MASTHEAD

vol. 15 | 2019-2020

EDITORS-IN-CHIEF

Andrew Cao + Emily Suen

FACULTY ADVISOR

Allen Taflove
MANAGING EDITORS

Leslie Bonilla + Irene Chang

ART DIRECTORS

Maia Brown + Sarah Tani

DIRECTOR OF OUTREACH

Joy Zheng
DIRECTORS OF DEVELOPMENT

Lucy Yuan + Shreya Sriram

EDITORS

Pranav Baskar, Haley Chang, Daisy Conant,

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

Jenna Greenzaid, Siying Luo,

Bryan Sanchez, Nancy Qian
OUTREACH TEAM

Gabrielle Tsoi, Alex Solivan, Khaled Abughoush

DEVELOPMENT TEAM

Khaled Abughoush, Ina Huang, John Cao

1

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 TABLE OF
CONTENTS
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
Institutionalism

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

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
Endangerment

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 LETTER FROM THE
ADVISOR
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 thenurj.com, 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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 LETTER FROM THE
EDITORS
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, thenurj.com.

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!

Sincerely,

Andrew Cao and Emily Suen

Editors-in-Chief

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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.
com/2019/02/15/sports/nfl-colin-kaepernick-protests-timeline.html
2 Ibid.
3 S. R., Harper, “There would be no FL without black players. They can resist anthem policy.”, The Washington Post, May 24,
2018, https://www.washingtonpost.com/news/posteverything/wp/2018/05/24/there-would-be-no-nfl-without-black-players-
they-can-resist-the-anthem-policy/?utm_term=.92367bb814b2\
4 Jahmal, Corner, “NFL: League under Scrutiny for Lack of Minority Coaches.”, Reuters , January 1, 2019, www.reuters.com/
article/us-football-nfl-coaches/nfl-league-under-scrutiny-for-lack-of-minority-coaches-idUSKCN1OV1CQ
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
Economics, www.washingtonpost.com/news/monkey-cage/wp/2017/04/27/nfl-draft-profiles-are-full-of-racial-stereotypes-and-
that-matters-for-when-quarterbacks-get-drafted/?utm_term=.e5584096c4e7, pp. 23-43.

97023 Body_176pg_6.7x9.8_R5.indd 6 1/11/21 10:16 AM

 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, www.washingtonpost.com/news/monkey-cage/wp/2017/04/27/nfl-draft-profiles-are-full-of-
racial-stereotypes-and-that-matters-for-when-quarterbacks-get-drafted/?utm_term=.e5584096c4e7.
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.

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

 player skill and other factors.13 David Ber-
ri and Rob Simmons conducted a similar
study in 2009, and also found evidence for
discrimination against minority quarter-
backs at salary quantiles above 50%.14 As
such, both of these papers conclude that
minority quarterbacks are paid lower wag-
es for comparable performance and con-
tract characteristics.
The inconsistent results in the prior
literature highlight the perils of omitted
variable bias, or OVB, and the importance
of adequate model specification in the
study of discrimination. If a key variable
is omitted that is also correlated with race,
the discrimination that we seek to detect
may be washed out by OVB. Additionally,
every existing study has been constrained
by using wage discrepancy as the basis
on which to assess discrimination. NFL
salaries are largely influenced by external
bargaining factors, which dilute the effect
of a team’s decisions on salary outcomes and
inhibit the interpretation of discrepancies
as team/owner racial preference.15 In this
study, I will use NFL Draft decisions as a
tool to better understand these preferences.
Methodology and Findings
Methodology Overview
As a starting point to develop models
to detect discrimination among NFL quar-
terbacks, I rely on a generalized labor mar-
ket research methodology outlined by the
National Academy of Sciences.16 To detect
discrimination in observational data, it is
critical to adequately control for variables
that are correlated with both race and the
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, www.forbes.com/sites/franktherber/2016/03/08/the-
anatomy-of-an-nfl-player-contract/#7b4238aa3faa.
16 Rebecca M., Blank, et all, “Measuring Racial Discrimination.”, National Academies Press
17 Ibid.
97023 Body_176pg_6.7x9.8_R5.indd 8
mistakenly attributing non-discriminatory
racial differences as due to employer racial
preference.17 Following the guidelines set
forth in the NAS report, I developed sev-
eral statistical models to tease apart these
non-discriminatory racial differences, thus
isolating the residual differences that may
be due to discriminatory behavior.
To build these models, we require an
outcome variable on which to assess racial
differences. No prior literature has used
the NFL Draft to assess discrimination,
which is a missed opportunity to observe
the preferences of NFL teams. At the be-
ginning of each season, teams are given the
chance to select top young players emerg-
ing from college football to play for their
franchise. Each team is assigned a num-
ber of draft picks, and players are selected
sequentially until all 250 picks have been
used. The draft provides a strong basis
on which to observe decisions behind the
evaluation of players, as outcomes are or-
dered, easily comparable, and entirely at
the discretion of NFL teams.
I use both collegiate and NFL data to
assess two distinct research questions re-
garding racial differences in the NFL Draft.
I will first use pre-draft information to ex-
amine whether race influences teams’ quar-
terback assessments, controlling for factors
related to college career and performance. I
will then flip this research question and use
professional career data to examine wheth-
er minority quarterbacks are systematical-
ly under-valued in the draft based on how
they go on to perform in the NFL.
My methodology is not exempt from
potential estimation biases resulting from
1/11/21 10:16 AM
 unobservable variables. It should be noted
that NFL teams rely primarily on qualita-
tive scouting to evaluate collegiate quarter-
backs. We must then consider the potential
for OVB arising from differences between
our quantitative proxy and the true scout-
ing evaluation. Generally, omitting a factor
that is important in predicting an outcome
variable leads to misspecification bias in
the model, such that the expected value of
the estimated parameters differ from their
true population values.18 In developing a
model where this OVB is unavoidable, it
is valuable to understand the direction and
magnitude of the biases on the coefficients
of interest.
The bias is dependent on the pair-
wise correlations between race, scouting
evaluation, and the other covariates.19 It
can be shown that that the bias on the race
coefficient, say c , is Bias (L Ny ,
c ) = bk d
where b k is the slope coefficient for the
effect of scouting evaluation on draft pick
in the population model, and is the slope
coefficient for the effect of race on scouting
evaluation in an auxiliary regression — see
full text for detailed analysis. We assume
b k will be negative, as higher scouting
evaluations will lead to earlier selection
in the draft. The effect of race on scouting
evaluation, dNk , is unknown. However, we
can infer that any effect of race on scout-
ing will be due to the same discriminatory
behavior that we are seeking to assess in
our estimated model, and expect the bias to
work in the same direction as our observed
discrimination coefficient. As such, our es-
timate of the race effect may be an inflated
overestimate, but the directionality will be
reliable.
Because of the potential for OVB,
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.
97023 Body_176pg_6.7x9.8_R5.indd 9
it is critical to find an adequate proxy for
scouting. This proxy should be directly
indicative of a quarterback’s value to his
team. For this purpose, I rely on a metric
employed by Berri & Simmons that they la-
bel “Net Points.” To benchmark a quarter-
back’s in-game contributions, Berri et al.
regressed points scored by a team’s offense
on factors associated with moving and
possessing the ball.20 These models provide
marginal effects of the performance of an
individual quarterback, or QB, on the out-
come of a typical game.
Given the marginal effects, the au-
thors normalize the value of plays and
turnovers around one yard, thus obtain-
ing an intuitive metric that they label “QB
Score”.21 The weights on these three quar-
terback statistics are outlined as follows in
Equation 1:
(1) QB Score = All Yards - 3 * Plays
- 30 * Turnovers
QB Score provides a straightforward
metric on which to evaluate quarterbacks
based on their direct statistical contribu-
tions to a team’s probability of winning.
Assessing Relationship between Race and
Draft Evaluation
The first component of this analysis
will examine whether race influences NFL
teams’ evaluation of quarterbacks, con-
trolling for information available before
the draft. I seek to answer two questions
at this stage in the analysis. First, does race
influence draft order among players who
are drafted, all else equal? Second, among
collegiate players, does race influence the
likelihood of being drafted at all?
The sample contains NFL Draft data
for 2002-2018, and collegiate passing sta-
1/11/21 10:16 AM
 tistics and other factors from 2002-2017.
This information was available for 849
NCAA Football Bowl Subdivision (FBS)
quarterbacks, 180 of whom were selected
in the NFL draft. All collegiate and draft
data were obtained from ProFootballRef-
erence.com. All data manipulation and sta-
tistical analyses were performed using R
software version 3.5.3.
In an effort to isolate the effect of race,
we must identify covariates that are known
to influence a player’s pre-draft evaluation.
Because in-game performance will certain-
ly affect a player’s perceived value, I include
the “QBScore” metric outlined in the pre-
ceding section. Player evaluations are also
influenced by the caliber of competition
faced by a QB in his college career.22 To
account for this, I include “Conference,”
a 6-factor categorical variable. To control
for team success, I define “Ranked25” as a
binary variable taking a value of 1 if the
player’s team finished in the top 25 in AP
polling in more than half of his seasons, and
“WinPercent” as the proportion of games
won during his career. Finally, because the
data span over a 16-year time period, bias
may arise from aggregate changes in the
value of the QB position over time. Thus,
I include yearly fixed effects terms to ac-
count for variability of quarterback value
in the draft.
The literature suggests that the effect
of race will not be consistent at differing
levels of on-field performance; for exam-
ple, Doran & Doran observed a significant
effect of race only at certain salary quan-
tiles.23 This differential race effect by skill
level makes sense intuitively, as teams may
moderate discriminatory behavior in order
to land a highly-touted player. Slope-vari-
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.
10
97023 Body_176pg_6.7x9.8_R5.indd 10
ant effects are captured by interacting race
and QBScore in the model.
I will first focus on the 180 quarter-
backs drafted between 2002 and 2018 to
determine whether race affects the order
in which players are selected in the draft.
Overall draft pick is used as the outcome
variable, and is treated as numeric. A linear
model to predict overall draft pick using
the established set of covariates is shown
below in Equation 2:
Picki = b 0 + cRi + b1 (Ri # QBScorei)
(2) 5 15
/ b j Xij + / dt Yearit + fi
j=2 t=1
where Ri represents a race indicator tak-
ing on a value of 1 for minority players,
Xij represents the value of covariate j for
player i, represents the race difference at
QBScore = 0, and b1 represents the rate of
change of the race effect at differing values
of QBScore. A significant and positive co-
efficient in this model would signify lower
average all-else-equal draft selections for
minority quarterbacks.
Estimated parameters for the regres-
sion model and their standard errors are
shown in Table 1. The estimated coeffi-
cients are statistically insignificant on both
the race dummy variable (p = .509) and the
race-QBScore interaction term (p = .805).
As such, we fail to reject the null hypoth-
esis that the effect of race on overall draft
pick is equal to zero, and conclude that
race does not seem to influence draft order
among players selected in the draft.
Though race does not appear to affect
the order that a player is taken in the draft,
there is still the potential for racial differ-
ences to play out among fringe players who
are on the cusp of being selected. To ad-
1/11/21 10:16 AM
 “For the 92% of Pi
(3)
ln ( 1 - P ) = b 0 + cRi + b1 (Ri # QBScore)

