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vol. 15 | 2019-2020


Andrew Cao + Emily Suen


Allen Taflove

Leslie Bonilla + Irene Chang


Maia Brown + Sarah Tani


Joy Zheng

Lucy Yuan + Shreya Sriram


Pranav Baskar, Haley Chang, Daisy Conant,

Hongrui He, Shreyas Iyer, Niva Razin,
Lydia Rivers, David Zane, Joy Zheng

Jenna Greenzaid, Siying Luo,

Bryan Sanchez, Nancy Qian

Gabrielle Tsoi, Alex Solivan, Khaled Abughoush


Khaled Abughoush, Ina Huang, John Cao


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4 6 17
Letters Statistics Feature
Dedications from Editors-in- Assessing Racial Discrimination Lamar Jackson and Patrick
Chief Andrew Cao and Emily of Quarterbacks in the NFL Mahomes: Portending a
Suen, and Faculty Advisor Draft Different Future for
Allen Taflove Black Quarterbacks?

21 33 36
African- Feature International
American Studies Degrees Don’t Make Them Studies
Radical Redress: Black Birth Distant: Researching with #MeToo In The
Workers Respond to Maternal Graduate Students European Parliament: A
Mortality Case Study in Feminist

54 56 74
Feature German Feature
Interview with Type 2 Diabetes Care A Day in the Life of
Kimani Isaac and Management: A a Summer Student
Comparison of German Researcher
and American Approaches

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76 82 86
History Feature Mathematical
“A Man With Many Tracking Northwestern’s Methods in the
Faces, All Turned in the Same Research Response Social Sciences
Direction”: Julius Lester on Anti- to COVID-19
Semitism, Anti-Blackness, and Colonial Distortions
Black-Jewish Coalitions

98 102 117
Feature Political Science Philosophy
"Keep going in the face of Quyud: Educational The Subsumptivist
inevitable setbacks": Constraints in Generalist Position
Research advice from Palestine in Ethical A.I. Research
faculty and students and its Motivation

126 129 145

Feature Human Development Feature
Media Studies Goes Evaluating Interactive Social Office of Undergraduate
Transnational with Justice Education: Research
Professor Anthony Fung The Relationship Between
Responsive Fiction and Social

151 159 164

Asian Languages Feature Contributors
and Cultures 2019 Research Biographies and
Missing the Point: China, Award Winners Interviews from NURJ
Chineseness, and Rhinoceros Thesis Contributors

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Dear readers:

Welcome to Volume 15 (the 2019-20 issue) of the Northwestern Undergraduate

Research Journal! NURJ is an annual student-produced print and web-based
publication funded by the Offices of the President and the Associate Provost.

We are very grateful to President Morty Schapiro and Provost Miriam Sherin for their
generous support, especially during these challenging times when the University’s
normal campus life and finances have been impacted by the COVID-19 pandemic.

I have been the faculty advisor of NURJ since its inception in 2003. But for me, in that
context, the past academic year has been unique (even before COVID-19).

Namely, during 2019-20, NURJ has been led by an extraordinary group of student
editors whose dynamism and vision has been breathtaking. It’s been my privilege to get
to know these students, and I’d like to express this in a public shout-out to them!

As readers of NURJ Volume 15 and as online visitors to, you will experience
the results of their year-long efforts: excellent Northwestern undergraduate student
research published in a professional manner by a group of talented undergraduate
student editors.

It’s enough to make anyone associated with Northwestern very proud, including me, a
Tech alum (‘71, ‘72, ‘75).

Best regards,

Allen Taflove, Professor

Department of Electrical and Computer Engineering
McCormick School of Engineering
Northwestern University

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Dear readers:

The NURJ has witnessed tremendous growth in the past two years. In July 2018, we
were only a two-person team with a greater vision for what the Journal could be.
Since then, we have grown to 65 members across eight teams and have solidified our
newest digital publication, the NURJ Online. This year, we are pleased to announce
that both the NURJ Paper and the NURJ Online publications have registered ISSNs,
and individual works are equipped with Digital Objective Identifiers (DOIs), enhancing
the visibility of our published content.

The global pandemic that we are currently facing is unexpected and unnerving for all
of us. In these uncertain times, we are also reminded of the importance of research and
publicizing new findings. We are immensely proud of our team for quickly adapting
and constructing this Journal. In your hands, you will find a selection of department-
recommended senior theses, as well as features written by our staff. In addition to the
NURJ Paper Volume 15, we also invite you to read the most recent Volume 3 of the
NURJ Online, which follows a global health theme, and the NURJ x EXPO issue, a
collaboration with the Office of Undergraduate Research (OUR). Both of these can be
accessed on our website,

We would like to thank President Morton Schapiro and Associate Provost Miriam Sherin
for their generous sponsorship and continued guidance. We would also like to thank
Dean Sarah Pritchard, Dr. Peter Civetta, Dr. Megan Wood, Professor Jocelyn Mitchell,
Chris Diaz and numerous other faculty, staff and student researchers at Northwestern
University for all their support. Lastly, we want to give a huge shoutout to Professor
Taflove, who created this journal 18 years ago and has served as our faculty advisor
since. We would not be where we are today without him. Although we are graduating
this Spring 2020, we are excited to see where our newest Editors-in-Chief, Maia Brown
and Shreya Sriram, will take the Journal next!


Andrew Cao and Emily Suen


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Department of Statistics

Assessing Racial
Discrimination of
Quarterbacks in
the NFL Draft
by Sam Allnutt

Introduction This event brought racial issues in the

In recent years, the National Football NFL to the forefront of public attention,
League, known as the NFL, has been rid- but it is by no means the first racial con-
dled with controversy regarding racial is- troversy to face the league. For one, 94% of
sues. One such controversy was brought to NFL franchise owners are white, and there
the national spotlight with Colin Kaeper- is currently only one minority general man-
nick’s kneeling protest of the nation- ager in the league.34 This dismal minority
al anthem, which he began in 2016. As a representation is in stark contrast with the
result of his act of defiance against police racial makeup of the NFL’s players, 70% of
brutality and racial profiling, Kaepernick whom are black.5 The quarterback position
was not offered a job from a single NFL is a notable exception, as 82% of NFL quar-
team when his contract expired, despite a terbacks are white. Until 1993, only 8 black
strong performance in the prior season.1 quarterbacks had ever played in the NFL.6
Kaepernick sued the NFL for colluding to The exceptionally low number of mi-
keep him out of the league, and in Febru- nority quarterbacks is at least partially due
ary 2019, the league paid settlements to to longstanding stereotypes regarding mi-
both him and fellow protester Eric Reid.2 nority athletes. The quarterback position
is widely considered the most important
1 V.A, Mather, “Timeline of Colin Kaepernick vs. the N.F.L.” The New York Times, 2019, https://www.nytimes.
2 Ibid.
3 S. R., Harper, “There would be no FL without black players. They can resist anthem policy.”, The Washington Post, May 24,
4 Jahmal, Corner, “NFL: League under Scrutiny for Lack of Minority Coaches.”, Reuters , January 1, 2019,
5 Harper, “There would be no FL without black playes...”
6 David J., Berri, and Rob Simmons, “Race and the Evaluation of Signal Callers in the National Football League.”, Journal of Sports
that-matters-for-when-quarterbacks-get-drafted/?utm_term=.e5584096c4e7, pp. 23-43.

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in the game, and success depends heav- performed by labor economist Lawrence
ily on mental traits like leadership ability M. Kahn in 1992 and Mark Gius and Donn
and football acumen. Early in their athletic Johnson in 2000. These authors developed
careers, minority youth players are often log-linear regression models to determine
ushered away from the quarterback posi- whether race influences salary while con-
tion due to stereotypes about their capacity trolling for exogenous variation. In his
to learn these intangible skills.7 Stereotypes final model specification, Kahn observed
have been shown to play out at the profes- no significant effect of race on salary when
sional level as well. A Washington Post controlling for other known determinants
study found racially-stratified language in of player wages.9 Gius & Johnson observed
quarterback draft profiles hosted on the a 10.27% pay premium for minority play-
NFL’s website; while minority quarter- ers, a surprising result given the NFL’s his-
backs tend to be discussed in terms of their tory of racial controversy.10 However, I ar-
physical attributes, white quarterbacks are gue that the results in these papers are not
more often praised for their intelligence, reliable, given the sensitivity of the models
understanding of the game, command of employed to crucial omitted variables. Both
the team, and poise under pressure.8 of the papers fail to include a numerical
To address the potential effect of ra- measure of on-field performance, which is
cial stereotypes on NFL players, this study a key influencer of player salary. As such,
will use quantitative methods to determine any existing pay discrimination against mi-
whether minority quarterbacks are sys- norities could easily be washed out by re-
tematically undervalued in the NFL Draft. sidual performance differences that are left
By comparing empirical data on draft de- unaccounted for in these analyses.
cisions and outcomes, statistical method- James Doran and David Doran pro-
ology may be used to isolate the potential vide a more reliable study by including a
effect of racial stereotypes on draft day. measure of performance in their analy-
sis.11 Their log-linear regression approach
Prior Studies is largely similar to the papers discussed
Previous studies have reached differ- above, but Doran & Doran notably include
ing conclusions in evaluating quantitative a “skill” variable in their model to predict
evidence for discrimination in the NFL. salary, which they define as an unspeci-
Overall, researchers have employed simi- fied combination of on-field statistics.12
lar methodologies, but certain nuances in Additionally, Doran & Doran narrowed
their analyses and assumptions have re- their focus to analyzing the quarterback
sulted in conflicting findings. position, and found 28% higher wages for
The earliest relevant studies were white quarterbacks when controlling for
7 Patrick, Ferrucci, and Edson C. Tandoc, “The Spiral of Stereotyping: Social Identity and NFL Quarterbacks.”, Howard Journal of
Communications, pp. 107-125
8 Christopher, Boylan, et al., “NFL Draft Profile Are Full of Racial Stereotypes. And That Matters for When Quarterbacks Get
Drafted.”, The Washington Post,
9 Lawrence M., Kahn, “The Effects of Race on Professional Football Players Compensation.”, Industrial and Labor Relations
Review, pp. 295-310
10 Mark, Gius, and Donn Johnson, “Race and Compensation in Professional Football.” Applied Economics Letters, pp. 73-75
11 James S., Doran, and David R. Doran, “Inequality in Pay: A Study of Wage Disparity in the NFL.”, Social Science Research
Network Electronic Journal, pp. 107-125
12 Ibid.

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player skill and other factors.13 David Ber- mistakenly attributing non-discriminatory
ri and Rob Simmons conducted a similar racial differences as due to employer racial
study in 2009, and also found evidence for preference.17 Following the guidelines set
discrimination against minority quarter- forth in the NAS report, I developed sev-
backs at salary quantiles above 50%.14 As eral statistical models to tease apart these
such, both of these papers conclude that non-discriminatory racial differences, thus
minority quarterbacks are paid lower wag- isolating the residual differences that may
es for comparable performance and con- be due to discriminatory behavior.
tract characteristics. To build these models, we require an
The inconsistent results in the prior outcome variable on which to assess racial
literature highlight the perils of omitted differences. No prior literature has used
variable bias, or OVB, and the importance the NFL Draft to assess discrimination,
of adequate model specification in the which is a missed opportunity to observe
study of discrimination. If a key variable the preferences of NFL teams. At the be-
is omitted that is also correlated with race, ginning of each season, teams are given the
the discrimination that we seek to detect chance to select top young players emerg-
may be washed out by OVB. Additionally, ing from college football to play for their
every existing study has been constrained franchise. Each team is assigned a num-
by using wage discrepancy as the basis ber of draft picks, and players are selected
on which to assess discrimination. NFL sequentially until all 250 picks have been
salaries are largely influenced by external used. The draft provides a strong basis
bargaining factors, which dilute the effect on which to observe decisions behind the
of a team’s decisions on salary outcomes and evaluation of players, as outcomes are or-
inhibit the interpretation of discrepancies dered, easily comparable, and entirely at
as team/owner racial preference.15 In this the discretion of NFL teams.
study, I will use NFL Draft decisions as a I use both collegiate and NFL data to
tool to better understand these preferences. assess two distinct research questions re-
garding racial differences in the NFL Draft.
Methodology and Findings I will first use pre-draft information to ex-
amine whether race influences teams’ quar-
Methodology Overview terback assessments, controlling for factors
As a starting point to develop models related to college career and performance. I
to detect discrimination among NFL quar- will then flip this research question and use
terbacks, I rely on a generalized labor mar- professional career data to examine wheth-
ket research methodology outlined by the er minority quarterbacks are systematical-
National Academy of Sciences.16 To detect ly under-valued in the draft based on how
discrimination in observational data, it is they go on to perform in the NFL.
critical to adequately control for variables My methodology is not exempt from
that are correlated with both race and the potential estimation biases resulting from
outcome in question, in order to avoid
13 Ibid.
14 David J., Berri, and Rob Simmons, “Race and the Evaluation of Signal Callers in the National Football League.”
15 Frank,Therber, “The Anatomy Of An NFL Player Contract.”, Forbes,
16 Rebecca M., Blank, et all, “Measuring Racial Discrimination.”, National Academies Press
17 Ibid.

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unobservable variables. It should be noted it is critical to find an adequate proxy for
that NFL teams rely primarily on qualita- scouting. This proxy should be directly
tive scouting to evaluate collegiate quarter- indicative of a quarterback’s value to his
backs. We must then consider the potential team. For this purpose, I rely on a metric
for OVB arising from differences between employed by Berri & Simmons that they la-
our quantitative proxy and the true scout- bel “Net Points.” To benchmark a quarter-
ing evaluation. Generally, omitting a factor back’s in-game contributions, Berri et al.
that is important in predicting an outcome regressed points scored by a team’s offense
variable leads to misspecification bias in on factors associated with moving and
the model, such that the expected value of possessing the ball.20 These models provide
the estimated parameters differ from their marginal effects of the performance of an
true population values.18 In developing a individual quarterback, or QB, on the out-
model where this OVB is unavoidable, it come of a typical game.
is valuable to understand the direction and Given the marginal effects, the au-
magnitude of the biases on the coefficients thors normalize the value of plays and
of interest. turnovers around one yard, thus obtain-
The bias is dependent on the pair- ing an intuitive metric that they label “QB
wise correlations between race, scouting Score”.21 The weights on these three quar-
evaluation, and the other covariates.19 It terback statistics are outlined as follows in
can be shown that that the bias on the race Equation 1:
coefficient, say c , is Bias (L Ny ,
c ) = bk d (1) QB Score = All Yards - 3 * Plays
where b k is the slope coefficient for the - 30 * Turnovers
effect of scouting evaluation on draft pick
QB Score provides a straightforward
in the population model, and is the slope
metric on which to evaluate quarterbacks
coefficient for the effect of race on scouting
based on their direct statistical contribu-
evaluation in an auxiliary regression — see
tions to a team’s probability of winning.
full text for detailed analysis. We assume
b k will be negative, as higher scouting Assessing Relationship between Race and
evaluations will lead to earlier selection Draft Evaluation
in the draft. The effect of race on scouting The first component of this analysis
evaluation, dNk , is unknown. However, we will examine whether race influences NFL
can infer that any effect of race on scout- teams’ evaluation of quarterbacks, con-
ing will be due to the same discriminatory trolling for information available before
behavior that we are seeking to assess in the draft. I seek to answer two questions
our estimated model, and expect the bias to at this stage in the analysis. First, does race
work in the same direction as our observed influence draft order among players who
discrimination coefficient. As such, our es- are drafted, all else equal? Second, among
timate of the race effect may be an inflated collegiate players, does race influence the
overestimate, but the directionality will be likelihood of being drafted at all?
reliable. The sample contains NFL Draft data
Because of the potential for OVB, for 2002-2018, and collegiate passing sta-
18 Jeffery M., Wooldridge, “Introduction to Econometrics: A Modern Approach.”, Cengage Learning
19 Ibid.
20 David J., Berri, and Rob Simmons, “Race and the Evaluation of Signal Callers in the National Football League.”
21 Ibid.

