First Person

Laws Aren’t The Only Barrier To Abortion Access. So Is Cost.

When thinking of abortion access challenges in the United States, waiting periods, mandatory ultrasounds, biased pre-abortion counseling, bans on federal and some state funding, and a dwindling number of independent clinics come to mind. These challenges delay abortion care, increase medical risks, and especially hurt minors. After navigating extreme restrictions and logistical needs to get to the clinic, another problem may arise for some patients: additional fees, which can range from $50-250 (on top of an average cost of $500 for a first trimester abortion), for factors entirely out of the patient’s control, such as having a negative blood type, being over a certain weight, or having a twin pregnancy. Although additional fees are common among various medical procedures, the lack of public and private coverage for abortion costs makes them difficult for some to afford — especially in places where the rate of uninsured people is high.

I have firsthand experience with one: Rhogam. Like 15 percent of the population, I lack the Rhesus factor in my blood, which means I have a negative blood type. If your partner has a positive blood type (or if their blood type is unknown), the fetus can inherit their factor, causing problems with the pregnancy. Pregnant people in this position can be given an injection of rho(D) immune globulin, such as Rhogam, to create antibodies that desensitize our physiological response if our blood comes into contact with the fetus’ blood, should it be Rhesus positive. Without the injection, it could be problematic for not only the health of the pregnant person and developing pregnancy, but the development of future pregnancies. Normally, Rhogam isn’t given during pregnancy until the 28th week, but abortion providers still routinely provide it at earlier gestations.

I had the privilege of using insurance when I delivered my two children, including one through a cesarean section. Unexpected fees weren’t something I anticipated when I needed an abortion while living uninsured — and I live in Texas, where in 2017 a bill passed prohibiting insurance plans from providing coverage for abortion unless the pregnant person has a separate premium they’ve purchased specifically for abortion. And for most people, Medicaid won’t cover it, either. I learned I’d need to pay $100 because of my blood type, on top of $450 for a surgical abortion. My local abortion fund helped, but it wasn’t enough for me to afford Rhogam and sedation. So I experienced my surgical abortion completely aware, which wasn’t comfortable for me. Nor what I wanted, since medical settings give me anxiety.

Some clinics have taken measures to address the challenges of added fees. And abortion funds, such as the Mississippi Reproductive Freedom Fund, also provide financial assistance. Some abortion providers combine what would typically be additional costs with the price of the abortion, or try to be up front about these fees on their websites. But not everyone has access to the internet, or if they do, it isn’t always easy to find accurate information. Crisis pregnancy centers often use similar names to trick people, who may not realize they’re on a site that isn’t legitimate. So it isn’t unusual for us to learn — for the first time — that we have to pay hundreds of dollars upon visiting the clinic.

“We’ve had patients who choose our clinic specifically because we don’t charge for Rhogam,” one clinic told me. Other clinics may waive the fee for those who need help paying for it, when resources are available to do so. “We received a grant that allowed us to provide our patients with financial assistance for things, and at the time we decided to use it on Rhogam, so people wouldn’t have to miss their appointment over an unexpected thing,” another clinic said. “We recognize the hardship this creates for many people, especially when a lot of people have no idea what their blood type is to begin with.”

Our right to choose means nothing if we can’t access it.

The extra cost of Rhogam increased the time one patient needed to pay back a loan they took out on their car in order to afford the procedure. “I had to travel to a different state because it was closer than the clinic where I lived. I had the money from a loan I took out already, but when I found out I’d need to pay $100 more because of my blood type — in addition to the barriers I was already facing — I realized I’d be stuck in this cycle of debt longer than I hoped for,” they said.

I also spoke with Desiree — whose name has been changed to protect her privacy. “I remember standing at the window and being told it would be an extra $100 because of my blood type. It had already taken me weeks to get the $400, and I needed an abortion a few days before rent was due. I had to step aside and really think about what this could mean for my living situation,” she said, since she’d already needed assistance from a local abortion fund.