quarterbacks in our sample

i
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-
quarterbacks.
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-
Score.
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

11

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

 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-
omy

12

97023 Body_176pg_6.7x9.8_R5.indd 12 1/11/21 10:16 AM

 than under purely skill-based evaluation.
As such, minority quarterbacks will have
higher average performance for compara-
ble draft placement. Under this framework,
I will determine whether there are system-
atic racial differences in “draft error;” that
is, examine whether minority quarterbacks
tend to out-perform their draft ranking to
a greater degree than white players.
To employ this strategy, we need
outcome variables that are indicative of a
quarterback’s career success at the profes-
sional level. I again use QBScore from Ber-
ri et al. to account for per-game on-field
performance factors. To assess team suc-
cess, I will use career win percentage and
number of wins over the quarterback’s ca-
reer. Longevity is also an important factor,
so I include games started over a player’s
entire career.
The sample contains NFL passing and
team statistics from 2000-2018, and NFL
Draft data from 2000-2011. To avoid cen-
soring bias, I only include players drafted
in or before 2011 to allow sufficient career
development. This procedure resulted in a
sample of 99 quarterbacks.
To detect racial differences in draft
error, I regress each outcome measure on
race and overall draft pick. Once again,
to account for differential effects of race
across the skill spectrum, race and draft
pick are interacted in each model. I ob-
served a non-linear, decaying relationship
between overall draft pick and the longev-
ity outcomes, so I assign an inverse func-
tional form to the pick variable in the mod-
els for “Wins” and “Games Started.”
A generic regression equation for this
analysis is shown in Equation 5 below:
(5) Yi = b 0 + cRi + b1 (Ri # QBScorei)
+ b2 Pick + f i
where Yi represents the outcome for each
13
97023 Body_176pg_6.7x9.8_R5.indd 13
model, and the “Pick” independent variable
is assigned an inverse transformation for
the Wins and Games Started models. Es-
timated coefficients and their standard er-
rors are shown for each model in Table 3.
As anticipated, overall draft pick is
significant and negatively associated with
each performance outcome (p < .001 in all
models), that is, players taken earlier in the
draft tend to perform better in the NFL.
Both the race dummy variable and the
interaction term are insignificant in pre-
dicting QBScore and career winning per-
centage. However, turning to the longevity
outcomes on the right half of the table, we
observe significant coefficients for both
the race dummy variable and the interac-
tion term.
In the model to predict games start-
ed, we observe a coefficient of -29.410 (p
= .048) on the race dummy variable, and
an offsetting positive coefficient of 0.281 (p
= .077) on the race-pick interaction term.
Given these parameters, the sign of the ef-
fect flips in the early fourth round of the
draft, at pick 104. As such, we infer that,
with regard to longevity, minority players
tend to be under-valued relative to white
players in the later rounds of the draft and
over-valued in the early rounds.
We observe a similar result in the
model for career wins, with a coefficient of
“In both stages of the
analysis, I observe
racial differences only
at the lower end of
the skill spectrum.”
1/11/21 10:16 AM
 -16.50 (p = .067) on the race dummy and a
positive coefficient of 0.168 (p = .081) on
the interaction term. With similar inter-
pretation to the prior result, we infer that
minority players are under-valued relative
to white players in the later rounds of the
draft.
The results for games started and
wins are represented visually in Figure 2.
Each player in the sample is represented by
a point, and model estimates are shown for
white and nonwhite subsets of the data for
the regression with an inverse transforma-
tion on the pick variable. We can observe
the differential effect of race over the draft
range by inspecting the varying slopes of
the subset models.
Discussion
Though the present analysis does not
escape the limitations inherent in detect-
ing racial discrimination through obser-
vational data, several of the shortcomings
in the prior literature were addressed and
palliated through this new methodology.
The use of the draft as an outcome variable
improves upon past research, as the draft
is not diluted by guidelines surrounding
contract negotiations. Additionally, this
14
97023 Body_176pg_6.7x9.8_R5.indd 14
study improves upon existing methodolo-
gy by adequately controlling for individu-
al player characteristics, most notably in-
game performance. In using NFL data to
detect differences in outcomes controlling
for draft order, there is no need to make
assumptions about the NFL’s consensus
player evaluations. Rather, I am able to use
differences in factual outcomes to deter-
mine whether minority players are system-
atically overlooked.
There are still limitations inherent
in this analysis. In addition to the omitted
variable bias discussed above affecting the
collegiate data models, there is a limited
sample size of minority quarterbacks avail-
able for the NFL analysis. Of the 99 quar-
terbacks in the sample, only 19 were non-
white. Having such an unbalanced sample
limits the precision of estimates. Though
these results may point to the presence of
discrimination in the draft, the limitations
inherent in observational analysis as well
as those specific to this study make it dif-
ficult and unjust to label the differences as
outright discrimination.
However, the historical evidence for
racial controversy in the NFL makes the
present results worth considering. In both
1/11/21 10:16 AM
 stages of the analysis, I observe racial dif-
ferences only at the lower end of the skill
spectrum. This selective effect among low-
skill quarterbacks may have a meaningful
practical interpretation. Highly valued mi-
nority players are unlikely to be discrimi-
nated against given their well-known po-
tential to add value to an NFL team, which
could likely offset any discriminatory ten-
dencies. In addition, these players are high-
ly touted and discussed in the media before
the draft, and discrimination against these
players would have to be played out much
more visibly in the public eye.
Further, minority players with lower
natural ability may be easier targets for dis-
crimination. While higher draft picks are
primarily evaluated on their raw athletic
talent that they demonstrated in college,
lower draft picks will be highly scrutinized
based on their potential to learn and im-
prove. Evaluation of these “intangible”
skills may be influenced to a greater degree
by racial biases. This point is well illus-
25 Boylan, Christopher, et al. “NFL Draft Profiles Are Full of Racial Stereotypes. And That Matters for When Quarterbacks Get
Drafted.”
15
97023 Body_176pg_6.7x9.8_R5.indd 15
trated by the Washington Post study cited
earlier, which found that white players are
more often praised for their intelligence,
understanding of the game, and command
of the team.25 These are the “intangible”
assets that NFL teams are looking for in
late-round draft picks, which may partially
explain the selective effect of race on low-
skill quarterbacks observed in this study.
Though these findings must be taken
with a grain of salt due to fundamental lim-
itations, they do point in the direction of an
ongoing and problematic trend in the NFL.
The issues surrounding race in the league,
such as the anthem protest, the Kaeper-
nick lawsuit, and the weak representation
of minorities in ownership have often es-
calated into full-blown controversies and
have become politicized beyond the point
of productive dialogue. Given the sensitiv-
ity of these issues, empirical study is critical
in order to understand the problem from
a neutral perspective. This study serves
as an attempt to uncover and understand
1/11/21 10:16 AM
 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