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tistics and other factors from 2002-2017. ant effects are captured by interacting race
This information was available for 849 and QBScore in the model.
NCAA Football Bowl Subdivision (FBS) I will first focus on the 180 quarter-
quarterbacks, 180 of whom were selected backs drafted between 2002 and 2018 to
in the NFL draft. All collegiate and draft determine whether race affects the order
data were obtained from ProFootballRef- in which players are selected in the draft. All data manipulation and sta- Overall draft pick is used as the outcome
tistical analyses were performed using R variable, and is treated as numeric. A linear
software version 3.5.3. model to predict overall draft pick using
In an effort to isolate the effect of race, the established set of covariates is shown
we must identify covariates that are known below in Equation 2:
to influence a player’s pre-draft evaluation. Picki = b 0 + cRi + b1 (Ri # QBScorei)
Because in-game performance will certain- (2) 5 15

ly affect a player’s perceived value, I include / b j Xij + / dt Yearit + fi

j=2 t=1
the “QBScore” metric outlined in the pre-
ceding section. Player evaluations are also where Ri represents a race indicator tak-
influenced by the caliber of competition ing on a value of 1 for minority players,
faced by a QB in his college career.22 To Xij represents the value of covariate j for
account for this, I include “Conference,” player i, represents the race difference at
a 6-factor categorical variable. To control QBScore = 0, and b1 represents the rate of
for team success, I define “Ranked25” as a change of the race effect at differing values
binary variable taking a value of 1 if the of QBScore. A significant and positive co-
player’s team finished in the top 25 in AP efficient in this model would signify lower
polling in more than half of his seasons, and average all-else-equal draft selections for
“WinPercent” as the proportion of games minority quarterbacks.
won during his career. Finally, because the Estimated parameters for the regres-
data span over a 16-year time period, bias sion model and their standard errors are
may arise from aggregate changes in the shown in Table 1. The estimated coeffi-
value of the QB position over time. Thus, cients are statistically insignificant on both
I include yearly fixed effects terms to ac- the race dummy variable (p = .509) and the
count for variability of quarterback value race-QBScore interaction term (p = .805).
in the draft. As such, we fail to reject the null hypoth-
The literature suggests that the effect esis that the effect of race on overall draft
of race will not be consistent at differing pick is equal to zero, and conclude that
levels of on-field performance; for exam- race does not seem to influence draft order
ple, Doran & Doran observed a significant among players selected in the draft.
effect of race only at certain salary quan- Though race does not appear to affect
tiles.23 This differential race effect by skill the order that a player is taken in the draft,
level makes sense intuitively, as teams may there is still the potential for racial differ-
moderate discriminatory behavior in order ences to play out among fringe players who
to land a highly-touted player. Slope-vari- are on the cusp of being selected. To ad-

22 Blair, Kerkhoff, “SEC Leads Breakdown of NFL Draft Picks by Conference since 1998.”, The Kansas City Star
23 James S. Doran and David R. Doran, “Inequality in Pay: A Study of Wage Disparity in the NFL,” Social Science Research Net-
work Electronic Journal, 2004, doi:10.2139/ssrn.628422.


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“For the 92% of Pi
ln ( 1 - P ) = b 0 + cRi + b1 (Ri # QBScore)

quarterbacks in our sample

5 15

+ / b j Xij + / d t Yearit

below this performance

j=2 t=1

where the symbols on the right-hand side

of the equation are identical to those in
threshold, being a Equation 2, and Pi represents the proba-
bility that player i is selected in the draft.
minority decreases the In order to develop a more useful interpre-
tation of the model, the coefficients may
odds of being selected in be exponentiated to obtain odds ratios, as
demonstrated in Equation 4.

the draft, all else equal.” The interpretation on the odds ratio
is more intuitive; a unit increase in X mul-
tiplies the odds of being drafted by the odds
dress this question, I include all 849 FBS
ratio. Thus, in the presence of discrimina-
quarterbacks in the sample period and con-
tion, we would expect the sum of the ex-
struct a logistic regression model to pre-
ponentiated coefficient and interaction
dict the likelihood of being drafted, again
coefficient to be less than 1, implying de-
controlling for quantitative information
creased odds of being drafted for minority
available to teams before the draft. The co-
variate model specification is identical to
Odds ratios for the estimated param-
the preceding analysis. A generic form of
eters in the logistic regression model and
the logistic regression model is shown in
their standard errors are shown in Table 2.
Equation 3:
In this model, we observe a significant (p
= .002) odds ratio on the race dummy co-
efficient of 0.436, and an odds ratio on the
interaction coefficient of 1.017 (p = .012).
Thus, race has a significant negative effect
in predicting the odds of being drafted,
with the negative effect diminishing and
eventually flipping at higher levels of QB-
The sign of the race effect flips at a
QBScore of 48.765, which is in percentile
92 of the QBScore distribution. Thus, for
the 92% of quarterbacks in our sample be-
low this performance threshold, being a
minority decreases the odds of being select-
ed in the draft, all else equal. At a QBScore
of 100, the race effect is insignificant, with
95% confidence bounds [.484, 10.817]. As
such, we may infer that among high skill


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quarterbacks with high levels of QBScore, ination, the discriminated group will re-
there is no significant effect of minority ceive less compensation for comparable
status on the odds of being drafted, while performance. If this is true, a team that
for lower-skill quarterbacks, there is a employs more of the discriminated group
strong and significant negative effect. will receive greater output per unit cost,
This result is represented visually in and thus perform better over time.24
Figure 1. Each point represents a predicted I will extend Syzmanski & Preston’s
probability of being drafted for each player logic to player-level characteristics. In the
in the sample, as generated by fitted values presence of discrimination, minority quar-
for the logistic regression model. Logistic terbacks will be drafted later on average
regression estimates are shown for white
and nonwhite subsets on the data. The
selective effect of race on low-skill quar-
terbacks can be observed by noting the
lower predicted probabilities for nonwhite
players on the left side of the figure.
Assessing Racial Differences in Draft Error
I will now flip the question in the pri-
or analysis and use post-draft NFL perfor-
mance data to determine whether minori-
ty players are systematically under-drafted.
The idea is similar to that used in a 2008
paper by Stefan Syzmanski and Ian Preston
in detecting discrimination in English soc-
cer. The authors compared the success of
soccer clubs to determine whether teams
with higher minority representation tend
to perform better. The logical basis in the
analysis is that, in the presence of discrim-

24 Stefan, Syzmanski, and Ian Preston, “Racial Discrimination in English Professional Football.”, Scottish Journal of Political Econ-


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than under purely skill-based evaluation. model, and the “Pick” independent variable
As such, minority quarterbacks will have is assigned an inverse transformation for
higher average performance for compara- the Wins and Games Started models. Es-
ble draft placement. Under this framework, timated coefficients and their standard er-
I will determine whether there are system- rors are shown for each model in Table 3.
atic racial differences in “draft error;” that As anticipated, overall draft pick is
is, examine whether minority quarterbacks significant and negatively associated with
tend to out-perform their draft ranking to each performance outcome (p < .001 in all
a greater degree than white players. models), that is, players taken earlier in the
To employ this strategy, we need draft tend to perform better in the NFL.
outcome variables that are indicative of a Both the race dummy variable and the
quarterback’s career success at the profes- interaction term are insignificant in pre-
sional level. I again use QBScore from Ber- dicting QBScore and career winning per-
ri et al. to account for per-game on-field centage. However, turning to the longevity
performance factors. To assess team suc- outcomes on the right half of the table, we
cess, I will use career win percentage and observe significant coefficients for both
number of wins over the quarterback’s ca- the race dummy variable and the interac-
reer. Longevity is also an important factor, tion term.
so I include games started over a player’s In the model to predict games start-
entire career. ed, we observe a coefficient of -29.410 (p
The sample contains NFL passing and = .048) on the race dummy variable, and
team statistics from 2000-2018, and NFL an offsetting positive coefficient of 0.281 (p
Draft data from 2000-2011. To avoid cen- = .077) on the race-pick interaction term.
soring bias, I only include players drafted Given these parameters, the sign of the ef-
in or before 2011 to allow sufficient career fect flips in the early fourth round of the
development. This procedure resulted in a draft, at pick 104. As such, we infer that,
sample of 99 quarterbacks. with regard to longevity, minority players
To detect racial differences in draft tend to be under-valued relative to white
error, I regress each outcome measure on players in the later rounds of the draft and
race and overall draft pick. Once again, over-valued in the early rounds.
to account for differential effects of race We observe a similar result in the
across the skill spectrum, race and draft model for career wins, with a coefficient of
pick are interacted in each model. I ob-
served a non-linear, decaying relationship
between overall draft pick and the longev-
“In both stages of the
ity outcomes, so I assign an inverse func-
tional form to the pick variable in the mod-
analysis, I observe
els for “Wins” and “Games Started.”
A generic regression equation for this racial differences only
analysis is shown in Equation 5 below:
at the lower end of
(5) Yi = b 0 + cRi + b1 (Ri # QBScorei)
+ b2 Pick + f i the skill spectrum.”
where Yi represents the outcome for each


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-16.50 (p = .067) on the race dummy and a study improves upon existing methodolo-
positive coefficient of 0.168 (p = .081) on gy by adequately controlling for individu-
the interaction term. With similar inter- al player characteristics, most notably in-
pretation to the prior result, we infer that game performance. In using NFL data to
minority players are under-valued relative detect differences in outcomes controlling
to white players in the later rounds of the for draft order, there is no need to make
draft. assumptions about the NFL’s consensus
The results for games started and player evaluations. Rather, I am able to use
wins are represented visually in Figure 2. differences in factual outcomes to deter-
Each player in the sample is represented by mine whether minority players are system-
a point, and model estimates are shown for atically overlooked.
white and nonwhite subsets of the data for There are still limitations inherent
the regression with an inverse transforma- in this analysis. In addition to the omitted
tion on the pick variable. We can observe variable bias discussed above affecting the
the differential effect of race over the draft collegiate data models, there is a limited
range by inspecting the varying slopes of sample size of minority quarterbacks avail-
the subset models. able for the NFL analysis. Of the 99 quar-
terbacks in the sample, only 19 were non-
Discussion white. Having such an unbalanced sample
Though the present analysis does not limits the precision of estimates. Though
escape the limitations inherent in detect- these results may point to the presence of
ing racial discrimination through obser- discrimination in the draft, the limitations
vational data, several of the shortcomings inherent in observational analysis as well
in the prior literature were addressed and as those specific to this study make it dif-
palliated through this new methodology. ficult and unjust to label the differences as
The use of the draft as an outcome variable outright discrimination.
improves upon past research, as the draft However, the historical evidence for
is not diluted by guidelines surrounding racial controversy in the NFL makes the
contract negotiations. Additionally, this present results worth considering. In both


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stages of the analysis, I observe racial dif- trated by the Washington Post study cited
ferences only at the lower end of the skill earlier, which found that white players are
spectrum. This selective effect among low- more often praised for their intelligence,
skill quarterbacks may have a meaningful understanding of the game, and command
practical interpretation. Highly valued mi- of the team.25 These are the “intangible”
nority players are unlikely to be discrimi- assets that NFL teams are looking for in
nated against given their well-known po- late-round draft picks, which may partially
tential to add value to an NFL team, which explain the selective effect of race on low-
could likely offset any discriminatory ten- skill quarterbacks observed in this study.
dencies. In addition, these players are high- Though these findings must be taken
ly touted and discussed in the media before with a grain of salt due to fundamental lim-
the draft, and discrimination against these itations, they do point in the direction of an
players would have to be played out much ongoing and problematic trend in the NFL.
more visibly in the public eye. The issues surrounding race in the league,
Further, minority players with lower such as the anthem protest, the Kaeper-
natural ability may be easier targets for dis- nick lawsuit, and the weak representation
crimination. While higher draft picks are of minorities in ownership have often es-
primarily evaluated on their raw athletic calated into full-blown controversies and
talent that they demonstrated in college, have become politicized beyond the point
lower draft picks will be highly scrutinized of productive dialogue. Given the sensitiv-
based on their potential to learn and im- ity of these issues, empirical study is critical
prove. Evaluation of these “intangible” in order to understand the problem from
skills may be influenced to a greater degree a neutral perspective. This study serves
by racial biases. This point is well illus- as an attempt to uncover and understand

25 Boylan, Christopher, et al. “NFL Draft Profiles Are Full of Racial Stereotypes. And That Matters for When Quarterbacks Get


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the controversies that have faced the NFL to acknowledge Dr. Hongmei Jiang for
for years, and hopefully future research in volunteering as a reviewer and providing
this area will spur the league to address any
a valued second opinion on the thesis. I’d
problematic tendencies. like to thank all of the professors in the
statistics department who have served as
Acknowledgements role models and mentors to me in the past
I’d like to thank Dr. Thomas Severi- four years. And of course, I want to thank
ni for serving as my advisor this year. His my family for their continued support and
support throughout the research process encouragement through my four years at
and contributions to the methodology and Northwestern. ■
manuscript were invaluable. I’d also like

Belzer, Jason. “2018 NFL Draft First- “The Spiral of Stereotyping: Social trieved from https://www.nytimes.
Round Rookie Salary Projections: Identity Theory and NFL Quarter- com/2019/02/15/sports/nfl-col-
What Mayfield, Barkley And backs.” Howard Journal of Commu- in-kaepernick-protests-timeline.html
Darnold Will Make.” Forbes, nications, vol. 29, no. 2, Dec. 2017, Reid, Jason, and Jane McManus. “The
Forbes Magazine, 27 Apr. 2018, pp. 107–125., doi:10.1080/10646175. NFL’s Racial Divide.” The Undefeat- 2017.1315693. ed, n.d.,
zer/2018/04/27/2018-nfl-draft-1st- Gius, Mark, and Donn Johnson. “Race features/the-nfls-racial-divide/.
round-rookie-salary-projections- and Compensation in Professional Sports Reference LLC. Pro-Foot-
what-mayfield-barkley-and-darnold- Football.” Applied Economics Let- - Pro Football
will-make/#367162cc4581. ters, vol. 7, no. 2, Feb. 2000, pp. 73– Statistics and History. https://www.
Berri, David J., and Rob Simmons. “Race 75., doi:10.1080/135048500351843. Used to
and the Evaluation of Signal Callers Harper, S. R. (2018, May 24). There obtain all collegiate, professional, and
in the National Football League.” would be no NFL without black draft data.
Journal of Sports Economics, vol. players. They can resist the anthem Syzmanski, Stefan, and Ian Preston.
10, no. 1, Feb. 2009, pp. 23–43., policy. Retrieved from https:// “Racial Discrimination in English
doi:10.1177/1527002508327383. Professional Football.” Scottish
Blank, Rebecca M., et al. Measuring posteverything/wp/2018/05/24/ Journal of Political Economy, vol.
Racial Discrimination. National there-would-be-no-nfl-without- 47, no. 4, 2008, pp. 342–363., doi:
Academies Press, 2004. black-players-they-can-resist- 10.1111/1467-9485.00168.
Boylan, Christopher, et al. “NFL Draft the-anthem-policy/?utm_ter- Tadych, Frank. “Image, Marketing
Profiles Are Full of Racial Stereo- m=.92367bb814b2 Everything for NFL Rookies.” NFL.
types. And That Matters for When Hlavac, Marek. stargazer: Well-Format- com, National Football League,
Quarterbacks Get Drafted.” The ted Regression and Summary Statis- 26 July 2012,
Washington Post, WP Company, tics Tables. R package version 5.2.1. news/story/09000d5d80938690/
27 Apr. 2017, www.washington- 2018. article/image-marketing-every- package=stargazer. Used to generate thing-for-nfl-rookies.
wp/2017/04/27/nfl-draft-profiles- all original tables in this manuscript. Therber, Frank. “The Anatomy Of
are-full-of-racial-stereotypes-and- Kahn, Lawrence M. “The Effects of An NFL Player Contract.” Forbes,
that-matters-for-when-quarter- Race on Professional Football Forbes Magazine, 31 Mar. 2016,
backs-get-drafted/?utm_term=. Players Compensation.” Industri-
e5584096c4e7. al and Labor Relations Review, ber/2016/03/08/the-anatomy-of-an-
Corner, Jahmal. “NFL: League under vol. 45, no. 2, 1992, pp. 295–310., nfl-player-contract/#7b4238aa3faa.
Scrutiny for Lack of Minority doi:10.1177/001979399204500207. Wickham, H. ggplot2: Elegant Graphics
Coaches.” Reuters, 1 Jan. 2019, www. Kerkhoff, Blair. “SEC Leads Breakdown for Data Analysis. Springer-Verlag of NFL Draft Picks by Conference New York, 2016.
coaches/nfl-league-under-scruti- since 1998.” The Kansas City Star, Used to generate all figures in this
ny-for-lack-of-minority-coaches- 6 May 2014, www.kansascity. manuscript.
idUSKCN1OV1CQ com/sports/spt-columns-blogs/ Wooldridge, Jeffrey M. Introduction to
Doran, James S., and David R. Doran. campus-corner/article351211/SEC- Econometrics: A Modern Approach.
“Inequality in Pay: A Study of Wage leads-breakdown-of-NFL-Draft- Cengage Learning, 2014.
Disparity in the NFL.” Social Science picks-by-conference-since-1998. Berri, D J, and B Burke. Economics
Research Network Electronic Jour- html. of the National Football League:
nal, 2004, doi:10.2139/ssrn.628422. Mather, V. A Timeline of Colin the State of the Art. Edited by K G
Ferrucci, Patrick, and Edson C. Tandoc. Kaepernick vs. the N.F.L. 2019. Re- Quinn, Springer, 2014. Chapter 8.