Laurie Bertram Roberts, co-founder and executive director of the Mississippi Reproductive Freedom Fund, told TalkPoverty: “We hear from many callers that struggle more because of these extra costs. It’s already hard as it is to raise hundreds of dollars for the procedure, especially for our callers who are experiencing homelessness and other barriers related to accessing abortion.”

This issue also affects those who don’t have a negative blood type. “I wasn’t even Rh-negative, but the clinic I went to gives everyone Rhogam,” said another patient. She said the additional cost caused her to drive home on “fumes,” because she had to use her last $50 that was originally intended for gas after driving out of town for her abortion.

When it comes to the extra cost associated with Rhogam, fortunately, things are changing. In Contraception Journal, the National Abortion Federation (NAF) recognized last year that testing for the Rhesus factor in abortion care has become a barrier. They refer to Dutch guidelines, which say the injection is unnecessary for pregnancies less than eight weeks — and Sweden also recommends against the injection for early medical abortion.

NAF recently updated its recommendations regarding when Rhogam is required. They no longer recommend it for early abortions less than eight weeks, most of which are medical abortions and account for two thirds of the abortions performed in the U.S., according to the Guttmacher Institute. Now, people with a negative blood type — who find out about their pregnancy early on — may have the ability to forego Rhogam at NAF-member clinics. Some experts say it isn’t necessary for a first pregnancy at all.

Dr. Alice Mark, NAF’s Medical Director, told TalkPoverty: “We know giving the Rhogam injection at 28 weeks decreases the risk of sensitization, but what we don’t know is that any intervention before that has any impact on the outcomes…The studies [on sensitization] use methods that are outdated, and we were doing this intervention without knowing whether or not it benefited patients.” They drew heavily on data from Europe, where not providing Rhogam early in gestation has “no appreciable impact.”

Dr. Mark stressed that some clinics may want to follow American Congress of Obstetricians and Gynecologists (ACOG) recommendations to protect their patients, and that’s not wrong. “But because we’ve made this change, it’s been taken to ACOG to be discussed on their committees,” said Dr. Mark.

One clinic I spoke with told TalkPoverty that, “We’re going to follow the [NAF] recommendations, and we should be updating the guidelines in the next month. All of our physicians are really excited to follow these guidelines — there’s a lot of research on it. It’s an extra barrier for patients.” Patients are also growing more aware. “I didn’t need it because I’m less than eight weeks,” said one person I spoke with before her abortion.

This isn’t the fault of clinics. It is the result of the systemic issues related to extreme abortion restrictions. After all, paying for abortion could be a lot easier if there wasn’t a federal ban on public funding. Independent clinics perform the majority of abortions in the U.S., but they receive absolutely no support from our government. Use of state dollars for Medicaid reimbursements for abortions is highly restricted in Texas and a number of other states, so while some providers may combine these additional fees in the cost of the abortion, it’s inevitable not all would be able to in order to sustain the operation of the clinic. In eleven states, including Texas, most people can’t use their private health insurance for their abortion, either.

And with providers across the country facing closures due to medically unnecessary restrictions, accessing a clinic becomes less of a reality for many even without these additional costs. Next month, Missouri will give a final ruling in the case of the state’s only abortion provider shutting down. Six states currently have only one clinic, and Missouri could be the first with zero. In Texas, we have the most cities more than 100 miles away from an abortion clinic. For some of us, there is no choice: we’re forced to continue a pregnancy we don’t feel ready for.

Because even though we have a legal right to have an abortion, lawmakers continue to remind us that our right to choose means nothing if we can’t access it.

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Feature

Jail Isn’t A Drug Treatment Center. Stop Promoting It As One.

Kathleen Cochran is no stranger to the term “enabling.” These days, she manages 11,000 acres of ranchland in the lush Santa Ynez Valley, just north of Los Angeles. Her daughter, who has struggled with heroin addiction for 15 years, is stable. But those 15 years were a tumultuous ride, riddled with harmful advice from fellow moms and accusations that she was “enabling” her child by preventing her from suffering the worst consequences of drug addiction. Some of the most prevalent advice Cochran was given was to call the police on her daughter, or otherwise allow her to become and remain incarcerated. Common refrains included a false belief that she was safer behind bars where she could not get drugs but would be provided three hot meals a day, or that people who do the crime deserve the time, and that it might give her the space to think critically about how she was living. What these families fail to understand is that incarceration leads to a host of problems for people struggling with drug addiction, both immediate and long-term.

