becomes sustainable because of the trust and loyalty of the patients and their willingness to support us in supporting them.

Photo Credit: Filmmaker Paolo Patruno

Joseph speaking with a family at her central Florida clinic. (Credit: Filmmaker Paolo Patruno)

RewireWhat are your thoughts on the decision in Florida not to expand Medicaid at this time?

JJ: I consider health care a human right. That’s what I know. That’s how I was trained. That’s what I lived all the years I was in Europe. And to be here and see this wanton disregard for health and humanity breaks my heart.

Not expanding Medicaid has such deep repercussions on patients and providers. We hold on by a very thin thread. We can’t get our claims paid. We have all kinds of hoops and confusion. There is a lack of interest and accountability from insurance payers, and we are struggling so badly. I also have a Change.org petition right now to ask for Medicaid coverage for pregnant women.

Health care is a human right: It can’t be anything else.

Rewire: You launched the National Perinatal Task Force in 2015. What do you hope to accomplish through that effort?

JJ: The main goal of the National Perinatal Task Force is to connect perinatal service providers, lift each other up, and establish community recognition of sites committed to a certain standard of care.

The facilities of task force members are identified as Perinatal Safe Spots. A Perinatal Safe Spot could be an educational or social site, a moms’ group, a breastfeeding circle, a local doula practice, or a community center. It could be anywhere, but it has got to be in a community with what I call a “materno-toxic” area—an area where you know without any doubt that mothers are in jeopardy. It is an area where social determinants of health are affecting mom’s and baby’s chances of being strong and whole and hearty. Therein, we need to put a safe spot right in the heart of that materno-toxic area so she has a better chance for survival.

The task force is a group of maternity service providers and concerned community members willing to be a safe spot for that area. Members also recognize each other across the nation; we support each other and learn from each others’ best practices.

People who are working in their communities to improve maternal and infant health come forward all the time as they are feeling alone, quietly doing the best they can for their community, with little or nothing. Don’t be discouraged. You can get a lot done with pure willpower and determination.

RewireDo you have funding to run the National Perinatal Task Force?

JJ: Not yet. We have got the task force up and running as best we can under my nonprofit Commonsense Childbirth. I have not asked for funding or donations because I wanted to see if I could get the task force off the ground first.

There are 30 Perinatal Safe Spots across the United States that are listed on the website currently. The current goal is to house and support the supporters, recognize those people working on the ground, and share information with the public. The next step will be to strengthen the task force and bring funding for stability and growth.

RewireYou’re featured in the new film The American Dream. How did that happen and what are you planning to do next?

JJ: The Italian filmmaker Paolo Patruno got on a plane on his own dime and brought his cameras to Florida. We were planning to talk about Black midwifery. Once we started filming, women were sharing so authentically that we said this is about women’s voices being heard. I would love to tease that dialogue forward and I am planning to go to four or five cities where I can show the film and host a town hall, gathering to capture what the community has to say about maternal health. I want to hear their voices. So far, the film has been screened publicly in Oakland and Kansas City, and the full documentary is already available on YouTube.

RewireThe Black Mamas Matter Toolkit was published this past June by the Center for Reproductive Rights to support human-rights based policy advocacy on maternal health. What about the toolkit or other resources do you find helpful for thinking about solutions to poor maternal health in the Black community?

JJ: The toolkit is the most succinct and comprehensive thing I’ve seen since I’ve been doing this work. It felt like, “At last!”

One of the most exciting things for me is that the toolkit seems to have covered every angle of this problem. It tells the truth about what’s happening for Black women and actually all women everywhere as far as maternity care is concerned.

There is a need for us to recognize how the system has taken agency and power away from women and placed it in the hands of large health systems where institutionalized racism is causing much harm. The toolkit, for the first time in my opinion, really addresses all of these ills and posits some very clear thoughts and solutions around them. I think it is going to go a long way to begin the change we need to see in maternal and child health in the United States.

RewireWhat do you count as one of your success stories?

JJ: One of my earlier patients was a single mom who had a lot going on and became pregnant by accident. She was very connected to us when she came to clinic. She became so empowered and wanted a home birth. But she was anemic at the end of her pregnancy and we recommended a hospital birth. She was empowered through the birth, breastfed her baby, and started a journey toward nursing. She is now about to get her master’s degree in nursing, and she wants to come back to work with me. She’s determined to come back and serve and give back. She’s not the only one. It happens over and over again.

This interview has been edited for length and clarity.