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Lamar Jackson and

Patrick Mahomes:
Portending a Different Future for
Black Quarterbacks?
by Shreyas Iyer


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O n Sept. 22, 2019, the Kansas City Chiefs and Baltimore Ravens faced off in a
battle between two of the National Football League’s brightest stars, in quarter-
backs Lamar Jackson and Patrick Mahomes. Although the Ravens held a 6-point lead
after the first quarter, the team’s defense fell prey to a Chiefs onslaught in the second
quarter, as Kansas City scored 23 unanswered points. The Chiefs won the game 33-28,
en route to the franchise’s first Super Bowl victory in February 2020 against the San
Francisco 49ers.
That September game may eventually reside in the footnotes of football history:
a normal Week 3 game on just another fall Sunday in America. That contest, how-
ever, may be a harbinger of a different NFL that most football devotees have not yet
seen, one in which black quarterbacks thrive in offenses tailored to their skill sets and
inspire legions of fans to enjoy a new generation of stellar quarterback play.
In Sam Allnutt’s thorough examination of minority quarterbacks in the NFL,
he finds that lower-evaluated minority players are undervalued by the NFL’s draft
process. Whereas higher-ranked black stars — Heisman-winning Arizona Cardinals
quarterback Kyler Murray comes to mind imme-
diately — tend to be graded more fairly, low-
er-ranked quarterbacks may face more obsta-
cles to carving out a stable playing career.
As Allnutt notes, racial controversy and
accolades, and
discrimination is no stranger to football; from abilities be damned;
youth leagues on, black players are shepherded
away from the quarterback position toward po- a black quarterback
sitions that rely less on intangibles and leader-
ship. Despite a record-setting Heisman cam- is a runner first, and a
paign in 2016 and a similarly astounding 2017
follow-up, NFL commentators, most notably passer second.”
former Indianapolis Colts general manager Bill
Polian, ascribed the seemingly-perfect role for
someone of Jackson’s build: running back.
Production, accolades, and abilities be damned; a black quarterback is a runner
first, and a passer second. Although Allnutt’s analysis does not take into consideration
players drafted after 2011, the recent play of black quarterbacks across the league is
inspiring optimism for those who want greater parity in football’s most important
and influential position.
Mahomes and Jackson were the most recent two NFL Most Valuable Players
and are at this point surefire stars, but the current spate of black quarterback success
remains unprecedented in NFL history. Last season should have put to rest any lin-
gering doubts of if minority quarterbacks can succeed in the NFL. Jackson, Mahomes,
and Seattle Seahawks quarterback Russell Wilson dominated MVP chatter last fall
when all three scored in the top 5 in total quarterback rating, or QBR, for the season.
The rating, created by ESPN in 2011, quantifies all of a quarterback’s impacts
on winning. Fellow signal-caller Deshaun Watson dragged another decent Houston
Texans squad to the playoffs, and much-maligned Dallas Cowboys quarterback Dak


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Prescott threw a personal record of 30 touchdowns off of 4,902 yards. Four black
quarterbacks finished with an elusive perfect passer rating in at least one game out
of five quarterbacks total. Four black quarterbacks finished in the top five in total
touchdowns scored last season. Four black quarterbacks led their team to the playoffs,
and won a combined five playoff games. By any measure, black quarterbacks in 2019
excelled in ways we have not seen before.
And yet, racial controversy continues to rear its ugly head. After a 20-17 loss
to Tennessee in 2018, Watson was castigated on social media for his performance.
One of those comments, by Texas school superintendent Lynn Redden, claimed that
“you can’t count on a black quarterback” to make “precision decision making.” The
statement went viral and cost Redden his job. San Francisco 49ers analyst Tim Ryan
compared Jackson’s skin color to a football and claimed that defenders could be easily
misled by the quarterback’s fakes. Quarterbacks at the collegiate level, as Bill Polian’s
earlier running back comment shows, are still subject to double standards when com-
pared to their white peers, who are often considered more intelligent than they are.
The quarterback position is one of the few positions in any sport that has at-
tained an almost superhuman significance in popular culture. Star quarterbacks are
deified by fans and vilified by foes, and are almost always the face of their respective
teams. Tales of winning under pressure and leading a team in the face of adversity
typically feature a quarterback rallying his troops. As such, improving equity at the
quarterback position is vital for how we perceive traits such as leadership, poise, acu-
men, and other factors that Hall-of-Fame quarterbacks possess.
In the past, pseudo-intellectual myths of subpar black intelligence buttressed
the notion that only white players could play quarterback. Whenever a commentator
suggests that a black college star transition to wide receiver, they reinforce, perhaps
unknowingly, these Jim Crow tropes. Americans accustomed to football management
shuttling black players to these more “athletic” positions may view the positive traits
associated with quarterbacks as reflecting whiteness. An NFL brimming with black
quarterbacks, however, could cement black leadership on millions of TV sets around
the nation and eradicate many of the pernicious falsehoods that surround black ath-
In this regard, it may be more important for us to look not at the top of the QBR
rankings to observe progress on this front, but rather at the bottom of the depth
chart. A stronger measure of where minority quarterback stands may lie with how
NFL management views lower-performing black quarterbacks.
Allnutt writes that scouts frequently undervalue black quarterbacks during the
draft process; they end up less heralded than their more successful peers. If this is
the case, the next standard by which we discern the state of black quarterbacks in the
NFL should be whether black quarterbacks that lack the talent of a Mahomes or a
Prescott can stick around in the league.
The verdict on this statistic is historically not great, but more black quarterbacks
are establishing themselves as backups and spot starters. Tyrod Taylor established
himself as a reliable starter and back-up after making the 2015 Pro Bowl and lead-
ing the Buffalo Bills to the 2017 playoffs. Teddy Bridgewater was one of the most


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sought-after free agents this past winter after not losing a game for the New Orleans
Saints, and should start for the New York Jets this fall. Others, such as Brett Hundley,
Geno Smith, Josh Johnson, and Robert Griffin III still compete for backup spots. The
Las Vegas Raiders signed Marcus Mariota to compete with Derek Carr, and Jameis
Winston should land on his feet by the time training camp begins after throwing 30
touchdowns last season.
The future is undoubtedly bright for younger minority quarterbacks. Last year,
Murray and Dwayne Haskins, Jr. were first-round draft picks and started for their
respective teams; Murray went on to win Offensive Rookie of the Year and displayed
tantalizing potential in spurts for the Cardinals. Alabama star Tua Tagovailoa and
Utah State’s Jordan Love, and Oklahoma’s Jalen Hurts heard their names called in
the first two rounds of this year’s draft. Ohio State’s Justin Fields led his team to the
College Football Playoff, and a slew of other quarterbacks, including Arizona State’s
Jayden Daniels and Georgia’s Jamie Newman, can increase their national profiles with
strong seasons.
Minority quarterbacks have taken the league by storm as NFL teams have begun
to design their offenses around the prodigious abilities that these quarterbacks have
brought to the league. Alnutt points to discrepancies at the lower end of the talent
spectrum as an indication that despite the success of minority quarterbacks, the NFL
still has work to do to ensure racial parity at the position. Alnutt’s research should
serve as a springboard for the tough discussions we need to have in order to develop
the mindsets required to ensure equal opportunity for all budding athletes. Hopefully,
we will begin to view black quarterbacks, and black leadership, as emblematic of an
NFL that supports the best of what our country’s athletes have to offer. ■


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Department of African American Studies

Radical Redress:
Black Birth Workers
Respond to Maternal
by Onyinyechi Jessica Ogwumike

Since the postpartum death of #BlackLivesMatter activist Erica
Garner in December 2017 and the harrowing birth narrative released
by tennis champion Serena Williams in January 2018, an apparent crisis
of Black maternal mortality has breached public discourse in the Unit-
ed States.12 The public’s uptake of this tragedy aligns with the nation’s
anti-Black preoccupation with sensationalizing Black pathology.3 Me-
dia representation of the crisis elides the pre-existing grassroots activ-
ism through which Black people directly confront the social structures
that endanger Black birthing people. This paper centers the narratives
of Black birthers and birth workers — midwives and doulas — to reveal
the practices through which Black people heal themselves and one an-
other through birth work. I will briefly analyze the media coverage of
Black maternal mortality and establish how Black birth workers address
it through counter-representational movements toward honoring Black
embodied knowledge. Using qualitative interviews with seven Black
doulas and midwives, I argue that Black birth workers draw from their
positions as Black people in an anti-Black society to oppose obstetric vi-
olence. This study demonstrates how Black people enact radical care to
combat popular media’s pathologizing treatment of Black birth and con-
solidate birth and racial justice agendas.

1 Katie Mitchell, “Why We Need To Talk About Maternal Mortality After Erica Garner’s Death,” Bustle,
2 Rob Haskell, “Serena Williams on Motherhood, Marriage, and Making Her Comeback,” Vogue, www.
3 Haile E. Cole, “Reproduction on Display: Black Maternal Mortality, The Newest Case for National Action,”
Northwestern University Department of African American Studies, 19 April 2018, Kresge Centennial Hall,
Evanston, IL. Talk.


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#BlackBirthsMatter wifery as a radical tradition being systemat-
On Feb. 18, 2019, Ancient Song Doula ically effaced. To begin, Efe retold the sto-
Services, a community-based birth justice ry of hospital birth as an emerging norm:
organization, and BYP100, a national racial Black women home-birthed throughout
justice organizing coalition, rallied outside the 20th century due to anti-Black hospi-
of Kings County City Hospital in Brook- tal discrimination. Black and Indigenous
lyn, New York. I streamed their rally via grand midwives “stepped up” to act as
Instagram Live at 1 p.m.,1 becoming one of holistic healthcare providers “while they
hundreds of global participants witnessing were being criminalized and over-regu-
the storytelling of Black birth workers and lated.” According to Efe, there is a history
birthing people.2 One birth worker, a dou- of Medicaid and other state health depart-
la and student midwife named Efe, spoke at ments “eradicating” Black and Indigenous
the rally with a mother for whom she had grand midwives and “only then” allowing
provided doula care. New York had recent- Black people into hospitals in lieu of Black
ly proposed a Medicaid expansion to cover midwifery. She argued that “bringing our
doula services, but Efe’s speech sought to midwives back into our hospitals” should
steer the conversation away from this de- be a key fight under the banner of birth
cision. Efe shifted focus toward the impor- justice, asking, “Why isn’t [midwife sup-
tance of Black and Indigenous midwives, port] our focus? So that doulas can con-
who she said laid the groundwork for the tinue to act as bodyguards?” She said that
very inception of doula care. she was tired of being “kicked out of hos-
Efe’s storytelling reframes doula care’s pital rooms” and “cornered by nurses” so
potential for redressing Black maternal that her clients could be manipulated and
mortality, calling attention to Black mid- abused. Efe explained that doula care alone
cannot sufficiently shift a system built to
1 A great deal of the social media sources here analyzed were ephemeral texts. For example, Instagram stories and lives (videos)
often disappear after 24 hours unless the original person who posts the story or live elects to archive that material for continuous
public access. That being the case, if an item is not cited it is because it cannot be referenced again, but I was fortunate to engage
with it and analyze it while it was available. Instagram posts (videos and pictures on a public page), tweets, Facebook statuses, and
other social media with more permanence are cited.
2 Throughout this work, I have tried to remain skeptical of how birth has been gendered as the inherent domain of cis-women.
In an era in which trans and gender nonconforming people are increasingly gaining access to labor, facing obstetric violence, and
seeking birth work, it would be inaccurate to suggest every Black person who gives birth identifies as a woman. Additionally,
gender nonconforming and birth workers who identify as men are often erased from this practice (Graham). When speaking of
Black people engaging childbirth as a general experience, I will aim to use genderless language (birth giver, birther, person giving
birth, people, etc.). When speaking of professionals facilitating birth in general, I will use “birth worker,” “doula,” and “midwife”
as genderless terms (although gender has been built into the etymology of these labels, and another space for radical imagination
would be formulating new vocabulary for more accurately discussing birth). When gendered language is incited, it will be because
I refer to a specific entity whose gender identity is publicly known and has been stated in the source. For example, many of my
featured Black midwives refer to themselves as Black women. Unfortunately, only two of my respondents identified as queer Black
people, and only one used the gender-neutral pronoun “they” interchangeably with “she” (which is reflected in the section in which
their sentiments are used). It would be a priority of future, more extensive research to expand my body of respondents to include
more gender non-conforming, gender non-binary, and genderqueer persons.

“My next birth is gonna be different. It’s gonna be so

different, because I’m not gonna have to feel like
I’m not gonna be heard.”

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silence and harm Black birthing people and demonstrate the violent alienation and
birth workers. dehumanization Black birthing people ex-
Efe’s birth work is informed by a larg- perience in labor and the postpartum peri-
er project of racial justice, and she provides od. While the popular media stories about
care in connection to the history of crimi- Black maternal life focus on sudden death
nalization marking Black midwifery in the and neglect, Black birth workers and birth
U.S. For Efe, as she would go on to state in justice activists have long exposed the sub-
our later interview, radical Black doula care tler wounds inflicted on birthing people.
requires the genuine recuperation of Black These wounds accumulate in the body and
midwifery. These coupled care practices result in a disproportionate risk of death.
vitally disrupt a birth industry in which The protesters marched to another
obstetricians hold the greatest power. city hospital with a similar reputation of
Efe’s client shared her own experi- harming Black birthing people. Organiz-
ence at Kings County. Her words demon- ers made it clear that the second hospital,
strate her imagination of what birth justice which predominantly served Black people,
could afford her and other birthers: “The had such poor quality of care that it was
reason I’m out here is so simple: my next “basically a grave site.” The Instagram Live
birth is gonna be different. It’s gonna be ended as organizers remarked, “Black death
so different, because I’m not gonna have is literally in the air as we stand.” Sever-
to feel like I’m not gonna be heard. I’m al people can be seen gripping their coats
not gonna have to feel like I’m gonna walk closer to their skin, as if to seal themselves
into a hospital, and they’re gonna do what- up from lingering fragments of literal and
ever the hell it is that they’re gonna want “social death.”3
to do with my body without my consent. I open with this vignette to illustrate
...That’s gonna be a story that’s not gonna the powerful organizational and personal
be told anymore.” partnerships characterizing Black birth as
This speaker participated in this rally a site of activism and radical care. Efe and
to register her outrage and manifest her vi- her client illustrate how birth workers and
sion of repair. She asked whether the disre- birthing people ally in their Blackness to
gard she experienced in a city hospital was reconstruct the stories told about Black
due to her race, age, or her use of Medic- birth.
aid. She queried whether some facet of her
social identity determined her experience. The Birth Justice Banner
She asked, “Why? Why do you treat us this The previously-detailed rally aimed
way?!” Her voice and body shook, as she to advance birth justice. The Black wom-
exclaimed, “How can you strap me down en-led birth justice grassroots organiza-
to perform a c-section? I’m the last person tion Black Women Birthing Justice defines
to hold my baby! I had to wait a whole 24 birth justice as the end-state that results
hours to hold my son! He was in the NICU; when “women and transfolk are empow-
I didn’t know why!” ered during pregnancy, labor, childbirth,
This mother shared her trauma to and postpartum to make healthy decisions

3 Michael J. Dumas and Kihana Miraya Ross, “‘Be Real Black for Me,’” Urban Education, vol. 51, no. 4, 2016, pp. 415–442.,


97023 Body_176pg_6.7x9.8_R5.indd 23 1/11/21 10:16 AM

for themselves and their babies.”4 Birth
justice attends to the ways in which social
structures determine one’s experience of
“Anti-Blackness ... is
the physiological event of birth, perinatal
care, and childrearing. Birth justice activ-
the belief that the Black
ists such as the organizers in the vignette
confront racial disparities in childbirth, body exists as mutually
contending with Blackness as a social po-
sition shaping one’s birth. exclusive from the
In 2016, a jarring statistic from the
Centers for Disease Control and Preven- human.”
tion, or CDC, circulated via numerous
provides emotional, physical, and infor-
media pieces, such as “Black mothers die
mational support to women during labor,
at three to four times the rate of white
delivery, and the immediate postpartum
mothers.”5 In 2017, ProPublica and NPR
period.”7 This quote characterizes doula
co-published the story of Shalon Irving, a
work as a “profession” but many doulas,
Black mother who died postpartum despite
especially those interviewed as part of this
having attained high levels of education
thesis, such as Efe, reflected an under-
and financial security, factors generally
standing of doula work that resists profes-
expected to protect birthing people from
sionalization. Doula care has been proven
adverse outcomes.6 This story led a wave
to improve birth outcomes for marginal-
of news coverage that seemed to suggest
ized populations, significantly lowering
Black birthing people were dying of their
preterm births, improving birth weight,
own accord; a media sensation emerged,
and bettering birthing people’s chances of
fixated on a pathological image of Black
completing often life-saving postpartum
birth. This paper will illuminate the ap-
proaches, practices, and networks through
An under-examined underpinning to
which Black people redress Black maternal
the efficacy of doula care is its continuity
mortality through birth work, centering
with the community-based care of gran-
the (counter) stories they tell about Black
ny midwives. Granny midwives, who Efe
mentioned in her rally speech, are general-
This research focuses on doula care
ly local female elders who assist births and
and midwifery as forms of birth work, al-
provide other health resources.9 Granny
though birth work is a term representing a
midwifery leverages ancestral knowledge;
wide umbrella of professions and roles en-
it is a practice passed down generational-
listed to support the perinatal experience.
ly, initiated during the time of Black en-
A doula is “a trained childbirth [aid] who
slavement and eroded by governmental
4 “What Is Birth Justice?”, Black Women Birthing Justice,
5 Nina Martin, and Renee Montagne, “Nothing Protects Black Women From Dying in Pregnancy and Childbirth,” ProPublica,
6 Ibid.
7 Mary-Powel Thomas et al., “Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population,”
Maternal and Child Health Journal, vol. 21, no. Supplement 1, 2017, pp. 60.
8 Ibid., pp. 60-61.
9 Susan Lynn Smith, “Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950,” University
of Pennsylvania Press, 1995, pp. 119.


