Episode 05

Ending Racism & Discrimination During Childbirth

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Too often, treating women with respect is seen as a luxury. It is not. Violations of human rights during childbirth are all too common in labor wards, hurting women’s chances of surviving pregnancy and childbirth.

This episode of White Ribbon Alliance’s Brave Voices, Bold Actions podcast explores Article 5 of the Respectful Maternity Care Charter, and the human right to equality, freedom from discrimination & equitable care during pregnancy and childbirth.

We hear from Bruce McIntyre, who bravely shares the story of his partner Amber Rose Isaac’s experience with racism during childbirth, and Dr. Joia Crear-Perry, who is a leading expert on structural racism and is working with her organization, the National Birth Equity Collaborative, to make sure women and newborns receive the quality, respectful care they deserve.

Together, we have the power to destroy the structures that harm women during pregnancy and childbirth!

  • Why are Black women three to four times more likely to die from pregnancy-related causes than White women in the United States of America?
  • What is the impact of violence and lack of autonomy on Black and indigenous women during childbirth?
  • How can the Respectful Maternity Care Charter save the lives of BIPOC women in America and across the world?

Diana Copeland (00:02): Too often treating women with respect is seen as a luxury, it is not. Respectful care and a life free from abuse is due to every woman and every health system around the world no matter what. On White Ribbon Alliance's, Brave Voices, Bold Actions podcast, we're taking a close look, episode by episode, at the 10 basic rights women and newborns are due in childbirth.

Diana Copeland (00:28): My name is Diana Copeland and I work with White Ribbon Alliance, a locally led, globally connected grassroots movement, advocating for the health and rights of women and newborns. In each episode of the Brave Voices, Bold Actions podcast I'll be joined by White Ribbon Alliance colleagues from around the world, global human rights advocates, and community leaders creating real change.

Diana Copeland (00:51): Today, we are examining article five of the respectful maternity care charter and the right to equality, freedom from discrimination, and equitable care with Dr. Joia Crear-Perry from the National Birth Equity Collaborative, as well as chatting with human rights lawyer, and our resident expert on respectful care, Elena Ateva. But first, what does discrimination during childbirth look like?

Bruce McIntyre (01:16): So my name is Bruce McIntyre, I am the partner to Amber Rose Isaac and I live in the Bronx, New York.

Diana Copeland (01:23): Bruce's partner, Amber Rose Isaac was a black, soon to be mother, who passed away because of racial discrimination and inequitable care. She was 26.

Bruce McIntyre (01:33): Once you're a pregnant black woman, you're not really cared for. You're not hurt, your last. Amber was facing incompetence very early on with our OB/GYN. It started from the very first appointment. The OB/GYN seemed really distraught in our marital status. She asked if Amber and I were married? We told her no, but we have plans.

Diana Copeland (02:06): After that, Bruce says the OB/GYN was less attentive and rude. It would take forever to get basic documents back. Amber would reach out to voice her concerns and her healthcare providers would just not respond.

Bruce McIntyre (02:20): Amber was tired of it. She wasn't being seen. She was in her second trimester, coming into her third. She should have been seen every week, coming into every two weeks, coming into every week, but she wasn't being seen at all.

Diana Copeland (02:32): They were facing so much neglect that Bruce and Amber decided to hire midwives instead, but once they got in touch with a midwife, she informed them of something they hadn't yet heard from their OB/GYN.

Bruce McIntyre (02:44): We can't accept you because you're you're high risk. And then she made us aware that Amber's platelet levels were dropping at a staggering rate. Her OB/GYN and other doctors, it was like four other doctors that were signing off on her paperwork, and they're not telling us that her platelet levels are dropping like this. We had to find out through a midwife, which is ridiculous. They didn't find out that she had HELLP syndrome until the day that she passed away.

Diana Copeland (03:13): HELLP syndrome is a life threatening pregnancy complication usually considered to be a variant of preeclampsia. It caused Amber's platelets to reach dangerously low levels. Once Amber headed into the hospital for an induction, they tested her twice for COVID-19, both tests came back negative. The head surgeon told Amber, "Hey, we're still going to act as if you are a COVID patient."

Bruce McIntyre (03:36): Her platelet levels were very low. Very, very, very low when ever we were in the hospital. And instead of bringing her platelets up, they're testing her for COVID.