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 FEATURE

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-
“Production,
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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 FEATURE

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-
letes.
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
Mortality
by Onyinyechi Jessica Ogwumike

Abstract
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,
www.bustle.com/p/after-erica-garners-death-we-need-to-talk-about-how-maternal-mortality-affects-
black-women-7739678.
2 Rob Haskell, “Serena Williams on Motherhood, Marriage, and Making Her Comeback,” Vogue, www.
vogue.com/article/serena-williams-vogue-cover-interview-february-2018.
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
birth workers.
Efe’s birth work is informed by a larg-
er project of racial justice, and she provides
care in connection to the history of crimi-
nalization marking Black midwifery in the
U.S. For Efe, as she would go on to state in
our later interview, radical Black doula care
requires the genuine recuperation of Black
midwifery. These coupled care practices
vitally disrupt a birth industry in which
obstetricians hold the greatest power.
Efe’s client shared her own experi-
ence at Kings County. Her words demon-
strate her imagination of what birth justice
could afford her and other birthers: “The
reason I’m out here is so simple: 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. I’m
not gonna have to feel like I’m gonna walk
into a hospital, and they’re gonna do what-
ever the hell it is that they’re gonna want
to do with my body without my consent.
...That’s gonna be a story that’s not gonna
be told anymore.”
This speaker participated in this rally
to register her outrage and manifest her vi-
sion of repair. She asked whether the disre-
gard she experienced in a city hospital was
due to her race, age, or her use of Medic-
aid. She queried whether some facet of her
social identity determined her experience.
She asked, “Why? Why do you treat us this
way?!” Her voice and body shook, as she
exclaimed, “How can you strap me down
to perform a c-section? I’m the last person
to hold my baby! I had to wait a whole 24
hours to hold my son! He was in the NICU;
I didn’t know why!”
This mother shared her trauma to
3 Michael J. Dumas and Kihana Miraya Ross, “‘Be Real Black for Me,’” Urban Education, vol. 51, no. 4, 2016, pp. 415–442.,
doi:10.1177/0042085916628611.
23
97023 Body_176pg_6.7x9.8_R5.indd 23
demonstrate the violent alienation and
dehumanization Black birthing people ex-
perience in labor and the postpartum peri-
od. While the popular media stories about
Black maternal life focus on sudden death
and neglect, Black birth workers and birth
justice activists have long exposed the sub-
tler wounds inflicted on birthing people.
These wounds accumulate in the body and
result in a disproportionate risk of death.
The protesters marched to another
city hospital with a similar reputation of
harming Black birthing people. Organiz-
ers made it clear that the second hospital,
which predominantly served Black people,
had such poor quality of care that it was
“basically a grave site.” The Instagram Live
ended as organizers remarked, “Black death
is literally in the air as we stand.” Sever-
al people can be seen gripping their coats
closer to their skin, as if to seal themselves
up from lingering fragments of literal and
“social death.”3
I open with this vignette to illustrate
the powerful organizational and personal
partnerships characterizing Black birth as
a site of activism and radical care. Efe and
her client illustrate how birth workers and
birthing people ally in their Blackness to
reconstruct the stories told about Black
birth.
The Birth Justice Banner
The previously-detailed rally aimed
to advance birth justice. The Black wom-
en-led birth justice grassroots organiza-
tion Black Women Birthing Justice defines
birth justice as the end-state that results
when “women and transfolk are empow-
ered during pregnancy, labor, childbirth,
and postpartum to make healthy decisions
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-
visits.8
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
birth.
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, www.blackwomenbirthingjustice.org/what-is-birth-justice.
5 Nina Martin, and Renee Montagne, “Nothing Protects Black Women From Dying in Pregnancy and Childbirth,” ProPublica,
www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth.
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.

