Hello, everybody. Yeah, my name is Tom Burdick. I work at Intel. This is my talk on kernel timers, jitter drift and expectations, some hard lessons were learned on my part and others to sort of build up this knowledge and understanding or sort of intuition about kernel timers. I really wanted to kind of share that with with many of you and hope in hopes that, you know, I might save some time or help help build some some intuition about curl timers for those watching. So, I guess, let's let's talk about what the idealistic kernel timer might look like in Zephyr, right. Well, we create our timer with either a macro or a timer in it. And then we go in and we want to set up a timer to to occur with some sort of delay or period. Maybe we give it a, you know, a delay of one millisecond and a period of one millisecond and then the expectation then is, you know, we got our function callback at exactly one millisecond after we call starts. There after every millisecond passes, we get a callback in our code runs. And really the, in the ideal scenario, the only thing that would ever cause any sort of problems with, with, you know, the exact one millisecond period or delay would be in the harbor right the clock source is actually, you know, oftentimes a crystal or an RSC oscillator those things have, you know, small, small variants and timing. That would be the ideal scenario right exactly one millisecond every time no problems. No delay is no drift no jitter. That's not reality. We live in an imperfect world. So what is a realistic kernel timer look like well, the delay is really a minimum. So you can say you know hey I want to call my function in a millisecond. And getting some, some feedback that I don't have the mics really hot. But yeah, so. But yeah, the, you know, the delay is really only given as a minimum.  Well, it's really, you know, your function will be called guaranteed after one millisecond, one millisecond or further into the future. And that's true period as well. And really the the accuracy of, you know, how accurate can you can you set your delay or period is really the accuracy of one kernel tick. It's, you know, so we, you know, in the kernel timer API right you can arbitrarily pass in a timeout value could say oh I want to timer in one microsecond. But the reality is, it's, you know, it's going to be rounded up to the nearest tick. And, you know, the other thing about a realistic kernel timer is there's very likely some jitter involved in your timer so you know trying to rely on a kernel timer for, for, you know, exact periodicity, periodic behavior. You know, there's some things to look out for it's not that you can't make it work well in that in that scenario but there are a lot of sort of gotchas and you know there's some things to kind of keep in mind when doing that. And, and last but not least there there's there's there's there's actually a strong possibility that there's some drift, depending on your hardware.  You're on a different board and it could be a little bit surprising that oh no that's it's not. It's not a millisecond it's it's a little more than a millisecond, and that can cause some drift and some issues so again something else to keep in mind and look out for. So I guess yeah like what is what is clock jitter I mean I think probably many of you already know but some of you don't send. And what are the sources of jitter so jitter is sort of a loss of precision so if I, you know, set my timer for one millisecond, and it's sort of like, you know, here's one millisecond, and the reality is it's like it's kind of firing you know in this this window of time after and the wider that window is the less precise my timer is. So that's clock jitter if you kind of imagine like oh the timer was scheduled here but happened here here here here over and over and over again. That's a loss of precision. And that can cause that for kernel timers. Well there's many potential sources of your and in Zephyr with kernel timers interrupt masking mantras jitter which includes if you go to use like an IQ lock or a spin lock. If your priority interrupts than the timer interrupts in your hardware. That can also prevent the timer interrupt from firing and then there's some jitter there's some delay and getting back to you to the timer system and getting your call back and all that. From flash can also, you know, another source of jitter right hey like my timer interrupt fires I got to go fetch code from flash to then load into SRAM. Okay, well that might take a minute will not a minute reality but you know, a little bit more time than the maybe expected. So a little bit more time from when the the timer actually fired to when your code runs.  Right there's some some bus arbitration that needs to happen there's some delays variants and memory access time you're trying to you know touch, you know, tightly coupled memory versus SD RAM off often off on the board somewhere that might might take some time. And of course you know the hardware clock itself can be a source of jitter, but probably not a realistic one. In most cases, most people are probably going to be using crystals. What's using like a, you know, 555 or RC oscillator or something then all bets are off right. And so what you know what do I mean by clock drift clock drift is really a loss of accuracy. So, you know, if we kind of go, you know, I think a lot of people think about that. I'm sorry my daughter came up to say hi. Yeah, so if you think about what what you know, precision and accuracy might look like.  And, and that can be caused much, you know, the only thing that I know that that would cause drift in in Zephyr kernel timers is really the grounding so the minimum and also yeah like you the minimum unit of time that you can really schedule things is one tick. So if you if you, you know, if you try to schedule a timer for one microseconds. That's, that's, you know, maybe that works on some hardware with with, you know, like a mega her clock or more, but then you go to run it on some different hardware, maybe the clock is a lot of no three 2.7 state like is on a Nordic board for the most part or maybe on an XP board with the low power clock.  So then, right, the conversion from from six to clock cycle can cause. And, yeah, so what are the expectations of current timers then, you know, given all of this right. They should be schedule every tick. And this is really important you should be able to schedule a timer.   You should expect, you know, some drift if you're using time units rather than ticks, and especially you're trying to look for you know code to work across multiple boards with with K timers with with time units of the behavior may vary. And this is something so it's not it's not always hardware agnostic to simply say, I have a K timer with a one millisecond time out. It may vary behavior over over a different heart. Some small manager, regardless of what you're doing. It's, it's, it's almost it should be expected, unless you're very careful.  And you can kind of see what your hardware does with with this. What one moment I apologize. Yes, working from home has it's a benefit. Anyway, um, Now, let's do the demo here. Yeah, so what is this kind of look like here. I need to do sure. Okay, so I have, I have Nordic board right next to me that I'm that I'm running live with the test, so you can see the actual output of this time or just time or dirt test. Yeah, so it's going to, you know, it kind of like runs through it collects samples and it does some statistical analysis and we can see on this Nordic board for example. And, and, you know, the so we've set a timer for one millisecond. This is actually, you know, a not an integer number of cycles that that ends up being because it's a clock of 32.768.  And, and there's definitely some drift right if we if we set like a timer for one millisecond over time will be drift and in fact like it's expected, you know, in this test case that we're going to see that trip, and let's kind of know that we can also see this, you know, on the hardware as well. You know, I changed my test a little bit so that we can get a API open toggling every time the timer fires. And here we can see, you know, this is the last thing it's a demo but. Yeah, I mean we're having statistics the same kind of statistics that that are on from the test here. We need we need to do a little bit of math because this scope I couldn't I couldn't set it up to get the, you know, the period and frequency based on both edges but you know, again if we divide this by to the time period here, it's about 1.01 milliseconds. Again, we're going to see, you know, from some grips. And if we look at our standard deviation here. Sure we can divide by two but I believe we can hear. Not quite, but there is going to be some standard deviation right there's going to be some variants from here in our clock as well. So yeah, I hope I hope talk was was really helpful and sort of maybe you know building up some intuition about kernel timers how what to kind of expect out of them. They might work on different hardware, you know, they're going to work differently on different hardware. And yeah, that's it. Any questions. Great. So just looking at the text output from your tests it the non rounded value is 32.768 cycles per interrupt or whatever. But the minimum was 36, like that's a substantial difference. It is, it's, it's, yeah, so in this case for sure that again. This is a, you know, this is a Nordic board and if we look at so this is kind of tied into the kernel create. So if we look at the kernel create here. The kernel tick rate is going to be, you know, it's actually higher than the clock rate clock rate is 32.768 kilohertz but the kernel tick rate is actually 8192 Hertz. And that's, I believe that's because on Nordic boards, the timer can only be set like once every four for timer cycles I could be wrong I'm not a Nordic engineer, but I recall seeing that in a PR. So this is sort of tied in right exactly how, you know, this is all set up and again kind of going back to the point right where you can only set a timer as as accurate as it is. You know, right I think it's going to be one over 8,182, but it's going to round up the next. Right. No, yeah, I mean, but, but yeah, exactly. It's kind of. Yeah. So these things can be, again, I think kind of, I mean, it's like it's all sort of there in the back here are minds I think right but the, but it can still catch us off guard. It catches me off guard sometimes. And especially when when going from different hardware, where, you know, again, like, I want to set a timer for one millisecond that works great on my hardware and then I go to run it on some other hardware. And, oh, it's not one millisecond that's not, you know, that could that could cause some chaos. Things can go wrong. Another question as well. Sorry. Sorry. I think, oh, there we go. I just can't tell directions. Hold on. Okay. My question is like a that actually like two ways that you can have like a, for example, you can have your K timers. Other one is you can have some of your work you write them and then you can and you can do some scheduling. Right. So, as you think, so which method would have the lowest clock jitter. So, the other part, I mean, I heard about the K time, was it schedule will work is that is it was that the, for example, like a, in addition to using the K timer, you can have a working item and then you can have this thing. Like a, you can do some scheduling after some delay, and then inside the work you write them, I mean, after this, the work you write them get executed, you can actually do actually reschedule again. Right. So then in this way. Yeah. So, so this is kind of like another interesting part about curl timers.  