“I understand the sheer panic of not knowing what to do, and you want to get your kid off the street because you really honestly believe they’re going to die,” said Cochran. “But I had a thought that, you know, if my daughter gets arrested, she’s gonna have a record.”

The concepts of “enabling,” “rock bottom,” and other punitive approaches toward addiction are mainstays of the 12 step programs that continue to dominate recovery culture despite a lack of scientific evidence backing their efficacy. It’s not uncommon for parents of people in the throes of addiction to feel compelled to call the police on their loved one, pray for their incarceration, or feel relief when their loved one gets locked up. Cochran still encounters the mentality frequently in “Moms for All Paths to Recovery,” an arm of her nonprofit “Heart of a Warrior Woman,” dedicated to disseminating the harm reduction tools and tenets she wished had been more available when she was desperate for ways to help her child.

“In that moment, [parents] say nothing else is working,” explained Cochran. “They need a reprieve and somehow they think no matter what anyone has told them, [their child’s incarceration] gives them a reprieve.”

Parents, however, are not the only people who uphold the myth that incarceration benefits people struggling with addiction. Many people in recovery credit incarceration with their turnaround. It’s not uncommon to hear people say they would never have stopped using if they hadn’t gotten locked up, or that detoxing felt psychologically easier in jail, where they knew they couldn’t get a hit. Amanda Mansur, a restaurant server and mother living in Massachusetts, told TalkPoverty over the phone that, in retrospect, being incarcerated was a “positive experience.”

“It taught me…about gratitude. You don’t realize how good you have it until you lose everything,” said Mansur.

But incarceration is highly traumatic and embedded with both short- and long-term negative consequences. In the long term, convictions, especially felonies, can follow people for years after their release from jail or prison. People with felony drug convictions face difficulties renting homes, gaining employment, and even accessing public benefits.

Most states no longer enforce a lifetime ban on public benefits like food assistance and cash benefits for families with children, but many still impose temporary bans or reinstatement requirements outside of their criminal sentence. That can mean drug testing, which is costly, invasive, and not always accurate; the more common, less expensive urine drug tests, for example, are prone to false positives, which can result from the use of over-the-counter medicines or even edible poppy seeds.

If my daughter gets arrested, she’s gonna have a record.

The negative consequences of incarceration are compounded for people of color. Members of Black and Latinx communities are more likely to be incarcerated for drugs, and one in nine Black children has an incarcerated parent, as opposed to one out of every 57 white children. One study conducted in New York City found that Black men with criminal backgrounds faced harsher employment discrimination than white men with similar convictions. One out of every 13 Black Americans will lose voting rights in their lifetime due to felony disenfranchisement. Over 250,000 immigrants have been deported as the result of drug charges since 2007, according to data compiled by the Drug Policy Alliance.

But all of these consequences hinge on the assumption that a person survives the ordeal of incarceration. For people who are addicted to drugs, survival is not guaranteed.

“Any time someone has to use drugs in a way that’s secret, that’s hidden, that’s rushed, that’s not around people, that’s not in a safe secure network where you can get help, you see increased harms,” said Kim Sue, the medical director of the Harm Reduction Coalition, who also performs clinical work at Rikers Island Correctional Facility and recently published a book titled “Getting Wrecked: Women, Incarceration, and the American Opioid Crisis,” that examines the use of methadone and buprenorphine within jails and prisons. Those harms can include increased rates of infections and diseases like HIV and Hep C that can result from sharing syringes and other equipment.

Those harms can also manifest as death due to withdrawal. Although opioid withdrawal is not conventionally considered fatal among otherwise healthy adults, a number of people have been found dead in cells across the country. In 2017, Mother Jones reported that although nobody is tracking how many of these deaths are taking place, 20 lawsuits were filed against United States correctional facilities between 2014 and 2016 in response to alleged opioid withdrawal-related deaths. Withdrawal-related dehydration is often cited as a primary factor in these deaths. In more than one of these cases, distressed inmates reported concerns for their life to family members over the phone, or begged staff for water and medical care in earshot of their cellmates. Surveillance cameras caught the excruciating withdrawal and death of a 32-year old Michigan man who was in addiction treatment when he was arrested and sentenced to 30 days in jail for failing to pay a driving ticket.

