EBB 227 – Amplifying the Need for Intersectional Birth Support for QTBIPOC Birthing People with Xian Brooks of the Dandy Doula

Learn more about Xian Brooks and The Dandy Doula here. Follow The Dandy Doula on Facebook and Instagram. 

Hoyert DL. Maternal mortality rates in the United States, 2019. NCHS Health E-Stats. 2021. DOI: https://doi.org/10.15620/cdc:103855.

Hunter, L., McMahon, E., Graves, B., Wooten, A., Kriebs, J., Pickett, E., Tanner, T., Garcia, R., Apatov, N., Burkman, R., Hodges, K., & Bright, C. (2019). (rep.). 2019 Demographic Report (p. 1). Linthicum, Maryland: American Midwifery Certification Board.

Loewenberg Weisband, Y., Klebanoff, M., Gallo, M. F., Shoben, A., & Norris, A. H. (2018). Birth outcomes of women using a midwife versus women using a physician for prenatal care. Journal of Midwifery & Women’s Health, 63(4), 399–409. https://doi.org/10.1111/jmwh.12750

Taffe MA, Gilpin NW. Racial inequity in grant funding from the US National Institutes of Health. Elife. 2021;10:e65697. Published 2021 Jan 18. doi:10.7554/eLife.65697. 

Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. Issue briefs, Commonwealth Fund. 

Rebecca:

Hi everyone. On today’s podcast we’re going to talk with the founder of Dandy Doula, Xian Brooks, about the importance of intersectional birth work and amplifying the need for intersectional birth support for queer, trans, and BIPOC birthing bodies.

Welcome to the Evidence Based Birth® podcast. My name is Rebecca Decker and I’m a nurse with my PhD, and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See evbirth.com/disclaimer for more details.

Hi everyone. My name is Rebecca Decker, pronouns she/her, and I will be your host for today’s episode. Today we are so excited to welcome Dandy Doula founder, Xian Brooks. Before we interview Xian, I want to let you know that we will mention transphobia, misgendering, deadnaming, racism, police violence, and birth trauma. If there are any other detailed content or trigger warnings, we’ll post them in the description or show notes that go along with this episode. Now we’d like to introduce our honored guest. 

Xian Brooks, pronouns he/him is a public health professional from Louisville, Kentucky, where he is a community-based birth doula and master of science of nursing student.

Xian completed his Bachelor’s of Science in Public Health Education at North Carolina Central University and his Master’s of Public Health and Community and Behavioral Health at the University of Colorado. Over time, Xian has accumulated a lot of experience in queer, trans, and non-binary, and gender non-conforming reproductive health education. Xian’s training has equipped him to understand the root causes for perinatal death rates among Black individuals and how race, gender, sexual orientation, and class are not mutually exclusive when it comes to health disparities. Xian’s lived experience recognizes that health disparities are more than just numbers on a page. Xian is currently working towards becoming a nurse-midwife as a representation in healthcare is extremely important to Xian. He firmly believes it is necessary to overcome negative health outcomes and revolutionize healthcare. We are so thrilled to have Xian with us today. Welcome, Xian to the Evidence Based Birth® podcast.

Xian:

Hi, thank you. Thank you for having me. I’m happy to be here.

Rebecca:

Can you share with our listeners more about what got you started in birth work, at this point in your career?

Xian:

Yeah. I have my MPH, as you mentioned, and one of the first things is that I was like, I don’t think I’m ever going to see my return on investment, on my MPH, which is not to say that I’m going to see my return on investment on anything else, but it seemed very clear to me throughout my various interview processes. Public health is a field that is a very, very white woman field, and I think they like it that way. I was like, I’m not going to fight against this for too much longer, but basically, specifically with birth, it started out with me and my spouse wanting to be parents, and I wanted to make sure that I had the tools and the knowledge to be able to support them throughout pregnancy and birth.

That’s when I’d applied for a scholarship from this local organization called mama to mama and I was able to participate and be trained as the Donna International Birth Educator and Doula. That said, birth work is not something that I thought that I would be doing. It’s definitely a calling, I think, and I think unfortunately, like many people who are diasporic identified, specifically those of us who are African American, I don’t know a lot about my ancestral history past my maternal grandmother, but I do feel very strongly that somebody was a birth worker. I say that because of my first birth, I was super nervous beforehand, and then when I had to go, it was really weird, I was like, this is not my first time.

