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Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2

BLACK VOICE NEWS — While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.
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CA acknowledges doula services as part of the solution to reduce maternal mortality

By Breanna Reeves | Black Voice News

The topics of Black maternal mortality and pregnancy-related death have become more prevalent over the last decade as the U.S. has been identified as having one of the worst maternal mortality rates among high-income countries.

report published by the Commonwealth Fund found that the U.S. had the highest maternal mortality rate among wealthy nations: 23.8 deaths per 100,000 live births in 2020. That rate is double for Black maternal mortality: 55.3 deaths per 100,000 live births.

While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.

Available data for maternal mortality rates across race/ethnicity for Riverside and San Bernardino Counties are not available for public access. According to a representative from the California Department of Public Health, the agency “does not publish pregnancy-related death counts or pregnancy-related mortality ratios (PRMR) by race/ethnicity at the county or regional level to maintain data confidentiality and ensure statistical stability,” but noted that across the state, Black birthing people “continue to have the highest PRMR.”

The disproportionate rate at which Black women and birthing people die from pregnancy-related deaths is not new to Black doulas.

Chantel Runnels has been a doula for 14 years, something she said she was “called to do.” Family history of fatal maternal health care, a desire to see public health care change and her own pregnancy experience served as catalysts for her becoming a doula. She was introduced to the Sankofa Birthworkers Collective, an Inland Empire-based organization, through a friend who is a midwife.

A midwife is an individual who is medically trained to assist with labor and delivery and provides prenatal, intrapartum and postpartum care, as well as family planning care. The Sankofa Birthworkers Collective consists of a well-rounded group of birthworkers including licensed midwives, postpartum doulas, lactation specialists, maternal mental health experts and midwives-in-training.

“To be around other Black women who may have secondary or tertiary lines of work that affect Black maternal health care or are directly in Black maternal health care was really attractive to me,” Runnels explained. “To be a part of a community of women who live across the [Inland Empire], who come from different demographics, but want to support each other and just wanted to come together was super attractive.”

Married for nearly 15 years and a mother of four, Runnels provides services to a diverse clientele, some who pay out of pocket for private services, others who receive free services through community-based programs like Sankofa or through insurance programs like the Doula Access Program.

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

Runnels explained that as the need for doulas grows, doula training is that much more important to help ensure that they are trained to meet the needs of the community and have the availability to serve clients.

“This is why compensation for doulas is important, too, because the wages that doulas are paid can’t really compensate for the availability that’s required for the job,” Runnels explained.

As the state began to recognize the invaluable services provided by doulas, legislation to implement doula services throughout the state was introduced prior to the start of the pandemic.

Elevating, expanding, standardizing and compensating doulas in CA

In February 2020, Majority Leader of the California State Assembly Eloise Gómez Reyes (D-Colton) introduced Assembly Bill 2258 which aimed to lower maternal and infant maternal mortality rates in California by launching a three-year Medi-Cal pilot program to provide doula services in 14 counties with the highest birth disparities. The bill fell through when the COVID-19 pandemic shifted priorities in March 2020.

The momentum to introduce legislation that addressed maternal mortality picked up again when Governor Gavin Newsom budgeted funding for a Medi-Cal benefit, which will allow doulas to be reimbursed for full spectrum care rendered to Medi-Cal enrollees. I​n order to add these services as a benefit, the Department of Health Care Services (DHCS) is required to submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) and receive federal approval — essentially an agreement between the state and federal government on how their Medicaid program will operate and assures the state will abide by federal rules.

Over the last year, DHCS has worked with stakeholders from across California including birthworkers, doulas and community organizations to develop a comprehensive SPA that specifies what doula coverage will look like under Medi-Cal, including the scope of services. Following the first draft of the SPA, a coalition of stakeholders made recommendations for an updated version of the SPA that requested the need for specific language to define doula care and services.

The letter recommended revising the definition of a doula to specify the types of services and support they offer. Part of the letter recommended that the SPA add: “The doula care provided will offer any and all aspects of full-spectrum doula care, including prenatal and postpartum or post-pregnancy doula care, continuous presence during labor and delivery, and doula support during miscarriage, stillbirth and abortion. Doula care includes physical, emotional and other nonmedical care.”

Alexis Robles-Fradet is a Health Policy Analyst at National Health Law Program (NHeLP) in Los Angeles, CA, and drafted the coalition letter in April. Alongside Amy Chen, a senior attorney at NHeLP and member of the stakeholder group, Robles-Fradet has published several reports about the components of successful doula programs and pilot doula programs in other counties as part of the Doula Medicaid Project, launched in 2018.

