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As we mark the tenth anniversary of the Flint, Michigan, water crisis, we highlight the remarkable contribution of Dr. Mona Hanna-Attisha, a pediatrician whose advocacy brought to light one of the nation’s most horrific public health disasters and exposed government officials’ negligence.

Mona’s parents, Iraqi scientists, dissidents, and members of the persecuted Christian, minority fled Saddam Hussein’s repressive regime for England in the 1970s. Shortly after Mona was born in 1976, her parents moved to Michigan, where her mother taught English to other immigrants, and her dad worked for General Motors as a metallurgical engineer.

Unable to return to Iraq for over 25 years, Mona’s family did not see her grandparents and frequently received letters with sentences cut out. Incensed by her family’s experience as a persecuted minority, Mona began advocating for vulnerable communities facing injustices in high school. She rallied classmates at Kimball High School in Royal Oak, Michigan, to oppose a polluting incinerator in Madison Height that was causing asthma and other respiratory problems for nearby residents.

During her undergraduate studies at the University of Michigan in 2002, Mona became increasingly aware of environmental racism and the disproportionate impact of environmental contaminants on low-income communities. After completing her medical training at Michigan State and obtaining a master’s degree in Public Health Management and Policy from the University of Michigan, Mona was determined to advocate for children and families in underserved areas.

Her tenure at Children’s Hospital of Michigan and her appointment in 2011 as director of the pediatric residency program at Hurley Medical Center, a public non-profit hospital in Flint, Michigan, provided her with firsthand insight into the challenges faced by marginalized communities. By 2013, based on the respect she’d gained within the medical community, Michigan Governor Rick Snyder appointed her to the state Public Health Code Advisory Committee, tasked with comprehensively reviewing Michigan’s 35-year-old Public Health Code.

In August 2015, while enjoying a glass of wine with a high school friend, Hanna-Attisha experienced a life-changing event. Her friend, an engineer, a certified water operator, and a former EPA employee, told Hanna-Attisha that
Flint’s water wasn’t treated properly. Recent tests by world renowned expert in water lead contamination, Professor Marc Edwards of Virginia Tech, had revealed it contained dangerous lead levels, and city and state officials were ignoring this evidence.

Once a thriving hub of the auto industry, Flint had fallen into disrepair since the 1980s as most of the auto industry moved to low-cost labor areas of the US and the world. By 2011, its population, majority Black, had plummeted by half to just 100,000 people, about one-third of whom lived below the poverty line. Cash-strapped and shouldering a $25 million deficit, Michigan Governor Rick Snyder appointed an emergency manager, replacing the mayor and disenfranchising Flint residents, to oversee Flint and cut city costs.

As a cost-saving measure, effective April 25, 2014, the emergency manager switched the city’s water supply from the Detroit Water and Sewerage Department, sourced from Lake Huron and the Detroit River, to the highly polluted Flint River. Unbeknownst to residents, the new treatment plant failed to apply corrosion inhibitors to the water and lead from aging lead pipes leached into the water in thousands of homes. A public health crisis ensued, including an outbreak of Legionnaires’ disease that killed approximately 12 people, sickened at least 87 people, and caused irreversibly damaging lead levels in 6,000 to 12,000 children.

Immediately after the water switch, Flint residents started complaining that water from their taps looked, smelled, and tasted foul. Officials dismissed their complaints of skin rashes, hair loss, and itchy skin, maintaining the water was safe despite proof of discolored water lugged in jugs by residents to community meetings. In fact, the Michigan Department of Environmental Quality failed to inform the EPA about Flint’s lack of corrosion controls. It further excluded two samples from its initial report on lead levels, artificially lowering the results to meet federal standards.

Concerned for their families’ health, in early 2015 Flint residents sent samples of Flint’s water to Marc Edwards. Tests conducted by Edwards and his water study team concluded by early September 2015 that water from the Flint River was 19 times more corrosive than from the Detroit water system, and 40% of Flint homes had elevated lead levels. They recommended the state of Michigan declare Flint water unsafe for drinking or cooking.

Meanwhile, knowing how serious a public health issue lead poisoning is, particularly in children – irreversible brain damage, development delays, speech problems, a boosted risk for behavioral issues, and serious chronic conditions – Dr. Mona Hanna-Attisha swiftly responded to her friend’s disclosure of the ongoing crisis. Launching a study using Hurley Medical Center’s electronic medical records, she analyzed the blood lead levels of Flint children under 5 years old before and after the April 2014 water switch.

She was alarmed by her findings. The percentage of Flint children with unsafe blood lead levels doubled, nearly tripling in the inner city, and rose from 4 percent to 10.6 percent in the areas with the highest water lead levels. Hurley Medical Center promptly inserted lead warnings in Flint children’s medical records, urging doctors to remain vigilant for lead poisoning symptoms, which can take up to 10 years to surface, and offer guidance to affected families.