So this is about as precise as you can get in terms of like software, you know, driven timers in Zephyr without without using. There's another subsystem that lets you directly tie into like a different timer compare. And that's cycle, you can get like cycle accurate timers with that. But basically every other timer in Zephyr is built on K time out including K timers. So for example, like your schedule will work you item that's built that's built on. That's basically built on K timers, like semaphores with delays, right where you where you can say I'm going to wait for my semaphore for like a millisecond that's built on a K timer for for the, you know, the wait time. So, so all of those things where all those kernel API is where you can, you can pass in, you know, time, or you can also pass in tick values typically, and the accuracy precision jitter drift, all those rules still apply. And so again, that can, that can kind of, you know, if you need something more accurate, right there, there, there is like a hardware driver API that you can tie into and get cycle accurate timers. Yeah. Okay, we have another one. Yeah. If you want to have a real precision where you want to have especially zero drift, would it be an option to accumulate the elapsed time and then compare to your ideal time value. And then basically, slightly tweak the the next delay. Is that supported? That's absolutely so it's not directly supported by any kernel API, but you can do that.  There's, you know, a cycle get API is where you can get the cycle accounts of the timer and and base your, you know, base your next time out on that so rather than setting like a period so exactly like what you're talking about right but there's no, there's no automatic periodicity like try, you know, like, there's no API to do what you're talking about where it tries to, you know, if you if you go too far it kind of shifts it back. There's no sort of like API to deal with that in the current I think it'd be a cool API as sort of like a build, you know, a library that you can build on top of kernel timers but the way it is now. It's not done that way I think predominantly because that adds more logic right there's more code that needs to happen to make it work that way. But yeah that would be a really cool addition as like a, you know, a little layer on top of these, but no it does not exist, but you can build it yourself in your application. Okay and we do have a virtual comment that someone wanted to add which I think relates to what you were previously talking about but they say just wanted to add a comment that setting your scope to infinite persistence is also a nice way to eyeball jitter on clock. Absolutely. Yeah, in fact, yeah right exactly. So if you do that, you'll start seeing like the, you know, kind of the fuzziness of where the edges are sort of spreading out. It'll kind of look like, I mean, ideally it'll look like a little bit of a Gaussian right like it'll be really bright in the middle and then fuzzy as as sort of the window of jitter is there. And you can see that. Definitely. Yeah, it's a cool way of doing it. We're doing a last check for any other questions. I think we are we are we have gotten them all in Tom if someone wanted to reach out to you are you on discord are you in any kind of community they can get into what are the best ways to reach you. I'm on I'm on discord. My, my name is Tom B. So yeah, feel free to reach out to me. Just ping me. I'm pretty active and mostly discord channels so you should be able to find me. Wonderful. Thank you. And I'm going to do one more final check. I think we are all set then Tom. Thank you so much for your time today and for joining us virtually and from wherever you are and we understand that life happens. So thank you so much and we'll we'll see you soon. Thank you. Thank you.


Understanding and cultivating the requirements for living a healthy life is one of the most important foundations we need to build as both individuals and as a species. We can see very clearly that when the body is healthy, the mind works right. When the mind works right, the emotions are more fluid and true. When the emotions are true, the spirit can thrive. And simply having a more healthy body can dramatically increase our spiritual connection to ourselves. When the whole ecosystem of our body of consciousness thrives, we become powerful creators in our own rights. As we do this collectively, the entire world is transformed into the paradise it's designed to be through our good work in the world. It is critically important that we do this work, both internally and externally, because we need to bring both into balance to create real harmony. As Bruce Lipton teaches us, epigenetics, the environment, is what shapes our genetics, the individual. Epigenetics is the subset of phenomenon which affects genes from outside the DNA. But of course, the DNA still plays a vital role. Epigenetics are simply described as changes caused by the environment that affect how our genes are passed on. These flow hand in hand in a perpetual cycle of give and take throughout our existence. We would be remiss not to follow the basic rules of planet Earth, for these are the most important rules that make a difference when it comes to living as connected, planetary beings. Throughout our series on food, nutrition and health, we've touched on only a few of the challenges and roadblocks to living a life full of health and wellness. There are so many more things we could talk about, like the environmental and ethical atrocities of leather farms, the greenhouse gas emissions produced by factory animal farming, the deforestation of the Amazon to produce beef, the mass pollution of waterways from the runoff of these farms, the amount of grain and water required to feed all of these farm creatures that deforest and pollute even more land, and bioaccumulation of toxins in our water, using render farms to grind up dead animals to feed to our pets. Cruel fishing methods, mass marine extinction, and so much more. And honestly, if we just focus on that all the time and nothing else, it's like, oh Lord, excuse me, it's time for me to go live on a mountain in seclusion for the rest of my life. However, before you sell all of your worldly possessions, allow me to share with you something that can really make a difference and support the cultivation of great change. Now don't get me wrong, focus on the problems is important for us to understand them, to see how we've created the mess we have. But if we stare for too long and do nothing, we just make ourselves depressed and never create anything new. If we can shift our mindset and focus to a solutions-based approach to these challenges, we can shift our behavior and produce beautiful change with rapid speed. And this is exactly what happened in Australia many years ago. In the late 1960s, two pioneering academics in the world of agriculture came together to develop a new way of looking at how we live on the earth. In relationship with the requirement of healthy food, safe shelter, clean water, appropriate sun, fresh air, strong communities, and happy lives. By 1978, Bill Mollison and David Holmgren published Permaculture One and made it available to the public. This evolved into the final design manual presented to the world by Bill Mollison in 1988, entitled Permaculture, a designer's manual. It is from this manual that the world has been effectively changed for good, and we are seeing the effects today. Permaculture is the modern world's first approach to a truly integrated set of practices that takes into consideration all aspects of the ecology in any given region and allows for human populations to thrive alongside them, not at the expense of the ecology, but rather because of it. In fact, in 2018, Jeff Lawton, the protege and permaculture torchbearer of Mollison since his death in 2016, there is a project that was established in the Dead Sea Valley of Jordan, the driest and most desolate place on the earth, which shows just how powerful the living earth actually is when her principles are used in very specific ways. Now, not to spoil the surprise or anything, but there is now a living food forest there with self-enclosed running water, fruiting trees, vegetable and herb gardens, thriving animals and a whole series of other miracles that would not have been possible without these incredible practices. When we can get the paradigm correct, everything becomes clear and concise. The actions we need to take become specific, measurable, attainable, relevant and timely. These are referred to as smart goals. Sure, these may have been introduced as a way for people to be more productive in the workplace, but they are applicable across anything that we have a clear sailing objective towards. In the case of permaculture, we have been able to achieve not just a clear objective, but also very specific results across the globe, even in desert regions that nobody believed would be able to grow anything. We know very well today that all living beings live as a part of a larger ecological framework. If forests are destroyed, the soil cannot thrive. If the soil is devoid of the biodiversity it requires to sustain life, plants cannot thrive. If plants are nutritionally