Diana Copeland (03:51): Amber entered the OR for C-section. As Bruce waited outside.

Bruce McIntyre (03:54): There was these double doors that I was looking through. I didn't know if Amber was in there or not, but I seen them rushing my baby out. He was covered in blood, and I'm just thinking, "Wow, he's here." And then right after that, I hear the intercoms go off, and the announcer's calling for all medical emergency staff to attend to Amber's room. They had to say that she was a non COVID patient three times before people really started rushing to her aid.

Diana Copeland (04:22): Bruce walked to meet his family, but on his way, he heard people yelling.

Bruce McIntyre (04:28): I'm hearing people at the front desk shout, "Hey, where is this at? This hasn't arrived from the blood bank yet? Where is this?" And they're having to go to the other side of the hospital to get blood, to rush blood. When they told me that they had everything ready in her room, they told me they had, that everyone that I would want to be in that room with Amber was going to be in that room. So they weren't prepared.

Diana Copeland (04:55): After two and a half hours. Bruce says he asked a nurse if Amber had at least been closed up after her C-section, and the nurse told him, "No, they're still cutting."

Bruce McIntyre (05:05): So I can feel my heart in my throat at that point. My family gets there, the head nurses, and everyone's trying to get me away from the window. They tell me to go say, Hey, to my family, but I'm just not, I'm not all there. I just want to go beside Amber, but they ended up cutting her some more. Mind you, her platelet levels are very low, her blood is water like, her blood is not clotting. We're still waiting around for updates.

Bruce McIntyre (05:36): We see black doctors leaving Amber's room, shaking their head and looking at me like they want to come tell me something, but they can't. Then you have white doctors leaving her room, coming up to me, patting me on my shoulder. "Oh, you're going to be fine. You're going to be okay." There was just a lot of stuff done wrong. What she had was 100% preventable. All of this stuff could have been caught early on if Amber would have received standard care. If Amber would have received standard care, she would be here. Simple as that.

Diana Copeland (06:15): Implicit racial bias and discrimination can sometimes be hard to identify, but that's what makes it so important to call out. Amber and Bruce faced hurdle after hurdle and frequently spoke out about the subpar care Amber was receiving. Amber's mother, a hospital employee filed two complaints. It was clear early on that there were major problems, but everyone who was supposed to listen to Amber refused to hear her voice.

Bruce McIntyre (06:44): Trying to tell Amber her body, when she's telling them she's not feeling well at all. And instead of her taking the time to figure out what was really going on with Amber, I definitely feel if Amber was a white woman, they would have definitely paid more attention to her. Because if this would have happened to a white woman, all hell would have broke loose. Black women just aren't being paid attention to, they're not being listened to. I've heard Amber voice her concerns so many times. I've had to speak up. Amber's mothers had to speak up. Amber left her own testimony before she passed. Those are words from Amber.

Diana Copeland (07:23): Amber's last tweet was, "Can't wait to write a tell all about my experience during my last two trimesters dealing with incompetent doctors at Montefiore [hospital]," four days later, she had passed away. Article Five of the Respectful Maternity Care Charter says that, "No one is allowed to discriminate against you or your newborn because of something they think or do not like about either one of you." It also says that, "Equality requires that pregnant women have the same protections under the law as they would have when they are not pregnant, including the right to make decisions about what happens to their body." Black women are three to four times more likely to die from pregnancy related causes than white women in the United States of America. And a study that came out just this week, showed that when cared for by white doctors, black babies are about three times more likely to die in the hospital than white newborns.

Diana Copeland (08:18): This disparity was cut in half when black babies were cared for by a black doctor, but for white newborns, the race of their doctors makes little difference to their chances of survival. These are the facts. Not treating women with the respect they deserve, including unconscious racism among white doctors towards black women and their babies, cost countless lives in the United States and across the world. It's on all of us to change this.