One of the biggest challenges with finalizing the SPA has been the reimbursement rate offered. The initial proposed rate was one of the lowest rates in the country. Upon receiving the first draft of the SPA from DHCS, the coalition noted in the letter: “We do not believe this benefit will be successful if the reimbursement rate is $450.”

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

With the high cost of living in California and the amount of time doulas spend with their clients, Robles-Fradet explained that $450 is not a living wage and would be a barrier to getting the necessary workforce to cover Medi-Cal patients. Medi-Cal covered more than half of all births in California in 2019.

“Doulas deserve to be paid a fair wage. I know we talk about [a] living wage, but I think we should shift into thriving wages, like they’re doing great work and they’ve been doing this great work for so long,” Robles-Fradet stated. “They know how to support their communities.”

Robles-Fradet explained that listening to the doulas and making sure that the benefit will be equitable for them are important factors that will contribute to the success of the Medi-Cal benefit.

As a member of the stakeholder group, Runnels said that the group has worked “tirelessly” to demonstrate that the situation is nuanced. One of the first tasks for DHCS and the stakeholder group was to define doula services and qualifications since it isn’t defined in state law.

“The doula stakeholders did emphasize to us that the length of service in terms of time that they were spending with individuals needed to be considered since doula services typically last significantly longer than other visits with a licensed practitioner,” said René Mollow, Deputy Director of Health Care Benefits & Eligibility.

Mollow explained that doula services as a benefit will be offered through both the Medicare fee-for-service delivery system and Managed Care delivery systems, so doulas will need to be enrolled as Medi-Cal providers and will have contracts with Managed Care plans.

“The majority of covered populations in our program here in California are served through Medi-Cal managed care plans,” Mollow added. “So, that’s where we would expect to see the bulk of the services being provided.”

Following several stakeholder meetings, feedback from birthworkers and Governor Gavin Newsom’s revised 2022-23 budget, California’s current proposed reimbursement rate has increased to $1,154 with one initial visit paid at $126.31, eight perinatal visits paid at $60.48 per visit and one labor and delivery visit paid at $544.28.

“California is such a large state. We have so many births a year. The cost of living for doulas and families in San Francisco varies greatly to doulas and families that are serving Barstow,” Runnels clarified. “And so, helping them understand that the original rate…was embarrassing. Even other states do better than that. And the rate that they’ve come to now is still embarrassing.”

There are more than 400,000 births each year in California which is roughly one-eighth of all U.S. births, nearly half of which are paid for by Medi-Cal, according to the California Health Care Foundation. Comparatively, in 2020, there were 39,817 births in Oregon. In June 2022, Oregon updated its SPA to increase the doula reimbursement rate to $1,500.

“I am so grateful for the work that the State Plan Amendment workgroup is doing to really work on this,” Runnels stated. “[But] also, it still does not reflect how critical the role of a doula is in addressing maternal health care in the state of California, particularly for those most vulnerable, which are Black women.”

Stakeholder meetings are ongoing as the group continues to discuss the SPA and work on developing a Provider Manual. DHCS plans to publish a public notice and formally submit the SPA in September.

This article is the second in a series produced as a project for the USC Annenberg Center for Health Journalism’s 2022 California Fellowship.

The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 appeared first on Black Voice News.

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Excerpt:

Photo Captions:

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

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Reading and Moving: Great Ways to Help Children Grow

NNPA NEWSWIRE — In these formative years, your little one will learn to walk, learn how to grab and hold items, begin building their muscle strength, and more. Here are some ways to facilitate positive motor development at home:

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Council for Professional Recognition

Before a child even steps into a classroom or childcare center, their first life lessons occur within the walls of their home. During their formative years, from birth to age five, children undergo significant cognitive, motor, and behavioral development. As their primary guides and first teachers, parents, and guardians play a pivotal role in fostering these crucial aspects of growth.

The Council for Professional Recognition, a nonprofit, is dedicated to supporting parents and families in navigating questions about childcare and education training. In keeping with its goal of meeting the growing need for qualified early childcare and education staff, the Council administers the Child Development Associate (CDA). The CDA program is designed to assess and credential early childhood education professionals. This work gives the Council great insights into child development.

Cognitive Development: Building the Foundation of Learning

Cognitive development lays the groundwork for a child’s ability to learn, think, reason, and solve problems.