poor, insects and animals suffer. If these systems suffer, so does the ability for all of life to maintain the ecosystems. Although humans have developed systems of agriculture that appear to be separate from this cycle of life, this is only an illusion. We are just as intimately connected to ecologies around us as any other creature on this wondrous living planet. One article on this subject writes, our research suggests that people who live in areas that have more and or larger trees on the streets report better health perception after controlling for demographic factors such as income, age and education. This same increase in health perception is also, on average, equivalent to being seven years younger. Results suggest that people who live in areas that have more and or larger trees on the streets report significantly fewer cardiometabolic conditions. The reason why permaculture is so important right now and possibly the most important subject we can attend to in this day and age is because it is a practice which brings back the biodiversity of a living planet once again. A biodiversity and ecology that we can participate with and thrive in. Permaculture is also available to everyone. It's not very expensive to invest in some basic materials to get yourself started. And due to the demand for healthy food, there are many people now bringing permaculture to the marketplace in their own unique ways. Permaculture itself is like a social-spiritual farming revolution, bringing us back to the age of farming but in a new, techno-savvy way that doesn't require the same amount of land or equipment and encourages creativity in how you approach your practice. For those who are interested, you'll find a link in the comments below to a website to help you get started with permaculture. As we've been exploring in some of our other videos lately, where we invest our energy, focus, time and resources is what we will continue or discontinue to create in the world. Even if you yourself are not called to start your own permaculture garden, you can support your local permaculture farmers. The point is, I want to invite you to do your best to live in alignment with the principles of the Earth and maybe even discover just how powerful your daily micro-commitments can be towards creating a more harmonious world, one small act of love at a time. Your increased health, wellness and longevity will be its own reward for your efforts. Bringing this series to a close, there is one final thing that I must share. As we've looked at before, we are what we eat. If we are eating healthy and living food, then we will in turn reflect that same vibrance in life. According to a recent estimate by the National Institute of Health, 90% of cells in the human body are bacterial, fungal or otherwise non-human.  At a conscious level, everything you eat is or was alive at some level, unless you're that one guy who ate the plane. And when food is ingested, it becomes part of your body of consciousness. If the food we eat is artificially modified, poisoned or raised in an environment of fear and stress, we will take on that same energy simply by putting it into our body. What's amazing about this is that this is where many of our cravings actually come from. It's not necessarily that we, as in our souls, want that cheeseburger, but that the microorganisms that live inside us are hungry for a particular chemical combination of salt, sugar and fat, and are emitting signals to our bodies that asks us to keep eating those foods. But if we create the opportunity for ourselves to cleanse our bodies, such as through fasting or eating differently or even plant medicine, we clear out those microorganisms, and over time, the cravings we have change naturally as a result. We have this incredible ability to adapt. Our bodies do it on a daily basis. If we have grown up eating unhealthy foods, our bodies become used to this diet and learn to make it work. However, just because we can survive this way does not mean we are thriving. To add to this more, we must take into consideration that in addition to what you eat, we must also be mindful of how we eat. There is a practice known as mindful eating, which is slowly eating, chewing thoroughly, taking time to appreciate the texture and flavor of your food. A great article published by Psychology Today about mindful eating says, it helps us to become aware of who in the body-heart-mind complex is hungry and how and what is best to nourish it. Each of us are responsible for what we put into our bodies and we're responsible for the way that we feel as a result. When we can learn to shift our relationship with food and health, we begin to thrive. The more that we personally thrive, the greater an impact we can have on the world. Albert Einstein wrote that, a new type of thinking is essential if mankind is to survive and move toward higher levels. What this means is that with all of the problems in the world, no amount of tinkering with these problems will create a dramatic change unless we change our own internal state first. We learn from hermeticism that our outer world reflects our inner world. The more we shift inside, the greater ability we have to create a shift in the world outside. One of the ways we do this is by recognizing that the internal and external are in constant flux.  So ask yourself, what am I bringing into my body today? And then, what am I putting out into the world as a result? Throughout this series, we've looked at a lot of different information regarding food, health and how to optimize our personal ecosystems to thrive in a chaotic world. With this, I thank you so much for watching. Please don't forget to leave a comment if you learned something fun. And we'll see you again soon in another Spirit Science video.


Good afternoon. Good afternoon. On behalf of the Clayton Center and the Department of Obstetrics and Gynecology and the Bucksbaum Institute, it's a pleasure to welcome you back to the spring quarter lecture series continuing our year long lecture series on reproductive ethics. It is a great pleasure to introduce today's speaker, Melissa Gilliam. Dr. Gilliam is serving as vice provost for academic leadership, advancement, and diversity. This is a role in which she supports the provost in activities relating to faculty development and institutional diversity. Dr. Gilliam is a professor of obstetrics and gynecology and of pediatrics here at the university. She holds the Ellen H. Block Professorship of Health and Justice. Melissa serves in addition as chief of the section of family planning and contraceptive research, directs the fellowship and family planning in the Department of Obstetrics and Gynecology. Melissa holds a bachelor's degree from Yale, a master's degree in philosophy and politics from Oxford, her medical degree from Harvard, and a master of public health degree from the University of Illinois at Chicago. She's also a member of the National Academy of Medicine that was formerly known as the Institute of Medicine. Here at the university, Dr. Gilliam heads CI3, which is a university-wide interdisciplinary research center. CI3 works with and on behalf of young people marginalized by race, class, and sexual orientation and takes an asset rather than a risk-based approach to addressing sexual and reproductive health, educational attainment, physical safety, and economic security. Within the Department of Obstetrics and Gynecology, Dr. Gilliam leads the NIH contraceptive clinical trials network, conducts qualitative and quantitative studies, and develops clinical and community health interventions to promote reproductive health and rights. Today, Dr. Gilliam's talk is entitled Not Much Choice, Reproductive Justice and Women of Color. Please join me in giving a warm welcome to Melissa Gilliam. Good afternoon. Thank you so much, and thank you for that introduction, Mark. So today, I'm going to move my bag so I don't trip. This afternoon, I'm going to talk to you about the topic of reproductive justice. And this is a topic that is really near and dear to my heart and something that I've grappled with throughout my career. And the reason why is that when I first started training in obstetrics and gynecology, we learned a lot about all of these different contraceptive methods, and I was so excited about it. And one of my earliest studies was a qualitative study with young Latinos on the west side of Chicago. And their understanding and thoughts about contraception were so different from what I was learning. They had a lot of concerns, absolutely opposed to many forms of contraception, and really were very concerned about not so much about, I want to prevent pregnancy in order to have all of these other outcomes, but really thinking about, if I use these methods, what are the effects on my future fertility? And so it gave me a lot of pause. I thought, I have all of these tools, and it's not clear that people actually want to use them. And so I had to start to rethink a lot of what I had learned, and that's how I came to the topic of reproductive justice. So what I'm going to do today is talk to you a little bit about the history of reproductive justice. Then we'll talk a bit about how it's particularly related to issues of contraception and sterilization. And then I'll actually turn to my own work and how it's been informed by the topic of reproductive justice. And then we'll talk very specifically about a project that I'm working on right now in India with a number of you in the room as an example of how these principles of reproductive justice have really changed the way that I am thinking about and conducting research. What is reproductive justice? If we think about reproductive health, and as you heard in the introduction, part of my training is in public health, think about it as this big population level impact. This is incredibly important. Thinking about the role of clean water and other big systemic interventions and how it can change the health of a population. This was just an absolutely eye-opening way for us to think about health and the way that we can transform the health of many, many people. And so a very important concept, public health. Reproductive rights. I think this is kind of a good image.  