24

97023 Body_176pg_6.7x9.8_R5.indd 24 1/11/21 10:16 AM

 “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
Action
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.”
17

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-

25

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

 “Field of action” describes the context in
which resistance is performed. For birth
workers, this context is defined by histor-
ically-rooted obstetric violence and the
structures that protect it. Deidre Cooper
Owens’ “Medical Bondage: Race, Gender,
and the Origins of American Gynecolo-
gy” analyzes the torture of enslaved Black
women at the hands of James Marion
Sims, the American Father of Gynecology.
Owens explains obstetrics’ foundations in
this violence. Owens says, “Slavery, medi-
cine, and science had a synergistic relation-
ship,” in that “the various medical inter-
ventions performed on enslaved women’s
bodies were the sine qua non of racialized
medicine and the legitimization of medical
branches like obstetrics and gynecology.”18
Owens narrates how the emergence of ob-
stetrics as a medical profession required
the eradication of Black midwifery, pro-
viding obstetrics with Black bodies as sites
of experimentation. He explains, “When
white men integrated obstetrics and gy-
necology, pregnant enslaved women who
experienced difficult birthing processes
became disproportionately represented in
surgical cases in which doctors used blades
and forceps to remove fetuses. Surgeries
were quite rare in the first half of the nine-
teenth century, so it is astounding how
many medical journal articles listed en-
slaved women as surgical patients.”19
Black birthing people were not over-
represented in medical journals due to
some recurrent racial birthing pathology;
they were overrepresented as medical sub-
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.
26
97023 Body_176pg_6.7x9.8_R5.indd 26
jects because they were made more avail-
able for intervention. In the early- to mid-
1800s, physicians targeted Black midwives
and healers alongside their birth-giving
clients. Midwives were subject to punish-
ments including execution, although their
practices were often regarded amongst
enslaved Black and white women alike
as “more efficacious.”20 Dorothy Roberts’
“Killing the Black Body” depicts how Black
birthers, there gendered as women, are dis-
proportionately vulnerable to policing and
surveillance, because the state assumes that
they will pass their inherent “degeneracy”
down to their offspring.21 The over-po-
licing of Black birthing people more con-
temporarily is continuous with the logic of
slavery-era obstetricians and gynecologists
who, “[w]hen infants died, castigated the
sloth and ignorance of their mothers and
the black midwives who attended them.”22
Black birthers and midwives were blamed
for the deaths, ignoring “antebellum doc-
tors’ disdain for hand washing” and the
unsanitary settings to which slave shacks
were relegated to keep them as far as possi-
ble from “whites’ dwellings.”23 Conditions
and context, as well as the harmful practic-
es of white authorities, were overlooked in
favor of criminalizing the Black body.
Obstetricians mobilized racialized im-
agery to construct midwives’ Blackness as a
source of contagion claiming Black infant
lives. For example, in 1925, a doctor “read
a paper before the Southern Medical As-
sociation in which he described the black
midwife as ‘filthy and ignorant and not far
1/11/21 10:16 AM
 removed from the jungles of Africa, laden
with its atmosphere of weird superstition
and voodooism.’”24 Interestingly, as recent-
ly as 2018, birth workers described obste-
tricians who said similar things to their
Black clients. One said, “I was once assist-
ing a mom from Sudan who didn’t want to
do a vaginal exam because she was a victim
of female genital mutilation ... Later, when
this mom was having trouble pushing, I
remember the doctor saying, ‘What’s your
problem, you have other kids. Didn’t you
give birth in the jungle, anyway?’”25 Here,
the common incitation of “the jungle” as
a signifier of proximity to animality and
backwardness speaks to the underlying co-
lonial racism that haunts birth in the U.S.
The anti-Blackness of the U.S. medical
complex is a vestige of racial chattel slav-
ery, and Black birth workers utilize vari-
ous practices to intervene upon this field
of action.
Roberts, Owens, and Washington
revisit the ghost of enslavement as foun-
dational to Black people’s navigation of
reproductive healthcare, because, as one of
my research respondents said, this trauma
“has to live in the body.”26 The institution
of slavery naturalized Black pain and re-
jected Black sentience, according to Said-
iya Hartman. She imagines “redress” for
this violence as predicated upon a theory
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, www.thecut.com/2018/08/
what-its-like-to-be-a-doula-for-women-of-color.html.
26 “Bailey, Doula”. Interview. By Onyinyechi Jessica Ogwumike. 13
Mar. 2019. Telephone Interview.
27 Hartman, “Scenes of Subjection,” pp. 50.
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,
https://www.npr.org/2017/12/07/568948782/black-mothers-keep-
dying-after-giving-birth-shalon-irvings-story-explains-why
30 Linda Villarosa, “Why America’s Black Mothers and Babies Are
in a Life-or-Death Crisis,” The New York Times, www.nytimes.
com/2018/04/11/magazine/black-mothers-babies-death-mater-
nal-mortality.html.
31 “SJ, Doula”. Interview. By Onyinyechi Jessica Ogwumike. 4 Mar.
27
97023 Body_176pg_6.7x9.8_R5.indd 27
of “practice.” For Hartman, practice en-
tails “a way of operating defined by ‘the
non-autonomy of its field of action,’ in-
ternal manipulations of established order,
and ephemeral victories.”27 In other words,
practices are short-lived moments resist-
ing the determination of an overarching
structure. Birth work is a practice that ma-
nipulates the medical order from within,
providing inroads by which Black birthers
may access more respectful and pleasurable
care. Hartman characterizes practice as be-
ing constituted by “ephemeral victories.”
Each delivery is a single, transient instance
within the lifetime of a birthing person,
but it has the potential to reflect and trans-
form their relationship to medical power, a
potential that respondents such as Carmen
and Qiddist center in their birth work.
Stories & Counter-Stories
By erasing Black people’s health activ-
ism and the history of medical marginal-
ization in the U.S., media coverage of Black
maternal mortality has sought to make
Black birth givers responsible for their
own deaths. ProPublica,28 NPR,29 and The
New York Times30 led a wave of news cov-
erage that many of my respondents refer to
as “sensationalizing” Black maternal mor-
tality.31 Already previewed in these article
titles, it would appear that Black mothers
“Media coverage of Black
maternal mortality has
sought to make Black
birth givers responsible
for their own deaths.”
1/11/21 10:16 AM
 “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
experiences.
According to Haile Cole, a professor
of sociology and anthropology at Amherst
College, the current conversation sur-
rounding Black maternal mortality simply
replicates a national obsession with the dis-
eased Black body. Her emerging research
on this topic asks, “Why is it important to
locate reproduction within the larger dia-
logues about racial domination and con-
trol, and how does reproduction work in
conjunction with other technologies of
racial and gender-based oppression?”32 Po-
tential answers to these questions begin
at analysis of the spectacle made of Black
birth, especially as the media’s storytell-
ing serves to erase Black agency — mak-
ing Black birthers into people who “need
saving” to fit easily into the American
psyche.33 By demonstrating that neither
wealth nor education could protect these
birthing people, these reports suggest that
race — the identity of Black womanhood,
especially — is irrevocably damning. These
reports never made the essential pivot to-
ward elucidating race as an “organizing
principle” of power.34 They did not attend
to how Black birthers have historically and
contemporarily been made vulnerable to
violence.
2019.
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.
28
97023 Body_176pg_6.7x9.8_R5.indd 28
Centering Black Birth Work
as Radical Redress
In interviewing seven Black doulas
and midwives, I learned how Black birth
workers approach their care in response to
Black maternal mortality, both as a public
health crisis and a media sensation. I inves-
tigate how Black birth workers approach
Black birth, asking them to reference their
own and their clients’ social positioning
using semi-structured interviews. I ana-
lyzed my transcripts using codes organized
by three key themes: race and storytelling,
including the media surrounding Black
birth; race and birth work, or the tangible
practices informed by social positioning;
and race and redress, or how birth workers
imagine solutions to maternal mortality
disparities. The first names or pseudonyms
of birth workers are used to properly attri-
bute their insights, according to their stat-
ed preference. Applying critical race fram-
ing to my coded transcripts, I learned that
Black birth workers approach birth work
as racial justice activism and seek to redress
deep obstetric wounds that result from his-
tories of medical violence.
Storytelling
All the birth workers interviewed de-
scribed the media sensation surrounding
1/11/21 10:16 AM
 Black maternal mortality as de-histori-
cized, and many of them saw Black birthers
bearing disproportionate blame rather
than having their accounts believed.35 Birth
workers also spoke to how the media sen-
sation created around Black maternal mor-
tality influences their work with clients.
When Efe, doula and student midwife,
sees people talking about Black maternal
mortality on Instagram and Twitter, “peo-
ple are scared; they’re terrified.” As Qiddist,
a doula, says, headlines such as her “least
favorite but most telling,” which was the
ProPublica “Nothing Protects Black Wom-
en From Dying in Pregnancy and Child-
birth,” relegate Black birthers to a position
of fear and doom. Qiddist says that Black
birthing people seem like “a lost cause,” and
ultimately, “[t]hat’s just not true!” Qiddist
feels that her role intervening in this nar-
rative is to provide clients with diasporic
practices, which she calls “protective fac-
tors,” reminding birthers that they “are not
broken” and instead live within a violent
system. Efe and Qiddist respond to the
media sensation by guiding their clients
toward avenues by which they can birth
safely.
Trauma as a Basis for Black Birth Work
As Black midwives and doulas are
personally familiar with the specifics of be-
ing Black in an anti-Black world,36 they use
birth work to combat the systematic dehu-
manization of their clients and themselves.
Based on the responses of my interlocu-
tors, I understand birth work as a practice
of reciprocal healing because its radical
care grasps at the root, addressing obstetric
violence as just one of many manifestations
of “endemic anti-Blackness.”37 What does
it mean to perform birth work from this
35 “Venus, Nurse Midwife”. Interview. By Onyinyechi Jessica Ogwumike. 6 Mar. 2019. Telephone Interview.
36 Dumas and Ross, “Be Real Black”
37 Ibid.
29
97023 Body_176pg_6.7x9.8_R5.indd 29
depth of consideration? It means assuming
trauma as a presupposition for clients and
seeing birth work and training as racially
circumscribed. Doula SJ reflects that most
of her Black clients specifically had “com-
plicated relationships either to doctors or
Western medicine” or knew “about how
Black women are at higher risk for all sorts
of complications during labor, and they
[came] into that experience with more
apprehension and more worry.” Similar-
ly, doula Sade was attracted to doula care
via her personal encounters with medical
professionals, who generally treated her
like she had no knowledge of her own
body. She found doula work as a method
for facilitating the reclamation of bodily
autonomy for others, “specifically Black,
indigenous, and queer” birthers. Sade acti-
vates her racial empathy into a birth work
practice focused on recuperating personal
power. In this way, Sade finds healing for
herself and her clients.
Radical Redress
Efe applies an abolitionist framing
to birth justice because she finds the en-
tire medical system culpable for maternal
deaths and aims to dismantle it. To think of
birth justice through an abolitionist frame-
work, making contemporary Black mater-
nal mortality continuous with the legacy of
slavery, indicates that Efe processes her role
as a birth worker in relationship to a larger
project of racial liberation. Interviews with
doula Bailey and professional midwife Car-
men were similarly saturated with radical
imaginations of what redress could resem-
ble for Black birthing people. For instance,
Carmen considers her midwifery a method
of direct action, emphasizing that she uses
midwifery to “interrupt trauma.” Bailey
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
40