I was definitely labeling it, and I was like, I’ll think more about this later. It was a very weird, calm and assuring, like somebody’s with me, you got this type thing. I was like, huh, that’s interesting. I also always wanted to be a direct care provider. I used to think that it was going to be gynecology because I knew about the need for lower body and reproductive care for trans folks and non-binary folks and general nonconforming folks. When I decided that I was going to do that by way of being a nurse practitioner, I have lots of friends that are in healthcare, many of whom are midwives themselves, and so I got lots of offers for shadowing. One of those offers came from certified nurse-midwife, Damara Van Irvin, who was one of the first, if not the first, midwife to work out of University Louisville Hospital.

I always wanted to be well rounded, and so even though I wasn’t sure that I wanted to go on to birth work, I agreed, and that experience I was able to walk away from that with new knowledge, specifically that I didn’t know that, at the time the certified nurse-midwives also operated as PCPs, and I was like, oh, I can do what I initially wanted to do, and then some. That is what got me into it. I’d also be remiss if I didn’t say that it came out of fear as well, a little bit, the statistics for Black birthing people, are appalling to say the least, especially for a country that is considered to be economically privileged.

Rebecca:

Well, that’s incredible that you got to shadow Damara because she has quite the reputation in Kentucky. First of all, can we back up to being a doula? I would love to hear more your thoughts and feelings about what it’s like to be at births. You mentioned that you felt very calm and you felt like an ancestral calling. What else do you find rewarding about being there with families when their babies are born?

Xian:

Yeah. It’s so interesting how life takes you. I consider myself to be very practical, I’m not like a robot, but I’m very practical, I’m very logical, feelings aren’t… It’s funny, my partner got me this box of feelings. I could look through this and look at feelings and their definitions. I think it’s interesting that I’ve gotten called to this practice that involves a lot of feelings, and I think that perhaps one of the reasons that I was called to it was so I can grow in that way. I feel like it’s a super sacred opportunity to be a part of, and I feel honored that people trust me enough to be there with them and to take care of them during something that’s, for lack of a better term, super intimate. We’re close, we’re all up in each other’s grills. There’s this process happening. I do, I consider myself to be super lucky to get to participate in that.

Rebecca:

For taking it to the next step, to becoming a nurse-midwife, can you tell us a little bit about how that journey is going, being a nurse-midwife student and how do you get from master’s in public health to a master’s in nursing? Do you have to go through nursing school first? What has your journey been like?

Xian:

Yeah. I’m not quite a midwifery student yet. Like you said before, I’m in an accelerated MSN program, and so that program doesn’t have midwifery as a specialty as far as their DMP or any program. Because my other degrees were not in nursing, doing an accelerated program was the way to go, without having to do another four-year degree, which is what people traditionally, they do their four year BSN, and then that sets them up to usually be able to do an MSN in midwifery. I don’t really have that. The program that I’m in right now, at the end of this incredibly grueling two years, we’ll have our BSN and our MSN.

Because I didn’t do a four year BSN, there are still some courses that I don’t have, and so my options after this, are that if I could find their certificate program, that would be awesome, but more than likely I’ll be going the route of a DNP, which would be an extra year to a year and a half. But, in the meantime would still be able to sit for my NCLEX, and will probably do labor and delivery nursing or something in the meantime. What I will say that’s interesting about in our class is that, there are some people that are interested in labor and delivery, but you know, I’m the only one that’s interested in midwifery. There are 27 students that we have left now, I’m one of seven Black students, there’s one other Black male, and I was super shocked. I was just like, oh my God, there’s another one, yay. I’m one of four male-identified, the only one that’s not cis-gendered identified, and one of three openly queer people. That’s just kind like how I think, whenever I enter a room or something, I’m always thinking about demographics, who’s in the room, who’s not in the room, et cetera.

Rebecca:

I can tell you, coming from nursing education myself and being a former nursing professor that probably 10 years ago, those demographics would’ve been a lot more lopsided.