And often we talk about the issue of choice, the ability to choose and for each person being able to choose what is right and what is wrong for them. And yet there seems to be the need for a third term, which is reproductive justice. And the way that I started thinking about it, and this quotation has meant a lot to me and so I've used it a number of times. But it was somebody writing actually about the city of Chicago. And what they're saying is that things are separate and unequal. And in this quotation, Warren moves from the ideas of school dropout rates, school segregation, but then gets into health, obesity, asthma, cancer, and then into reproductive health, pregnancy, breast cancer, and that somehow all of these different structures and processes are related. And so this is the idea behind reproductive justice, that we need something more than talking about the big public perspective or the individual perspective, but we also need to add the systems level thinking. And people have taken this even further to kind of think about this as more of a dynamic process. So this is work by Paul Farmer, who is a practitioner of public health, who really talks about how the privilege of some is associated with lack of privilege, lack of access for other people, and that lack of access actually is not just neutral, right? It almost has a violent effect. It almost has a harmful effect on other people. And so another way of thinking about it is that we can't just simply think about people's rights if we don't actually think about the larger structures or systems that they live in. And this is a picture of a community on the south side of Chicago, and that access to all of those things, whether we look at Warren's example of school, school, healthcare, all of those things actually impair people's rights. And so when we think about reproductive justice, we need this sort of broader conception. We need to think about people's access to being able to safely raise their children. It's not only about the right not to have children, it is the right to have children. And when you have children, it's about the right to be able to raise them in a place that is healthy and safe and supports their well-being. So reproductive justice might also look like this. So I think one of the best definitions I've seen comes from a group called Asian Communities for Reproductive Justice. And now you'll often see them talking about their current work as families forward. And what they say is that reproductive justice exists when all people have the social, political, and economic power and resources to make health decisions about our gender, bodies, sexualities, and families for ourselves and our communities. And what's important about this is that this is moving beyond an issue that is specifically about women. It is not specifically about a certain color of women or a certain class of women. It is really a very universal idea. So where did this come from and what's the need for it? So there are many reasons why reproductive justice is such an important concept for me, but you'll see that it's really ineluctably linked to the history of obstetrics and gynecology. And then specifically family planning. And we'll talk a bit about that today. So Marion Sims, any OBGYN in the room or aspiring OBGYN will probably know about Marion Sims. And Marion Sims has been considered the father of modern gynecology. And he was born in 1813 and he's really, he was one of the most famous American surgeons of his time and of the 19th century. And if you go to what we call ACOG, the American College of Obstetricians and Gynecologists, you'll see pictures of Marion Sims and we have devices that are still named after this person. And Sims became really well known for his treatment of the vesco vaginal fistulas. This is a really debilitating condition that happens after childbirth where there's a fistulous track between the rectum and the vagina and it can really change people's lives and it continues to be a problem today. But one of the things that, one of the ways that Sims learned how to repair fistulas was actually by working with African American slaves. And so he would keep in his, behind his house, he had a hospital where he was practicing and treating these surgeries. And this is, I'll let you all dive into this history and make your decisions about the ethics of it. So on the one hand, he was really heralded because these were techniques that people didn't know how to do. And because of the surgical advancement and he has kind of an interesting history, he was kind of a mediocre student and kind of a mediocre doctor. And then suddenly he discovered all of these innovations in surgery. And so these are things that are practiced to, some of the things are practiced to this day and really change the practice of gynecology. But on the other hand, the women who he performed these surgeries, there were people who were operated on as many as 30 times. And this idea of what we think of in the modern times of consent and what it means to the complications of surgery. And I told you we're talking about the 1800s so we're not talking about antibiotics and the safety of those procedures again. So much of what we benefit from today are really happened at the expense of people who didn't have a lot of autonomy. The one of your earliest speakers was a friend and colleague, Dorothy Roberts. And Dorothy Roberts is an amazing person, but her book, Killing the Black Body, it just had an incredible impact. And one of the earliest things she describes is slave women. They would dig a hole in the ground, lay the women on top of it, but that hole would protect the pregnant belly, would protect the fetus. And so then when she was whipped, there wouldn't be harm to the fetus. And so this idea is, what Dorothy argues is that you're already seeing the separation of a woman from her child and a differential interest in the offspring in the mother herself. And this idea is kind of this beginning of thinking about women and women of color as somehow not being valued in the same way that the fetus is, that somehow the interest of the mother is different than the interest of the fetus. And she brings this forward to even think about some of the lectures that you've also heard in this lecture series where women are being prosecuted for having an exposure to drugs. Sometimes these are very weak exposures, they're past exposures that happen before pregnancy, but somehow the woman can be incarcerated because of potential harm to the fetus. And so these were, these are some of the historical examples, but these are things that actually come into the present. And because this idea of access to healthcare, this idea of thinking about the children of African-American women or women of color or poor women differently, then we might think about the wellbeing of other children. There was a group of women as they returned from the conference on population and development in Cairo, which was an incredibly important time for women and women's rights, they said we are not hearing the needs of women of color being met in the same way. Our needs are different and they have to do with much more systemic and structural violence and inequities. And so they said, you know, we need another term that is beyond rights and beyond health and this is a term reproductive justice. And one thing that's particularly wonderful about this topic is that it originated here in Chicago. It was a group of women activists working in Chicago who coined this term and really are the owners. And so again, this other connection. So the topic of reproductive justice is actually very salient within the field of family planning. And I wanna just give you some examples of both historical and present about how that has worked. One of the things that got a lot of attention is the contraceptive device, norplant. It's modern, it's not that ancient history, but it's modern successor is the single rod implant, implant on or next one on. But at the time when norplant came along, it was really revolutionary because it could be placed and stay in the arm and provide protection for five years and was highly effective. And so people started thinking about it from a public health perspective. My gosh, we can do all of these things around the issue of unintended pregnancy. But this is a article from the Philadelphia Inquirer because, and the editorial board said, you know what, I just, we had one article about approving norplant. And then we had this other article about how many poor women there are who are having children. Let's put the two things together and can norplant really solve the problem of the underclass? And this went on in multiple settings just to give you a few examples in these, some of which come from Dorothy Roberts' work, that there were people who were introducing legislation to give financial incentives for people to use norplant and giving more money for each year you kept it in. So if you got the full five years that would prevent women from having children. Other people were saying, okay, I'll let you out of jail if you agree not to have children. And so this idea of somehow linking this public health goal to contraception is something that was established fairly early on. This is what norplant looks like, and this is important because you'll see that it actually has six rods and there was not a lot of training for people to put them in. And so when I was finishing residency, I was part of the cohort of people who had to take them out. And it was really hard. It could take an hour and you could find them in lots of different places. And so you're kind of at the end of clinic doing a minor surgical procedure, trying to identify all of these rods that were somehow in someone's arm. And so it ended up there, there ended up being a number of lawsuits. None of them that were actually won by the way, but there were a number of lawsuits including a large class action lawsuit. And so by the time that there was a lot that did not have adequate drug levels, again, no pregnancies resulted in it, but they were concerned about the bioavailability of drugs. They actually ended up saying enough, it's coming off of the market. And so norplant is no longer available. But yeah, so it's an interesting story. Sheldon Siegel is really one of the greats in contraceptive development. And before he passed, he actually came and gave a talk here at the University of Chicago. And he said, you know, I never wanted to make it with six rods. I didn't think that was the best thing for women, but that kind of technically that seemed to be the easiest way to make sure that we had sufficient drugs. And so on the one hand, it's sort of this great method, highly effective, but