Diana Copeland (08:45): Joining us in our discussion on the impact of discrimination on childbirth is Dr. Joia Crear-Perry. Dr. Crear-Perry is the founder and president of the National Birth Equity Collaborative based in New Orleans. Dr. Crear-Perry was awarded the Congressional Black Caucus Healthcare Heroes award and the Maternal Health Task Force at Harvard University Global Visionary award for commitment to advancing women's health. Her writing on structural racism has been featured in Essence and Ms. Magazine. She is currently working with the American College of Obstetrics and Gynecology to develop a standard for respectful maternity care, as well as serving on the advisory committee of the Black Mamas Matter Alliance. Welcome Dr. Crear-Perry.

Dr. Joia Crear-Perry (09:30): Well, thank you so much for having me. I'm excited to begin this conversation.

Diana Copeland (09:35): We're extremely excited to have you on too. You are an OB/GYN and an advocate, what led you to this work? And I'm also curious, did becoming an OB/GYN influence your advocacy, or have you always been a lifelong advocate?

Dr. Joia Crear-Perry (09:50): That's funny because I've never thought of myself as an advocate, but the more and more people keep calling you that, I realize that, that's always been my identity. If you were to ask my parents, they would say, "Yeah, I've been advocating a long time." And when raising my children, I can tell you that it must be in the blood. But my personal personality always is looking for justice and looking for ways and asking reasons why. And so I got into obstetrics, I went to medical school, my father was an ophthalmologist. And so I went to medical school to do ophthalmology. And once I got there, I actually was pregnant.

Dr. Joia Crear-Perry (10:24): I was 21 years old when I had my first child and I was looking for a female gynecologist, a woman doctor, and they were all booked up. I said, "Well, man, that might be something I need to look into." Then when I got into medical school and started taking classes, I really enjoyed OB/GYN, much more than ophthalmology. I love talking to women, listening to our stories. I mean, delivering the baby is so amazing. It's a beautiful moment, that moment, when a baby comes out, it can be anything. And so that's really, so I guess my personality is an advocate and my passion is working with women and I've been able to luckily find a career that allows me to do both.

Diana Copeland (11:02): Yeah, that is beautiful. So how did you go about actually founding the National Birth Equity Collaborative and what does the collaborative do?

Dr. Joia Crear-Perry (11:11): Yeah, sure, sure. So I was practicing OB in private practice in New Orleans up until hurricane Katrina and the person who was my mentor and partner was also the city health director. And then when the storm hit, I called him up and I had evacuation to North Louisiana, to a rural town where I grew up. And I called him and I said, "Hey, listen, I have these ideas around health. We can do these things." And he said, "Well, Joia, I don't have any money, but I have a computer and a desk. So if you come back to New Orleans, I will, you'll be the director of maternal and child health."

Dr. Joia Crear-Perry (11:43): So when I had the opportunity five years ago, with some funding from the WK Kellogg Foundation to start the National Birth Equity Collaborative, it was a mixture of both my experience as a practicing private practice OB/GYN, as a black woman who has a mother of three children, and also understanding public health and public policy, having worked with that at government. And it's a mixture of all those three parts of my identity and building them out into a real actual organization that can help support birthing and parenting mothers, black people.

Diana Copeland (12:14): Yeah. Let's talk about that too, because the United States is the only developed country in the world where maternal mortality is on the rise. And of course the rise is highest within communities of color. Why exactly is that happening? And how has it been allowed to continue, frankly?

Dr. Joia Crear-Perry (12:28): Yeah. You know what you don't count, you don't value. And we hadn't had an official count, the maternal mortality in the United States, since 2007, we had stopped funding and that, and investing in structures to make sure that women were thriving and surviving in childbirth. We, in fact, back in the 1950s, there's an article where our public health service proclaimed that the United States had cured maternal mortality. Our rates were a hundred per a hundred thousand, and we were the best in the world and we'd fixed it. And if you know now it's like, there are places that have six per a hundred thousand, 10 per a hundred thousand. So we proclaimed a victory and then we proceeded to just like, we dismantled our public healthcare system in general, dismantle our systems that count and make sure that maternal deaths were addressed.

Dr. Joia Crear-Perry (13:16): So we, about 2015, I was brought into this conversation because the data that show from Amnesty International, from the Center for Reproductive Rights, and Sister Song, organizations like the White Ribbon Alliance pointing out that we were the only industrialized nation where the numbers were increasing and that black women were at three to four times the rate of their white counterparts.