Xian:

Yeah, that’s my understanding. Even when we’re doing clinicals, I still don’t see… Honestly, I’ve seen a lot of Black male PCAs, I have not seen any Black male nurses, I definitely haven’t shadowed or worked with any. Then when I tell people, because they’ll ask us questions as students, what we’re interested in, when I tell them that, they’re surprised, and I get it. I’m not going to be like… I understand, I understand it’s something that’s not really seen a lot.

Rebecca:

Yeah. Can you talk with our listeners about what is intersectional birth work and what is its importance? Especially for people giving birth or who are birth workers who are queer, or trans, or Black, indigenous, or people of color.

Xian:

Yeah. To me, intersectional birth work basically just means practicing or providing services in a way that people can bring their full selves into their care. Then when I think about how that looks, that looks like people that are part of the global majority, not having to educate their providers. That looks like having providers that acknowledge racism and systemic oppression and not only the impact that they have on health outcomes, because I think that people are really good, they’ve gotten a lot better, about acknowledging how they impact things, but they also have to have a willingness and a dedication to challenging all aspects that racism touches with regards to healthcare, and that doesn’t just include care. I’ll probably talk about this a little bit later, but that includes research, that includes data, that includes data dissemination.

It also looks like people being listened to, and seen, as the experts of their own bodies, people being treated holistically and with dignity, and more importantly, not having to ask for it or negotiate it. Not being misgendered, not being dismissed, discounted, or having any, or all of your health conditions and or health status, indicated by your fatness. Not having your family makeup assumed, not assuming that you’re cisgendered, or you’re hetero, or you’re in a monogamous relationship, or that your family looks, quote unquote normal or that your pregnancy is not going to involve medical technology interventions, and not considering that to be abnormal. Having people’s experiences and traumas believed, valued, and taken seriously. I think that is important.

When I say research, it’s always with the understanding that the peer review process and academia is incredibly problematic, but we know that research shows that health outcomes do improve when there is racial and or cultural concordance. Those things that I listed off, it’s not tried and true because even like I mess up, everybody messes up, we all get things wrong. However, the less barriers that a person has to overcome in getting their care, because there’s already lots of barriers, just in finding the right provider. Finding a provider that looks like you, finding the provider that you feel can do and bring any of those intersectional pieces to their practice, let alone to then maybe not find the person, but then to get to a room after you’ve done all this work, insurance, whatever. Having to then educate them, or I know when you all talk to Moss and talking about like the apologies. Just having somebody apologize to you, in a way that’s, one, not authentic, and two, just really over the top, is exhausting and traumatizing.

Rebecca:

Wanting you to comfort them.

Xian:

Yeah. I think, the other thing that I find interesting is that you got midwifery and doula work as well. These practices that are deeply rooted in diasporic and Indigenous knowledge and practice and often was provided by two spirit folks, non-gender people, other gender folks. Now, what we have seen is that there’s these colonizing, power structures that have demonized the practice, and that’s why we have these certification processes now.

Rebecca:

Kind of white-ify it.

Xian:

Exactly, it’s been totally whitewashed. It’s been totally gentrified. Gentrified, whitewashed, whatever you want to call it. I remember I had to write a personal statement for a scholarship that I have and I was just looking at the stats and it’s like 0.05% of midwives identify as trans, 6.1%, identify as Black. I’ll give you all my references and whatnot, but how is it that we go from… Let’s be real, I feel that the further the practice moved away from that diasporic and Indigenous root, the further we got away from some of those things that I mentioned. As far as how intersectional birth work or just intersectional healthcare, can look, because all of those things, gender, fatness, colonization, all of those, are very white supremacist structures, which is what our healthcare system is rated in.

Rebecca:

You could say the pendulum swung all the way to abusive and mistreatment, in advertising.

Xian:

Absolutely.

Rebecca:

Now we have birth workers who are trying to reclaim their birthright essentially.

Xian:

Yeah. It’s been super cool. It’s been like really great to see, and again, I think it’s really great to be a part of. I think I can say, I’m pretty lucky in that I got my call during this time, during this Renaissance time.

Rebecca:

Can you tell us a little bit… I’m assuming, did you get your calling while you were living in Louisville or in one of the other places you were living?