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“Afro-pessimism holds that there has never been a
discontinuation breaking contemporary Black life from
the traumatic condition of enslavement. ”
intervention.10,11 Birth justice activists and breaking contemporary Black life from the
birth workers nationwide have mobilized traumatic condition of enslavement. This
behind doula access, but my conversations continuity means that Blackness is always
with Black birth workers suggests a pivot “already targeted for death, in the literal
in focus toward healing the historical den- sense and in terms of what Orlando Pat-
igration of Black midwives. By centering terson (1982) calls ‘social death,’” which is
and honoring Black birth workers as au- where “the participation of Black people in
thorities on Black birth, we extract a richer civic life, as citizens, is made unintelligible
picture of the care and crises intermingled by the continual re-inscribing and re-jus-
in the Black perinatal experience in the tification of violence on and against Black
U.S. bodies.”13 Anti-Blackness, which is the
belief that the Black body exists as mutu-
Theorizing Birth Justice ally exclusive from the human,14 is consis-
The birth workers featured in this tently present as racialized subjects move
research actively generate racialized birth through the medical complex of the U.S.15
theory through which they imagine jus- Throughout this nation’s history, extreme
tice. The social location of Blackness in policing has marked Black peoples’ birthing
an anti-Black society shapes the relation- experiences, codifying Blackness as a social
ships Black people have with structures of location characterized by reproductive op-
the U.S. medical complex. This research pression.16 Birth justice is an end-state in
will wield the following assumption about which one may birth and parent outside
what it means ontologically to be racial- the reach of harm regardless of one’s social
ized as Black in the U.S.: “Antiblackness location; birth justice activists engage re-
is endemic to, and is central to how all of sistance tactics to work toward this vision.
us make sense of the social, economic, his-
torical, and cultural dimensions of human Toward Justice: Defining
life.”12 Birth Worker’s Field of
This tenet of Black critical race the-
ory, BlackCrit, comes out of the project
of Afro-pessimism. Afro-pessimism holds I pull the term “field of action” from
that there has never been a discontinuation Saidiya Hartman’s “Scenes of Subjection.”

10 Ibid.
11 Onnie Lee Logan, and Katherine Clark, “Motherwit an Alabama Midwife’s Story,” Plume, 1991.
12 Dumas and Ross, “Be Real Black,” pp. 429.
13 Ibid.
14 Sylvia Wynter, “‘No Humans Involved:’ An Open Letter to My Colleagues,” Forum N.H.I. Knowledge for the 21st Century, vol.
1, no. 1, 1994, pp. 42–73.
15 See Bridges for examples regarding pregnancy.
16 Dorothy Roberts, “Killing the Black Body: Race, Reproduction, and the Meaning of Liberty,” Vintage Books, 1997.
17 Saidiya V. Hartman, “Scenes of Subjection: Terror, Slavery, and Self-Making in Nineteenth-Century America,” Oxford Universi-


97023 Body_176pg_6.7x9.8_R5.indd 25 1/11/21 10:16 AM

“Field of action” describes the context in jects because they were made more avail-
which resistance is performed. For birth able for intervention. In the early- to mid-
workers, this context is defined by histor- 1800s, physicians targeted Black midwives
ically-rooted obstetric violence and the and healers alongside their birth-giving
structures that protect it. Deidre Cooper clients. Midwives were subject to punish-
Owens’ “Medical Bondage: Race, Gender, ments including execution, although their
and the Origins of American Gynecolo- practices were often regarded amongst
gy” analyzes the torture of enslaved Black enslaved Black and white women alike
women at the hands of James Marion as “more efficacious.”20 Dorothy Roberts’
Sims, the American Father of Gynecology. “Killing the Black Body” depicts how Black
Owens explains obstetrics’ foundations in birthers, there gendered as women, are dis-
this violence. Owens says, “Slavery, medi- proportionately vulnerable to policing and
cine, and science had a synergistic relation- surveillance, because the state assumes that
ship,” in that “the various medical inter- they will pass their inherent “degeneracy”
ventions performed on enslaved women’s down to their offspring.21 The over-po-
bodies were the sine qua non of racialized licing of Black birthing people more con-
medicine and the legitimization of medical temporarily is continuous with the logic of
branches like obstetrics and gynecology.”18 slavery-era obstetricians and gynecologists
Owens narrates how the emergence of ob- who, “[w]hen infants died, castigated the
stetrics as a medical profession required sloth and ignorance of their mothers and
the eradication of Black midwifery, pro- the black midwives who attended them.”22
viding obstetrics with Black bodies as sites Black birthers and midwives were blamed
of experimentation. He explains, “When for the deaths, ignoring “antebellum doc-
white men integrated obstetrics and gy- tors’ disdain for hand washing” and the
necology, pregnant enslaved women who unsanitary settings to which slave shacks
experienced difficult birthing processes were relegated to keep them as far as possi-
became disproportionately represented in ble from “whites’ dwellings.”23 Conditions
surgical cases in which doctors used blades and context, as well as the harmful practic-
and forceps to remove fetuses. Surgeries es of white authorities, were overlooked in
were quite rare in the first half of the nine- favor of criminalizing the Black body.
teenth century, so it is astounding how Obstetricians mobilized racialized im-
many medical journal articles listed en- agery to construct midwives’ Blackness as a
slaved women as surgical patients.”19 source of contagion claiming Black infant
Black birthing people were not over- lives. For example, in 1925, a doctor “read
represented in medical journals due to a paper before the Southern Medical As-
some recurrent racial birthing pathology; sociation in which he described the black
they were overrepresented as medical sub- midwife as ‘filthy and ignorant and not far

ty Press, 1997, pp. 50.

18 Dierdre Cooper Owens, “Medical Bondage: Race, Gender, and the Origins of American Gynecology,” University of Georgia
Press, 2018, pp. 11.
19 Ibid., pp. 54.
20 Harriet A. Washington, “Medical Apartheid: the Dark History of Medical Experimentation on Black Americans from Colonial
Times to the Present,” 1st ed., Doubleday, 2006, pp. 48-64.
21 Roberts, “Killing the Black Body,” pp. 9.
22 Owens, “Medical Bondage,” pp. 63.
23 Ibid., pp. 62.


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removed from the jungles of Africa, laden of “practice.” For Hartman, practice en-
with its atmosphere of weird superstition tails “a way of operating defined by ‘the
and voodooism.’”24 Interestingly, as recent- non-autonomy of its field of action,’ in-
ly as 2018, birth workers described obste- ternal manipulations of established order,
tricians who said similar things to their and ephemeral victories.”27 In other words,
Black clients. One said, “I was once assist- practices are short-lived moments resist-
ing a mom from Sudan who didn’t want to ing the determination of an overarching
do a vaginal exam because she was a victim structure. Birth work is a practice that ma-
of female genital mutilation ... Later, when nipulates the medical order from within,
this mom was having trouble pushing, I providing inroads by which Black birthers
remember the doctor saying, ‘What’s your may access more respectful and pleasurable
problem, you have other kids. Didn’t you care. Hartman characterizes practice as be-
give birth in the jungle, anyway?’”25 Here, ing constituted by “ephemeral victories.”
the common incitation of “the jungle” as Each delivery is a single, transient instance
a signifier of proximity to animality and within the lifetime of a birthing person,
backwardness speaks to the underlying co- but it has the potential to reflect and trans-
lonial racism that haunts birth in the U.S. form their relationship to medical power, a
The anti-Blackness of the U.S. medical potential that respondents such as Carmen
complex is a vestige of racial chattel slav- and Qiddist center in their birth work.
ery, and Black birth workers utilize vari-
ous practices to intervene upon this field Stories & Counter-Stories
of action. By erasing Black people’s health activ-
Roberts, Owens, and Washington ism and the history of medical marginal-
revisit the ghost of enslavement as foun- ization in the U.S., media coverage of Black
dational to Black people’s navigation of maternal mortality has sought to make
reproductive healthcare, because, as one of Black birth givers responsible for their
my research respondents said, this trauma own deaths. ProPublica,28 NPR,29 and The
“has to live in the body.”26 The institution New York Times30 led a wave of news cov-
of slavery naturalized Black pain and re- erage that many of my respondents refer to
jected Black sentience, according to Said- as “sensationalizing” Black maternal mor-
iya Hartman. She imagines “redress” for tality.31 Already previewed in these article
this violence as predicated upon a theory titles, it would appear that Black mothers
24 Smith, “Sick and Tired,” pp. 125.
25 Emily Bobrow, “What It’s Like to Be a Doula for Women of
Color,” The Cut, New York Media,
“Media coverage of Black
26 “Bailey, Doula”. Interview. By Onyinyechi Jessica Ogwumike. 13
Mar. 2019. Telephone Interview.
27 Hartman, “Scenes of Subjection,” pp. 50.
maternal mortality has
sought to make Black
28 Martin and Montagne, “Nothing Protects Black Women.”
29 Nina Martin and Renee Montagne, “Black Mothers Keep Dying
After Giving Birth. Shalon Irving’s Story Explains Why,” NPR,
30 Linda Villarosa, “Why America’s Black Mothers and Babies Are
in a Life-or-Death Crisis,” The New York Times, www.nytimes.
birth givers responsible
31 “SJ, Doula”. Interview. By Onyinyechi Jessica Ogwumike. 4 Mar.
for their own deaths.”

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“Through redressive practices that intervene on the
birth industry as an oppressive field of action, they hope
to craft new potential for pleasure and healing for
birthing Black bodies.”
are trapped in hopelessly pathological birth Centering Black Birth Work
experiences. as Radical Redress
According to Haile Cole, a professor
of sociology and anthropology at Amherst In interviewing seven Black doulas
College, the current conversation sur- and midwives, I learned how Black birth
rounding Black maternal mortality simply workers approach their care in response to
replicates a national obsession with the dis- Black maternal mortality, both as a public
eased Black body. Her emerging research health crisis and a media sensation. I inves-
on this topic asks, “Why is it important to tigate how Black birth workers approach
locate reproduction within the larger dia- Black birth, asking them to reference their
logues about racial domination and con- own and their clients’ social positioning
trol, and how does reproduction work in using semi-structured interviews. I ana-
conjunction with other technologies of lyzed my transcripts using codes organized
racial and gender-based oppression?”32 Po- by three key themes: race and storytelling,
tential answers to these questions begin including the media surrounding Black
at analysis of the spectacle made of Black birth; race and birth work, or the tangible
birth, especially as the media’s storytell- practices informed by social positioning;
ing serves to erase Black agency — mak- and race and redress, or how birth workers
ing Black birthers into people who “need imagine solutions to maternal mortality
saving” to fit easily into the American disparities. The first names or pseudonyms
psyche.33 By demonstrating that neither of birth workers are used to properly attri-
wealth nor education could protect these bute their insights, according to their stat-
birthing people, these reports suggest that ed preference. Applying critical race fram-
race — the identity of Black womanhood, ing to my coded transcripts, I learned that
especially — is irrevocably damning. These Black birth workers approach birth work
reports never made the essential pivot to- as racial justice activism and seek to redress
ward elucidating race as an “organizing deep obstetric wounds that result from his-
principle” of power.34 They did not attend tories of medical violence.
to how Black birthers have historically and Storytelling
contemporarily been made vulnerable to All the birth workers interviewed de-
violence. scribed the media sensation surrounding

32 Cole, “Reproduction on Display.”
33 Ibid.
34 Khiara Bridges, “Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization,” University of California Press,
2011, pp. 16.


97023 Body_176pg_6.7x9.8_R5.indd 28 1/11/21 10:16 AM

Black maternal mortality as de-histori- depth of consideration? It means assuming
cized, and many of them saw Black birthers trauma as a presupposition for clients and
bearing disproportionate blame rather seeing birth work and training as racially
than having their accounts believed.35 Birth circumscribed. Doula SJ reflects that most
workers also spoke to how the media sen- of her Black clients specifically had “com-
sation created around Black maternal mor- plicated relationships either to doctors or
tality influences their work with clients. Western medicine” or knew “about how
When Efe, doula and student midwife, Black women are at higher risk for all sorts
sees people talking about Black maternal of complications during labor, and they
mortality on Instagram and Twitter, “peo- [came] into that experience with more
ple are scared; they’re terrified.” As Qiddist, apprehension and more worry.” Similar-
a doula, says, headlines such as her “least ly, doula Sade was attracted to doula care
favorite but most telling,” which was the via her personal encounters with medical
ProPublica “Nothing Protects Black Wom- professionals, who generally treated her
en From Dying in Pregnancy and Child- like she had no knowledge of her own
birth,” relegate Black birthers to a position body. She found doula work as a method
of fear and doom. Qiddist says that Black for facilitating the reclamation of bodily
birthing people seem like “a lost cause,” and autonomy for others, “specifically Black,
ultimately, “[t]hat’s just not true!” Qiddist indigenous, and queer” birthers. Sade acti-
feels that her role intervening in this nar- vates her racial empathy into a birth work
rative is to provide clients with diasporic practice focused on recuperating personal
practices, which she calls “protective fac- power. In this way, Sade finds healing for
tors,” reminding birthers that they “are not herself and her clients.
broken” and instead live within a violent Radical Redress
system. Efe and Qiddist respond to the Efe applies an abolitionist framing
media sensation by guiding their clients to birth justice because she finds the en-
toward avenues by which they can birth tire medical system culpable for maternal
safely. deaths and aims to dismantle it. To think of
Trauma as a Basis for Black Birth Work birth justice through an abolitionist frame-
As Black midwives and doulas are work, making contemporary Black mater-
personally familiar with the specifics of be- nal mortality continuous with the legacy of
ing Black in an anti-Black world,36 they use slavery, indicates that Efe processes her role
birth work to combat the systematic dehu- as a birth worker in relationship to a larger
manization of their clients and themselves. project of racial liberation. Interviews with
Based on the responses of my interlocu- doula Bailey and professional midwife Car-
tors, I understand birth work as a practice men were similarly saturated with radical
of reciprocal healing because its radical imaginations of what redress could resem-
care grasps at the root, addressing obstetric ble for Black birthing people. For instance,
violence as just one of many manifestations Carmen considers her midwifery a method
of “endemic anti-Blackness.”37 What does of direct action, emphasizing that she uses
it mean to perform birth work from this midwifery to “interrupt trauma.” Bailey
35 “Venus, Nurse Midwife”. Interview. By Onyinyechi Jessica Ogwumike. 6 Mar. 2019. Telephone Interview.
36 Dumas and Ross, “Be Real Black”
37 Ibid.


97023 Body_176pg_6.7x9.8_R5.indd 29 1/11/21 10:16 AM

hopes greater visibility for Black maternalworkers’ often trauma-informed, radi-
mortality in public media will culminate incal care seeks to nourish alienated bodies.
support for more birth centers, communi- Through redressive practices that inter-
ty-based doula collectives, and greater con-
vene on the birth industry as an oppressive
cern for Black women’s health overall, not field of action, they hope to craft new po-
just when they are “dying in pregnancy and tential for pleasure and healing for birthing
childbirth.”38 These doulas invoke birth Black bodies. Blackness and its attendant
work toward a vision of repair in which social death inspire these birth workers to
life in a Black body is not immediately tied
think about “care” differently from their
to death. white counterparts, as they “comfort, and
defend…those living lives… in the pres-
Conclusion ence of death.”39 Assisting birth in the con-
SJ, Efe, Venus, Sade, Carmen, Qid- text of constant death looks like teaching
dist, and Bailey all approach their birth childbirth education in view of an altar
work from the social location of Black- for the lost. Black birth work, sitting in

ness. The specificity of being Black in an the wake of slavery, must be centered in
anti-Black world makes the body a target conversations of Black maternal health be-
for dismemberment and dehumanization, cause it leads us to unpack what it means
both in birth as a physio-social event and to birth when one is socially constructed in
the stories we tell about it. These birth antagonism to life. ■
38 Bailey referencing the title of the article by Martin and Montagne.
39 Christina Elizabeth Sharpe, “In the Wake: on Blackness and Being,” Duke University Press, 2016, pp. 38.
40 See Appendix Image 1.


Image 1: A screenshot of @ancientsong’s

Instagram story depicting an altar in
honor of the Black mothers recently
lost nationwide to maternal mortality.


97023 Body_176pg_6.7x9.8_R5.indd 30 1/11/21 10:16 AM

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97023 Body_176pg_6.7x9.8_R5.indd 32 1/11/21 10:16 AM


Degrees Don’t Make Them

Researching with Graduate Students
By Andrew Laeuger

Given Northwestern University’s outstanding reputation, it is no surprise that

this school has a sizeable graduate student population. In fact, according to the offi-
cial Northwestern website, more than 8,000 undergrads call this place home, while
over 13,000 graduate students hide among us, sneaking back to their apartments on
the 201 while we eat at Sarge and Allison.
Though there are few classes on campus in which graduate and undergraduate
students mix, there are many opportunities to interact with graduate students within
Northwestern’s academic research environment. To learn more about the experience
of researching with graduate Wildcats, I caught up with Daniel Grass, a junior in the
Integrated Sciences Program who works with many graduate students and postdocs
in a laser optics lab.


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AL: When you first joined your optics lab, were you the only undergraduate at the
DG: I was the only undergraduate at Northwestern in this lab. However, when I
joined, the lab at Reno (University of Nevada, Reno, the prior location of the optics
lab group) was transitioning to Northwestern, so I believe there were undergraduates
back there. However, I never interacted with any of them.

AL: Since you were the first Northwestern undergraduate in your lab, was that new
step in your college experience daunting?
DG: It was a little daunting. … But everyone was really supportive. The postdocs
specifically gave me projects that I could work on at my own pace and that weren’t too
high-pressure or dependent on the results or a certain calculation. Everyone felt new
to the environment and I had been at Northwestern longer than most of the graduate
students moving here from Nevada. So, in my specific scenario, there wasn’t much
pressure or any awkwardness really.

AL: What did you do to adjust to a lab setting with a lot of grad students?
DG: In high school, I definitely knew a decent amount [about physics], but you have
to reset that idea and know that you’re one of the least informed people, or the least
informed person, in the room. This doesn’t necessarily mean biting your tongue, but
just remembering that they know what they’re doing better than you do.

Sometimes, when making comments or suggestions, I would preface those comments

with the notion that “I might be telling you that water is wet, but here’s an idea to con-
sider.” I just made it clear that I knew my position, and in turn, no external pressure
was placed on me.