In late September 2015, shortly after Edwards released his water study results, Dr. Hanna-Attisha presented her findings of dangerously high blood lead levels in Flint’s children directly to state officials, who did not take it seriously. Because the enormous public health implications demanded urgency, she went public to reveal her findings and advocated for action before her research had been scientifically peer reviewed. Instead of addressing the crisis, the Michigan Department of Environmental Quality criticized her findings, accusing her of “slicing and dicing” data and “causing near hysteria,” and labeled Edwards a “troublemaker.” Dismissing their research, the Department repeated the refrain that its tests at Flint’s treatment plant showed no lead, and its home tests registered acceptable lead levels.

Undaunted and aware that nearly 9,000 children were supplied lead- contaminated water for 18 months, Dr. Hanna-Attisha persisted. She persuaded the newly appointed state chief medical executive Dr. Eden Wells, with whom she had previously worked, to compare her analysis to that of the state epidemiologists. Finding issues with the state’s methods, they forced state health epidemiologists to reanalyze their data, which confirmed Hanna- Attisha’s results.

This, plus dangerous lead levels detected in Flint schools’ water and embarrassing publicity for Gov. Snyder, caused the Michigan State Legislature on October 15, 2015, to approve $9.3 million to switch Flint’s water source back to the Detroit Water Sewerage System. The next day the switch was made.

By January 16, 2016, city, state, and federal officials had declared a state of emergency in the city of Flint and Genesee County, opening the door to state and federal funding to replace lead pipes and provide health services for the long-term effects of lead poisoning. Eventually, in part due to Hanna-Attisha’s advocacy, the EPA granted Flint $100 million and the state allocated $250 million to address the crisis.

Ten years later, however, the scars of betrayal linger in Flint as the fallout from the water crisis persists. Justice remains elusive despite over a dozen lawsuits, including several class actions, directed at Michigan, the city of Flint, the EPA, and various officials involved in the ill-fated decision to change the water source.

The 2017 Settlement Agreement directed replacing lead lines in Flint by 2020, yet 30 homes still await resolution. The constant failure to meet deadlines has left nearly 2,000 residents contending with damaged properties from pipe replacements. In March 2024, a federal judge finally held Flint in contempt.

Another $651 million settlement against Michigan, Flint, and other responsible parties, announced in 2020 and finalized in 2024, provides payouts to people who were children at the time of the crisis while also reserving additional money for special education services. Nevertheless, no resident has, yet, received payments. The Settlement specifies that residents’ payments are contingent upon resolving all 90,000 claims, with June 2024 as the most recent deadline.

Criminal accountability for those in power has been absent. Despite the Michigan attorney general brining 34 felony charges, including involuntary manslaughter, against nine individuals, including Governor Snyder, Nick Lyon, head of the Health Department, and Dr. Eden Wells, criminal prosecutions ceased in October 2023 after the Michigan Supreme Court dismissed all charges on procedural grounds. Flint residents responded with anger and hurt, but not surprise.

While today, the EPA says Flint water is safe, the lead level is lower than federal safety limits, many Flint residents, ten years since the water crisis, still refuse to drink tap water because of a well-deserved major distrust of the government.

Forever changed by the Flint water crisis, Dr. Hanna- Attisha’s work since has been driven by a fundamental principle: “It’s about not being OK with poisoned water, and it’s about not being OK with babies growing up in poverty.” Today, she is Associate Dean and Professor of Public Health at Michigan State University College of Human Medicine and a renowned international champion for safe water and fierce spokesperson for impoverished children.

Knowing the dire state of our nation’s drinking water infrastructure is a public health crisis, during numerous testimonies before the United States Congress, Hanna-Attisha has called, urgently, for federal action to replace lead pipes.

Her advocacy has borne fruit. Recently the EPA proposed revisions to 30-year-old regulations regarding lead- in- water, calling for replacing lead service lines in most water systems within a decade, enhanced lead testing requirements, and lowering the action level for lead from 15 parts per billion (ppb) to 10 ppb. As part of the Bipartisan Infrastructure Act, President Biden secured $15 billion for nationwide lead pipe replacement.

At the forefront of efforts to improve the lives of children in Flint, MI, two- thirds of whom live in poverty, Dr. Hanna-Attisha is founding director of the Pediatric Public Health Initiative, spearheading initiatives connecting families with essential programs and services to alleviate the burdens of poverty. She oversees the Flint Child Health and Development Fund, established in 2016, which has invested over $15 million in programs aimed at addressing and mitigating the impacts of lead poisoning and trauma experienced by many Flint children.
To tackle and monitor the irreversible, chronic, long-term consequences of lead poisoning among Flint residents, Dr. Hanna-Attisha serves as the principal investigator of the Flint Registry. Among other health and social services, this pioneering program offers vital support for Flint parents grappling with what she terms “toxic stress”—a result of feelings such as guilt, fear, anger, and sadness. Notably, in the 2024 federal budget President Biden allocated $5 million to the Flint Registry, aiming to ensure that “families

in Flint receive high-quality healthcare, education, and proper nutrition as they navigate their recovery from the crisis.”