the way in which it was used and sort of its association with coercive practices really made it, its distribution ended. And so by 2002, it was no longer available. And so just again, this kind of connection between social justice issues and family planning. The other area that has been a really important part and is still an active debate today is the role of sterilization. And you all had the opportunity, those of you who are here to see Don Shapiro's work on sterilization. So you have a sense of the history of sterilization and the coercive use of sterilization. But this is something that still is alive and well. This is a quotation from Senator Russell Pierce who's like, hey, let's just, you know, we wanna solve these social problems and what we need is birth control implants and tubal ligations and nore plant, right? So still in modern times, people are thinking about this as a way to address larger social issues. And so these are, this is the reaction of women and of communities of color saying, don't force sterilization. So this has been an interesting area for me and something that I started studying at the very beginning of my career with my friend and colleague, Dr. Nikki Zeit. And what happened at the time is we noticed we were, at that time, I was at the University of Illinois at Chicago. And we noticed that when we were on labor and delivery, sometimes a woman would have all the requirements to have postpartum tubal ligations and sometimes not. And because of the larger history of sterilization, there actually, we have to sign a consent forming. You have to give women adequate notice in order to, so you have, there has to be 30 days between the time the consent is signed and the time the procedure is actually performed. And so when we actually looked at the rates of sterilization, if someone had requested sterilization, we found that only about 46% of women who had requested a postpartum sterilization, about 46% actually had an unfulfilled request. And this study ended up being repeated by other people across the country. So in San Antonio, they found that about 31% had an unfulfilled request. Another study in Philadelphia showed about 44% had an unfulfilled request. Now these papers are only for women who are using Medicaid funding to pay for the cost of sterilization. So if you don't require, if you weren't using Medicaid, then you wouldn't have this request form required. And so one way of looking at this is that, my gosh, we have a different requirement for women who have lower incomes than we have for women who have higher incomes. But what I wanted to do as well was to actually look and say, well, what's the consequence? And so I also followed women longitudinally forward and said, what actually happened? So these are the women who had requested sterilization during their pregnancy, had not received it than what happened next. So about 24% ended up having a sterilization at another time and about 18% became pregnant at about a year. And so some, one way of saying is like, oh, that could be a problem. Women who had wanted to have no more children actually ended up getting pregnant again. But what was interesting is that many of them were losing insurance. Many of them actually were happy not to have had the sterilization. There was a lot of inconsistency and it was difficult to say that it was purely a bad thing that their request was unfulfilled. And that was in that one cohort. So one of the challenges is that this issue of who is having an unintended pregnancy happens. It is more common among women who are low income or women who are people of color. And so many people have said, look, if we address this issue of unintended pregnancy and this address this issue of unintended sterilization, the thing to do would be to take away that paper so that women, as it came on labor and delivery, would be able to have a sterilization. And so a lot of people have argued that we should remove that 30 day waiting period and then Sonia Barrero even estimated the cost difference, right? If you included pregnancy and all of these other things that happened, if women had repeat pregnancies, you know there's actually a cost savings. The challenge though is that when you think about things that way, either the kind of cost effectiveness or even just maybe the ethics of removing a piece of paper, you're not using the reproductive justice framework, right? And when you start to think about it more in a social justice framework, you start to realize how much choice do women really have. In our study, we were finding that women lose insurance, they lose access to medical care. They may not have the same ability or autonomy in making contraceptive decisions as other women. And when you look more closely, what you realize is that Medicaid provides coverage up into a certain time and the Affordable Care Act has improved much of this. But at the time, Medicaid provides coverage until six weeks postpartum. And so maybe some of those decisions about having a postpartum sterilization had to do with will I have further access to contraception? Other places, women don't have access to all methods of contraception. And so some very important work that's happening here would led by Lee Hasselbacker and Deborah Stahlberg are looking at the access to contraception in religiously affiliated hospitals. And so if you think about that, that you don't actually have access to contraception, you might choose sterilization at the time of delivery. The other interesting issue is around the access to financial assistance for the number of children that you have. And so under the Clinton administration, there were a series of welfare reforms. And what happened in that welfare reform was women stopped getting additional financial support as they had more children. And these were called family cap policies. So as a result, you actually didn't have the money that you needed to raise more children. So maybe that's why you choose sterilization because having additional children actually threatens the economic wellbeing of your family. And about 19 states have these policies. And so what reproductive justice does is it forces us to complicate our understanding of what could initially seem only to be an issue of unfair access to a treatment. And what was interesting when there was sort of the drumbeat of articles about sterilization and removing barriers to sterilization is that some of the most vocal people about not removing these barriers were actually women of color led organizations, right? So the people that you think you're trying to help were actually the people who were most concerned. I'll give you another example of this. So this is a chart that's often used to help to counsel women about contraception with this idea of helping them understand the most effective method. Again, that's using this public health framework, right? If contraception is to prevent unintended pregnancy, you need to know the most effective method. And it led to, and so you put those on top and you give people this graphical understanding and this is how people understand efficacy. This is just a diagram from the contraceptive choice project. This was this idea of you give women choice and you remove their access to contraception and you tell them about the most effective method first. They are more likely to choose long-acting methods, the IUD or the implant, right? So choice results in this and then they also show the reduction in pregnancies and their reduction in abortion and the reduction in birth compared to people who are not in the choice study. But what's really interesting is the response to this type of research, right? Lowering access. Actually, this is a document by Sister Song which is one of the leading organizations in reproductive justice. And it's a letter that they are asked providers to sign and it's really about restraint in the use of long-acting methods. And so what they say is we call on reproductive health rights and justice communities including clinicians and funders and others to endorse the following principles and I'll just give you an example of what these principles look like. We acknowledge the complex history of the provision of LARC and seek to ensure that counseling is provided in a consistent and respectful manner that neither denies access, nor coerces anyone into using a specific method, right? So the study is called the choice study but the reaction of women and women in the community is this feels like coercion or there is a potential here for coercion. They want people to sign something that says we commit to ensuring that people are provided comprehensive, scientifically accurate information about the full range of contraception options in a medically ethical and culturally competent manner in order to ensure that each person is supported in identifying the method that best meets their needs. And so it goes on and this is something you can find on the web but it just gives you a sense that maybe the ways in which we're thinking about it either in a research context or a clinical context is not the same way that women and activist organizations and women of color and our patients are thinking about it. So these are topics that I've kind of grappled with and thought about for a long time and one thing that's important to remember about reproductive justice is that it is considered to be a women of color led movement but it's also a movement from women who are most affected by it and most marginalized by these issues. And so in many ways, it's not about the academy, right? It's not about us in a university setting trying to be leaders in this movement. And so that was a complicated thing and trying to figure out how to think about it. So in 2008, it gives you a sense of how long we've been sort of thinking about these issues here at the University of Chicago. We hosted a conference and we called it Beyond Choice, examining reproductive justice from scholarship to activism. People like Dorothy Roberts Kane, people like Lisa Harris, a number of women of color led organizations from our local community participated and it was really an opportunity to talk about the interface, talk about the history of reproductive justice but also to begin to think about the interface between the provider community and the reproductive justice community. And this is the article that resulted in it. This is an editorial that talked about the conference but also talked about the way that clinicians can interact