  • Read Together: One of the most powerful tools for cognitive development is reading. It introduces children to language, expands their vocabulary, and sparks imagination. Make reading a daily ritual by choosing age-appropriate books that capture their interest.
  • Play Together: Play is a child’s entry to the physical, social, and affective worlds. It’s a critical and necessary tool in the positive cognitive development of young children and is directly linked to long-term academic success.
  • Dance and Sing Together: These types of activities help young children develop spatial awareness and lead to improved communication skills. As a bonus, it’s also helpful for improving gross motor skills.
  • Invite your Child to Help you in the Kitchen: It’s a fun activity to do together and helps establish a basic understanding of math and lifelong healthy eating practices.
  • Encourage Questions: As children find their voice, they also find their curiosity for the world around them; persuade them to ask questions and then patiently provide answers.

Motor Development: Mastering Movement Skills

Motor development involves the refinement of both gross and fine motor skills, which are essential for physical coordination and independence. In these formative years, your little one will learn to walk, learn how to grab and hold items, begin building their muscle strength, and more. Here are some ways to facilitate positive motor development at home:

  • Tummy Time: Starting from infancy, incorporate daily tummy time sessions to strengthen neck and upper body muscles, promoting eventual crawling and walking. You can elevate the tummy time experience by:
    • Giving children lots of open-ended toys to explore like nesting bowls, a pail and shovel, building blocks, wooden animals, and people figures.
    • Hanging artwork on the wall that appeals to infants, including bold colors, clear designs, and art from various cultures.
    • Providing mobiles that children can move safely and observe shapes and colors.
  • Outdoor Play: Provide opportunities for outdoor play, whether it’s at a park, playground, or in a backyard. Activities such as running, jumping, climbing, and swinging enhance gross motor skills while allowing children to connect with nature. Also, try gardening together! Not only does gardening promote motor skill development, but it offers many other benefits for young children including stress management, cognitive and emotional development, sensory development, and increased interest in math, sciences, and healthy eating.
  • Fine Motor Activities: Fine motor skills relate to movement of the hands and upper body, as well as vision. Activities that encourage hand-eye coordination and fine motor skill development include:
    • Drawing and coloring
    • Doing puzzles, with size and piece amounts dependent on the age of the child
    • Dropping items or threading age-appropriate beads on strings
    • Stacking toys
    • Shaking maracas
    • Using age-appropriate, blunt scissors
    • Playing with puppets or playdough

This is the type of knowledge that early childhood educators who’ve earned a Child Development Associate credential exhibit as they foster the social, emotional, physical, and cognitive growth of young children.

Supporting Early Childhood Educators

Recently, a decision in Delaware has helped early childhood professionals further their efforts to apply this type of knowledge. Delaware State University, Delaware Technical Community College, and Wilmington University have signed agreements to award 12 credits for current and incoming students who hold the Child Development Associate credential.

Delaware Governor John Carney said, “I applaud the Department of Education and our higher education partners for this agreement, which will support our early childhood educators. Research shows how important early childhood education is to a child’s future success. This new agreement will help individuals earn their degrees and more quickly get into classrooms to do the important work of teaching our youngest learners in Delaware.”

Council for Professional Recognition CEO Calvin E. Moore, Jr., said his organization is honored to be a part of this partnership.

“Delaware and the work of these institutions is a model that other states should look to. This initiative strengthens the early childhood education workforce by accelerating the graduation of more credentialed educators, addressing the critical need for qualified educators in early childhood education. We have already seen the impact the work of the Early Childhood Innovation Center has brought to the children of Delaware.”

 

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Student Loan Debt Drops $10 Billion Due to Biden Administration Forgiveness

NNPA NEWSWIRE — The Center for American Progress estimates the interest waiver provisions would deliver relief to roughly 6 million Black borrowers, or 23 percent of the estimated number of borrowers receiving relief, as well as 4 million Hispanic or Latino borrowers (16 percent) and 13.5 million white borrowers (53 percent).

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New Education Department Rules hold hope for 30 million more borrowers

By Charlene Crowell, The Center for Responsible Lending

As consumers struggle to cope with mounting debt, a new economic report from the Federal Reserve Bank of New York includes an unprecedented glimmer of hope. Although debt for mortgages, credit cards, auto loans and more increased by billions of dollars in the second quarter of 2024, student loan debt decreased by $10 billion.

According to the New York Fed, borrowers ages 40-49 and ages 18-29 benefitted the most from the reduction in student loan debt.

In a separate and recent independent finding, 57 percent of Black Americans hold more than $25,000 in student loan debt compared to 47 percent of Americans overall, according to The Motley Fool’s analysis of student debt by geography, age and race. Black women have an average of $41,466 in undergraduate student loan debt one year after graduation, more than any other group and $10,000 more than men.