Dr. Joia Crear-Perry (13:40): And when you look over that time period, we increase our medicalization of birth. We decrease our community engagement with others. We increased our C-section rates from up to almost 30% at this point. And so all those things are factors. But when you look at why black women specifically are three to four times more likely, despite our income, so even when we have high income, even we have graduate degrees, even when we are normal weight or when we receive prenatal care in the first trimester, we're still more likely to die in childbirth than our white counterparts who have no, less than a high school education, have less, have no prenatal care and who are obese. So our public health strategies for fixing things always around individual choice and individual behavior does not address the structural interpersonal racism that impacts black women's bodies, that cause us to die at higher rates than our white counterparts.

Diana Copeland (14:35): You've been instrumental in this idea of replacing race with racism as a risk factor in health outcomes. Can you explain why that distinction is so incredibly important?

Dr. Joia Crear-Perry (14:46): It's huge. I mean, it's just like what I was just trying to articulate now, the way things work inside healthcare is that you, when you have a risk factor, you then address it based upon resources inside of the healthcare system. A risk factor for high blood pressure is eating too much salt. A risk factor for lung cancer is smoking. Those are things we'll say those are modifiable risk factors. So, that's what I was always trained, they're modifiable risk factors, and then there are non-modifiable. So for breast cancer, being a woman is clearly a non-modifiable risk factor, we know that women are more likely to get breast cancer. So there's not anything a woman can do to not be a woman. So we say, "This has increased your risk just because you're a woman."

Dr. Joia Crear-Perry (15:30): Well, this is what we do with all these diseases when it comes to black people. Since we know for a fact there is no biological basis of race, and that the only construction of race is social, and political, and the reasons that we have differences for birth outcomes, for maternal mortality when it comes to black people, would not be their genes or their biology, because it's a social political construct that it would be racism. So keying in on what the actual risk factor is and not blackness, or not my race, but racism is important because then we can actually address it. We can undo it. And that is what would end racial disparities and racial inequities in health outcomes.

Diana Copeland (16:10): I think the COVID-19 crisis has really opened so many people's eyes to the structural issues that we've had for so long. I'm curious about how you're planning with your work, and how you're planning to use this COVID-19 crisis to address human rights in a positive way?

Dr. Joia Crear-Perry (16:28): Yep. Well, first, that would be a great, major opportunity for us to agree as a nation, that we will no longer be the only industrialized nation out of 38, we're number 38, that does not believe that everyone has a right to health. If we had access to health care for all, then there are people who are dying in their homes because they don't have insurance, and they're afraid if they go to the hospital sick, that they're going to get a large bill and their family will be saddled with the bill. There are black people who will be found in their homes dead across the United States, because we have not chosen to provide health coverage to millions of Americans.

Dr. Joia Crear-Perry (17:05): Everyone should have access to healthcare and should have quality healthcare that meets their needs. And that's what we need leadership and showing. And it's that we can't say that people are expendable and you can't do these things because, that is what it gets us in these situations where we lose way more folks than we should, who are black, white, everybody. We are losing family members. We're losing loved ones. We're losing medical providers and it's unnecessary there.

Diana Copeland (17:31): It's unnecessary, it's unconscionable as well, that this is allowed to happen. If you could do anything right now to improve health and healthcare, not only in New Orleans, but in America and across the world, what would you do?

Dr. Joia Crear-Perry (17:42): The first thing would be to create a fund where everybody has access to healthcare. It is, people make really, really bad choices because they don't have access to being able to make better ones. We prohibit their ability to be free by not letting them have health insurance. We're not providing it. These are not controversial ideas to say, "Based upon your income, you can get Medicare. And if you," because I can tell you my older patients, they love, what would they call their red, white, and blue card that Medicare card. That Medicare card could make sure that if you got sick, you can get access to care.

Dr. Joia Crear-Perry (18:18): And when Medicare was created in the 1960s, it was really created racialized. It was believed that you could get free insurance for your health after you retired, so you've earned this benefit of being covered for your health. And then they excluded both farmers and housekeepers from being able to collect Medicare. And who were farmers and housekeepers in 1965? They were black people. So there's so many moments that this racism, this institutional, this structural racism in our history and in our current legacy of the United States harms all of us because now we're at this place where we could have had insurance for everybody a long time ago, but we racialized the benefits, devalued, a group of people. And now millions of us are suffering, white and black and every other race.