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.

Appendix

Image 1: A screenshot of @ancientsong’s

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

30

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

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Howard, Jacqueline. “Childbirth
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Hurtado, Aída. “Theory in the Flesh: To-
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 Johnson, Kimberly Ann, host. “Racha
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1/11/21 10:16 AM
 FEATURE

Degrees Don’t Make Them

Distant:
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
time?
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.

34

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 FEATURE

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
Institutionalism
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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97023 Body_176pg_6.7x9.8_R5.indd 36 1/11/21 10:16 AM

 Figure 1 ◀
wasn’t an odd choice for her to begin re-
cording accounts of inappropriate be-
havior in a small flowered journal in re-
sponse to what she saw. The “Little Sexism
Notebook” contained over 80 testimonies
by the time the Harvey Weinstein scan-
dal broke in October 2017 and the viral
#MeToo movement shook storied insti-
tutions around the world.3 Then Ponte’s
boss French MEP Edouard Martin men-
tioned the notebook, with her permission,
in an interview on a local radio station at
the same time #MeToo went viral on so-
cial media. As the world opened its eyes
to the reality of sexual harassment, Pon-
te’s story went everywhere within days.
The notebook’s revelation signaled
the start of the Parliament’s own #MeToo
movement. The months following Mar-
tin’s interview brought rapid action to ad-
dress Ponte’s revelation of the “open secret”
of gender-based violence in the Parlia-
ment.4 Interview requests flooded Ponte’s
inbox. Strangers recognized her on trains.
But spokespeople from the E.P. encour-
aged Ponte to tell her story, so she went
for it. Ponte answered every interview
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.
37
97023 Body_176pg_6.7x9.8_R5.indd 37
giving names in an effort to keep the story
about the problem, not the perpetrators.
Then, in January 2018, Ponte and
a coalition of Parliament workers offi-
cially started the MeTooEP movement.
The following October, they established
MeTooEP.com, an anonymous blog for
survivors to publish testimonies of sexu-
al violence in the E.P. Shortly after, they
announced the MeTooEP pledge in Febru-
ary 2019 for candidate MEPs to sign and
promise to no longer condone this behav-
ior ahead of the E.P. elections that May.
The activism following the note-
book’s reveal raised an essential question
for me: How do feminist movements
“The ‘Little Sexism
Notebook’ contained over
80 testimonies by the
time the Harvey Weinstein
scandal broke.”
1/11/21 10:16 AM
 2014
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 MeTooEP.com 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
MeTooEP as a case study to make sense
of the way feminist movements can per-
manently impact patriarchal structures.
My study of MeTooEP demonstrat-
ed to me that the movement’s strength
was its ability to focus public attention on
the internal, formal attempts the E.P. had
been taking to address gender-based vio-
lence, and how that focus revealed mech-
anisms that favored those in power, rather
than their victims. MeTooEP is a “causal
story;” it is a reaction which explains the
issues of sexual harassment through sym-
bology and storytelling.5 These totems
also instigated a refocusing on the gender
equality agenda across the international
political environment; at the same time
that the E.P. refocused its gender equality
agenda, so did other organizations in the
international political environment, such
as the United Nations. By making sense
of this recent history, this discussion de-
velops the study of #MeToo’s contribu-
tions to gender equality policy by applying
movement.6 This thesis is meant to be a
tool for feminists building movements,
so they too can change their institutions
from within. I hope this thesis becomes
part of a growing scholarly body of work
concerning #MeToo as a defining social
mobilizer, rather than as a viral flashpoint.
The image is a striking testimony to
the power of a social media message such
as #MeToo. First, I want to establish how
the virality of #MeToo was a “focusing
event” for the issue. According to Birkland,
Focusing events can lead interest
groups, government leaders, policy
entrepreneurs, the news media, or
members of the public to identify new
problems, or to pay greater attention
to existing but dormant problems,
potentially leading to a search for
solutions in the wake of apparent
policy failure.7
#MeToo re-oriented MEP and in-
terest group attention regarding the issue
of sexual harassment. Subsequent “media
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