AL: You’ve now been researching with grad students for 3 years. What has been the
best part about your time, and what part has taken the most time to become comfort-
able with?
DG: I like knowing that these graduate students and postdocs have been in my shoes
before — they’ve taken courses that I might want to take. It’s nice to have a bunch of
different experienced voices in the room that I can just chat with.

As for the hardest thing to adjust to, there really isn’t much. We all had relatively
shared experiences here at Northwestern, so we all took life as it happened.

AL: Are there any other advantages to working with graduate students that you’ve
seen specifically within the realm of research?
DG: Generally, it’s the sort of advantages you would expect with more educated
students: they would always be helpful with ordering parts or just bouncing off ideas.
Postdocs are also able to easily adjust their daily schedules — they usually roll up
whenever they feel like it, but work until they finish the work they need to do.


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I also worked for six months at Northwestern in a chemistry lab, where the postdocs
show up at 11 a.m. but stay until 8 at night. They definitely get their work done, and
they work hard. Since the postdocs worked rather adjustable schedules, I could be
confident that when I came into the lab after classes, there would be at least one grad-
uate student there to answer any questions or concerns I had.

AL: Northwestern has twice as many graduate students as undergraduates. Do you

think this hampers the ability of undergraduates to embark on their own projects?
DG: A lot of professors have specific projects and tasks set aside that undergraduates
can complete. They’re certainly not menial, whereas a project given to a high school
student may be. They’re important, but not too daunting. Professors know that to do
good research, you need a mix of undergraduates and graduate students to take on a
variety of projects. It’s just a matter of finding a professor who is doing work that is
undergraduate-friendly, and that’s a relatively easy process.

AL: You mentioned that when you first joined this lab, your projects or contributions
were generally proposed by other group members. What habits can undergraduates
pick up to get the most out of their time researching with older students?
DG: Listening is a key component. These experienced researchers know the common
pitfalls and have likely made mistakes similar to those you can and will make. For
research in general, always assume that you’ll forget things — constantly document
your work and check over your steps for consistency. Even in minor details, always be
asking yourself, “What am I missing here? What haven’t I counted for? How can this
go wrong?”

Every little part needs to be checked when you’re doing novel research. Be aware that,
however incredibly helpful graduate students may be, you will be the most informed
person regarding your specific project. Have confidence! Second check rather than
second guess.

AL: Do you have any other final advice for new researchers about getting involved in
this process?
DG: In my experience, as long as you try at something, your teammates will be gra-
cious that you are contributing to their work. It’s extremely unlikely that if you en-
counter difficulties, you will be holding up the entire lab. There aren’t any downsides
to it, so I’d say it’s good to just jump in and see what you learn and where you go. And,
of course, there will always be people there to help you.


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Department of International Studies

#MeToo In The
European Parliament:
A Case Study In Feminist
by Nicole E. Fallert

Introduction were treated in this environment, and

It all started with a notebook. Jeanne experienced unwanted sexual attention
Ponte was 23 years old in 2014 when she and aggression.1 Amidst rampant sexual
began working as an Accredited Parlia- harassment, Ponte saw that a “culture of
mentary Assistant, or APA, for a French silence” dominated the European Parlia-
Member of the European Parliament, or ment, or E.P. Ponte said her colleagues told
MEP, in Brussels, Belgium. As a young her, “‘This is normal behavior. You can’t
woman in a male-dominated workplace, change the rules. Politicians are like that.’”2
she immediately noticed how females Ponte’s friends and family know her
to always be carrying a notebook, so it
1 The definition of “sexual harassment” in this paper will accord with the EU’s official definition; “where any form of unwanted
verbal, non-verbal or physical conduct of a sexual nature occurs, with the purpose or effect of violating the dignity of a person, in
particular when creating an intimidating, hostile, degrading humiliating or offensive environment.”
2 Appendix 1


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Figure 1 ◀

wasn’t an odd choice for her to begin re- giving names in an effort to keep the story
cording accounts of inappropriate be- about the problem, not the perpetrators.
havior in a small flowered journal in re- Then, in January 2018, Ponte and
sponse to what she saw. The “Little Sexism a coalition of Parliament workers offi-
Notebook” contained over 80 testimonies cially started the MeTooEP movement.
by the time the Harvey Weinstein scan- The following October, they established
dal broke in October 2017 and the viral, an anonymous blog for
#MeToo movement shook storied insti- survivors to publish testimonies of sexu-
tutions around the world.3 Then Ponte’s al violence in the E.P. Shortly after, they
boss French MEP Edouard Martin men- announced the MeTooEP pledge in Febru-
tioned the notebook, with her permission, ary 2019 for candidate MEPs to sign and
in an interview on a local radio station at promise to no longer condone this behav-
the same time #MeToo went viral on so- ior ahead of the E.P. elections that May.
cial media. As the world opened its eyes The activism following the note-
to the reality of sexual harassment, Pon- book’s reveal raised an essential question
te’s story went everywhere within days. for me: How do feminist movements
The notebook’s revelation signaled
the start of the Parliament’s own #MeToo “The ‘Little Sexism
movement. The months following Mar-
tin’s interview brought rapid action to ad-
dress Ponte’s revelation of the “open secret”
Notebook’ contained over
of gender-based violence in the Parlia-
ment.4 Interview requests flooded Ponte’s
80 testimonies by the
inbox. Strangers recognized her on trains.
But spokespeople from the E.P. encour- time the Harvey Weinstein
aged Ponte to tell her story, so she went
for it. Ponte answered every interview scandal broke.”
request, never speaking alone and never

3 Corine Goldberger, “Jeanne Ponte, the Parliamentary Assistant Who Pins the Machos.” Figure 1.
4 Nicole Fallert, “Inside the Fight to Make the European Parliament Take Sexual Harassment Seriously.” Figure 2.


97023 Body_176pg_6.7x9.8_R5.indd 37 1/11/21 10:16 AM

Jeanne Ponte begins 10/15/17 10/26/17 May 2019
recording accounts of Alyssa Milano’s EP passes anti- October 2018 European
sexual harrassment #MeToo tweet harrassment Parliament
goes Viral resolution established Elections

2014 10/5/17 October 2017 January February 2019

Bureau decisions The New York Jeanne Ponte’s 2018 MeTooEP conference
establishes EP Times breaks the notebook goes MeTooEP announcing MeTooEP
Advisory Committee Harvey Weinstein public Movement Pledge
on harassment scandal established

▲ Figure 2

make institutional change? This the- a feminist institutionalist lens to a social

sis used the unprecedented campaign of movement.6 This thesis is meant to be a
MeTooEP as a case study to make sense tool for feminists building movements,
of the way feminist movements can per- so they too can change their institutions
manently impact patriarchal structures. from within. I hope this thesis becomes
My study of MeTooEP demonstrat- part of a growing scholarly body of work
ed to me that the movement’s strength concerning #MeToo as a defining social
was its ability to focus public attention on mobilizer, rather than as a viral flashpoint.
the internal, formal attempts the E.P. had The image is a striking testimony to
been taking to address gender-based vio- the power of a social media message such
lence, and how that focus revealed mech- as #MeToo. First, I want to establish how
anisms that favored those in power, rather the virality of #MeToo was a “focusing
than their victims. MeTooEP is a “causal event” for the issue. According to Birkland,
story;” it is a reaction which explains the Focusing events can lead interest
issues of sexual harassment through sym- groups, government leaders, policy
bology and storytelling.5 These totems entrepreneurs, the news media, or
also instigated a refocusing on the gender members of the public to identify new
equality agenda across the international problems, or to pay greater attention
political environment; at the same time to existing but dormant problems,
that the E.P. refocused its gender equality potentially leading to a search for
agenda, so did other organizations in the solutions in the wake of apparent
international political environment, such policy failure.7
as the United Nations. By making sense #MeToo re-oriented MEP and in-
of this recent history, this discussion de- terest group attention regarding the issue
velops the study of #MeToo’s contribu- of sexual harassment. Subsequent “media
tions to gender equality policy by applying propagation” of symbols related to the

5 Deborah Stone, “Causal Stories and the Formation of Policy Agendas.” 285
6 According to Lune (2014), social movements are “sustained and organized campaigns for social change” (p. 161).
7 Thomas A. Birkland, “Focusing Events, Mobilization, and Agenda Setting.” 55


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event, such as Ponte’s notebook, “give less unique in that the movement has been mo-
powerful groups an advantage in policy bilized for over two years.10 Focal events
debates.”8 MeTooEP also draws symbol- are received differently among policy com-
ogy through the MeTooEP blog and the munities, but the case of #MeToo upholds
Pledge. This is one explanation why we see Birkland’s argument about saliency. If the
anti-harassment policy reach the agenda event gives human agency and cause to
created — or, an opportunity to make in- an issue, interest groups will better influ-
stitutional change, in the eyes of Birkland. ence the policy agenda. The interpreta-
Work had been done before #Me- tion of #MeToo as a focusing event helps
Too’s rise, but the image of MEPs holding us understand why the mobilization of
signs in a 2017 Strasbourg plenary session MeTooEP was significant, and how the
alerted feminists within the institution movement’s sustained visibility and polit-
that this was the chance to do more. Un- ical pressure — especially given the status
precedented issue visibility in the Parlia- quo of the pro-change coalition in the Par-
ment heightened the importance of gen- liament — are leading to the 2019 elections.
der-based violence to its members. The
pro-change group, some of whom are Feminist Institutionalism (F.I.)
victims of such violence, were “suddenly” In studying MeTooEP, I have drawn
given enough attention to mobilize their on the feminist institutionalist approach.
cause, while more powerful groups, such as If institutions are a “collective entity or any
E.P. leaders and MEPs, were given a win- way of organizing relationships that are
dow to respond — or defend the existing widely familiar and routinely practiced”
policies. The understanding of #MeToo as and often contain “unwritten rules,”11 fem-
a focusing event explains how MeTooEP inist institutionalism is an approach that
rose as a highly-organized advocacy coa- strives to examine how institutions’ orga-
lition which was able to achieve sustained nization and rules form, and how they are
relevance within the E.P. community. influenced by gender inequalities. Kro-
One reason MeTooEP has sustained ok and Mackay explain that F.I. theory
the energy from the focusing event for evolved along with neo-institutionalism
nearly two years is that the movement to provide a framework that explained
asserts who, and what, is to blame for how our increasingly organized world is
the issue.9 The coalition identifies caus- gendered.12 In other words, feminist insti-
al factors for sexual harassment and vi- tutionalism looks at how ideas, norms and
olence in the Parliament: failed formal values are experienced unequally along the
mechanisms and a culture of silence. lines of gender.13 In the E.P. context, F.I.
As 2020 looms, many discussions of urges us to evaluate the Parliament’s orga-
#MeToo read as if the movement is over nization and rules in relation to gendered
and done. MeTooEP’s strategy has kept criteria.
the focal event from “blowing over;” it is In an ever-structured society, gender

8 Ibid. 56
9 Ibid. 67
10 Ibid. 72
11 Howard Lune, Understanding Organizations. 2
12 Ibid. 125
13 Mona Lena Krook and Fiona Mackay, Gender, Politics and Institutions. X.


97023 Body_176pg_6.7x9.8_R5.indd 39 1/11/21 10:16 AM

norms become further incorporated into E.P. is a gendered institution because ex-
institutions’ policies.14 Feminist institu- ternal conditions in Europe influence the
tionalists study how these invisible social Parliament’s status quo.
constructs are reflected as a “logic” deter- My analysis follows the three com-
mining attitudes and actions.15 For fem- ponents of the feminist institutionalist
inist institutionalists, metrics frequently framework: formal processes, including
used to provide gender equality do not do the mechanisms, committees, laws, etc. al-
enough to correct disparity and the patri- ready addressing gender-based violence in
archal structures that constraints women’s the Parliament; informal processes, such
actions.16 This thought process emphasiz- as the empowering social movement that
es the importance of paying attention to rose in reaction to a focal event; and con-
qualitative factors to measure how organi- nections between the formal and informal
zations are gendered. processes, or how long a social movement
A byproduct of a more organized lasts until its terms must be institution-
world is an increase in the number of social alized.22 The efficacy of the Parliament’s
movements, including MeTooEP.17 The formal processes regarding sexual harass-
F.I. lens also provides an understanding of ment demands an analysis of MeTooEP as
the potential impact of movements such as an empowering reaction to these formal
MeTooEP by showcasing how these coali- processes. However, social movements
tions can become “legitimate participants” may only last to an extent before they must
in the organizational world.18 In an envi- work with institutional structures.
ronment of organizations, external social
movements like MeTooEP are issue “en- Why the E.P.’s steps against
trepreneurs” advocating new demands.19 gender-based violence weren’t
Furthermore, feminist institutionalism
evaluates organizations as “open systems,” enough
suggesting that the internal structure of the It’s important to acknowledge that
Parliament does not function in “isolation” a history of gender equality work existed
of the greater European political and his- in the Parliament and the greater political
torical environment.20 Values, norms, and environment long before #MeToo went
beliefs concerning gender trickle in from viral. While gender-based violence was on
the European political context into the the Parliament’s policy agenda, these for-
Parliament’s culture and decision-making. mal attempts did not successfully change
The F.I. lens reveals that this environment the institutional logic which enables an en-
affects the Parliament because gender in- vironment of harassment in the first place.
equality and discrimination are functions Reflecting on the Parliament’s formal pro-
of power more broadly in Europe.21 The cesses, which existed before #MeToo, lets
us understand how they do not “have the
14 Mona Lena Krook and Fiona Mackay. IX
15 Howard Lune, Understanding Organizations. 79
16 Ibid.
17 Howard Lune, Understanding Organizations. 127
18 Ibid.
19 Mona Lena Krook and Fiona Mackay, Gender, Politics and Institutions. 191
20 Howard Lune, Understanding Organizations. 107
21 Mona Lena Krook and Fiona Mackay, Gender, Politics and Institutions. 3
22 Ibid 4-6


97023 Body_176pg_6.7x9.8_R5.indd 40 1/11/21 10:16 AM

“Values, norms, and beliefs concerning gender trickle in
from the European political context into the Parliament’s
culture and decision-making.”
effects the creators intended” and are too Council “call[ing] on the Member States to
weak to support survivors of gender-based improve their national laws and policies to
violence.23 combat all forms of violence against wom-
The E.U. has taken legislative steps en and to act in order to tackle the caus-
against gender-based violence since its ini- es of violence against women, not least
tiation. The Maastricht Treaty (1993), the by employing preventive measures, and
Treaty of Rome (1957), and Treaty of Ac- called on the Union to guarantee the right
cession (1973) provided initial protections to assistance and support for all victims of
to women in E.U. institutions, establish- violence.”28 However, member countries
ing “equal opportunities and equal treat- have been slow to implement anti-discrim-
ment” for all E.U. citizens.24 The European inatory measures, let alone criminal pun-
Convention on Human Rights (1953), as ishment for sexual harassment. By 1992,
well as these treaties, expect that all new France was the only member state with
member countries promote human rights penal law addressing sexual harassment.29
and anti-discriminatory policies in order In other states, broadly written laws con-
to be granted accession — a meaningful cerning domestic violence are applied to
first step against gender-based violence.25 cases of sexual harassment.30 E.U. policy is
Formal measures to protect women have not sufficient because it does not require
been a priority in the Parliament’s work for member countries to implement universal
years since the E.U. was founded. In 2009, anti-discrimination standards and specific
the Parliament passed a resolution which rules applying to gender-based violence.
recognized that male violence against fe- But the fact these policies reached the
males was an “inequality” issue and a “pub- Parliament floor reveals to us that legisla-
lic health problem,” heightening the status tors knew gender-based violence was an
of gender-based violence on the E.P. agen- issue long before MeTooEP. In February
da.26 A related 2011 resolution “demands 2014 — three years before #MeToo went
Member States to ensure that perpetra- viral — the European Parliament Recom-
tors are punished in accordance with the mendations to Commission on Combating
gravity of the crime,”27 while a 2012 direc- Violence against Women were announced.
tive was passed by the Parliament and the The recommendations focus on six areas
23 Howard Lune, Understanding Organizations. 11
24 Gender Equality in Ireland, “Equality between Men and Women.”
25 European Court of Human Rights, “Gender Equality.” 1
26 European Parliament, “Elimination of Violence against Women.” 2
27 European Parliament, “European Parliament Resolution of 5 April 2011 on Priorities and Outline of a New EU Policy Frame-
work to Fight Violence against Women.”
28 “Directive 2012/29/EU of the European Parliament and of the Council of 25 October 2012 Establishing Minimum Standards on
the Rights, Support and Protection of Victims of Crime and Replacing Council Framework Decision 2001/220JHA.”
29 Tanya Martinez Shively, “Sexual Harassment in the European Union: King Rex Meets Potiphar’s Wife.” 1103
30 Ibid.