“If you’re doing a lot of vomiting or a lot of diarrhea…[that] can lead to different electrolyte disturbances which can affect cardiac function, leading to cardiac arrest,” explained Sue, who also noted that many times, medically untrained guards are the only people available to assist incarcerated people in withdrawal. She added that even when inmates are transferred to medical units, most facilities do not have doctors on site full time.

There is a growing awareness among criminal justice authorities that medications used to treat opioid use disorder, like methadone and buprenorphine, are essential for people struggling with opioid addiction. Often prompted by lawsuits, several facilities have begun inducting incoming inmates who are addicted to opioids, or allowing people already prescribed the medications to continue taking them. Regardless, the majority of facilities do not allow the use of these medications, except for people who are pregnant (even then, patients are typically tapered off after pregnancy, sometimes while still recovering from childbirth).

This means that most people who are incarcerated while addicted to opioids will undergo forcible detox. In some cases, even when people are given methadone or buprenorphine as a withdrawal aid or for maintenance while inside, they are not given adequate referrals on the outside. In some areas of the country, these medications are difficult to access or too expensive to pay for out of pocket. For people addicted to opioids, being forcibly detoxed without adequate access to evidence-based treatment like methadone or buprenorphine can be dangerous upon release because it leaves them at risk of relapse, but without their former tolerance. Opioid-addicted people who have been released from incarceration are at significantly heightened risk of overdose in their first several weeks back in the community.

Even in facilities where evidence-based treatment is offered, the risk of trauma remains ever-present. “[People who are incarcerated] get killed by staff, they get killed by other inmates…they get raped, they get sodomized,” said Dinah Ortiz, a vocal harm reductionist and parent advocate at a New York defense firm. “You don’t know how many rapes I saw, you don’t know how many women I saw sodomized during my little six months in Rikers.”

“If you’re the kind of person who needs to take a walk when you’re feeling stressed, you cannot do that [while incarcerated]. If you’re anxious around other people who are loud or fighting, you can’t avoid that. The environment is not therapeutic,” said Jonathan Giftos, who worked as the clinical director of substance use treatment for the Division of Correctional Health Services at Rikers Island. “A lot of the health side works hard to mitigate the harms of the environment, but you can only do so much.”

Even when formerly incarcerated people praise their experience behind bars, they also often share stories of trauma and relapse that didn’t end with jail or prison, but with evidence-based care that they accessed in the community. Mansur, for example, admitted that she relapsed shortly after her release, and continued using for three years before achieving sobriety with the help of a self-referred buprenorphine prescription. She detailed that she’s had difficulty renting apartments because of her conviction, which was for theft that she committed in order to pay for drugs. She’s also unable to work in the medical field or with vulnerable populations like children or the elderly, which she finds disappointing because she had studied psychology in college.

“Maybe if I had been introduced to medication-assisted treatment previously from going to jail, maybe that would have prevented [the need to be arrested],” Mansur stated, before acknowledging that her addiction became “much worse” after she was released from jail.

“If your [child] is out of control there are ways to go about [helping them] that do not involve incarceration,” advised Ortiz. “If you have that mentality that I prefer they be in jail, then that’s the mentality that they are going to have, too.”

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First Person

I Was Ready for College. College Wasn’t Ready for Me.

The upstairs toilet is wobbly. It’s been this way for a few months. Whenever someone sits on it or shifts their weight, it makes an unsettling clunk. Strangely, that’s not the upsetting part to me. See, I know how to fix it; in this age of YouTube and WikiHow, you can find and teach yourself how to do almost anything. I know what tools I need, where to get them, and I even have the funds available to take care of it. What I don’t have is time, and that is largely due to my decision to continue my education as an older, non-traditional student. According to the American Council on Education’s “Post-traditional Learners Manifesto,” as many as 40 percent of undergraduate students nationwide are non-traditional, defining non- or post-traditional as over the age of 25 with varying factors such as financial independence, number of dependents, high school graduation status, and military experience.