with reproductive justice organizations. And we were fortunate enough to get funding from the Harris Foundation to continue to have a policy program. And one of the things that we learned was the lack of access to information and to articles. And if you tried to get an article and you're not part of the university, you're often asked to pay $30, $40, $50 for a single article. And so one of the things that became really important for us to do was just be the group that read through, synthesized data and provided to organizations that were working in activist organizations or other organizations that were on the front line of actually changing unjust policies. So just to give you sort of a sense of the things that we highlighted in that conference is that it's the breadth of reproductive justice, how it's not just focused on family planning but it really is much more complicated. So for example, women who recently immigrate to the US are often closed out of access to a broad range of reproductive healthcare, whether it's breast exams, physical exams, family planning visits. We talk about the Hispanic paradox that women who come, Latina women, Mexican-American women who immigrate to the US actually have better birth outcomes than most US women. And you can see this in other colorectal cancer for other populations, but for pregnancy, this has been noted. Over time, that boost, that protective factor actually diminishes and part of that is because of the systemic discrimination, whether it's due to culture or language or fear of incarceration due to documentation status. And then unless we're thinking about these larger systemic factors, we can't just sit in our clinical environment and think that we are providing excellent healthcare. And so this is worked by a colleague, Lisa Harris who talks about the role of in vitro fertilization. And in vitro fertilization was originally developed to prevent for women who had tubal disease, right? So the fallopian tubes were blocked. And so this was a way of taking a fertilized egg and putting it directly into the uterus. Blocked tubes are actually much more common among low-income African-American women because of higher rates of chlamydia and gonorrhea. And so it really is the ideal treatment for this problem. And yet the actual access to IVF is incredibly low for these populations. And so it's actually the populations that are the least able to use it. So we have Medicaid coverage for sterilization with the barriers that I talked about, but not Medicaid coverage for fertility services. So again, this differential access to the right to bear children. So the key to reproductive justice is that it is considered empowerment of and leadership by people who have been disempowered. And what's important about that is that the idea is not only to change access, it is really to empower and to change people's ability to make changes for themselves. And so in some ways, you know, on the one hand it's this enlightening and really important framework, but as I said, it is not necessarily, it does not necessarily put academics or academic physicians at the center of the movement. And so I wanna talk a little bit about why we ended up starting CI3 and how my work has been informed by the topic of reproductive justice. So CI3 is a center with, run by those people up there. And thank you. And we started this in 2011, 2012, really with this idea of trying to think about interacting and working with communities in a very, very different way than I had been trained to do either through research or through clinical care. And I wanna talk to you about some of these projects and show you how they work. And hopefully you can kind of see the echoes of reproductive justice and how that is an outgrowth of this work. So we work in three areas, we kind of call them three verticals, and then throughout we combine policy and research and communications. And so one thing, and so my work is with adolescents. So one key project has been the work in the Game Changer Chicago Design Lab and that's work that I do with Patrick Chagoda and Ashlyn and Bea and her team. And the idea was to think about how we can bring people who are not experts in health, but are experts in their own health and experts in their own lives into the process of actually designing the intervention. And this is an example, it's taken us a while to kind of come up with the way to design games and interventions, but the idea is that from the very beginning we are planning and bringing young people and educators into the process of designing. Then we do a lot of play testing round and round and now really making sure that we're constantly exposing young people and ourselves to these interventions. And then we only then do we start to do the actual research and the actual scaling. And this has led to a very different approach to research, a very different approach to designing interventions, but one that both changes us and I think changes the people who interact and in many ways the process of designing it is as much the research as the outcome. So we're very interested in both the process and the outcome. So I just wanna give you a few examples.  This is a game called Bystander that with the idea that to teach young people about sexual assault and sexual violence, rather than making them the victims, we wanna make them the assets and the people, assets, we wanna make them the people who have the ability to address the issue. And so Bystander interventions are ways and kind of pro-social approaches to changing community norms around issues. And so for this game, the young person is always positioned as a person who can intervene, address and gain skills. And this is a project that we're working on right now in some of the Chicago public schools. And so this is an example of one of the modules. You have a scenario where a young person espouses a rape myth and then you as a Bystander, your job is to say, is this true or is it not? And to give advice to your colleague. And then you can get the answer wrong. You can pretend you don't know the answer. You cannot know the answer and then you get feedback. And when we did this, we had, for example, young men said we're always the bad people whenever we talk about sexual violence. And so we also included a module about young men. So this is an example of another module where the young man is actually the person who's trying to look for episodes of sexual harassment or sexual misconduct and then trying to show them the different interventions. This is another example. This is a game that we're working on right now. It's called The Test. And it's a game for young MSM to start to think about how and where to get HIV tested. And so again, we work with young people from the population and we actually bring them in constantly getting input and advice on how to design it, what works for them, what doesn't. But also creating scenarios and personas that actually reflect their actual lived experience. And so through this, the idea is to address some of the real barriers that people experience with trying to get HIV tested and embedding that teaching into the game. This is another example. This is a project being developed by my colleague, Brandon Hill, really talking about the role of pre-exposure prophylaxis for prevention of HIV. And again, having young men who are at very high risk for HIV being engaged in the development of the intervention. And this is a similar project and it's called Our Plan. Really trying to help young people start to think about using contraceptive methods, but also finding a method to prevent sexually transmitted infections as well as unintended pregnancy or undesired pregnancy. And what was interesting about this is that they felt very strongly about the use of condoms and very concerned about saying long acting methods were more effective than condoms when many of them felt that they're much higher risk for sexually transmitted infections. And so there's a huge emphasis on condoms and discussing condoms and really going through a lot of the barriers they feel they have to condom use. So that gives you an example of how we've kind of reframed and rethought the way that we do contraception research and other behavior change research in CI3. The next lab that we work through is called the Design Lab. And this is led by Amanda Geppert here. And it's really trying to bring young people into the whole process of designing interventions. The project that we're really excited about is a project working with a mobile health unit. And what's important about this is that we work with the community from the very beginning of kind of this idea of inspiration. What is the problem that we're trying to fix? Generating a lot of ideas that actually come from the communities affected and then really trying to just iterate from there on potential solutions. And so this is a project right now that we're working on with people from the mobile health unit, the Comer mobile health unit, to think about how do you provide section reproductive health in the mobile health unit? So one of the big issues for young people is transportation. Like how the heck am I going to get to the clinic and have my parent take time off? And so this idea of actually being able to bring reproductive health care to young people is really important. And I just glanced up at my friend and colleague, Lisa Massenter, because she's like, why don't we just use the mobile health unit? Why not? And so we are. And what we're seeing as young people is the mobile health unit coming today to my school because we really need to get section reproductive health care. And this was a place that really wasn't provided, was kind of focusing on school physicals and now is able to provide section reproductive health care. The third lab works in the area of narrative. And we started this work because the, a lot of times we're relegating people to surveys or even to qualitative. These are the things that we want to hear from you. But through narratives, people are able to tell you kind of what is pressing and what is most important to them. And what I'll do, just to kind of show you how all of this comes together, I'm gonna skip ahead and talk about a project that we're working on right now in India. And I think it kind of gives you a sense of how reproductive justice, these ideas of designing and making with the community in order to help them address systemic change is reflected in this project. So Kisa Kahane is a project