97023 Body_176pg_6.7x9.8_R5.indd 41 1/11/21 10:16 AM

▲ Figure 3: Members of the European Parliament hold up #MeToo signs in plenary
session in Strasbourg, France in October 2017.
“underlying any measures to combat vio- received a formal complaint of sexual ha-
lence against women:” policy, prevention, rassment, according to a E.P. press release
protection, prosecution, provision, and immediately following an episode in which
partnership.31 By recommending policy to MEPs held up #MeToo signs during the
the Commission, the Parliament appears plenary session.3233 By 2019, the Commit-
already aware of issue prevention in the tee had received 16 complaints, according
context of Europe. The irony is how quick- to E.P. Quaestor and Committee Member
ly it becomes clear that the Parliament’s Elisabeth Morin-Chartier. Fifteen of these
recommendations do not recognize what cases have been closed and one is ongoing.
is happening within its own walls. The president has imposed sanctions on
five cases, two involving MEPs.34 There
The Committee is a clear discrepancy between the num-
MeTooEP also drew public attention ber of cases which reach the president’s
to the fact that existing response mech- desk and the pages of testimonies acces-
anisms did not allow victims to feel safe sible on, however. After
enough to share their stories. Since 2014, Ponte’s notebook became public, an offi-
the Advisory Committee on Harassment cial statement entitled “Parliament rolled
and its Prevention at the Workplace has out campaign against sexual harassment
been the body that hears victim testimo- last year,” claimed the Committee was
nies. It consists of five members nomi- ahead of MeTooEP in battling sexual ha-
nated by the Parliament’s president. As of rassment. However, the high number of
October 2017, the Committee had never harassment reports exposed by MeTooEP
31 Parliament, “European Parliament Resolution of 25 February 2014 with Recommendations to the Commission on Combating
Violence Against Women.”
32 European Parliament, “Parliament Rolled out Campaign against Sexual Harassment Last Year.”
33 Judith Mischke, “#MeToo: Female MEPs Tell of the Own Sexual Harassment Experiences.”
34 Appendix 6


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and the low number of cases reviewed by law against gender-based violence at the
the Committee contradicts this claim that time this thesis was written.
the Parliament was in control of the situ- Especially in the case of the Octo-
ation. The Committee’s “campaign” con- ber 2017 Parliament resolution reacting
sisted of mere leaflets distributed to MEPs to #MeToo, these suggestions from the
explaining “how to avoid improper behav- Parliament have not yet influenced the
ior towards your staff.”35 The “pro-active” Commission to use its right of initiative
action by the Committee was clearly not to propose such a law. According to E.U.
successful, given that over 127 female and law, the right of initiative is only for the
11 male E.U. employees reported cases of Commission; the Commission pitches leg-
sexual harassment to POLITICO Europe islation and the Parliament sees through its
in 2017.36 Even more revealing is the fact development with the help of the Coun-
that only about 40 out of 751 MEPs have cil.40 Given that ideas of harassment and
opted for mandatory anti-harassment legal approaches vary by member country,
training.37 Therefore, few officials are even the likelihood that MEPs would agree on
aware of the E.P.’s official definition of sex- a single policy seems low, even if it is ini-
ual harassment, let alone that the Commit- tiated.
tee exists to hold them accountable. The The October 2017 resolution may not
80 testimonies in Ponte’s notebook alone have resulted in an E.U.-wide law, but the
demonstrate the issue is much greater than measure is different from the previous an-
the Committee can handle. ti-harassment resolutions passed from the
1970s through 2014. The resolution was
Barriers to a European Solution an instance in which #MeToo was men-
MeTooEP brought attention back to tioned in an E.P. measure, the first official
the resolutions the Parliament had previ- response to the movement.41 The fact the
ously passed to address sexual harassment. resolution is a direct response to the #Me-
It also indicated that these attempts didn’t Too movement also changes the meaning
succeed. Resolutions are non legally-bind- of a “zero-tolerance” approach to gen-
ing “[suggestions for] a political desire to der-based violence. The 2017 resolution
act in a given area.”38 These create policy reiterates a 2014 resolution’s zero-toler-
windows for the E.U. — opportunities for ance policy, but this time it was a response
ideas to reach the Commission’s agenda to a feminist social movement.42 In the F.I.
and the Parliament to pressure member perspective, the Parliament’s decision to
countries to pass specific national laws.39 formally address #MeToo and advocate for
The most significant reason Parliament those without power is considered a fem-
resolutions aren’t credited with addressing inist win.43 As a result, the resolution is a
this issue is the absence of an E.U.-wide “resource” that gives power to individuals

35 European Parliament, “Parliament Rolled out Campaign against Sexual Harassment Last Year.”
36 Ryan Heath, “Harassment in the Brussels EU Bubble.”
37 Appendix 1
38 Nicholas Moussis, “3.3 The Legal System of the European Union.”
39 Thomas A. Birkland, “Focusing Events, Mobilization, and Agenda Setting.”
40 “Right of Initiative.”
41 European Parliament, “Combating Sexual Harassment and Abuse in the EU.”
42 Ibid.
43 Moya Lloyd, “Power, Politics, Domination, and Oppression.” 112


97023 Body_176pg_6.7x9.8_R5.indd 43 1/11/21 10:16 AM

“Only E.U. law fully binds the European political context. National
lethargy toward the issue of gender-based
violence trickles into the Parliament.
the member countries.” Courts have also diminished inter-
est in proposing a European anti-gender
in the institution.44 In this way, we see how violence law. In connection to the afore-
the Parliament was making the greatest ef- mentioned parliamentary immunity, few
fort within its competence to address gen- member countries would feel compelled
der-based violence. to direct their resources to European ha-
The absence of a Commission propos- rassment cases rather than their own le-
al is one part of a long history of approach- gal priorities, further disincentivizing the
es to gender-based violence existing on the acceptance of an E.U.-wide law. Gender
policy agenda without resulting in execut- parity within the Parliament also matters
ed change. For example, the E.U. Commit- in making E.U. law. If there were more
tee on Employment and Social Affairs was female MEPs, the 2017 resolution may
appointed in February 2001 to produce a have been more widely endorsed, prompt-
report on harassment at the workplace.45 ing the Commission to initiate a law. For
Nearly six months later, the report moved example, Hungary has many more male
for a motion for a resolution addressing MEPs, a likely explanation for why that
the “calls” and “recommendations” for in- country has yet to act locally on behalf of
stitutional action. This resolution merely the Resolution. Hungary’s MEPs are only
suggested that member countries establish 19% female.47 Official Parliament measures
procedures, training programs, and confi- are only as effective to a member country,
dential mechanisms for reporting. As long and the E.U. at large, as the priorities of
as formal responses remain in the form of that nation’s MEPs.
resolutions, member countries will nev- Further, the Resolution may have
er be legally compelled to make changes been passed for more political reasons by
on the national level. Only E.U. law fully some MEPs. The fact that members have
binds the member countries. been slow to implement the resolution na-
As a result of the resolutions system, tionally suggests some may have voted to
each E.U. member country has approached pass the measure in solidarity with the Par-
the Parliament’s October 2017 resolution liament, but fear local repercussions from
differently. It is up to them to decide how voters for promoting such a policy.
to implement the document’s suggestions. The Parliament continues to make
France, for example, legally banned street suggestions, however. On Nov. 9, 2018,
harassment in August 2018. In a November MEPS adopted renewed measures against
2017 survey of Hungarians, half of all re- sexual harassment.48 As in previous ex-
spondents believed sexual harassment cas- amples, the language used by the E.P. can
es require no legal consequences.46 Recall recommend, but not make law. By merely
how the Parliament is not “isolated” from “adopting measures,” the E.P. is not indi-

44 Ibid.
45 Committee on Employment and Social Affairs, “Report on Harassment at the Workplace.”
46 Kitti Erdo-Bonyar, “Hungarians’ Views On Sexual Harassment - Survey.”
47 European Parliament, “Men and Women Distribution.”
48 European Parliament, “MEPs Adopted Measures to Combat Mobbing and Sexual Harassment.”


97023 Body_176pg_6.7x9.8_R5.indd 44 1/11/21 10:16 AM

cating a permanent change on any level. tained public relevance through its sym-
The measures instead constitute another bology. Time magazine’s cover of “the
kind of resolution. However, 528 of 751 empty chair,” the Time’s Up logo, actresses
MEPs voted in favor of the measures, donning black gowns at the 2018 Golden
which ask the Commission to develop le- Globe Awards, and pussy hats at the 2017
gal standards concerning violence against Women’s March: these images have come
women. These standards may be applied to represent the #MeToo ascendence to
within the E.U.’s jurisdiction. By creat- the public agenda. Ponte’s flowered note-
ing a unified judicial approach to sexual book now joins these symbols as artifacts
misconduct, MEPs would be considered of this history.
under European law — potentially elimi- While an artifact implies temporali-
nating the power of parliamentary immu- ty, Ponte’s notebook joins these symbols
nity. The fact remains that the Parliament as signals of a more permanent realiza-
can only work within its competences; an tion: the breakage of a culture of silence.
E.U.-wide law would need to come from Recurring symbols of #MeToo like Ponte’s
the Commission and the Council. How- notebook are more than a flash of celeb-
ever, even if this were passed by the E.P., rity endorsement or scandalized firings.
successful implementation would not be They demonstrate cause and intent. Stone
guaranteed. Because the Parliament is not writes, “[Causal stories] claim that a condi-
isolated from the European political en- tion formerly interpreted as accident is ac-
vironment, the E.U. would struggle to re- tually the result of human will, either indi-
move local barriers and pass a supreme law rectly (mechanical or inadvertent cause) or
banning gender-based violence. directly (intentional cause); or they show
that a condition formerly interpreted as
#MeToo’s storytelling devices indirectly caused is actually pure intent.”51
Symbols attribute intent over acci-
What is dangerous is silence. Sexual
dent. Ponte’s physical representation of
harassment is an open secret because
every worker, woman or man, knows the invisible culture of harassment “de-
who they need to avoid. They know scribes harms and difficulties, attributes
what kind of strategy you need to them to actions of other individuals or or-
develop in order to not be looked at as a ganizations, and thereby claims the right
piece of meat — to try to protect yourself. to invoke government power to stop the
- Jeanne Ponte49
Causal stories like those of MeTooEP are
amplified through illustrative tools. Ac- “Activists use symbols
cording to Stone, “[the] deliberate use of
language and of symbols in particular [is] like the notebook to
a way of getting an issue onto the public
agenda or, alternatively, keeping it off.”50
The #MeToo movement has largely main-
“manipulate” the issue —
to myth-make.”
49 Appendix 1
50 Deborah Stone, “Causal Stories and the Formation of Policy Agendas.” 282
51 Ibid. 289


97023 Body_176pg_6.7x9.8_R5.indd 45 1/11/21 10:16 AM

Figure 4 ▶

“Resources” “Power”
• EM- • Privileges
• Feb Conference • Broker deals
• MeTooEP pledge • Power as

harm.”52 Activists use symbols like the context of a feminist movement, “em-pow-
notebook to “manipulate” the issue — to erment” is a process in which resourc-
myth-make. The narrative associated withes transform into the power necessary to
the symbols reinforces the issue’s humanmake institutional change.
culpability everytime it confronts the pub- When the Parliament’s formal pro-
lic eye. We see the notebook and we assign
cesses couldn’t address an institutional is-
how all are responsible for this, and what
sue, a group of workers without political
we can do to address this violence. power gathered resources: testimonies on
In the F.I. perspective, causal symbols
the, participation in the
are “resources” which give power to Me- MeTooEP conference, over 300 signatures
TooEP. For someone encountering these on the MeTooEP pledge. This conceptual-
symbols for the first time or the hundreth,
ization of empowerment as a process ex-
they provoke the mind to recount why theplains how these resources made the group
issue was caused and to what end it has powerful enough to influence the policy
been addressed. Consider the MeTooEP agenda, according to a 2019 article for the
logo: the feminine pink-purple color, the
journal Women’s Studies International Fo-
logo with a faded E.U. flag; the logo is a
rum by S. Laurel Weldon. Weldon writes
causal device. The logo keeps the issue in
that #MeToo was able to make an impact
public consciousness when shared on social
on the institutional level because of its
media or posted on the MeTooEP pledge. specific approach to de-powering patriar-
Subconsciously, we see these symbols chal structures and em-powering targeted
and attribute causality to the image. This
groups.53 Weldon also suggests that “pow-
meaning-making process fueled MeTooEP er flows through us by virtue of our social
into public consciousness following #Me-identity and institutional position, whether
Too’s virality. or not we wish to exercise power (fig. 4).54
On the other hand, we may be silenced by
Empowerment these same identities and social positions
Empowerment is a word frequently in other contexts.” Highly bureaucratic

used in media concerning #MeToo. In the environments like the Parliament quiet the
52 Ibid.
53 S. Laurel Weldon, “Power, Exclusion and Empowerment: Feminist Innovation in Political Science.”
54 S. Laurel Weldon, “Power, Exclusion and Empowerment: Feminist Innovation in Political Science.” 130.
55 Ibid.


97023 Body_176pg_6.7x9.8_R5.indd 46 1/11/21 10:16 AM

power of certain groups, such as APAs, fe- be influential; however, they cannot be to-
male MEPs, and other marginalized groups tally powerful in the way that males in the
in order to maintain a functioning system, institution can, as “power consists in the
often without these groups’ conscious con- relationship between men and women, a
sent. Em-powerment refers to the con- relationship that accords men certain pow-
scious process of breaking that silence. The ers over women.”58 Here we see why no
“em” prefix to the word “power” implies the amount of formal work by the Parliament
act of silenced groups of gaining governing could successfully address the invisible dis-
ability by collecting resources. According crepancy between the resources available
to feminist institutionalists, MeTooEP is to men versus women.
an example of em-powerment because vic- Due to socialized institutional logics,
tims whose voices were previously silenced organizations dominate social groups in
by an institutional force are now given the the way that men dominate women.59 In
power to speak, and, eventually, influence the social understanding of men as sexu-
dominant Parliament decision-makers. ally dominant of women, masculine insti-
Em-powerment is a necessary phe- tutional logics are dominant to feminist
nomena, given women’s traditional roles institutional logic. MeTooEP is propelled
within institutions. Historically, female by feminist institutional logic. There-
power in this context is implicit rather than fore, through the process of em-power-
explicit.56 Their authority is so silenced ment, MeTooEP has gathered resources
that women cannot access labor without to challenge the power of dominant de-
the help of men and must influence others cision-makers. Because the Parliament is
indirectly in order to achieve their goals. in the resource-holding role, the institu-
Resources such as money and education tion will dominate MeTooEP no matter
are typically given by men to women so what. Therefore, MeTooEP must use the
they may gain access to any level of labor, Parliament’s own institutional logic as a
let alone excel. According to the October means to an end, in order to make an or-
2017 Parliament resolution, 75% of wom- ganizational change. This explains why the
en in top management positions in Europe em-powerment process is a continuous cy-
have been sexually harassed. Even if wom-
en gained enough resources to be influen-
tial in institutions, they still lack sufficient “‘Em-powerment’ is a
social resources to protect themselves from
the dominating power of men. process in which resources
While men have the pleasure of ac-
cessing any organizational resources they
please, women must only engage with men
transform into the power
in situations which are dictated by the level
of resources they own.57 By merit of their
necessary to make
position, women in the Parliament have
acquired enough resources to presumably
institutional change.”
56 Ibid.
57 Ibid.
58 Ibid. 114
59 S. Laurel Weldon, “Power, Exclusion and Empowerment: Feminist Innovation in Political Science.”


97023 Body_176pg_6.7x9.8_R5.indd 47 1/11/21 10:16 AM

“Feminist solutions like male APAs may seek further responsibility
or promotion by silencing and objectifying
their female equals. Male employees are
Burke’s and Ponte’s have also more likely to work full-time — there
were 367 males on part-time E.P. staff vs.
adapted to being left out of 1,221 female part-time staffers in 2017
— granting them more opportunities to
formal peace talks.” connect with promotion opportunities.61
In 2017, the number of women in middle
cle of gathering resources, gaining power, management posts in the E.P. Secretariat
and making change. increased by nearly 40%; however, merely
The em-powerment process can be incorporating women within a patriarchal
stalled by conflicting ideas of gender equal- structure does not eliminate the risk of
ity among EU decision-makers. Even if gender-based discrimination.62 For these
MeTooEP appeals to their decision-mak- reasons, em-powerment must be an effort
ing logic, inherent norms can conflict from the ground up. If only top officials
with the acceptance of the cause. An em- make changes, the issue will persist on oth-
powered formal Parliament approach to er levels.
gender-based violence must coalesce the
diverse positive and negative associations #MeToo as Entrepreneurship
of female power from within the bloc, but
Em-powerment from the ground
this is easier said than done.
up requires issue entrepreneurship — the
With thousands of international em-
campaigning of a movement within an
ployees, the Parliament consists of conflict-
institution to gather resources. MeTooEP
ing perceptions of female value. For exam-
exemplifies how feminist movements
ple, only two women hold management
within organizations are self-starting and
positions in the Parliament, whereas over
half of APAs are female.60 Employing more
The Me Too Movement is a recent
women in secondary and tertiary roles in chapter in a much longer feminist history.
the Parliament reinforces ideas that wom- In the U.S., the Me Too Movement existed
en should supplement men’s work. Even if long before #MeToo went viral on Octo-
APAs are working for female MEPs, they ber 15, 2017, eleven days after The New
still exist beneath the dominating power of York Times published an report reveal-
the institution. Male APAs may presume ing sexual harassment allegations against
they have more power than their female Hollywood producer Harvey Weinstein.63
counterparts and even exert that power in
Tarana Burke founded the Me Too Move-
the form of sexual misconduct. Perpetra-
ment in 2006 to support victims of sexu-
tors sexualize victims in situations when
al violence and “to build a community of
both actors hold the same amount of pow-
advocates,” initially for black and low-in-
er in order to appear dominant. Therefore,
come women.64 The hashtag didn’t go vi-
60 European Parliament, “Women in the European Parliament.”
61 Ibid.
62 Ibid.
63 Jodi Kantor and Megan Twohey, “Harvey Weinstein Paid Off Sexual Harassment Accusers for Decades.”
64 MeToo Movement, “History & Vision.”