Xian:

Yeah. I don’t know. I guess maybe the thing about callings is that they don’t happen all at once. I think I could say, that perhaps, my first experience was when I lived in North Carolina, I moved to Durham from San Diego, California. I went from, Kentucky to San Diego and there was that culture shock, and then went from San Diego to Atlanta, which was that culture shock. One of the cool things, when I was in San Diego, was that was a time where I had started, I guess what they say, socially transitioning, but also had decided to medically and chemically transition and start taking testosterone.

There was this really great program called the Tuesday Night Clinic. It was run by this amazing Black trans woman named Tracy, Miss Tracy Jada O’Brien. This was such a long time ago, but it was so impactful that I remember these things. It was a clinic on one night that operated out of a health center. This was a clinic where in trans folks, pretty much anybody, but specifically existed for trans folks to be able to go and have monitored hormone therapy safely. It was an issue because San Diego’s so close to Mexico, Tijuana and medication over there is a lot cheaper, I definitely went over there to get my Albuterol and my Advair, but people also would go to get hormones and it was discovered there was a need, because people were maybe not getting the right hormones, or they weren’t dosing it correctly, and so it became a safety issue, so they created this clinic.

At the same time, people could go there for anything. It’s just like, if you had a cold, you had the flu, and you just wanted to see a doctor that wasn’t going to make your cold or flu about your genitals, then you could go to the Tuesday Night Clinic. I was able to participate in that, and I’m really glad that I had that experience. Then when I moved to North Carolina, I’m a PCP and there was a health clinic around the corner from my house and I just walked over there and made an appointment, and then a little bit later I went to my appointment and when I went to it, in addition to being, and at this time, this was 2008, 2009, we’re not even talking about a time where people were asking about pronouns verbally, or on paperwork.

But, my name was still my name and what I checked on my box as gender is what I checked on my box as gender, which was male and still was mis-gendered, still called by the name that my mother gave me because they ask what your previous name is, that name was different than what was on my insurance, et cetera. All that to say, I get into this room with this provider and was informed that the clinic was for regular, normal, members of the community. I was like, all right dude. I don’t even remember what my reaction was, but I do remember that I did not see him again. I did end up seeing a physician’s assistant within that practice. I told her exactly what happened, and of course she was appalled and I had a great experience with her and continued to see her for quite some time. I can’t say that I would’ve been able to come through that as I did, had I not had that positive experience in San Diego, had I not seen how healthcare could be for me and for people like me. Also at that time, I had friends who were either trans-masculine identified or gender-nonconforming identified who, they were having issues that were affecting the reproductive systems and didn’t feel safe dealing with them.

I had a friend who had a Bartholin cyst, that he said had gotten to the size of a golf ball and couldn’t even get an appointment because when he called, was informed that the clinic was for women and they couldn’t understand basically why was this masculine voice calling this clinic. I feel like, just things like that, just seeing that, and that’s what led me to want to research and educate about reproductive health and trans-masculine folks and masculine-presenting folks, and then when I was in undergrad, I had gotten a fellowship, a cancer research fellowship at UNC Chapel Hill, which was right up the street from the school that I went to.

They were working on this really cool project where they were testing a home HPV test, this was probably in 2010 or so. They were testing a home HPV test with folks, cisgender women in Buncombe County, Asheville. I remember thinking, this would be awesome to do with queer and trans people. God, it would be so amazing if we could just do our HPV tests at home and not have to go to a provider. But I was a broke college student, I didn’t have any money, the NIH, they don’t know who I am, nobody’s giving me any money. I was like, well, let’s just figure out like what people know. As part of my undergrad capstone project, created a survey, based on some instruments that were out there and modified them and sought out to see trans-masculine and masculine-presenting and gender nonconforming and non-binary individuals in the Southeastern United States knew about HPV and cervical cancer risk, behaviors, testing, et cetera.

Then I analyzed that data and presented it for my graduate school capstone. Funny story coming full circle, here I’m in nursing school, my bio stats teacher, who also worked at UNC Greensboro, which is up the street, what we call like a Southern up the street, in Greensboro from Durham. When we were doing our introductions in our class, I looked at her work and I was like, whoa, she was working on, here in Louisville, the same thing. She was working on, basically doing the preliminary work to move towards testing a home HPV test among LGBTQ folks. I was just like, hey, I’m a broke college student, do you need a graduate research assistant? Because I did the same, I basically did the same thing in undergrad, and we’re kind of on the same page about that. Now I’m working on that project which has been pretty neat.