Like many of my cohorts, I was sold the line that higher education was the golden ticket to a successful life. Off I set at eighteen to Eastern Michigan University, sure of what I wanted and what I would do. But life being as it is, and plans going the way they often do, I didn’t graduate. I dropped out to have a baby, joined the Navy, was medically discharged, and left drifting without tangible purpose. This is at least in part due to my husband’s active duty status, taking us overseas. This is not unusual, as the same manifesto notes that as of 2017, 60 percent of non-traditional students are women. At least I had my Post-9/11 G.I. Bill, a college payment incentive offered for military enlistment after the 9/11 attacks, and since my life became more stable in my late 20s and early 30s, the time seemed right: I enrolled at the University of Hawai’i at Mānoa.

As a disabled veteran and mother of a teenager, I knew some of the challenges awaiting me after admission. Being significantly older than my peers and being mistaken for a graduate student or instructor were odd blows to my self-esteem. There were numerous others I’d not considered. But as I sit here three weeks from graduating at the time of this writing, I’ve realized that I’ve succeeded despite higher education institutions failing to understand the needs of non-traditional students.

The university experience in the United States is designed to pipeline high school graduates through it and into the workplace as fast as possible, even with the reality that financial success is not necessarily waiting at the other end. Our campus is full of eye-catching signs encouraging undergraduate students to finish in four years, encouraging a fifteen-credit course load if you mean to finish within four years, instead of a full-time load of just twelve. Each syllabus reminds us that we should expect three hours of outside class work per week per credit hour. A fifteen-credit schedule alone starts with fifteen hours a week under instruction. If each class sticks to only that three hours per week outside of class, you’ve racked up forty-five hours of homework. Being a full-time student is more than full time. If your only responsibility is class, and you budget your time well, that may just be doable.

As a theatre major, like many other majors, it’s also not unheard of to have to fit in many outside-of-class activities. I study stage management and playwriting, and that requires me to run shows. I am lucky to have instructors who help me find alternate routes to these requirements, but not every department is this accommodating.

Class and homework are not always the only things people are balancing.

In addition to family duties and disability status, I’m an author, which is a demanding job that comes with irregular hours, most of them unpaid. My time is valuable. My work and financial circumstance allow me to put projects on pause, to the frustration of my ambition. But I still find it difficult to keep up with the amount of self-promotion being an author requires. I was asked to choose between my GPA and my income.

40 percent of undergraduate students nationwide are non-traditional.

My share of the responsibilities of my home life doesn’t stop for my school day, not if we want things like packed lunches and clean underwear. Even with on-campus services like the Student Parents at Mānoa (SPAM), who help to fill in gaps in childcare, there are limitations. Families need fed. Meals need planned. Perpetual chores pile up each and every day, even if you did them the day before. My family is great about sharing chores, but they have school and jobs too. Of course, traditional students often have to deal with this, as a record number of young people currently live in a household with at least one other generation, which only further emphasizes the need for more support.

And commutes! My commute of twenty miles one way is over an hour. By the time I get home, with a mountain of homework or paperwork, those languishing piles of laundry and cat boxes in need of scooping make me want to cry. Plus, between commuting, family care, instruction time, homework, paid and unpaid non-school work, sleep must happen.

As a person living with chronic pain and mental illness, I often find the demands on my time challenging. My mobility is largely unaffected, which is good, since several of the buildings I frequent lack elevators for my second and third floor classes. With chronic pain often comes chronic fatigue, and while I can make it up and down all of those stairs, it takes its toll.

Managing disability and mental health requires appointments. Appointments take time out of home, work, rest, and class since they tend to be during standard business hours. Going to school for me means staying on my medications. Keeping that medication requires monthly appointments. Many classes penalize overall grades — some as much as one-third of a letter grade deduction — for missed instruction time. If you maintain attendance and miss appointments, health issues inevitably arise, requiring more missed class hours. My teenage child also has appointments, which my spouse and I must take turns with so neither of us miss too much work or school.