Diana Copeland (19:06): It's awful. In this podcast, we're also talking about what people at home can do within their own communities. What would you recommend? Someone can take an action to improve the human rights that are available or that are accessible within their community?

Dr. Joia Crear-Perry (19:21): Well, even if we start with what New Orleans did with getting the city council to say that healthcare is a right, is huge. And then next, so petitioning, working with your city council around paid leave, getting a bond, some commitment from, I could say here in New Orleans, we have a lot of, most of our economy is tourism. So many people are out of work. And so really working with government to find local supplements for food. We are really worried about birthing people and, and they're not having access to having a person in the room with them. So if you have the capacity to donate things like iPads or ways for technology, for folks to be able to still have connection to people at home while they're birthing, that would be a great gift to others.

Dr. Joia Crear-Perry (20:10): It's hard for me sometimes to think of small things, because I feel like we could revolutionize much bigger things. My Katrina experience taught me that at this moment during COVID-19, we are going to move to a better place afterwards. We have to agree that everybody should be able to come on board with that place. So in your local environment, really pushing your local government to say, "What is the place you want to see your city be when this is over and how do we build a safety net for all people to get to that place?"

Diana Copeland (20:40): That's wonderful. And listeners are going to be able to find information on how to support the National Birth Equities Collaborative at their work, your work in the episode, show notes. So that way they can join in this collaborative effort. Thank you so much for joining us today.

Dr. Joia Crear-Perry (20:54): Thank you so much. Yeah, that's really, and to always remember that we are, the least of these is as important, and we're an all in this together. And we're going to come out on the other side stronger and better, and we're going to build an infrastructure that values all.

Diana Copeland (21:10): And now we turn to Elena Ateva, a human rights lawyer and the convener of the Respectful Maternity Care Council to learn more about the human right to equality, freedom from discrimination, and equitable care. Welcome, Elena, how are you doing today?

Elena Ateva (21:25): Great Diana, thanks for having me.

Diana Copeland (21:28): It's great to have you on and especially about this really important topic. I'd love to hear more about your thoughts on article five. Everyone has the right to equality, freedom from discrimination, and equitable care.

Elena Ateva (21:39): It's interesting to think about discrimination because the minute we meet somebody for the first time, we start making conclusions about them, based on how they look, whether they're able bodied, what language they speak, their race or ethnicity, their education, their social standing, everything. And all of this is also conditioned by the history of the country we live in, and by long ingrained attitudes.

Elena Ateva (22:07): In the United States, for example, we have racism. And the very real consequences of racism are that more black women are dying in childbirth. We know that in any society, women with disabilities, be it physical or psychological, are discriminated against very often, not even allowed to become pregnant or to have children. In the region I'm from, in Eastern Europe, Roma women have been discriminated against for many, many years, and many have been sterilized as a form of state control. Babies, newborn babies are also discriminated against based on how they look. Very often, small, babies who are born small or premature might be discriminated because of that.

Diana Copeland (22:58): So knowing that discrimination exists, how do we then ensure that equitable care is provided to mothers and babies everywhere?

Elena Ateva (23:12): I think the best thing a person can do is really educate oneself and also teach our kids about human rights from early on. Human rights and also history, the history of systemic oppression in the country in which you live. And whether that's the history of slavery and racism or the history of colonialism, the history of women's rights, or migrants rights, it's really important to know that and understand it well from an early age.

Elena Ateva (23:49): For me personally, it was eye opening when I was sitting the history of racism in the United States and the history of slavery, to learn that the word slavery actually originates from the region I am from, from Eastern Europe. The word slave comes from the word slav, which is the word of the people who lived in Eastern Europe. In the middle ages, they were taken as slaves for Italian city States.

Elena Ateva (24:28): And I didn't know that that was not something that was taught in schools, in Bulgaria, where I grew up. I felt that, that was part of my history as well, that I was not studying somebody else's history any longer. That was part of human history and part of my history as well. And I think that's true for every aspect of our identities. I think if we dig deeper, we find more in common with other people, discrimination of any kind impacts on every one of us, whether we feel it firsthand or not, because it creates a world that is divided and that's less safe for everyone. And we see that, especially in pregnancy and childbirth.