38

97023 Body_176pg_6.7x9.8_R5.indd 38 1/11/21 10:16 AM

 event, such as Ponte’s notebook, “give less
powerful groups an advantage in policy
debates.”8 MeTooEP also draws symbol-
ogy through the MeTooEP blog and the
Pledge. This is one explanation why we see
anti-harassment policy reach the agenda
created — or, an opportunity to make in-
stitutional change, in the eyes of Birkland.
Work had been done before #Me-
Too’s rise, but the image of MEPs holding
signs in a 2017 Strasbourg plenary session
alerted feminists within the institution
that this was the chance to do more. Un-
precedented issue visibility in the Parlia-
ment heightened the importance of gen-
der-based violence to its members. The
pro-change group, some of whom are
victims of such violence, were “suddenly”
given enough attention to mobilize their
cause, while more powerful groups, such as
E.P. leaders and MEPs, were given a win-
dow to respond — or defend the existing
policies. The understanding of #MeToo as
a focusing event explains how MeTooEP
rose as a highly-organized advocacy coa-
lition which was able to achieve sustained
relevance within the E.P. community.
One reason MeTooEP has sustained
the energy from the focusing event for
nearly two years is that the movement
asserts who, and what, is to blame for
the issue.9 The coalition identifies caus-
al factors for sexual harassment and vi-
olence in the Parliament: failed formal
mechanisms and a culture of silence.
As 2020 looms, many discussions of
#MeToo read as if the movement is over
and done. MeTooEP’s strategy has kept
the focal event from “blowing over;” it is
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.
39
97023 Body_176pg_6.7x9.8_R5.indd 39
unique in that the movement has been mo-
bilized for over two years.10 Focal events
are received differently among policy com-
munities, but the case of #MeToo upholds
Birkland’s argument about saliency. If the
event gives human agency and cause to
an issue, interest groups will better influ-
ence the policy agenda. The interpreta-
tion of #MeToo as a focusing event helps
us understand why the mobilization of
MeTooEP was significant, and how the
movement’s sustained visibility and polit-
ical pressure — especially given the status
quo of the pro-change coalition in the Par-
liament — are leading to the 2019 elections.
Feminist Institutionalism (F.I.)
In studying MeTooEP, I have drawn
on the feminist institutionalist approach.
If institutions are a “collective entity or any
way of organizing relationships that are
widely familiar and routinely practiced”
and often contain “unwritten rules,”11 fem-
inist institutionalism is an approach that
strives to examine how institutions’ orga-
nization and rules form, and how they are
influenced by gender inequalities. Kro-
ok and Mackay explain that F.I. theory
evolved along with neo-institutionalism
to provide a framework that explained
how our increasingly organized world is
gendered.12 In other words, feminist insti-
tutionalism looks at how ideas, norms and
values are experienced unequally along the
lines of gender.13 In the E.P. context, F.I.
urges us to evaluate the Parliament’s orga-
nization and rules in relation to gendered
criteria.
In an ever-structured society, gender
1/11/21 10:16 AM
 norms become further incorporated into
institutions’ policies.14 Feminist institu-
tionalists study how these invisible social
constructs are reflected as a “logic” deter-
mining attitudes and actions.15 For fem-
inist institutionalists, metrics frequently
used to provide gender equality do not do
enough to correct disparity and the patri-
archal structures that constraints women’s
actions.16 This thought process emphasiz-
es the importance of paying attention to
qualitative factors to measure how organi-
zations are gendered.
A byproduct of a more organized
world is an increase in the number of social
movements, including MeTooEP.17 The
F.I. lens also provides an understanding of
the potential impact of movements such as
MeTooEP by showcasing how these coali-
tions can become “legitimate participants”
in the organizational world.18 In an envi-
ronment of organizations, external social
movements like MeTooEP are issue “en-
trepreneurs” advocating new demands.19
Furthermore, feminist institutionalism
evaluates organizations as “open systems,”
suggesting that the internal structure of the
Parliament does not function in “isolation”
of the greater European political and his-
torical environment.20 Values, norms, and
beliefs concerning gender trickle in from
the European political context into the
Parliament’s culture and decision-making.
The F.I. lens reveals that this environment
affects the Parliament because gender in-
equality and discrimination are functions
of power more broadly in Europe.21 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
40
97023 Body_176pg_6.7x9.8_R5.indd 40
E.P. is a gendered institution because ex-
ternal conditions in Europe influence the
Parliament’s status quo.
My analysis follows the three com-
ponents of the feminist institutionalist
framework: formal processes, including
the mechanisms, committees, laws, etc. al-
ready addressing gender-based violence in
the Parliament; informal processes, such
as the empowering social movement that
rose in reaction to a focal event; and con-
nections between the formal and informal
processes, or how long a social movement
lasts until its terms must be institution-
alized.22 The efficacy of the Parliament’s
formal processes regarding sexual harass-
ment demands an analysis of MeTooEP as
an empowering reaction to these formal
processes. However, social movements
may only last to an extent before they must
work with institutional structures.
Why the E.P.’s steps against
gender-based violence weren’t
enough
It’s important to acknowledge that
a history of gender equality work existed
in the Parliament and the greater political
environment long before #MeToo went
viral. While gender-based violence was on
the Parliament’s policy agenda, these for-
mal attempts did not successfully change
the institutional logic which enables an en-
vironment of harassment in the first place.
Reflecting on the Parliament’s formal pro-
cesses, which existed before #MeToo, lets
us understand how they do not “have the
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.

41

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 MeTooEP.com, 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