Most campuses now have disability services, like UH Mānoa’s Kōkua office. For many students, knowing what accommodations to ask for is daunting. What help can they offer for missed meds and bad traffic? Even if you know what to ask for, it needs to be documented by a qualifying medical professional, which is more outside-of-class time, and the hours per week are reaching untenable.

Universities could take great steps, including encouraging communication with instructors or eliminating graded attendance, in order to address some of these issues. Integrate more one-stop offices to help non-traditional students navigate enrollment and registration. Place non-traditional students on your student governments, boards of regents, and other organizations empowered to enact policy change. Create liaison positions for non-traditional students to direct their needs. Even small things, like eliminating assignments that are little more than busywork, can be an amazing reprieve.

Like I said, I’m in the final days. I would have to try to fail at this point, and even then it may not be enough to undo what I’ve accomplished. At the end of the term, many non-traditional and later-in-life students will graduate, but our successes are in spite of these circumstances. So, I guess that toilet is going to need to wait a few more weeks.

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The Criminal Justice System Is Too Big. It’s Time To Downsize.

My first encounter with the word downsizing was when my mother was laid off from her long-time job as a records management clerk. Bill Clinton was in his first term as president and the infamous 1994 Crime Bill was passing through Congress with bipartisan support. My mother called home from somewhere in Manhattan, distressed. She said, “Marlon, I lose meh job oday.  These people lay me off after over 20 years, yuh know, after slaving and travelling quite in White Plains at 5 o’clock every morning … I doh know what I’m gonna do now.”

Like any curious 14-year-old, I asked, “Why they let you go?” She responded with an undertone of cynicism: “They said they need to downsize, so they let me go.”

“Mommy, what does downsize mean?”

Since my overly expensive degree in Organizational Behavior from NYU, I’ve learned that not all downsizing is as bad as what happened to my mother.

According to the Harvard Business Review, proponents of downsizing argue that it is an effective strategy, with benefits such as increased performance and sales. Stepping out of Business 101 is decarceration, the downsizing of incarceration to reduce the scale and reach of the criminal justice system. It’s time to start now, especially as violent crime is down in most cities and lawmakers weigh the decriminalization of many offenses, such as drug possession/use and sex work.

Downsizing means police should not be mental health first responders. They need mental health treatment. They need help. Police officer suicides in 2018 were the highest ever, with 228 officers dying by suicide. Chuck Wexler, executive director of the Police Executive Research Forum, believes the 228 number “is undoubtedly underreported.” Probation and parole officers are not substance abuse counselors or employment specialists.

And all of this is okay because we don’t need them to be. They just need to get themselves healthy, and rightsizing should be an option. We already have proficient social workers, mental health professionals, substance abuse counselors, and employment specialists who are not utilized enough or funded appropriately.

The criminal justice system is a discordant machine of more than 55,000 criminal justice-related agencies nationwide inclusive of police, courts, district attorney offices, jails, prisons, parole and probation boards, and ecarceration. I’m sure I’ve missed a few here, but the point is that America’s criminal justice reform intoxication should include more than reducing the number of people in prisons or the amount of lockups closed: It should mean fewer institutions of incarceration, too.

Downsizing in this context means relieving some institutions of their duties and giving them a severance package that will allow them to take care of their own house.

We have a racialized system of control.

Our tax dollars pay the bill of more than $270 billion to keep the criminal justice system intact. If the criminal justice system were a country, it would be 41st on the GDP tally of 186 countries. We — and I mean “we,” because “We, the People” allow for this profane, ineffective, and inefficient use of resources — currently have open-air incarceration, where about 4.5 million people live under some form of community supervision, alongside the 2.3 million people in prisons. We spend $29 billion on the federal law enforcement budget (#99 on the GDP tally). We have 70 million people in the U.S., not incarcerated, but living freeish with a criminal conviction.