This same analysis found that Washington, DC residents carried the highest average federal student loan debt balance, with $54,146 outstanding per borrower. Americans holding high levels of student debt lived in many of the nation’s most populous states – including California, Texas, and Florida.

The Fed’s recent finding may be connected to actions taken by the Biden administration to rein in unsustainable debt held by people who sought higher education as a way to secure a better quality of life. This decline is even more noteworthy in light of a series of legal roadblocks to loan forgiveness. In response to these legal challenges, the Education Department on August 1 began emailing all borrowers of an approaching August 30 deadline to contact their loan servicer to decline future financial relief. Borrowers preferring to be considered for future relief proposed by pending departmental regulations should not respond.

If approved as drafted, the new rules would benefit over 30 million borrowers, including those who have already been approved for debt cancellation over the past three years.

“These latest steps will mark the next milestone in our efforts to help millions of borrowers who’ve been buried under a mountain of student loan interest, or who took on debt to pay for college programs that left them worse off financially, those who have been paying their loans for twenty or more years, and many others,” said U.S. Secretary of Education Miguel Cardona.

The draft rules would benefit borrowers with either partial or full forgiveness in the following categories:

  • Borrowers who owe more now than they did at the start of repayment. This category is expected to largely benefit nearly 23 million borrowers, the majority of whom are Pell Grant recipients.
  • Borrowers who have been in repayment for decades. Borrowers of both undergraduate and graduate loans who began repayment on or before July 1, 2000 would qualify for relief in this category.
  • Borrowers who are otherwise eligible for loan forgiveness but have not yet applied. If a borrower hasn’t successfully enrolled in an income-driven repayment (IDR) plan but would be eligible for immediate forgiveness, they would be eligible for relief. Borrowers who would be eligible for closed school discharge or other types of forgiveness opportunities but haven’t successfully applied would also be eligible for this relief.
  • Borrowers who enrolled in low-financial value programs. If a borrower attended an institution that failed to provide sufficient financial value, or that failed one of the Department’s accountability standards for institutions, those borrowers would also be eligible for debt relief.

Most importantly, if the rules become approved as drafted, no related application or actions would be required from eligible borrowers — so long as they did not opt out of the relief by the August 30 deadline.

“The regulations would deliver on unfulfilled promises made by the federal government to student loan borrowers over decades and offer remedies for a dysfunctional system that has often created a financial burden, rather than economic mobility, for student borrowers pursuing a better future,” stated the Center for American Progress in an August 7 web article. “Meanwhile, the Biden-Harris administration also introduced income limits and caps on relief to ensure the borrowers who can afford to pay the full amount of their debts do so.”

“The Center for American Progress estimates the interest waiver provisions would deliver relief to roughly 6 million Black borrowers, or 23 percent of the estimated number of borrowers receiving relief, as well as 4 million Hispanic or Latino borrowers (16 percent) and 13.5 million white borrowers (53 percent).”

These pending regulations would further expand the $168.5 billion in financial relief that the Biden Administration has already provided to borrowers:

  • $69.2 billion for 946,000 borrowers through fixes to Public Service Loan Forgiveness (PSLF).
  • $51 billion for more than 1 million borrowers through administrative adjustments to IDR payment counts. These adjustments have brought borrowers closer to forgiveness and addressed longstanding concerns with the misuse of forbearance by loan servicers.
  • $28.7 billion for more than 1.6 million borrowers who were cheated by their schools, saw their institutions precipitously close, or are covered by related court settlements.
  • $14.1 billion for more than 548,000 borrowers with a total and permanent disability.
  • $5.5 billion for 414,000 borrowers through the SAVE Plan.

More information for borrowers about this debt relief is available at StudentAid.gov/debt-relief.

Charlene Crowell is a senior fellow with the Center for Responsible Lending. She can be reached at Charlene.crowell@responsiblelending.org.  

Charlene Crowell NNPA Newswire Columnist

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Congressional Black Caucus Releases Groundbreaking Corporate Accountability Report on DEI

NNPA NEWSWIRE — Most Fortune 500 companies participating in the CBC’s survey demonstrated their commitment to DEI even after the Supreme Court’s ruling. CBC members said this is crucial because conservative organizations, such as Stephen Miller-led America First Legal, are increasingly waging legal and political attacks against corporations’ diversity initiatives. These groups argue that DEI initiatives violate federal law, threatening legal action against companies that continue to promote workplace diversity.