about storytelling. It's a project that we're conducting right now in Uttar Pradesh, India in the city of Lucknow. And it came out of this, it's funded by the Gates Foundation and it came from their work and Melinda Gates' interest in family planning. And yet we were working with younger adolescents and as you know from the reproductive justice framework, it would say maybe that is not the interest of this community or we have to understand where they are and what their needs and wants are, especially among adolescents, especially among unmarried adolescents. And so yes, while you can point statistically to what you would call an unmet need for contraception, you'd also have to understand more of the community perspective. And so our idea was we could use our techniques through storytelling and research to understand more about young people. The other key thing with reproductive justice is that we have to think not just about the person clinically, we have to think about their social interactions and the larger political systems that inform their health and well-being. And so that's how you get to something that we would call a socio-ecological approach. So Kisa Kahane has lots of different components. One of it is using some of the technologies and the games that we design actually is a research tool. And this actually turned out to be a very productive approach because a lot of the topics that about section reproductive health are really taboo or things that they are told and taught not to talk about. And so by using a game-based approach where they created scenarios in many ways, this is how we learned about how young people interact with one another, what they do in their downtime. And what we learned was that by kind of creating these groups and we'd have them kind of create these different scenarios and then we'd actually kind of create a guide and analyze kind of what we were hearing. And we were really able to see some of the barriers and stigma and issues that were related to sexual and reproductive health. One of the big themes was that there was a lot of harassment of girls over social media in school, in public places that really inhibited their mobility and their activities. And so this social media, very similar to what we see in the United States was this sort of threat to put your picture online was actually a real threat to them. Again, we couldn't find this in any other parts of our research until we use this game-based method. We also found out a lot about how inhibited they are from having relationships with one another. And so, and we can talk about this at another time, but the logistics of working in groups where boys and girls are meant to be segregated was quite significant. But the idea of having, being in a relationship was really considered very stigmatized and their goal was eventually to have girls get married as a way of bringing wealth into the family. So having relationships outside of marriage was a problem. Another method that we use in Kisafahani is something called body mapping. And I'll show you images of this, but basically what we do is we have young people draw outlines of their bodies and then they narrate stories related to different experiences and put it onto the map. And then we actually ask them to interpret the body map. And from this, we really learned about what the role of adolescence, and by becoming an adolescent and becoming an adolescent girl and having a menstrual cycle, that's really the moment where it's sort of a symbol of this is a time of danger, this is a time of risk, this is a time when girls can bring shame on your family. The other thing that we found in the body mapping work was what a safe space school was, this is one of the places where girls could learn as much as they wanted to, they really felt a sense of self-efficacy. But that a lot of that passage to school actually was fraught with a fair amount of danger and again harassment and lots of reasons why girls were inhibited from getting to school. And these are images of the body mapping and how the process worked. And also some of the findings. And so one of the things that girls talked about is that when they go out, they're sort of lewd comments that are made and they're stared at and they feel as if accessing the streets is just is, and certainly going out alone is very threatening. I'm gonna skip ahead and kind of talk to you about what we did as a result. So we use these different methodologies to learn about young people. And one of the things we asked them to do is create stories and we created beautiful digital stories with the help of Marquez Ryan on our team led this work. And we took these stories that were often traumatic around issues of family and violence. And we actually, by telling a story, girls actually became, or boys became the heroine or the hero of the story and really transform what was a rather painful event into a positive event. And these stories were then entered, we've shown them in lots of different settings, but one of the things that we did was to enter them into a film festival in India. And we gave young people the opportunity to view them. And so this is a picture of the Chen Film Festival. And these are the stories as they were going around India being seen by young people all over who actually rated them and decided which ones would go into the final jury decision. And the jury decision was an international contest and we were able to present it actually at our India Center, our Delhi Center in India. And one of our young people who created a film for the digital stories, Pinky, actually ended up winning a juried award. The last thing I'll just finish is by telling you the other component is we actually worked with young people and we trained them to design their own interventions to the problems that they were identifying in their community. And so these are our research team and they're working with young women and young men, really teaching them about the human center design process so that they can identify those problems and start to find solutions. And so they started to, as I told you before, they started to kind of plan and iterate and come up with potential ideas. And this is led by Amanda and Suchi did the day-to-day work on this. And they came up with potential solutions for how they would address issues of sexual harassment, sexual violence, lack of access to reproductive health in their communities. And so these projects are ongoing with a number of the young people in the NGOs that they are working with. So I'm just gonna end that. We've talked about reproductive justice, about a history and about the framework. We've talked about how much it's informed my approach to research and the work that we do in CI3. And then I'm gonna just end with a series of kind of what I think are recommendations for how providers and healthcare providers and people who are interested in these issues but probably, but may have a privilege that might make it so that you're not at the center of the reproductive justice movement. But there is always, when people are trying to address systems and systems that are either ingest or oppressive, there is such a role for people who are allies. And so these are the ideas that we came up with following the conference that we held in 2008. But I think there's still a resonate and are meaningful today. One of our roles is advocating for policies and practices that enable people who are marginalized to access clinical care, childcare, housing stability and transportation. And in our center, this is work that's led by Lee Hasselbacker, really trying to identify barriers that we're seeing, whether it's in our clinical setting or in our research setting and thinking about how we can be part of the support that changes the policies that limit women's access to care. Really addressing some of the limits of access to abortion, whether that's around stigma or shame or access to care, but not, but also how we as providers promulgate some of these negative aspects. Really promoting policies that expand coverage to contraception and that's something that we've been very involved with here in the section of family planning and also at CI3. I'm really thinking about the role of violence and sexual violence screening regularly in clinic and having the tools and ability to help people find resources. And this goes to many other social issues that I think we often as clinicians ignore because they're difficult to solve. One of the things that we did in the section of family planning is we have the privilege of having a social worker who sits in clinic with us because these were social problems that we weren't addressing. My colleague Candace Norcott just left but we also have a psychologist who sits in clinic because there are so many other mental health and behavioral health issues that our patients face that we were not addressing because we didn't have the ability. So again, just change in the way that we practice care and then removing barriers and limits to reproductive health for women with disabilities and a very large part of my practice in Julie Core and Amber Trueheart's practice is working with girls with disabilities because they have the same reproductive health and aspirations as other young people and then promoting the investment and comprehensive sexuality, giving people as much information as they possibly can, especially trying to shift money away from abstinence-only education. So those are my thoughts for how we can be supporters of the reproductive justice movement and a little bit about my own process and pathway through this work. So I thank you for your time and welcome any questions. Thank you for a really interesting talk. You focused mostly on issues that I care about a lot which is access to care. But I also wonder if in the current political climate, stop working. Oh, okay, thanks. I just stopped hearing the echo. We need to, you know, in a climate where a US representative can stand up and talk about other people's children as though they're terrorists or a drain on the economy, if there might be more danger currently going in the other direction that is more coercion of women of color, minorities, immigrant women, not to have children, if we might be going back to that. Can you talk a little bit about what you see happening in that realm? Yeah. You know, the modern moment is a really complicated one and I think one of the, you know, this question of access, not access. It's