To address the underlying poverty that allowed the Flint Water Crisis to occur, in January 2024 Hanna-Attisha launched RX Kids. Targeting the first year of a child’s life, statistically shown to be the hardest on family finances and most critical for child development, this first-ever US city program gives all pregnant and new moms in Flint– regardless of income – a one-time payment of $1,500 during their pregnancy and $500 a month for the first year of their baby’s life.

To spread word of the devastation wrought by lead poisoning, Dr. Hanna- Attisha has authored her memoir of the Flint water crisis, the award-winning What the Eyes Do Not See. In November 2023, Children’s Day, she published a poignant article reminding the world of our collective responsibility to safeguard the health and well-being of innocent children, urging us to “take a stand for all the kids born in the wrong places” and to refuse to turn a blind eye to the tragedy and suffering endured by innocent children in Gaza.”

As Flint commemorates the 10-year mark of its water crisis, Dr. Hanna-Attisha emphasizes that the preventable water crisis does not define Flint, but rather how the Flint community has come together to tackle lead poisoning and the trauma it produces.

Today, we honor Arab American trailblazer, pediatrician Dr. Mona Hanna- Attisha, a fearless hero of children. Her advocacy invites us to recommit ourselves to stand up and speak out for environmental and reproductive justice, and public policy that prioritizes creating sustainable communities that nurture all individuals, regardless of race, gender, or socioeconomic status.

Resources: The Flint Water Crisis, 10 Years Later

Flint’s Deadly Water on FRONTLINE

Since time immemorial, through herbs, womb coverings, and sheaths for the penis, women have been trying to control their reproductive lives – to increase the likelihood of becoming pregnant, prevent pregnancy, and terminate a pregnancy. In the mid-to-late 20th century, with advances in medical technology, women who couldn’t conceive a child received a new lease on creating a family through in vitro fertilization (IVF), which fertilizes an egg outside the body and implants the embryo into the uterus to create a pregnancy. By 2023, approximately 2.3% of all infants born in the United States were conceived using assisted reproductive technology, of which IVF was the most common.

Then, in February 2024, an Alabama Supreme Court decision in LePage v. Center for Reproductive Medicine legally recognized frozen embryos as “extrauterine persons,” jeopardizing the accessibility of IVF and establishing a dangerous precedent that could fuel the proliferation of fetal personhood laws.

For over a millennium, unknown women healers have been at the forefront of aiding infertile women in achieving pregnancy. Trótula di Ruggiero, a remarkable physician from the 11th century, challenged prevailing medical beliefs. Her treatises, attributed to her husband, posited that menstruation was not the origin of all women’s ailments and fertility problems did not always originate in women – revolutionary concepts that were inconceivable to the male medical establishment of that time.

Nonetheless, the breakthrough in fertility treatment came in the 1940s from the ground-breaking work of a scientific researcher, Miriam Menkin (1901-1992). After graduating with a master’s degree in genetics from Columbia university in 1923, Menkin worked in pathology research at Harvard Medical School and as a lab technician for George PIncus at Harvard.

When, in 1938, she joined the lab of the Harvard fertility expert John Rock, she began experiments to fertilize eggs outside the womb. Since Rock was rarely present, Menkin pursued her own ideas, developing her own protocol to fertilize eggs in vitro. Finally, after much patience and persistence, in February 1944 Menkin successfully fertilized an egg outside the human body, the first person to do so. In 1948, Rock and Menkin published a full report on their IVF achievement in The American Journal of Obsteterics and Gynecology, with Menkin listed as first author.

When in 1944 Menkin followed her husband, who had lost his job at Harvard, to North Carolina, IVF research in Boston ground to a halt. Without Menkin’s skills, none of Rock’s assistants succeeded in fertilizing an egg in vitro ever again. Until Menkin divorced her husband in 1949, she sought opportunities to continue her research, chasing down lab space and eggs without success. By the time Menkin moved back to Boston in 1950 and rejoined Rock’s lab, his attention had shifted to developing a hormonal contraceptive pill to prevent pregnancy. Now a single mother with an epileptic child, Menkin set aside her dreams to pursue fertility treatment research and became Rock’s “literary” assistant.

Nonetheless, her perseverance over the six years from 1938–1944 played a pivotal role in the advancement of IVF. While Menkin and Rock only let eggs fertilized outside the body develop for a couple of days, and did not attempt to transplant the embryos into a woman’s body, their revolutionary work laid the groundwork for subsequent IVF fertility treatment research.