Amid this display of laissez-faire governance, there is progress to soberly consider. Bail reform in several states is decreasing the debtor’s prison construct. Restorative justice models are sprouting up across the country, effectively decreasing exposure to all points of the criminal punishment system. Progressive judges like Victoria Pratt “sentenced” people who came before her court to write essays, instead of lockup. Law enforcement administrators from across the country have been meeting as Executives Transforming Parole & Probation (EXiT) to operationalize the downsizing of their reach and their caseloads. In their “Statement on the Future of Probation & Parole in the United States,” they assert: “As people who run or have run community supervision throughout the country and others concerned with mass supervision, we call for probation and parole to be substantially downsized, less punitive, and more hopeful, equitable and restorative.”

Several years ago, when I was a violence interrupter for the Cure Violence program in Brooklyn, New York, I spoke at an intimate convening of community residents, police, and elected officials. During my comments, I said my job is to figure out ways to put myself out of work. My work was to reduce shootings in the area of Brooklyn where the violence interrupter program operated. Even then, I understood that any person or institution engaged in intervention work should hope that their interventions are no longer needed. The criminal justice system is an operation of interventions ostensibly created to deal with violations of the societal contract. Because of the disproportionate use of these interventions on Black, Brown, Indigenous, and Asian Pacific Islander populations, we understand that we have a racialized system of control.

White supremacy aside for a moment (as if it is ever possible to put the ideology of white supremacy in timeout), the 55,000 agencies of the criminal punishment system, e.g., the courts, law enforcement, and community supervision, should keep a humbling view of themselves.  They should be working to put themselves out of business. They need to see downsizing as a means to community efficacy.

Since my mother’s untimely dismissal from her job, our family figured it out, like most working-class families. We pooled our resources together. My mother still has a few choice four-letter words in her Trinidadian accent to describe the process of being laid off. I assume the 55,000 criminal justice agencies will also have a vulgar reaction to real downsizing. But I am sure those of us in communities that are involuntarily cuffed to the criminal punishment system will also find a way to pool our resources together to create safe neighborhoods we all deserve.

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Black West Baltimore Is Still Waiting for Equity

In West Baltimore, on the corner of Baker Street and Pennsylvania Avenue, a man stands in the December chill selling shoes off a makeshift table. A block north, groups of unemployed men gather on the street corners in front of the Arch Social Club, a historic African American men’s club.

“West of [interstate highway] 83 there is no viable business district, no economic engine or opportunities for young people,” says James Hamlin, the owner of a local bakery.

Baltimore’s Pennsylvania Avenue was once a thriving cultural center for the city’s Black population during the era of segregation. Famous artists like Billie Holiday, Nat King Cole, and Duke Ellington all arrived in the city to play at Baltimore’s Royal Theater.

But the venue was demolished in the 1970s, and today most of the businesses that thrived during the era of segregation have closed. Most people who know the area think of the drug trade portrayed in the popular HBO show The Wire, or of the 2015 protests that erupted after police killed a 25-year-old Black man named Freddie Gray. Further east on North Avenue, the paint is chipped off the storefronts and the nearby townhouses are boarded up. It’s impossible not to notice the history of economic neglect in these majority-Black neighborhoods.

Meanwhile, residents claim that the city only responds to service requests, calls to change streetlights, or pick up trash in areas of Baltimore where the majority of the population is white. Black neighborhoods, many of which are cut off from other parts of the city by highways and a lack of public transportation, are largely left to fend for themselves.

But an ambitious plan put forward by the President of Baltimore’s City Council, 35-year-old Brandon Scott, aims to change that by tasking government agencies with finding solutions to the deep structural racism that has plagued the city for decades.

In November last year, the city voted overwhelmingly in favor of establishing a permanent Equity Assistance Fund that would be used exclusively to support efforts that aim to reduce race, gender, and economic inequality. The charter amendment that establishes the fund is one of the first in the country that explicitly mentions structural and institutional racism. A separate bill also obligates each government agency to analyze how it can address structural inequalities and come up with an equity action plan.

Scott, who has been working in local government since he was just 27, said his personal experience growing up in Baltimore motivated him to address the city’s longstanding history of inequality.