Diana Copeland (25:14): If a mother realizes that she is being discriminated against, the people who are supposed to be taking care of her are treating her harshly, they're not giving her equitable care because of who she is, what can she do to protect her health and also the health of her babies?

Elena Ateva (25:31): I think it's very hard when you're in a situation where you know you're discriminated against, it's very hard to speak up. And many women have tried and still ended up with adverse outcomes, and many have ended up dead. So I don't think it's, I don't think that's the solution. You need to find support outside, other family members might be able to help, organizations are there to provide support, but I think the best thing you can do is plan your pregnancy and childbirth. And from the very beginning find that support and make sure that the people who are caring for you are supportive.

Elena Ateva (26:19): There are organizations that are working very actively to ensure that. So you have to find that within your community, within your country. Find who is doing that type of work, I would say engage in that type of advocacy even before you think about pregnancy and childbirth, so that when the time comes conditions are there for you to deliver safely and not to have to worry about that. Not to have to worry, because this is it's really unfortunate that we put women and newborns in that situation. And women have to worry about themselves and their newborns too, whether they will be discriminated against, whether their preemie baby will be taken care of well, when they're not looking. And that shouldn't be. That shouldn't be, and it's on all of us to make sure that doesn't happen.

Diana Copeland (27:13): It definitely is. Well, thanks so much for joining us, Elena.

Elena Ateva (27:16): Thank you so much for having me, Diana.

Diana Copeland (27:20): Special thanks to Dr. Joia Crear-Perry, the National Birth Equity Collaborative, Bruce McIntyre, and the SaveaRose Foundation. This episode of Brave Voices, Bold Actions was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Marissa Ware, Nina Garcia Wright, Kendra Hanna, with support from the entire White Ribbon Alliance team. Our theme song is called, "Mama," by Eric Wainaina and can be found on White Ribbon Alliance's Advocacy in Audio. Learn more about the Respectful Maternity Care Charter and find more resources at whiteribbonalliance.org/bravevoicespodcast.

This transcript was exported on Aug 20, 2020 - view latest version here.

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Episode Team: This episode produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Marissa Ware, Nina Garcia Wright, Kendra Hanna, with support from the entire White Ribbon Alliance team. Special thanks to the National Birth Equity Collaborative and the SaveARose Foundation.


Diana Copeland

Senior Communications Officer

Diana Copeland joined White Ribbon Alliance in 2016 as the Communication Coordinator, working to strengthen and disseminate the organization’s message on its website and social media platforms, and was promoted in 2018 to Senior Communications Officer in order to oversee and grow White Ribbon Alliance’s digital and offline presence.
Rt. Hon Helen Clark

Dr. Joia Crear-Perry

Founder and President of the National Birth Equity Collaborative

Dr. Joia Crear-Perry is the Founder and President of the National Birth Equity Collaborative based in New Orleans. Joia was awarded the Congressional Black Caucus Healthcare Hero’s award and the Maternal Health Task Force at Harvard University Global Visionary Award for Commitment to Advancing Women’s Health. Her writing on structural racism has been featured in Essence and Ms. Magazine. She is currently working with the American College of Obstetrics and Gynecology to develop a Standard for Respectful Maternity Care, as well as serving on the Advisory Committee of the Black Mamas Matter Alliance. Follow Dr. Crear-Perry on Twitter at @doccrearperry and the National Birth Equity Collaborative at @BirthEquity.


Elena Ateva

Advocacy Manager

Elena Ateva is the Advocacy Manager at White Ribbon Alliance and the Maternal Health lead for the USAID/Health Policy Plus Project. She is responsible for facilitating the work of the Global Respectful Maternity Care Council, leading global advocacy efforts to strengthen the midwifery workforce and providing assistance to WRA National Alliances that campaign to improve reproductive, maternal and newborn health and rights. Elena is an attorney and a human rights advocate who has been involved in the movement for respectful care in her home country, Bulgaria, and throughout Eastern Europe. Prior to joining WRA, Ateva was the Eastern Europe Legal Advocacy Coordinator for the international non-profit Human Rights in Childbirth and later served on the board of the organization. Her work has also focused on prevention of other forms of violence against women, including domestic violence and trafficking in Bulgaria and the United States.


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