Rebecca:

That is so cool that you’re able to get engaged in, you saw the need for it in the community and then got to participate in that kind of research with the community, because, especially with something like HPV. If I’m understanding correctly, if you can do a home HPV test, then you don’t have to go into a gynecology clinic or a PCP clinic for a pap smear necessarily.

Xian:

Yes.

Rebecca:

You can avoid some of the traumas of dealing with the healthcare system and trying to get reproductive healthcare as a queer or trans person.

Xian:

Exactly.

Rebecca:

Okay. That seems like that would be really important for cancer prevention for that community.

Xian:

Yeah. Definitely.

Rebecca:

Yeah, so cool. Xian, coming back to full circle, to Louisville, where you started and then you moved away, and then eventually you came back. Can you tell us some of the struggles you’ve experienced and witnessed in the Louisville area regarding your experience in queer and transgender birth work?

Xian:

One of the main struggles is that, I was trained at the beginning of COVID and so the training that I enrolled for was supposed to happen in person and then COVID happened and they had to restructure a lot of things and then it ended up being virtual. The teacher that I had, Dr. Robin Elise Feis, did, I think, an amazing job at training us virtually and making sure that we were able to get the hands-on experience that we needed to get, in a safe way. That said, also at that time, a lot of hospitals were going back and forth about who was allowed to be there with patients as they were laboring and giving birth.

Sometimes doulas were on that list, and more oftentimes they were not. I think, that was pretty difficult because you’d have some people who would talk to the providers, they would let them know like, hey, I do want to work with the doula and provider would maybe tell them, oh yeah, they’re not allowed right now, and maybe that would be true or not true. I definitely had a lot of people reach out to be like, hey, is this true? Is this not true? Can you be there? Can you not be there? I think that was impactful and that it took a while for me to get clients, it also took a while for me to feel comfortable taking clients.

Again going back to it’s a pretty intimate experience, we’re all up in each other’s grills, and you didn’t really want that, for COVID reasons. That, I think made things a bit tricky. One of the other things too, I acknowledge it, is that I’m a male-identified doula, I’m a male-identified and male-presenting doula. That is something that I recognize to be uncommon. It’s also something that I recognize people might be uncomfortable with. I also have to recognize too, talking about the trauma and some of the experiences that people have had, is that, unfortunately, I think more often than not, some of that trauma and those experiences have been at the hands of male-identified folks. That impacts my practice in a way that I don’t mind, because it just is what it is and I honor and I respect that. Just also too, that we’re talking about a practice that, historically, yes, while often provided by third-gender, two-spirited, non-gender, people not generally attended to by male-identified or masculine-identified people.

Rebecca:

With the like exception of many OBs.

Xian:

Yeah, that’s a whole other thing.

Rebecca:

It’s okay for the male to be in charge, but not to be the supportive, hands-on person.

Xian:

Yeah. It’s funny. I thought about getting a shirt that says, yes, I’m a doula. Because I had a doctor which, literally a client had just given birth, and he was looking at me because he’s like looking, I was like, I’m the doula. He was just like, wait, what? I was just like, dude, we cannot have this conversation right now, right now.

Rebecca:

Can we go in hallway a little bit later?

Xian:

Right. Definitely like a moment of disbelief from him, because he is like, wait a second, you’re a dude, you’re Black, you’re a Black dude. Like what?

Rebecca:

You’re a doula. Yeah.

Xian:

Brain matter all over the place. That, I think, it was impactful and I’ve definitely had people reach out. Most recently I had somebody reach out, on behalf of a client, because I do contracting with one of the managed care organizations here, and it was definitely a situation, I guess what one would call like a cultural or structural competent situation, where I was like, no, based on what you’re telling me about this person, about their ethnic and tribal background, people aren’t a monolith and I don’t think it would be appropriate for me to provide services for this person.

Rebecca:

You did your birth work training at a difficult time and that also intersects with the shooting death of Breonna Taylor at the hands of the Louisville police, all at the same time.