“I lived in Lower Park Heights, so you have vacant homes, violence, of course, blight, lead paint in houses, and all of that stuff going on. And then right above me you had some of the most affluent areas in the city,” Scott said, describing a scenario that is typical for Baltimore City.

“The area right to the east of us, right across [highway] 83, is Roland Park, which is one of the most affluent neighborhoods. So when you grow up in the city and you are surrounded by what you see, and then you see the opposite not far away from you, it changes the way you look at the world,” Scott continued.

The differences between Baltimore’s neighborhoods even affect how long residents live. In Baltimore’s Greenmount East neighborhood, the average life expectancy is around 66 years. In Roland Park, in contrast, the average life expectancy is 84 years. The disparities mimic the difference in life expectancy between some of the world’s most and least developed countries.

This starkly unequal landscape was created largely through deliberate policies that aimed to separate the city’s white residents from the Black population. At the turn of the century, in 1910, Baltimore passed an extreme ordinance that prohibited Black and white populations from living in the same neighborhoods. Segregation allowed banks and the federal government to exclude majority-Black neighborhoods from their loan programs, making it nearly impossible for Black residents to become homeowners.

The 1910 ordinance didn’t last very long. The Supreme Court deemed it unconstitutional in 1917. But many of the city’s residential neighborhoods remain segregated over a century later.

Researchers have described Baltimore as having an L-shaped corridor down the center of the city where the white population lives, and a majority-Black, butterfly-shaped area that surrounds either side of the city’s main artery. Today, predominantly white neighborhoods in Baltimore receive between two and four times as much capital investment as majority-Black neighborhoods, according to recent estimates.

With all of this in mind, advocates argue that only robust public policy like the kind proposed by Scott can address the problems caused by nearly a century of racist policies.

We have assets but we don’t have infrastructure.

But one year after the city’s residents voted overwhelmingly in favor of the bills, the details are still nebulous. Agencies are currently working on their assessments and action plans, and the first agency budgets to be shaped through a lens of equity will be presented in the late spring and early summer.

Mara James, a legislative lead at Baltimore’s Bureau of the Budget and Management Research, noted that there is some concern about how to finance the Equity Assistance Fund.

“The legislation established the Fund but did not designate a funding source. At this point in time, no funding sources have been identified for the Fund,” James said. “We value the efforts of Council President Scott to put equity at the forefront of the City’s work, but our office is concerned about the impact that any dedicated fund may have on the City’s ability to respond to fiscal emergencies or large future costs and ensure we continue to provide core services to residents.”

One number often floated publicly is $15 million, or roughly 3 percent of the police department’s annual budget. But current Mayor Jack Young has also expressed some concern about where the extra money would come from and whether it would be possible to skim money from the police budget.

“The administration is not focused on that legislation. We’re focused on developing an equity framework,” James Bentley, a spokesman for the mayor’s office, said about the Equity Assistance Fund.

Bentley argues that the city doesn’t have the ability to finance the Fund because of a state-mandated policy that will require millions of dollars be invested into public schools over the next decade. But the mayor’s office wants to use data and statistics to find new ways to ensure that the city’s most impoverished neighborhoods get as much attention as the wealthier ones, he says.

“When you look at the data it clearly showed a discrepancy, that some areas get more attention to the detriment of others. Mayor Young wants us to use data to show where there are disparities,” Bentley said.

Young has also suggested that tax incentives could be used to attract business to parts of the city that lack economic investment. But some experts argue that purely economic policies may not be enough to achieve sustainable racial and economic justice.

“I wish there was one policy that would solve the history of a lack of investment or neighborhoods being where they are. Tax incentives alone can’t be the answer to structural racism,” said Leon Andrews, a director of the National League of Cities. “It can complement other things that you want to do, but if you just have tax incentives without thinking about the inequities and what that means for the neighborhood, you can repeat displacement and gentrification as we’ve seen in other neighborhoods. Tax benefits for what purpose? Who benefits?”

For many of the youth living around Pennsylvania Avenue, the government’s plans — mayor’s or council’s — mean little if they aren’t implemented.

“We have assets but we don’t have infrastructure,” says Hamlin, the local bakery owner. “The ideas are good but something has to happen.”

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