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By Stacy M. Brown, NNPA Newswire Senior National Correspondent
@StacyBrownMedia

Congressional Black Caucus (CBC) Chairman Steven Horsford (NV-04) and CBC members have released a first-of-its-kind report titled “What Good Looks Like: A Corporate Accountability Report on Diversity, Equity, and Inclusion.” The report aims to hold Fortune 500 companies accountable for their commitments to diversity, equity, and inclusion (DEI) in the wake of George Floyd’s murder and the racial justice movement that followed. This initiative comes as corporate America faces renewed scrutiny following the Supreme Court’s decision to overturn affirmative action in the Students for Fair Admissions v. Harvard case.

The CBC’s report highlights which corporations are making tangible progress in advancing DEI and offers a roadmap for other companies to follow. Despite efforts from right-wing groups to dismantle diversity initiatives, the report finds that many Fortune 500 companies are standing firm in their commitments. The report also examines DEI practices in manufacturing, finance, insurance, and technology sectors, providing industry-specific insights.

Most Fortune 500 companies participating in the CBC’s survey demonstrated their commitment to DEI even after the Supreme Court’s ruling. CBC members said this is crucial because conservative organizations, such as Stephen Miller-led America First Legal, are increasingly waging legal and political attacks against corporations’ diversity initiatives. These groups argue that DEI initiatives violate federal law, threatening legal action against companies that continue to promote workplace diversity.

The Findings

The CBC’s report offers a detailed analysis of diversity efforts across various industries, using data from the Global Industry Classification Standard (GICS) and the North American Industry Classification System (NAICS). Key findings include:

  • Sector Representation: The bulk of the responses came from companies in manufacturing (31%), finance and insurance (25%), and information (16%).
  • Best Practices: The report identifies 12 best practices, including leadership accountability, data disaggregation, talent retention, and pay equity. These examples provide a model for other companies to implement DEI strategies effectively.
  • Progress and Challenges: While many companies have made significant strides, persistent gaps remain, particularly in leadership diversity and retention rates. The report encourages corporations to move beyond public statements and implement measurable DEI outcomes.

The CBC hopes the report will serve as a tool for corporations to benchmark their progress and adopt more robust DEI measures. “What Good Looks Like” outlines not only where companies are succeeding but also where opportunities for improvement lie, urging corporate leaders to align their actions with their stated DEI values.

Conservative Backlash and the Fight for DEI

Officials said the CBC’s efforts to hold corporations accountable come amid heightened political tensions. Since the Supreme Court’s ruling, Donald Trump and his supporters have escalated their attacks on DEI programs. Right-wing legal campaigns have targeted not only corporate diversity efforts but also federal programs aimed at leveling the playing field for Black and minority-owned businesses.

Conservative attorneys general from over a dozen states have warned Fortune 500 companies, threatening legal action over their diversity programs. Additionally, anti-DEI bills have been introduced in more than 30 states, aiming to restrict diversity efforts in college admissions and the workplace.

Despite the attacks, the CBC said it remains steadfast in its commitment to advancing racial and economic equity. In December 2023, the CBC sent Fortune 500 companies an accountability letter urging them to uphold their DEI commitments in the face of political pressure, which catalyzed the report.

Corporate America’s response has been overwhelmingly positive. Since the CBC’s letter, companies have held over 50 meetings with CBC representatives, affirming their dedication to diversity. The CBC has also convened discussions with industry trade associations and hosted a briefing with more than 300 Fortune 500 company representatives to strengthen collaboration on DEI efforts.

Moving Forward

The CBC’s report is not just a reflection on past efforts but a call to action for the future. It highlights the importance of cross-industry learning, encouraging companies to share best practices and build upon one another’s successes. The CBC also recommends that corporations adopt consistent performance metrics to track progress and foster accountability.

Looking ahead, the CBC plans to push for more economic opportunities for Black Americans, focusing on closing the racial wealth gap. Horsford emphasized that DEI is not only a moral imperative but also an economic one. Research from McKinsey & Company shows that racially diverse companies outperform their peers by 39% in profitability, further underscoring the business case for diversity.

The CBC’s report offers a roadmap for companies committed to fostering a more inclusive and equitable future despite political and legal challenges.

“Following the murder of George Floyd on May 25, 2020, we witnessed a nationwide response calling for long-overdue justice and accountability,” Horsford wrote in the report. “Millions of Americans flooded the streets in protest to advocate for an end to the cycles of violence against Black Americans that are perpetuated by systemic racism ingrained deeply in the United States.

“Now, in order to move forward and achieve the goals of these commitments, we must evaluate where we are and stay the course. We cannot allow a handful of right-wing agitators to bully corporations away from their promises.”

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