Xian:

Yeah, it was a very interesting time. There were definitely times where I would be sitting in the room, that I was sitting in front of my computer at, for training, and because at the time we lived in old Louisville, on a pretty main street and there would be a motorcade, or there would be protests going on, and we lived not too far from downtown and we would hear helicopters. Also, too, the thing that was interesting and what I really liked about our trainer, as a white woman, there were lots of white women in our class, I was like one of, I don’t know, maybe four or five Black people, or the only guy.

I remember this moment in particular, was there was this white woman who, I don’t remember apropos of what we might have been talking about, social determinants or race or something. But, at any rate, she was taking the opportunity to do what she thinks was acknowledging the situation, that was like the F show of the United States at the time, because it was not just Louisville, there were lots of things happening all over the place. And was really doing that uncomfortable, I don’t want to say, uncomfortable apology that was definitely centering her and centering her whiteness, and tears were getting ready to come, the white tears were getting ready to come, and Robin wrapped that up so quickly, she wrapped it up so quickly and poetically, to basically let her know, hey, what you’re doing right now is not appropriate. It’s not appropriate, it’s not about you, and this isn’t the space for you to do that.

Rebecca:

It sounds like Robin was really working to try and create a safe space.

Xian:

Yeah. I think she did a great job for that. I think she did a great job for that, I think. One of the things that I think is important for people. I deal with a lot of trainings for different organizations, usually it’s about healthcare and racism or social determinants, health and racism, usually whatever it is. I find a way to talk about racism all the time, regardless of whatever training it is that I do. The thing that I think is important and what, at least in my experience with her to be true, is that you embody the work, you just do it, you do it when people are watching, you do it when people are not watching, you do it especially when people are not watching, you do it when it might be uncomfortable, you do it when you might upset a white woman who’s about to cry, because like she feels sorry about something, you embody the work.

Rebecca:

I had a student reach out to me recently, one of my former college students, and asked about doula trainings in Kentucky. I was talking about just the different options and that there are trainings that specifically center queer and trans people, which was important for this person. Is that something that you talk with other people about as well? Do you think that we need to be encouraging, and supporting, and affirming trainings that aren’t necessarily from the mainstream as well?

Xian:

Absolutely. I just had, a couple weeks ago, in class, it was a very interesting class, it was our adult health two class. The teacher had asked, she had posted something that morning that I ignored because it was on Blackboard, we get like 50 million things from Blackboard. I remember seeing that it was some kind of resource called Mind The Gap, and she literally came to me and was like, hey, are you familiar with Mind The Gap? I was like, no, but I do know that you just posted something this morning. Apparently Mind The Gap is a resource that was created by a Black medical student who basically realized what we all realized, which is there aren’t examples in books. We saw this recently, when a student, a Black student, had noticed, oh, there’s no examples of Black or brown birthing bodies, in books, so they created a resource, so this was similar to that.

This was similar to that, and specifically in looking at symptoms that can take place, like dermatologically. We don’t see that in books really, whenever we see the examples, it’s on white skin or fairly fair skin. She was super stoked about this, and she was like, I just really would love to get your professional opinion because you’re well versed on all things diversity and inclusion, this was a white woman, and I’m just like, well, I don’t know who told you that. I used to work at the office of diversity and inclusion at University of Louisville for their health science campus, and I did a lot of training and curriculum building for that. However, I don’t believe that diversity and inclusion is a thing, so I don’t practice diversity and inclusion, I practice like equity and equity building, but nah, not diversity and inclusion.

All of that to say, what I told her was I was like, yeah, I think this is a great resource, but I was like, more importantly than directly impacted people, having to make these resources, having to feel like they have to make these resources, maybe you make the resource or in your slides, have pictures of these things on Black or brown bodies. So that, at the very least, when people are looking at this resource that you posted, they understand that this is more of the rule rather than the exception, because I feel like oftentimes when we have these resources, when we have these supplemental things that are often about race, or sexual orientation, or gender identity, they’re supplemental, they’re not part of the actual built curriculum, it’s just this extra thing and it need not be.

I want to be clear, I’m not coming at this from this colorblind perspective or this, it’s this all one amalgamation of health. But, if anything, make the whiteness the exception. Don’t say, oh, this is what XYZ looks like, and then say, but on darker skin it looks like this. No, you say, this is what this looks like. This is what this looks like, period, on this skin and on this skin, or you say, this is what this looks like on this skin, and it looks like this on white skin. Definitely flip the narrative, but, no, I definitely think that there is a place.