97023 Body_176pg_6.7x9.8_R5.indd 48 1/11/21 10:16 AM

ral until American actress Alyssa Milano
posted: “If you’ve been sexually harassed or “Sexual harassment in the
assaulted write ‘me too’ as a reply to this
tweet” on October 15th.” According to the Parliament is a form of
Pew Research Center, #MeToo has been
used more than 19 million times through
September 30, 2018.65 The virality of the
social war.”
The understanding of the em-pow-
phrase stimulated responses from organi- erment process raises a new point about
zations across the globe,66 and allegations the nature of feminist movements like
against powerful individuals in politics, #MeToo. The process is entrepreneurial.70
television, and journalism, among other Feminist institutionalists argue that “gen-
industries, came to light.67 der equality entrepreneurs ... are needed
“Just because the media pressure of to construct and frame reform proposals
Hollywood is behind us does not mean to mobilize coalitions of different inter-
it is not still happening,” Ponte told ests to work together.”71 Women create
EUobserver in October 2018.68 solutions to social violence and have been
The MeTooEP movement was of- self-starters when brokering deals because
ficially started in March 2018 by Jeanne they have historically been unseated at the
Ponte and a coalition of E.P. workers in an negotiation table, according to Casale.72
effort to break down normalized behavior She added that peace talks which include
and make invisible violence visible. The women are 35% more likely to last 15 years
coalition supported the implementation or more. This fact is not because women
of the October 2017 resolution, which had are pacifiers:
been passed in plenary session the previous Often there’s this inherent argument
October, gaining 1,000 signatures within being made that women are inherently
one week to present to the Parliament.69 more peaceful. I do not subscribe to
The blog followed this petition, especially that school of thought. I think if the
as it became clear that enforcing new mea- situation were flipped, we would do
sures against sexual harassment could be just as much as men. It’s about power.
It’s about resources. It’s about getting
an uphill battle; change means giving up
the most inclusive view of how to solve
normative, formal patriarchal structures.
society’s problems — which is what
The resistance brings a historically private a peace agreement is — how to solve
issue into the political arena, through in- societal problems ... The argument is
dividual workers who call attention to the that no, it’s not that women are more
blurred boundary between governmental peaceful, nice or better people. We
and personal behavior. have been traditionally left of power

65 Monica Anderson and Skye Toor, “How Social Media Users Have Discussed Sexual Harassment since #MeToo Went Viral.”
66 Google Trends, “Me Too Rising.”
67 Zarkov, Dubravka, and Kathy Davis. “Ambiguities and Dilemmas around #MeToo: #ForHow Long and #WhereTo?” European
Journal of Women’s Studies 25, no. 1 (February 2018): 3–9. doi:10.1177/1350506817749436.
68 Petter Teffer, “Frustrated EU Parliament Staffers Set up #MeToo Blog.”
69 Sally Farhat, “#MeTooEP: Fighting Sexual Harassment in the European Parliament.”
70 Mona Lena Krook and Fiona Mackay, Gender, Politics and Institutions. 191
71 Ibid.
72 Appendix 7


97023 Body_176pg_6.7x9.8_R5.indd 49 1/11/21 10:16 AM

structures and had to go around the without risk. The consequence of #MeToo
system to be entrepreneurs of our is the potential loss of some goals as a com-
own needs, and society’s needs. That promise for investment from institutional
creativity gives us a leg up in solving leaders. Thus, MeTooEP cannot gain the
support of all MEPs without capitulating
Feminist solutions like Burke’s and on some elements of its platform, an issue
Ponte’s are distinct because they have that will likely be raised in the 2019-2024
adapted to being left out of formal peace mandate. The success of any entrepre-
talks. An example of a formal peace agree- neur depends on the interest of investors.
ment is the structure of the Advisory Com- For MeTooEP, the investors are people
mittee — victims were not at the decision with power in the Parliament. Until the
table. Low trust in the Committee pushes Parliament has a full stake in the cause of
victims away from formal mechanisms and movement, i.e., feminists holding all the
toward their own answers: the MeTooEP positions of influence, MeTooEP will have
blog and pledge. to strike deals with Parliamentary leader-
Sexual harassment in the Parliament ship. According to Casale, the movement
is a form of social war. If victims had been must “play the short and the long game.”75
included in discussions at the beginning, To focus too soon on the end goal — new
the violence may have been avoided. If Parliament organizations and E.U.-wide
victims had been included as the conflict laws against sexual harassment — would
started to arrive, they could have asked be self-sabotage for MeTooEP. Empow-
for protection for their bodies. Now, the ering less powerful individuals too quick-
conflict has occurred, and the victims are ly shocks the patriarchal system and is an
finally being included in reconstructive impetus for even more social violence,
conversations to demand equal resources i.e., pushback from powerful Parliament
to recover.74 Women in the Parliament are voices, such as the conservative MEPs. For
now creating structures to heal on their now, as the movement’s symbols gain vis-
own because they never got to fight for ibility, their testimonies will legitimize the
their security in the first place. need to put more resources into the issue
But no entrepreneurial venture goes of sexual harassment, helping the issue
gain stakeholders — to em-power. ■

73 Appendix 7
74 Appendix 7
75 Ibid.


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Teresa Casale, Lyric Thompson, Sarah Gammage, and Lila
O’Brien-Milne. “Progress Under Threat: A Report Card
on the Secretary-General’s Second Year from the Feminist
UN Campaign.” International Center for Research on
Women, 2018.
Teresa Welsh. “Guterres Improves Grade on Feminist UN
Campaign Agenda.” Devex, January 24, 2019. https://www.
The Council of the European Union. “COUNCIL DIRECTIVE
2000/78/EC.” Official Journal of the European Commu-
nities, November 27, 2000.
“The Legal System of the European Union.” Europedia.moussis.
eu. Europedia.Moussis.Eu (blog). Accessed April 1, 2019.
Thomas A. Birkland. “Focusing Events, Mobilization, and


97023 Body_176pg_6.7x9.8_R5.indd 53 1/11/21 10:16 AM


Interview with
Kimani Isaac
By Caroline Hsu

Kimani Isaac is a fifth-year Learning and Organizational Change

(LOC) student, and a knowledgeable resource for everything to do
with Northwestern’s Office of Undergraduate Research (OUR). During
her time at Northwestern, she’s participated in many of the programs
that the OUR offers, from Summer Undergraduate Research Grants
(SURGs) to Undergraduate Language Grants (ULGs). I sat down to
talk to Kimani about her experiences with the OUR and the wonderful
world of undergraduate research.


97023 Body_176pg_6.7x9.8_R5.indd 54 1/11/21 10:16 AM

CH: How did you first hear about the Office of Undergraduate Research?
KI: Wow, that takes me back! When did I get so old? I believe the first time I heard of
the OUR, I was doing this Summer Academic Workshop, and they came to do a pre-
sentation. I remember they had these weird (but cute!) cut-outs of all their research
grants, and I think it was [OUR Director] Peter [Civetta] who came to give the pre-
sentation to us. I think it was during the same week that I learned about the Office of
Fellowships, so that was the week I learned about really cool opportunities to design
projects or do research. Basically, that was the week I learned about making money at
CH: What grants and programs offered by the OUR have you participated in?
KI: It’s not every single one, but it’s definitely close! I’ve been very lucky in my expe-
rience at the OUR. I started out with a URG for the summer, and that was the first
major project that I did. It was a series of paintings that depicted two people’s expe-
riences of their synesthesia. [Note: Some of Kimani’s SURG paintings are currently
hanging on the walls of the OUR!] Then, I also applied for the ULG, and was lucky
enough to get that. I studied in Morocco for two months learning French. I also at-
tempted to apply for the Circumnavigators Travel Grant and the Academic Year URG,
but for the Circumnavigators Grant, my study abroad interfered with my eligibility.
CH: What advice do you have for students who want to get into under-
graduate research, but don’t know where or how to start?
KI: Go talk to an advisor! I don’t mean that in a rude way, or a dismissive way, I just
mean that everyone who works in the OUR is a sweet and caring human being who is
hired to help you do the things that you want to do. If you are unsure of what it is you
want to do, or unsure about what research even is, it costs nothing except a half hour
of your time to come in for an advising appointment, talk through your interests, talk
through what research is, and learn about it. Or, if you’re shy or introverted, you don’t
have to make a one-on-one advising appointment. During normal life, when there
isn’t a pandemic, there are on-campus events where you can go and learn about what
research is and what opportunities are available. At what other point in your life are
you going to get paid to do a project that you designed, from start to finish?
CH: Lastly, what is the most underrated resource that the OUR offers?
What’s something that a lot of people don’t know about, but has been
very helpful for you?
KI: There’s a lot! When you walk in, there are a lot of awesome decorations and
posters and pictures of cats, and it’s a really fun, cool office. It’s scary, because you’re
walking into the Financial Aid building, so I personally get sweaty, but when I walk
past Financial Aid and see the lighted office behind the glass door, and there are all
these cat posters and paintings and snacks, it’s just a really warm and welcoming en-
vironment. People get really intimidated either because of the building that it’s in, or
the location, or the fact that it has “Office” in its name, but it’s really not that stressful
if you just pop in, say “Hey” and grab some Teddy Grahams and go about your day!


97023 Body_176pg_6.7x9.8_R5.indd 55 1/11/21 10:16 AM

Department of German

Type 2 Diabetes Care

and Management:
A Comparison of German and
American Approaches
by Sarah Dinegar

Type 2 diabetes, or T2D, affects over 422 million people worldwide.
In 2017, diabetes care for the 29 million T2D Americans cost $327 billion,
an approximately 88% increase from an American Diabetes Association esti-
mate of $174 billion in 2007. These exorbitant costs are primarily associated
with the consequential secondary complications and hospitalizations of T2D.
These include cardiovascular disease, stroke, blindness, kidney failure, neu-
ropathy, Alzheimer’s, and lower limb amputation. Within their multi-payer
healthcare system, Germany has used standardized, evidence-based inter-
ventions called Disease Management Programs, or DMPs, to manage T2D
since 2002. Studies have shown markedly improved healthcare delivery and
health outcomes since DMP implementation, including reduced incidence
of diabetic secondary complications, decreasing financial burdens of T2D in
Germany. No such programs exist in the United States’ fragmented health-
care system. American reform configuration warrants examination of and
comparison with German T2D DMPs’ successful methods. This study em-
ploys interviews and surveys to investigate German and American primary
care physicians’ opinions of the efficacy of their nation’s respective T2D
management methods in improving health outcomes, healthcare costs, and
quality of care. German physicians reported similar protocol and resource
availability for T2D management, as they all enroll their T2D patients in
DMPs. In contrast, American physicians’ responses varied widely by clin-
ical network and patients’ insurers. This thesis will discuss strengths and
weaknesses of both systems as well as outline several universal challeng-
es encountered with management of T2D. It will also provide insight into
primary care physicians’ opinions and recommendations on best directions
forward for chronic disease management, particularly addressing these uni-
versal challenges.


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Background Information & according to Deutsches Ärzteblatt Inter-
Literature Review national.5 From 2012 data, the nationwide
German National Health Interview and
1. Why Type 2 Diabetes Needs to be Examination Survey for Adults found the
Noticed overall prevalence of T2D to be 7.4% in
Type 2 Diabetes, or T2D, is one of the German population between 18 and 79
two types of Diabetes Mellitus, a pathol- years of age.6
ogy characterized by the body’s inability Average healthcare expenditures for
to control the blood concentration of the diabetics were 2.3 times higher than what
small sugar called glucose that is central to expenditures in absence of diabetes would
nutrition and metabolism.1 Type 1 Diabe- be.7 Furthermore, care for diagnosed dia-
tes Mellitus usually manifests itself early in betics accounts for 1 in 4 healthcare dollars
life and is defined by the body’s inability to in the U.S., more than half of that expendi-
produce insulin, the hormone that controls ture being directly attributable to diabetes,
blood glucose levels.2 T2D, however, typi- according to the American Diabetes Asso-
cally develops later in life and is defined by ciation.8 These massive costs in both na-
progressive increased resistance to insulin tions are not primarily associated with the
due to prolonged high blood glucose levels. molecular cause of diabetes — the body’s
This thesis deals exclusively with T2D. inability to properly metabolize glucose
T2D has steadily risen to be one of the — but instead are largely associated with
most significant health concerns world- consequential long-term complications
wide: the number of individuals affected and hospitalizations due to prolonged high
has risen from 108 million in 1980 to 422 glucose levels, including cardiovascular
million in 2014.3 According to the National disease, leading to heart attack and stroke,
Diabetes Statistics Report in 2017, 8.9% of blindness, kidney failure, nerve damage,
the U.S. population, or 29 million people, Alzheimer’s, and lower limb amputation.9
have T2D. It was America’s seventh lead- In Germany, individuals with T2D had
ing cause of death in 2015. The number 1.81 times higher direct annual healthcare
of adults diagnosed with T2D is estimated costs, €3352 vs. €1849, and 2.07 times
to have tripled in the last 20 years,4 which higher indirect annual healthcare costs,
would suggest there are fundamental en- €4103 vs. €1981 annual healthcare costs
vironmental or behavior contributors as- than those without diabetes.10 As expect-
sociated with this non-communicable dis- ed, these increased costs were significantly
ease. There were approximately 5.8 million associated with cardiovascular complica-
people with T2D in Germany as of 2010, tions, long duration of diabetes, and treat-
1 American Diabetes Association,
2 Ibid.
3 C.D. Mathers and D. Loncar, “Projections of global mortality and burden of disease from 2002 to 2030,” PLoS Med, 3(11), e442.
4 Centers for Disease Control and Prevention, “National diabetes statistics report” (2017).
5 T. Tamayo , R. Brinks, A. Hoyer, O. Kuß and W. Rathmann, “The prevalence and incidence of diabetes in Germany: an analysis
of statutory health insurance data on 65 million individuals from the years 2009 and 2010,” Deutsches Ärzteblatt International,
113(11), 177.
6 Ibid.
7 CDC, “National diabetes statistics report” (2017).
8 American Diabetes Association, “Economic costs of diabetes in the US in 2017” (2018), Diabetes care, 41(5), 917-928.
9 C.D. Mathers and D. Loncar, “Projections of global mortality and burden of disease from 2002 to 2030.”
10 S. Ulrich, R. Holle, M. Wacker, et al., “Cost burden of type 2 diabetes in Germany: results from the population-based KORA
studies,” BMJ open, 6(11), e012527.


97023 Body_176pg_6.7x9.8_R5.indd 57 1/11/21 10:16 AM

ment with insulin.11 Beyond the intangible diabetic. More than one in three American
costs of pain, suffering, and decreased qual- adults fall into this category of prediabetes
ity of life that Type 2 diabetics experience — approximately 33.9% of the U.S. adult
with the accompanying health problems of population.17 Perhaps even more concern-
T2D, these economic estimates highlight ing is the fact that nearly 90% of those 84.1
the substantial financial burden that diabe- million adults are unaware they are predia-
tes imposes on society. betic.18 Prediabetes often leads to T2D, and
The estimated total economic cost due elevates risk of heart disease and stroke.19
to diagnosed diabetes in the U.S. in 2012 The consequential health and economic
was $245 billion, a 41% increase from the detriment that the massive and growing
previous estimate of $174 billion in 2007.12 epidemics of prediabetes and T2D in both
This cost was estimated to be $327 billion Germany and the U.S. calls for drastic ac-
in 2017, a further 26% from 2012 once ad- tion. This study will examine how such ac-
justed for inflation.13 Of this total, $237 bil- tion ought best be taken.
lion were due to direct medical costs while 2. German & American Healthcare
$90 billion can be attributed to reduced Systems Compared
productivity.14 These ever rising costs are Many industrialized countries employ
due to both the growth in T2D prevalence a universal mandate for healthcare cover-
and the increased medical costs per diabet- age, of which there are three primary pro-
ic, particularly among the population aged gram types. Universal coverage is charac-
65 years and older, thus contributing heav- terized by a health insurance mandate and
ily to the growing economic burden of the alleviates the costly overreliance on emer-
Medicare program.15 While these reported gency services that comes from a lack of
costs did not distinguish between Type 1 preventive care for uninsured populations.
and 2 diabetes, 90 to 95% of diabetes cases In the first type of universal coverage, a na-
in the U.S. are T2D, so the heavy majority tional health service, medical services are
of these costs can be assumed to be associ- delivered through government-salaried
ated with T2D.16 physicians in publicly-owned and -oper-
Diabetic progression is identified by ated hospitals and clinics, financed by the
a patient’s glycated hemoglobin (HbA1c) government through tax payments. Pri-
value, a key diagnostic marker used as an vate physicians collect their fees from the
index of mean glycemia, or blood glucose government and have specific regulations
levels, in diabetics. HbA1c levels corre- on their practices. Examples of this system
spondence to diabetic progression do vary include the United Kingdom, New Zea-
slightly among individuals, but the general, land, and Spain. In the second type, a na-
universal parameters are as follows: <5.7% tional health insurance or single-payer sys-
= normal, 5.7–6.5% = prediabetic, >6.5% = tem, a single government entity collects all
11 Ibid.
12 American Diabetes Association, “Economic costs of diabetes in the US in 2012” (2013), Diabetes care, 36(4), 1033-1046.
13 American Diabetes Association, “Economic costs of diabetes in the US in 2017” (2018).
14 Centers for Disease Control and Prevention, “National diabetes statistics report” (2017).
15 American Diabetes Association, “Economic costs of diabetes in the US in 2017” (2018).
16 Centers for Disease Control and Prevention, “National diabetes statistics report” (2017).
17 Ibid.
18 Ibid.
19 Ibid.