42

97023 Body_176pg_6.7x9.8_R5.indd 42 1/11/21 10:16 AM

 and the low number of cases reviewed by
the Committee contradicts this claim that
the Parliament was in control of the situ-
ation. The Committee’s “campaign” con-
sisted of mere leaflets distributed to MEPs
explaining “how to avoid improper behav-
ior towards your staff.”35 The “pro-active”
action by the Committee was clearly not
successful, given that over 127 female and
11 male E.U. employees reported cases of
sexual harassment to POLITICO Europe
in 2017.36 Even more revealing is the fact
that only about 40 out of 751 MEPs have
opted for mandatory anti-harassment
training.37 Therefore, few officials are even
aware of the E.P.’s official definition of sex-
ual harassment, let alone that the Commit-
tee exists to hold them accountable. The
80 testimonies in Ponte’s notebook alone
demonstrate the issue is much greater than
the Committee can handle.
Barriers to a European Solution
MeTooEP brought attention back to
the resolutions the Parliament had previ-
ously passed to address sexual harassment.
It also indicated that these attempts didn’t
succeed. Resolutions are non legally-bind-
ing “[suggestions for] a political desire to
act in a given area.”38 These create policy
windows for the E.U. — opportunities for
ideas to reach the Commission’s agenda
and the Parliament to pressure member
countries to pass specific national laws.39
The most significant reason Parliament
resolutions aren’t credited with addressing
this issue is the absence of an E.U.-wide
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
43
97023 Body_176pg_6.7x9.8_R5.indd 43
law against gender-based violence at the
time this thesis was written.
Especially in the case of the Octo-
ber 2017 Parliament resolution reacting
to #MeToo, these suggestions from the
Parliament have not yet influenced the
Commission to use its right of initiative
to propose such a law. According to E.U.
law, the right of initiative is only for the
Commission; the Commission pitches leg-
islation and the Parliament sees through its
development with the help of the Coun-
cil.40 Given that ideas of harassment and
legal approaches vary by member country,
the likelihood that MEPs would agree on
a single policy seems low, even if it is ini-
tiated.
The October 2017 resolution may not
have resulted in an E.U.-wide law, but the
measure is different from the previous an-
ti-harassment resolutions passed from the
1970s through 2014. The resolution was
an instance in which #MeToo was men-
tioned in an E.P. measure, the first official
response to the movement.41 The fact the
resolution is a direct response to the #Me-
Too movement also changes the meaning
of a “zero-tolerance” approach to gen-
der-based violence. The 2017 resolution
reiterates a 2014 resolution’s zero-toler-
ance policy, but this time it was a response
to a feminist social movement.42 In the F.I.
perspective, the Parliament’s decision to
formally address #MeToo and advocate for
those without power is considered a fem-
inist win.43 As a result, the resolution is a
“resource” that gives power to individuals
1/11/21 10:16 AM
 “Only E.U. law fully binds
the member countries.”
in the institution.44 In this way, we see how
the Parliament was making the greatest ef-
fort within its competence to address gen-
der-based violence.
The absence of a Commission propos-
al is one part of a long history of approach-
es to gender-based violence existing on the
policy agenda without resulting in execut-
ed change. For example, the E.U. Commit-
tee on Employment and Social Affairs was
appointed in February 2001 to produce a
report on harassment at the workplace.45
Nearly six months later, the report moved
for a motion for a resolution addressing
the “calls” and “recommendations” for in-
stitutional action. This resolution merely
suggested that member countries establish
procedures, training programs, and confi-
dential mechanisms for reporting. As long
as formal responses remain in the form of
resolutions, member countries will nev-
er be legally compelled to make changes
on the national level. Only E.U. law fully
binds the member countries.
As a result of the resolutions system,
each E.U. member country has approached
the Parliament’s October 2017 resolution
differently. It is up to them to decide how
to implement the document’s suggestions.
France, for example, legally banned street
harassment in August 2018. In a November
2017 survey of Hungarians, half of all re-
spondents believed sexual harassment cas-
es require no legal consequences.46 Recall
how the Parliament is not “isolated” from
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.”
44
97023 Body_176pg_6.7x9.8_R5.indd 44
the European political context. National
lethargy toward the issue of gender-based
violence trickles into the Parliament.
Courts have also diminished inter-
est in proposing a European anti-gender
violence law. In connection to the afore-
mentioned parliamentary immunity, few
member countries would feel compelled
to direct their resources to European ha-
rassment cases rather than their own le-
gal priorities, further disincentivizing the
acceptance of an E.U.-wide law. Gender
parity within the Parliament also matters
in making E.U. law. If there were more
female MEPs, the 2017 resolution may
have been more widely endorsed, prompt-
ing the Commission to initiate a law. For
example, Hungary has many more male
MEPs, a likely explanation for why that
country has yet to act locally on behalf of
the Resolution. Hungary’s MEPs are only
19% female.47 Official Parliament measures
are only as effective to a member country,
and the E.U. at large, as the priorities of
that nation’s MEPs.
Further, the Resolution may have
been passed for more political reasons by
some MEPs. The fact that members have
been slow to implement the resolution na-
tionally suggests some may have voted to
pass the measure in solidarity with the Par-
liament, but fear local repercussions from
voters for promoting such a policy.
The Parliament continues to make
suggestions, however. On Nov. 9, 2018,
MEPS adopted renewed measures against
sexual harassment.48 As in previous ex-
amples, the language used by the E.P. can
recommend, but not make law. By merely
“adopting measures,” the E.P. is not indi-
1/11/21 10:16 AM
 cating a permanent change on any level.
The measures instead constitute another
kind of resolution. However, 528 of 751
MEPs voted in favor of the measures,
which ask the Commission to develop le-
gal standards concerning violence against
women. These standards may be applied
within the E.U.’s jurisdiction. By creat-
ing a unified judicial approach to sexual
misconduct, MEPs would be considered
under European law — potentially elimi-
nating the power of parliamentary immu-
nity. The fact remains that the Parliament
can only work within its competences; an
E.U.-wide law would need to come from
the Commission and the Council. How-
ever, even if this were passed by the E.P.,
successful implementation would not be
guaranteed. Because the Parliament is not
isolated from the European political en-
vironment, the E.U. would struggle to re-
move local barriers and pass a supreme law
banning gender-based violence.
#MeToo’s storytelling devices
What is dangerous is silence. Sexual
harassment is an open secret because
every worker, woman or man, knows
who they need to avoid. They know
what kind of strategy you need to
develop in order to not be looked at as a
piece of meat — to try to protect yourself.
- Jeanne Ponte49
Causal stories like those of MeTooEP are
amplified through illustrative tools. Ac-
cording to Stone, “[the] deliberate use of
language and of symbols in particular [is]
a way of getting an issue onto the public
agenda or, alternatively, keeping it off.”50
The #MeToo movement has largely main-
49 Appendix 1
50 Deborah Stone, “Causal Stories and the Formation of Policy Agendas.” 282
51 Ibid. 289
45
97023 Body_176pg_6.7x9.8_R5.indd 45
tained public relevance through its sym-
bology. Time magazine’s cover of “the
empty chair,” the Time’s Up logo, actresses
donning black gowns at the 2018 Golden
Globe Awards, and pussy hats at the 2017
Women’s March: these images have come
to represent the #MeToo ascendence to
the public agenda. Ponte’s flowered note-
book now joins these symbols as artifacts
of this history.
While an artifact implies temporali-
ty, Ponte’s notebook joins these symbols
as signals of a more permanent realiza-
tion: the breakage of a culture of silence.
Recurring symbols of #MeToo like Ponte’s
notebook are more than a flash of celeb-
rity endorsement or scandalized firings.
They demonstrate cause and intent. Stone
writes, “[Causal stories] claim that a condi-
tion formerly interpreted as accident is ac-
tually the result of human will, either indi-
rectly (mechanical or inadvertent cause) or
directly (intentional cause); or they show
that a condition formerly interpreted as
indirectly caused is actually pure intent.”51
Symbols attribute intent over acci-
dent. Ponte’s physical representation of
the invisible culture of harassment “de-
scribes harms and difficulties, attributes
them to actions of other individuals or or-
ganizations, and thereby claims the right
to invoke government power to stop the
“Activists use symbols
like the notebook to
“manipulate” the issue —
to myth-make.”
1/11/21 10:16 AM
 Figure 4 ▶

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

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 MeTooEP.com, 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
55

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.