There’s a place, I think, for people who identify as Black, brown, queer, trans, non-binary, gender non-conforming, what have you, to be in a space amongst themselves and get this training. Because I find that when we’re in shared space, we oftentimes, creep over into being the educator. If we’re there to learn, we’re there to learn. I think that where I’m at in my life personally, is I did a lot of training, I built a lot of curriculums, about again, like I said, race, healthcare, social determinants of health, how all of those things interact and overlap. I had a, I guess you can call it a heated discussion, but it was a discussion with an OB, actually, on Saturday, where I was like, I’m done educating people, I don’t want to do that anymore.

I think that if things were going to get better, they would be better. If diversity and inclusion initiatives, if the goal was to make things better, they would be better. Which is not to say, oh, we have to live in this post racial society or this post gender society, no, but things have gotten worse. How is it that if diversity and inclusion has been something, I believe it’s been since the ’70s, how is it that, as of two years ago, had Black people dying in parking lots from COVID? How is it that the mortality rate for people who give birth in the United States in general is ridiculous, and then it’s worse for Black people. How did we get to that point?

So that’s what I mean, when I say representation is important and that’s my polite, professional, CV way of saying, this system isn’t working. I feel like, at some point, we have to ask ourselves, what are we doing? What are we trying to fix? What are we trying to fix? Is it fixable? I think at this point, we have to look at it. If we look at the United States as a car, the transmission’s out, the engines shot. You have to ask yourself, how much money have I put into this car already? Now it’s telling me that the engines shot, and the transmission’s gone. Am I going to put more money into that car? Or am I going to say, got to get another car, we got to get another car.

I think that there’s a place for people who want to continue to do the trainings, who want to continue to work within the system. Sure, okay, make your marginal change, that’s cool. We have to build our own stuff. I feel like we take care of each other, we take care of ourselves, who’s going to catch our babies. Who’s going to catch our babies, who is going to collect our data, who is going to tell our stories. Not centering whiteness, not centering cis-ness, not under the direction of another white, cis, principal investigator that just so happens to have their marginalized person as a program coordinator. Who’s going to do that? We have to do that. If things were going to change, they would’ve changed.

Rebecca:

We need a new workforce.

Xian:

Yeah. We need a new workforce and…

Rebecca:

We need a lot. We need a lot.

Xian:

Yeah. We need a new system. I think it’s easier said than done, but I always tell people, I’m not an optimist by any sense of the definition. But, I do feel, like I said, I am happy to be a part of, what I see and recognize, as a Renaissance, around birth work, and around healthcare, and around social justice and even politics. Even if we look at the people who are running for office, in these various states and districts, it’s amazing, it’s not spectacular, but it’s definitely seeing more younger people, more people of color, more young people of color, more queer people, more non-binary folks.

I think that everybody has a place. I’m not into politics, I grew up doing social justice, I learned very quickly, not for me. But there are people who that is for, and they’re making those changes, and there are people who are interested in judicial things, like law, and they’re there making those changes. When I think of social determinants of health, or I like to call them systemic determinants of health, I always like to think of the socio-ecological model, because it’s parallel with your social determinants, the ways in which we live, work, play, eat, and how that impacts our health. You’ve got your individual, your interpersonal, organizational community policy. Those things that I just named off, like your politicians, your legal folks, they all fit in, into that. If you’ve got people who believe and come from an anti-racist background doing public health, if you’ve got those of us that are in healthcare, those of us that are in politics, and those of us that are in law, ideally, we work together. Same as the system works together now, against us, because like they’re all bedfellows. If we’re occupying these spaces, we can do the same thing. Hopefully, ideally, with a different trajectory.

Rebecca:

Yeah. As you were talking about all the different professions and spheres of our community, I was thinking about mental health and how that’s a huge part, the lack of resources for people of color and for queer and trans people, and that is another huge piece of the puzzle. I like how you said, talking about being bedfellows, kind of like how the people in power worked between professions to keep their power and subverting that by also having people in all of those different fields working.