In 1959, the first birth in a nonhuman mammal resulting from IVF occurred. By 1978, the world’s first baby conceived by IVF was born in England, enhancing women’s ability to take charge of their reproductive destinies. Since then, subsequent medical advances that stimulate the production of eggs, pinpoint the most opportune time to extract an egg, and freeze and preserve a woman’s eggs to be used at a later date, have made IVF easier and more successful, bringing hope to millions of couples and single people. For the approximately 13.4% of women aged 15 to 44 in the United States who are infertile, an estimated 9.7 million individuals, IVF offers hope.

Since the natural fertility rate declines with age — women aged 40 experience less than a 5% chance of pregnancy per cycle — IVF offers the many women today who prioritize education, careers, and financial stability before starting a family, the means to delay parenting until it’s the right time. For those with medical complications such as endometriosis, or who are about to undertake treatments like chemotherapy or radiotherapy that decrease their fertility, IVF preserves their ability to have children. And IVF offers same-sex couples and single individuals the ability to create a family.

Despite IVF’s transformative potential, its accessibility is limited to those with substantial financial resources. The steep cost of a single IVF cycle, averaging between $12,000 and $23,000, combined with the potential need for multiple cycles, renders it financially out of reach for most of those who need it. Compounding this, most public and private insurers do not cover fertility services. While 21 states plus DC have enacted fertility insurance coverage laws, only 15 include IVF coverage, and 17 address fertility preservation for iatrogenic (medically-induced) infertility, with significant variation between states.

Moreover, many large employers in the US do not cover fertility treatments, citing them as not “medically necessary,” leaving a substantial portion of individuals without access to these vital services. In addition, most poor women are generally excluded from the ability to choose when they want to become parents. While Medicaid supports over half of births in the US and the majority of publicly funded family planning services, only the New York and Illinois Medicaid programs cover any fertility treatment, and no Medicaid program covers artificial insemination or IVF. For most poor women, made up of many women of color, Medicaid provides many health services to prevent pregnancy and to support a healthy pregnancy. Still, there is almost no access to either terminate or achieve a pregnancy.

The February 2024 decision by the Alabama Supreme Court in LePage v. Center for Reproductive Medicine was based on the idea of fetal personhood – that life, thus personhood, begins at the moment of conception, whether inside or outside the womb. The decision threatens IVF as well as other reproductive technologies such as hormonal based birth control and medication abortion. At the heart of LePage, Alabama Chief Justice Tom Parker wrote, “Human life cannot be wrongfully destroyed without incurring the wrath of a holy God,” expressing both Roman Catholic doctrine as well as a view held by many Evangelical Christians.

While fetal personhood laws, which are at the forefront of the anti-aborion movement, endanger reproductive freedoms, they also have far-reaching implications. Would these extrauterine “children” be subject to child abuse if they are locked up and frozen? Does a pregnant woman count as two passengers if she’s traveling in the carpool lane? These are not hyperbolic fantasies. Already in Georgia, a fetus now qualifies for tax credits and child support, and is to be included in population counts and redistricting.

We honor Miriam Menkin’s legacy – her patience and persistence in her research; her monumental breakthrough in fertility treatments, successfully fertilizing an egg outside the body, which laid the groundwork for IVF that has empowered countless individuals to exercise control over their life choices by controlling their reproduction. We decry the decision of the Alabama Supreme Court in LePage v. Center for Reproductive Medicine that imperils the accessibility of IVF, potentially unraveling Menkin’s legacy, and threatens to fuel fetal personhood laws that jeopardize women’s reproductive freedom. We call on us all to remember that it is through collective action and unwavering solidarity that we will safeguard the hard-fought gains of the reproductive justice movement and ensure that all persons have the autonomy and agency to make decisions about their own bodies and lives. Watch our Stand UP, Speak OUT docuseries to learn more about the history of women’s rights and hear from women who experienced its impact on their lives.

BC Voices announces the East Coast premiere of its online historical documentary short, Stand UP, Speak OUT: Reproductive Rights – Know Your Rights, the story of American women’s 200+ years and ongoing fight for reproductive freedom, during the Valkyrie International Film Festival in Amherst, MA on March 22, 2024.

We were excited to hear from the festival directors about the passionate response from viewers:

“There were about 40 people (close to 100% of those who attended for the day). Loud applause at the end. People were upset by what has happened over the centuries. I believe it shocked people – they knew some of what was going on but didn’t know the severity. I know that during our break, a group of people passionately discussed the film in depth for about 15 minutes before returning to their seats.”

We are thrilled to announce upcoming premieres: the West Coast premiere of Know Your Rights on May 26, 2024 at the LA Independent Women in Film Awards in Los Angeles, and the Mid-Atlantic premiere of Know Your Rights in April 2024 at the Documentaries Without Borders Festival in Rehoboth Beach, DE .

We look forward to more festival screenings in the coming months.