46

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

 power of certain groups, such as APAs, fe-
male MEPs, and other marginalized groups
in order to maintain a functioning system,
often without these groups’ conscious con-
sent. Em-powerment refers to the con-
scious process of breaking that silence. The
“em” prefix to the word “power” implies the
act of silenced groups of gaining governing
ability by collecting resources. According
to feminist institutionalists, MeTooEP is
an example of em-powerment because vic-
tims whose voices were previously silenced
by an institutional force are now given the
power to speak, and, eventually, influence
dominant Parliament decision-makers.
Em-powerment is a necessary phe-
nomena, given women’s traditional roles
within institutions. Historically, female
power in this context is implicit rather than
explicit.56 Their authority is so silenced
that women cannot access labor without
the help of men and must influence others
indirectly in order to achieve their goals.
Resources such as money and education
are typically given by men to women so
they may gain access to any level of labor,
let alone excel. According to the October
2017 Parliament resolution, 75% of wom-
en in top management positions in Europe
have been sexually harassed. Even if wom-
en gained enough resources to be influen-
tial in institutions, they still lack sufficient
social resources to protect themselves from
the dominating power of men.
While men have the pleasure of ac-
cessing any organizational resources they
please, women must only engage with men
in situations which are dictated by the level
of resources they own.57 By merit of their
position, women in the Parliament have
acquired enough resources to presumably
56 Ibid.
57 Ibid.
58 Ibid. 114
59 S. Laurel Weldon, “Power, Exclusion and Empowerment: Feminist Innovation in Political Science.”
47
97023 Body_176pg_6.7x9.8_R5.indd 47
be influential; however, they cannot be to-
tally powerful in the way that males in the
institution can, as “power consists in the
relationship between men and women, a
relationship that accords men certain pow-
ers over women.”58 Here we see why no
amount of formal work by the Parliament
could successfully address the invisible dis-
crepancy between the resources available
to men versus women.
Due to socialized institutional logics,
organizations dominate social groups in
the way that men dominate women.59 In
the social understanding of men as sexu-
ally dominant of women, masculine insti-
tutional logics are dominant to feminist
institutional logic. MeTooEP is propelled
by feminist institutional logic. There-
fore, through the process of em-power-
ment, MeTooEP has gathered resources
to challenge the power of dominant de-
cision-makers. Because the Parliament is
in the resource-holding role, the institu-
tion will dominate MeTooEP no matter
what. Therefore, MeTooEP must use the
Parliament’s own institutional logic as a
means to an end, in order to make an or-
ganizational change. This explains why the
em-powerment process is a continuous cy-
“‘Em-powerment’ is a
process in which resources
transform into the power
necessary to make
institutional change.”
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
risk-averse.
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.”

48

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

49

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

 structures and had to go around the
system to be entrepreneurs of our
own needs, and society’s needs. That
creativity gives us a leg up in solving
problems.73
Feminist solutions like Burke’s and
Ponte’s are distinct because they have
adapted to being left out of formal peace
talks. An example of a formal peace agree-
ment is the structure of the Advisory Com-
mittee — victims were not at the decision
table. Low trust in the Committee pushes
victims away from formal mechanisms and
toward their own answers: the MeTooEP
blog and pledge.
Sexual harassment in the Parliament
is a form of social war. If victims had been
included in discussions at the beginning,
the violence may have been avoided. If
victims had been included as the conflict
started to arrive, they could have asked
for protection for their bodies. Now, the
conflict has occurred, and the victims are
finally being included in reconstructive
conversations to demand equal resources
to recover.74 Women in the Parliament are
now creating structures to heal on their
own because they never got to fight for
their security in the first place.
But no entrepreneurial venture goes
73 Appendix 7
74 Appendix 7
75 Ibid.
50
97023 Body_176pg_6.7x9.8_R5.indd 50
without risk. The consequence of #MeToo
is the potential loss of some goals as a com-
promise for investment from institutional
leaders. Thus, MeTooEP cannot gain the
support of all MEPs without capitulating
on some elements of its platform, an issue
that will likely be raised in the 2019-2024
mandate. The success of any entrepre-
neur depends on the interest of investors.
For MeTooEP, the investors are people
with power in the Parliament. Until the
Parliament has a full stake in the cause of
movement, i.e., feminists holding all the
positions of influence, MeTooEP will have
to strike deals with Parliamentary leader-
ship. According to Casale, the movement
must “play the short and the long game.”75
To focus too soon on the end goal — new
Parliament organizations and E.U.-wide
laws against sexual harassment — would
be self-sabotage for MeTooEP. Empow-
ering less powerful individuals too quick-
ly shocks the patriarchal system and is an
impetus for even more social violence,
i.e., pushback from powerful Parliament
voices, such as the conservative MEPs. For
now, as the movement’s symbols gain vis-
ibility, their testimonies will legitimize the
need to put more resources into the issue
of sexual harassment, helping the issue
gain stakeholders — to em-power. ■
1/11/21 10:16 AM
 Bibliography
Allyson Hobbs. “One Year of #MeToo: The Legacy of Black
Women’s Testimonies.” The New Yorker, October 10,
2018. https://www.newyorker.com/culture/personal-his-
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 FEATURE

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.

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 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
Northwestern!
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!

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 Department of German

Type 2 Diabetes Care

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

Abstract
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, https://www.diabetes.org/diabetes/type-2.
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.

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

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 “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
studies.”
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.

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

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 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-
sicians.40
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.

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 T2D DMPs in:
1. Improving health outcomes of
T2D patients?
2. Reducing costs associated with
secondary complications of T2D?
3. Improving quality of care deliv-
ered to T2D patients?
D. Considering the opinions of all of the
physicians questioned, what are the cur-
rent most effective management and
treatment practices for T2D?
E. Looking forward, what changes in phy-
sicians’ practicing or healthcare policy
would be most effective at improving
the health outcomes, cost burdens, and
quality of care of T2D patients?
Research Methods &
Designs
Overview
In Germany, I interviewed 8 prima-
ry care physicians, emailed them a link to
an online survey, and requested they for-
ward the link to primary care physician
colleagues to fill out the survey as well.
The length of time they have practiced
medicine was asked in the survey, but oth-
erwise, no other personal or demographic
information was recorded. Data from all 8
interviews were used in results, and a total
of 7 survey responses were correctly filled
out and recorded. All recruitment of and
communication with German physicians,
including emails, the interviews, and the
surveys, was conducted in German. In the
U.S., in Colorado, I interviewed 9 prima-
ry care physicians, emailed them a link to
an online survey, and requested they for-
ward the link to primary care physician
colleagues to fill out the survey as well. I
also interviewed a care coordinator in one
of the primary physician’s offices for sup-
plemental, contextual data. Additionally, I
63
97023 Body_176pg_6.7x9.8_R5.indd 63
conducted an informative interview with
an employee of the YMCA who runs Den-
ver’s branch of the Diabetes Prevention
Program, or DPP. The YMCA runs their
DPP in a partnership with the CDC’s Na-
tional Diabetes Prevention Program. This
DPP program is a version of a nationwide,
year-long lifestyle intervention program
for individuals at risk of developing T2D
that was started by the National Institute
of Diabetes and Digestive and Kidney
Diseases. Data from all 11 interviews was
used in interview results, and a total of 24
survey responses administered to primary
care physicians were correctly filled out
and recorded. The interviews were all ini-
tially recorded, and I listened back to each
recording following the interviews to take
detailed notes, then deleted the recordings.
The data from the results were compiled
into qualitative results, analysis, and con-
clusions.
Results
1. German Physician Results
1.1. T2D Diagnosis & Disease Management
Program Protocol in German Healthcare
Every 2 years after age 35, patients
have a check-up that is covered by health
insurance, though not everyone goes in
reality, physicians reported. There is a
screening for T2D at this check-up in the
measurement of HbA1c, and it was stressed
that many patients do not realize they have
T2D. Though the exact designations of
HbA1c levels vary by age and race, general
parameters in Germany were the same as
the U.S., where under 5.7% is normal, 5.7–
6.5% is pre-diabetic, and over 6.5% is dia-
betic. If patients have a prediabetic HbA1c,
physicians typically do not yet recommend
DMP enrollment but rather recommend
lifestyle changes, including nutritional in-
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
cialist.
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-