Xian:

Absolutely. The thing is, and I don’t know if they did it intentionally or if they just got lucky, but again, when we look at these social determinants, these systemic determinants, if you look at the… I don’t know, maybe in editing, you can provide an image of the socio-ecological model, you’ve got this circle here and that’s individual, and then right around that, encompassing individual, you’ve got interpersonal, and then over that, it’s building out, you’ve got organizational, community, policy. The rule is that it’s a multi-level approach, in order to impact health outcomes in a positive way, it’s a multi-level approach, individual as great as it is the least effective, policy is the most effective.

When you’re talking about mental health, yeah, it’s helpful to educate individuals about mental health, it’s important to have these small conversations to de-stigmatize mental health individually. It’s helpful to do it on a community level. You want people to have these conversations amongst each other, on an interpersonal level. Policy, what are we doing with policy and mental health? Whatever’s done with policy and mental health, it gets down to the individual, whatever we do with the individual, it’s harder to get up to the policy. It is policy, it is laws, it is regulations, that directly impact our health. Those decisions that are made, by those people in power, which are informed by people of a community, gatekeepers, which is informed by… It’s all the same. I had written down that, in addition to talking about, the socio-ecological model, I also like to talk about research. I’ll always say, any chance I get, the literature and the peer-reviewed process is a tool of white supremacy, point-blank, period. If you look at it, currently and historically, research is conducted predominantly by white people, specifically cisgender men.

National Institutes of Health is one of the largest funders for research, specifically intervention research. A 2011 analysis showed that, duh, Black people in the United States, that were principal investigators, were less likely to get NIH funding. White principal investigators are 1.7 times more likely to get funding. 35% of grants are awarded to people who identify as women. That’s as of 2020. Then 80.7% of what they call R01 Grants, which are the gold standard of grants, those are awarded to men. There’s even a difference in how much money is awarded by gender. This is a problem because the literature informs research, they’re generally together, that informs best practices, that informs program planning, which then informs intervention. You evaluate it to say yay or nay, and your evaluation also is influenced by the literature. Then you go back to research and you repeat. At some point you’re disseminating data, but let’s be clear, the data is never disseminated in a way in which the people who it directly impacts can understand, let alone challenge.

You’ve got this whole process that takes place, within this incredibly paternalistic, white supremacist, power structure, that can’t be challenged unless you’re in academia and that’s crap. Unless you’re a peer, unless you’re part of the peer-review process. When I think of, the socio-ecological model and how we use that in public health, to inform whether, its other theories too, that inform our interventions, they’re rooted in problems. Same thing as diversity and inclusion, it’s rooted in a problem. It’s an issue, and so that’s why I say, we have to create our own stuff because it is so ingrained. It is so ingrained.

Rebecca:

Well, Xian I really want to thank you for your time today, and especially this education you gave at the end about research and the peer-review process and literature review process, how it embodies white supremacy. I feel like I just attended an amazing lecture. I felt that when I was in academia, I could feel the sexism and the racism, but I didn’t realize what it was, in some ways, being a white woman, all I can describe is that I didn’t like it. The grant proposal…

Xian:

You’re like, it made me feel icky.

Rebecca:

I felt icky. The peer-review process is so degrading, the grant proposal process is grueling and degrading and it rewards power, people who already have power. It basically, like you said, it keeps the money and the power in the same kind of people. I was very open about the fact that I hated the whole process of trying to get grant funding, although I was able to several times, I hated it. I can see how people, like you said, the only way to make change is from within, but it’s so hard to stay within because you just want to get out.

Xian:

Yeah, it’s definitely exhausting, and like I said, there are those people who that’s what they want to do, and that’s great, and I say, go for it, have at it. It takes all of us to do different kinds of jobs, we all have our roles. I say, we all have our roles in the revolution. Definitely, people who do that, and then there’s people who are out doing other things.

Rebecca:

Yeah. Well, Xian, we don’t want to take up anymore of your time, because I know you’re super busy. I was wondering, in your busy life, what’s the best way for our listeners to follow you and your work?

Xian:

Pretty much, they can go to dandydoula.com and then from there they can find my Facebook, Instagram. I’m not super active on Instagram, but definitely go to dandydoula.com, Facebook. I probably should hire a social media person or something. But, definitely dandydoula.com.

Rebecca:

Yeah. Thank you so much for joining us and we are super excited for your journey.

Xian:

Thank you.