really tricky, right? I've talked a little bit about sometimes when you give, when we sort of think about access to long-acting reversible contraception, we might go too far in one direction and it becomes coercive. Other times we put unfair barriers and unfair limits. So the first thing I would say is right now I think the biggest risk is lack of access, right? Because the Affordable Care Act gives women access to contraception without a co-pay at this moment, there are ways that that could be quickly undermined. Important work that we worked on along with Everthrive provides some protections here for women in Illinois to access to multiple modes of contraception. But I think lack of access to contraception is at risk. There is clearly, there is a real drumbeat around defunding Planned Parenthood, which would be a tremendous impact on women's access to lots and lots of forms of reproductive healthcare. And then there is still the Hyde Amendment in place which limits women's access, poor women's access to abortion services because it prevents Medicaid from paying for it and had the Republican version of affordable healthcare gone through. There would have been, there was legislation to prevent women's access to having insurance cover abortion services. So I would say right now that those contraception and family planning access issues are very important. And I have heard less direct conversation about the value of other people's children, but that is clearly an undercurrent of all of this is not wanting those people in this country, not wanting questions about whether we should still by being born in this country that you have citizenship. That is absolutely what those conversations are about is a different value. So there are two things that I think are important. One is empowering people to make their decisions about contraception, right? It is not our decision about this person should use this type or shouldn't use this type really helping people make those choices themselves with a minimal amount of coercion. That's really important. And when you have financial access to one and not to another, that forces people's choices. So we have to think very, very broadly about those issues and our role might be to limit barriers, but at the ultimate decision making has to be about these women. But I completely agree this is an incredibly vulnerable time for many, many people and populations. Did you just want to make this thing happen or not? Yeah. It seems that the question for abstinence only in sex ed just never died. Yeah. And even in 2014, I think that part of the Affordable Care Act included like $50 million dedicated towards abstinence only sex education. Even though clearly the Obama administration was pro-comprehensive sex education as demonstrated by the establishment of the Office of Adolescent Health. I think a lot of that has to do with our representation doesn't look like all of us. It's a lot of old white men, unfortunately. So what do you think can be done to maybe bridge the divide there where younger people of color and young women and men are able to show these representatives that this is what matters to us and that these are decisions that really impact our health? So the question was about comprehensive sexuality education and one thing that the question points out is that so early on very forceful legislation around abstinence only, but even as abstinence only legislation has been rolled back, there's basically $50 million towards abstinence only education. The difference is that it required matching grants and so one of the ideas was that because there was a state matching grant requirement that it would be a disincentive to use to have abstinence only information. But, so whether it's who's the legislator and the color and the age of those people, I think there are a lot of people who believe in comprehensive sexuality education, but I think it gets at some fundamental points. I think you can kind of see it in our research in India which is there is fear of adolescence and fear of sexuality and fear of adolescence as sexual beings and so here's this kind of moment where reproduction and biologically young people are now open to the ideas of sexuality and it's biologically it's driven that way and yet we as a society are like, oh my gosh and then the sexuality of young women is particularly frightening and I think you've, I think you're touching on it. I think it goes beyond legislation. I think parents find when I talk to parents about your daughter is almost 12, they go, oh my gosh, you know, this is so terrible. It's so frightening. So there is something, there is something that is, that scares us but think about it, what problem is ever solved by making someone ignorant, right? When does ignorance actually make something better, right? You know, we are sitting here in an institution of education and so what we know is that knowledge is what makes things better and I think the last thing I might just point out is the issue of reproductive justice. So I sometimes talk about, I don't know if you need sex education or just education, right? You know, when kids are busy, when they have things to do after school, when they're in supportive, safe environments, they actually don't have very high rates of pregnancy, right? So there are all of these other systemic and social interventions and this is where it goes back to this idea of caring about other people's young people as much as you, other people's children as much as you care about your own children because working at this larger systemic level where we're worrying about safe schools, safe passage home, all of these other things, it really keeps kids, if you wanna call it, trouble out of trouble and then the second piece to remember is that it is absolutely normal and normative for young people to be interested in issues of sexuality and that if we don't talk to them about it, then they do it behind our backs. It's not gonna go away, right? It's sort of like abortion does not go away. It is just a question of is it safe and in the open or is it hidden and less safe? And so we know from studies in the Netherlands and for European countries that they have the same rates of sexual activity, the same age of onset of sexual activity but not the same outcomes and so I think it's a complicated reason why we are not teaching young people about giving people information but I will tell you it's absolutely wrongheaded. Yeah. Yeah. Other questions or concerns? The other one in the back. Thank you, I'm an outside visitor. Thank you. With the Religious Coalition for Reproductive Choice, I'm Betty Holcomb and for the 21 years that I've been sitting on this board, we have consistently pushed for comprehensive sexual education and uphill battle in spite of the Hyde Amendment, et cetera, demonstrations. We did receive some grant money for a while for that but we continue to find resistance right in the communities that are impacted the most by reproductive injustice and I wonder if you've had any type of luck in outreach in predominantly black communities of faith with the resistance that continues to be put up about information on reproductive health? Yeah. Have you had any success at all? Yeah. Yeah, no. So first of all, I thank you so much for being here and thank you so much for the work that you do and you are pointing to a very, very important issue. So I think some of the most powerful work that has been done was work being done by Tony Bond and Black Women for Reproductive Justice and one of the things that they did was these sort of like kitchen table conversations, right? How do we go and start talking about, not actually starting with her agenda but talking about things like douching, right? Things that may be slightly more neutral territory just to begin to show people that we can have those conversations and I think me and many of the people in our section, in our section, in our center spend, when groups ask us to come and speak, we make ourselves available because people wanting to hear about these issues, it's really important. One thing I will say is that sometimes you don't find as much resistance as you think you will at an individual level, at a group level, everyone's like, we're not allowed to say those things but when you talk to people one-on-one, you make a little more progress but the last thing I would say and it's what we're finding in also in our work around Kisa Kahane is that sometimes you have to let what we're finding and just from our perspective and it could be very different for you as a member of the community. I often think that you're probably a more powerful voice than someone like I would ever be but one thing that we found in our work in Kisa Kahane is that letting other people set the agenda but being there to give them the information so and maybe our work is a little more around creating demand, whether it's my work in higher education trying to make as much access to educational opportunities for young people and then they start to say, oh, I need the information so my child doesn't get pregnant or this because that opportunity is now available to them so my sort of thinking is that we put all of this together not just I'm coming here to talk to you about not getting pregnant but you put it into to, these are my other hopes and aspirations for you and your children and your community but you put these things together and these are the outcomes that you could get. Yeah, thank you. Great, thank you. Appreciate it. Thank you.


A myocardial perfusion scan during treadmill stress test is used to measure the heart's blood supply both during exercise and rest. If the stress scan looks normal, rest scan may not be performed. Pre procedure, do not consume caffeinated foods and please inform the doctor if you are pregnant. A 3 hour fast before the scan is advised. 24 hours before the procedure, don't take medications like statins, atin, metropolol, sorbitrate, etc. However, diabetic medications can be taken. During the procedure, an intravenous line will be placed and you will be asked to walk on a treadmill till the target heart rate is achieved. A small dose of radioactive injection is injected intravenous. During the peak exercise and scan is obtained after 45 minutes. After this, you will be asked to eat fatty foods before the stress scan. About 1 and a half hours after the scan, a second injection is given during rest and scan is obtained after 1 hour. Reports will be issued the same day.