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“American medical treatment is often overspecialized,
extremely inequitable, and problematically neglectful of
primary and preventative care.”
healthcare fees and pays out all healthcare among the best in the world, but American
costs. Canada, Denmark, and Sweden all medical treatment is often overspecialized,
employ this method in which medical ser- extremely inequitable, and problematical-
vices are publicly financed but not publicly ly neglectful of primary and preventive
provided. In the third type, a multi-payer care.22 While the U.S. ranked fifth for
health insurance or all-payer system, uni- quality of care, it came in last in efficiency,
versal health insurance is provided via healthiness of citizens’ lives, and efficien-
not-for-profit health insurance funds, or cy among those 11 countries. Germany fell
“sickness funds,” that collect premiums in the middle of the pack among the 11
from employees and employers and that countries regarding healthcare spending
are used to eliminate the administrative per capita at $4,495, while the U.S. ranked
costs for billing by paying physicians and highest at $8,508. However, Germans
hospitals at uniform rates. Japan, France, were the most likely of the 11 nationalities
and Germany all utilize this system. In con- to hear back from a doctor quickly if they
trast, the U.S. healthcare system is unique had a question, the most likely to be able to
and not uniform, with no universal health get a same-day or next-day appointment,
care coverage mandate.20 Instead of operat- the most likely to be able to access doctors
ing a national health service, a single-pay- after-hours without problem, and were
er national health insurance system, or a found to rarely use emergency rooms.
multi-payer universal health insurance The U.S. was at low end for each scenar-
fund, the U.S. healthcare system can be io.23 Additionally, according to an analysis
best described as a hybrid system. in the American Journal of Public Health,
In a Commonwealth Fund Commis- for each $100 Germany spends on health-
sion healthcare comparison contrasting care, it extends life by about 16 weeks.
the U.S. with Australia, Canada, France, Meanwhile in America, each $100 spent
Germany, the Netherlands, New Zealand, on healthcare resulted in only two to three
Norway, Sweden, Switzerland, and the weeks more of longevity.24
U.K., the U.S. ranked last overall in many
3. Type 2 Diabetes Care Compared
categories.21 This demands attention, espe-
cially with the American healthcare system 3.1. Type 2 Diabetes Care in the German
being by far the world’s most expensive Healthcare System
per capita. U.S. healthcare specialists are The nearly 6 million Type 2 diabet-

20 Department of Professional Employees, “The U.S. Healthcare System: An International Perspective Factsheet.”
21 K. Davis, K. Stremikis, D. Squires, & C. Schoen, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care
System Compares Internationally, 2014 Update.” The Commonwealth Fund Commission on a High Performance Health System.
22 Department of Professional Employees, “The U.S. Healthcare System: An International Perspective Factsheet.”
23 E. Mossialos, M. Wenzl, R. Osborn & C. Anderson, “International Profiles of Healthcare Systems,” The Commonwealth Fund.
24 O. Khazan, “What American Healthcare Can Learn from Germany,” The Atlantic.


97023 Body_176pg_6.7x9.8_R5.indd 59 1/11/21 10:16 AM

“Prevention is a priority healthcare,29 so Germany has tried to com-
bat its diabetes epidemic with a preventive
outlook. Disease Management Programs,
in German healthcare, so or DMPs, are programs geared towards
specific groups of patients suffering from
Germany has tried to combat a chronic illness, such as T2D, who receive
a standardized, coordinated, set of evi-
its diabetes epidemic with a dence-based interventions. The goals are
to enhance the patients’ long-term health
preventive outlook.” outcomes, lower healthcare spending
by reducing the need for hospitalization
and other costly treatments, and improve
quality of medical care.30 Though many of
ics in Germany is shown to be a 38% in- America’s pioneering DMPs in the 1990s
crease from 1998.25 Individuals with T2D did not show short-term positive impacts,
in Germany were found to incur approx- other nations including Germany have
imately twice as high both direct and in- since tried to follow suit with their own
direct healthcare costs annually than those nuanced approaches.31 German statuto-
without it.26 T2D complications, which in- ry health insurance funds started offering
clude foot amputation, retinopathy, blind- DMPs nation-wide in cooperation with
ness, nephropathy, end-stage renal disease, primary care physicians in 2002.32 As of
stroke, myocardial infarction/cardiac ar- 2006, 75% of primary care physicians in
rest, ischemic heart disease, chronic heart Germany were registered with DMPs,33
failure, and angina pectoris, have been and nearly four million patients had been
shown to have a significant impact on to- enrolled in T2D DMPs by 2014.34 In Ger-
tal healthcare costs in Germany not only at man DMPs, the primary care physician sees
the time of an event, but also in subsequent DMP-enrolled patients approximately ev-
years.27 Direct medical costs of diabetes in ery three months, keeps close tabs on their
Germany averaged 21 billion euros, and adherence to program protocol, and coor-
the prevalence of the disease in Germany dinates specialist referrals. The DMP pro-
is projected to continue increasing in up- tocol includes diabetes education, nutrition
coming years.28 consultation and guidelines, enrollment in
Prevention is a priority in German fitness classes and gym membership, reg-
25 “Diabetes in Zahlen,” Deutsche Diabetes Hilfe.
26 S. Ulrich, R. Holle, M. Wacker, et al., “Cost burden of type 2 diabetes in Germany: results from the population-based KORA
27 K. Kähm, M. Laxy, U. Schneider, et al., “Health Care Costs Associated With Incident Complications in Patients With Type 2
Diabetes in Germany,” Diabetes Care, 41(5): 971–978.
28 I. Köster, I. Schubert & E. Huppertz, “Follow up of the CoDiM-study: cost of diabetes mellitus 2000–2009,” Deutsche Mediz-
inische Wochenschrift, 137:1013–16.
29 O. Khazan, “What American Healthcare Can Learn from Germany.”
30 S. Brandt, J. Hartmann & S. Hehner, “How to design a successful disease-management program,” McKinsey & Company.
31 Ibid.
32 Bundesversicherungsamt, Zulassung der strukturierten Behandlungsprogramme (Disease Mangement Programme – DMP)
durch das Bundesversicherungsamt (BVA).
33 H. Nagel, T. Baehring & A. Scherbaum, “Implementing Disease Management Programs for Type 2 Diabetes in Germany,” Ger-
man Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University of Dusseldorf, Germany, 50-53.
34 S. Fuchs, C. Henschke, B. Blümel & M. Reinhard, “Disease Management Programs for Type 2 Diabetes in Germany,” Deutsches
Ärzteblatt International, 111(26), 453–63.


97023 Body_176pg_6.7x9.8_R5.indd 60 1/11/21 10:16 AM

ular foot, eye, and kidney exams, medica- a necessity. As discussed in the German
tions (varies by disease progression), and healthcare section, disease management
strict, routine blood sugar checks. programs emphasize educating the patient
Recent studies have shown markedly on how to better self-manage their con-
improved health care delivery and decreas- ditions using evidence-based guidelines.
es in enrolled patients’ HbA1c values35. Fragments of U.S. healthcare have also
Furthermore, Germany’s DMPs signifi- been making efforts to utilize models of
cantly reduced incidence of several diabet- integrated care with some characteristics
ic medical complications and had lowered similar to the German DMPs. Integrated
overall cost of care by 13% as of 2010.36 care, also known as coordinated care, and
These successful results, coupled with patient-centered collaborative care, or dis-
some of the past, more mixed, results war- ease management, have the clear purpose
rant further investigation into these pro- of providing individuals with chronic dis-
grams’ efficacy, as there are many variable eases with coordinated care that empowers
factors. This study approached evaluating the patient and as a result reduces demand
the efficacy of T2D DMPs via inquiry of for hospital admissions and improves
opinions of Germany primary care phy- health outcomes. One particular initiative
sicians. As they have been administering in the U.S. towards better disease manage-
T2D care through these programs to their ment is seen in the rise of accountable care
patients for many years, they have im- organizations, or ACOs, which have been
portant firsthand insights into the strong piloted in recent years by private insurers,
and weak points of the DMPs. Due to the states, and the Centers for Medicare and
lack of centralization of information from Medicaid Services.37 ACOs stand to im-
the nature of the U.S. healthcare system, prove clinical integration and coordination
comparable statistics for the U.S. disease and build a sharper focus on prevention,
management are largely inaccessible and disease, management, and self-care.38 An-
progress is thus harder to discern. Howev- other example of American disease man-
er, the nationwide success of German T2D agement can be seen with the American
DMPs apparent from these certain studies Diabetes Association’s Standards of Med-
warrants a point of comparison with the ical Care for Diabetes. Their guidelines in-
differing American approach. clude recommendations for glucose mon-
3.2. Type 2 Diabetes Care in the American itoring, nephropathy screening, glycemic
Healthcare System control, blood pressure control, lipid man-
With the rising burden of chronic agement, immunizations, detailed guide-
disease, America’s aging population, and lines for lifestyle management regarding
a tight financial healthcare climate, de- nutrition, weight management, physical
livering better care in a more cost–effec- activity, tobacco use, alcohol consumption,
tive and health outcomes–focused way is and effective strategies for coping with

35 K. Kostev, T. Rockel & L. Jacob, “Impact of Disease Management Programs on HbA1c Values in Type 2 Diabetes Patients in
Germany,” Journal of Diabetes Science and Technology, 11(1), 117-122.
36 S. Brandt, J. Hartmann & S. Hehner, “How to design a successful disease-management program.”
37 Health Policy Institute, McCourt School of Public Policy, “Diabetes Management Programs: Improving Health while Reducing
Costs?,” Georgetown University.
38 M. McClellan, J. Kent, S. Beales, et al., “Accountable care: focusing accountability on the outcomes that matter: report of the
Accountable Care Working Group,” World Innovation Summit for Health.


97023 Body_176pg_6.7x9.8_R5.indd 61 1/11/21 10:16 AM

stress.39 Providing guidelines-based care
is challenging for primary care physicians “There is an enormous need
largely due to the insufficient amount of
time primary care physicians have to spend to more robustly incentivize
with each patient; studies found that only
on average 54.9% of necessary recommen-
dations were found to have been provided
both patients and providers
to adult patients by their primary care phy-
to focus heavily on
U.S. healthcare’s current fee-for-
service reimbursement system, which is
successfully fulfilling
characterized by physicians being paid per
person per visit rather than being paid on preventative protocol,
a basis of patient health outcome metrics,
generally does not offer specific compen- particularly in the case of
sation to healthcare providers for em-
phasizing preventative guidelines to help T2D.”
patients make changes to improve their
care costs, and quality of care for patients
health. Prevention is not deemed to be at
– from the approaches used in the doctor’s
the forefront of importance in American
office with the patient to the insurance and
healthcare.41 But for T2D, research clear-
policy level.
ly shows that high-risk individuals can
avoid developing T2D — or, those already 4. Purpose of Research Study
diagnosed can improve or reverse the Questions
condition — by implementing preventive This study will address the following ques-
lifestyle improvements, including losing tions:
weight through dietary intervention and A. In the opinion of German primary care
regular physical activity.42 Given both the physicians, what are T2D DMPs’ big-
health outcome and financial motivations, gest:
there is an enormous need to more robust- 1. Strengths?
ly incentivize both patients and providers 2. Weaknesses?
to focus heavily on successfully fulfilling 3. Areas of possible improvement?
preventative protocol, particularly in the B. In the opinion of American primary care
case of T2D. As no experiential research physicians, what are their T2D care’s
of primary care physicians with disease greatest:
management programs exists, this study 1. Strengths?
provides new insight into what methods 2. Weaknesses?
of chronic care management providers of 3. Areas of possible improvement?
primary care themselves believe most ef- C. In the opinion of German primary care
fectively improve health outcomes, health- physicians, how effective are German

39 American Diabetes Association, “Standards of medical care in diabetes,” (2017), Diabetes Care, 40(S1), S1–S131.
40 E. A. McGlynn, S. M. Asch, Adams, et al., “The quality of health care delivered to adults in the United States,” New England
Journal of Medicine, 348(26), 2635-2645.
41 B. Frist & A. Rivlin, “The Power of Prevention,” U.S. News and World Report.
42 C. D. Mathers & D. Loncar, “Projections of global mortality and burden of disease from 2002 to 2030,” PLoS Med, 3(11), e442.


97023 Body_176pg_6.7x9.8_R5.indd 62 1/11/21 10:16 AM

T2D DMPs in: conducted an informative interview with
1. Improving health outcomes of an employee of the YMCA who runs Den-
T2D patients? ver’s branch of the Diabetes Prevention
2. Reducing costs associated with Program, or DPP. The YMCA runs their
secondary complications of T2D? DPP in a partnership with the CDC’s Na-
3. Improving quality of care deliv- tional Diabetes Prevention Program. This
ered to T2D patients? DPP program is a version of a nationwide,
D. Considering the opinions of all of the year-long lifestyle intervention program
physicians questioned, what are the cur- for individuals at risk of developing T2D
rent most effective management and that was started by the National Institute
treatment practices for T2D? of Diabetes and Digestive and Kidney
E. Looking forward, what changes in phy- Diseases. Data from all 11 interviews was
sicians’ practicing or healthcare policy used in interview results, and a total of 24
would be most effective at improving survey responses administered to primary
the health outcomes, cost burdens, and care physicians were correctly filled out
quality of care of T2D patients? and recorded. The interviews were all ini-
tially recorded, and I listened back to each
Research Methods & recording following the interviews to take
Designs detailed notes, then deleted the recordings.
The data from the results were compiled
Overview into qualitative results, analysis, and con-
In Germany, I interviewed 8 prima- clusions.
ry care physicians, emailed them a link to
an online survey, and requested they for- Results
ward the link to primary care physician
colleagues to fill out the survey as well. 1. German Physician Results
The length of time they have practiced 1.1. T2D Diagnosis & Disease Management
medicine was asked in the survey, but oth- Program Protocol in German Healthcare
erwise, no other personal or demographic Every 2 years after age 35, patients
information was recorded. Data from all 8 have a check-up that is covered by health
interviews were used in results, and a total insurance, though not everyone goes in
of 7 survey responses were correctly filled reality, physicians reported. There is a
out and recorded. All recruitment of and screening for T2D at this check-up in the
communication with German physicians, measurement of HbA1c, and it was stressed
including emails, the interviews, and the that many patients do not realize they have
surveys, was conducted in German. In the T2D. Though the exact designations of
U.S., in Colorado, I interviewed 9 prima- HbA1c levels vary by age and race, general
ry care physicians, emailed them a link to parameters in Germany were the same as
an online survey, and requested they for- the U.S., where under 5.7% is normal, 5.7–
ward the link to primary care physician 6.5% is pre-diabetic, and over 6.5% is dia-
colleagues to fill out the survey as well. I betic. If patients have a prediabetic HbA1c,
also interviewed a care coordinator in one physicians typically do not yet recommend
of the primary physician’s offices for sup- DMP enrollment but rather recommend
plemental, contextual data. Additionally, I lifestyle changes, including nutritional in-


97023 Body_176pg_6.7x9.8_R5.indd 63 1/11/21 10:16 AM

struction and an increase in physical activ- from 9 to 11 a.m. and 4 to 5:30 p.m. ev-
ity. They also request the patient come in ery day are only for the already planned
for more frequent appointments. appointments like these DMP appoint-
When a patient is diagnosed with a ments, which are each very brief, leaving
diabetic HbA1c, they are enrolled in a T2D sufficient time throughout the day for ap-
DMP. To enroll their patients in a DMP, pointments regarding more proximate or
German physicians must take an educa- urgent illnesses, explained this physician.
tion course; most primary care physicians
1.2. Strengths & Weaknesses of T2D DMP
participate in DMPs. DMPs are largely
Most of the doctors reflected that
covered by “Krankenkassen,” or health in-
they remembered having been quite an-
surance. Approximately 75 to 90% of the
noyed with DMPs when they were first
program components are fully covered by
implemented. They thought, “Why do I
insurance, and patients are generally will-
need to do this? This is pointless; I already
ing to pay the remaining small amount out
administer good enough care myself. For
of pocket, reported physicians. Health in-
whom should we do this? For the health
surance pays for most medicines that the
insurance companies?” But now, approx-
doctor deems necessary. The T2D DMP
imately 16 years after DMP implementa-
protocol includes enrollment in a diabe-
tion, almost every physician interviewed
tes education course, enrollment in fitness
admitted that they think the DMPs do add
programs, and consultation with a dietician
value for a variety of reasons.
to supplement nutrition recommendations
These reasons include the structure
from the doctor. The DMP protocol also
and regularity inherent to DMPs, the sus-
includes regular check-ups with an oph-
tainability of lifestyle changes they have
thalmologist, or an eye doctor; a podiatrist,
seen in their DMP-enrolled patients over
or a foot doctor; a nephrologist, or a kid-
time, the decreased incidence of secondary
ney specialist; and in extremely progressed
complications in DMP-enrolled patients,
cases, an endocrinologist, a hormone spe-
and the accountability that results from the
DMP platform. However, physicians also
The primary care physician receives
reported weaknesses, including excessive
feedback from each specialist; they over-
documentation and bureaucracy, a lack of
see and direct all aspects of care for the
customization to patients, the potential for
patient. A DMP participant must come to
alternate financial motives, and a lack of
regular appointments every three months.
added value.
Participants receive a phone call from the
health insurance company if they miss an 2. American Physician Results
appointment, in which the health insur-