I'm Tt and I'm Zakijah and from Spotify. This is Dope Labs. Welcome to Dope Labs, a weekly podcast that maxes hardcore science, pop culture, and how healthy does a friendship. This week is part two of our series on maternal health. If you haven't listened to last week's Lab yet with Simone Tape, we really recommend listening to that one. First, we talked to Simone about what services maternal health care encompasses.
We learn that there's a lot of bottlenecks when it comes to getting good maternal healthcare here in the United States, and we also dug into disparities in maternal health among specific groups. This week, we're zooming out to understand more of the context around the state of maternal health care today, how we got here, and how to make it better. Okay,
let's get into the recitation. What do we know? Well, you know, like you mentioned, we learned a lot from last week's Lab and sadly, we learned if you want good care, you basically need to move to Finland. But if you aren't trying to move to Finland, here are some of the major points from last week's episode about the state of maternal health care. Maternal health care in the United States is out of date and out of
touch with the needs of today's birthing population. Yes, we're seeing rising rates of both morbidity so those are health issues and mortality that's death as it's related to complications following pregnancy and giving birth. Some of the major bottlenecks and maternal health care include the hurdles that you have to jump over making monthly appointments, the lack of options of both in person and virtual care, and maternal health
care deserts. Also, mortality rates are disproportionate among women of color, so they are three to four times more likely to die from pregnancy or birth come implications. We also found out that fifty percent of the birthing population in the United States are on Medicaid, which means that they don't
have equal and equitable access to healthcare. And at the end of the last episode, we started talking about the Omnibus legislation, which focuses on bringing preventable mortality rates closer to zero, and that takes us to kind of what we want to know for this lab. Yeah, so my first question is why is maternal healthcare in the US
so bad. With the amount of money that Simone was telling us gets poured into our maternal health care system, you would think that that would mean that we are doing really great, but that's not the case, and I want to know why. And I want to know more about these programs. You know, So, how does insurance and the support that the federal government provides for birthing parents, how does that come into play? And why isn't it doing its job? It seems like that is such a
good question. And I also want to know what makes maternal healthcare quote unquote good. And once we know but makes it good, how do we make it even better? Yes? And I think when we consider that, who is the weak right should it be nonprofits and private agencies? Or are there policies and programs that our government should sponsor that might improve outcomes? That's what I want to know. Okay, I think we've got enough questions. Yes, let's jump into the dissection.
Let just ask you.
Our guest for today's lab is doctor Sarah Benattar.
My name is Sarah Benattar. I'm a principal research associated the Urban Institute in the Health Policy Center, So I do research mostly focused on maternal and child health.
The first thing we wanted to know from doctor Benatar is why maternal healthcare in the United States is so poor. She said, it's not about money.
The US spends more money on maternal health than any other country in the entire world, twenty five percent more per capita than the next highest spender. Despite all of that, we have some of the worst outcomes for pregnant people and infants.
And let's talk about those outcomes. We learned from simone last week about increasing mortality rates, but what are the specifics.
In twenty eighteen, the rate was seventeen per one hundred thousand births resulted in a maternal death. That went up in twenty nineteen to over twenty deaths per one hundred thousand pregnant people. In twenty twenty that was even higher at twenty three point eight. The next highest rate for a high income country is half that, so in Canada and France the rates are more around eight per one hundred thousand deaths.
And Sarah told us historically this upward trajectory hasn't been the trend.
The Commonwealth Fund has this terrific piece that worth looking at, where they have a chart of maternal mortalit starting in about nineteen eighteen, and you can see that it starts really really high, and then by the nineteen thirties or so, it's considerably lower, and it just keeps on going down until about the nineteen eighties, and in the nineteen eighties it goes up again, and now they just are creeping up consistently.
So this chart is looking at death per one hundred thousand pregnant people. In the eighties and nineties, you're only seeing about seven to eight deaths. But it's really sobering to learn that today we're up to about twenty three deaths per one hundred thousand pregnant people. That's a problem huge. Twenty three sounds like it's small, but when you look at like what it was significant, Yeah, yeah, anything increasing by times three you need to check on it.
Yes, a good segment of that can be attributed to discriminatory healthcare practices and systemic racism. I think because there is just an incredible amount of us and I think it's relatively well demonstrated that is not helpful for a pregnancy.
In addition to mortality rates, there are other stats that doctor Benattar points to that indicate the US is not up to par when it comes to maternal healthcare.
In the US. Some of the things that we really pay close attention to our low birth weight, so that's a baby that's born weighing less than five pounds eight ounces, and pre term birth, which is being delivered before thirty seven weeks gestation. So those are some of the bigger indicators. Another thing are the CEA section rates. Approximately a third of all deliveries are done by c section. Now the who said that the ideal rate would be around fifteen percent.
Cesarean deliveries, which are also known as c sections, do have more risk than delivering a baby baginally, but they're often medically necessary in order to protect the health of a birthing parent or a baby. There are some common chronic health conditions that sometimes require section delivery, and those include heart disease, high blood pressure, or gestational diabetes. And the disparities we've been talking about permeate all of these different areas.
If you look at this by race and ethnicity, the rates, particularly for black women and birthing people, are much higher, so maternal mortality rates can be three to four times higher. Sea section rates are quite a bit higher low birth rate and preach and birth rates are also higher for Black women and birthing people.
The math ain't mathing. Okay, Rights spends the most money on maternal healthcare but has the worst outcomes, especially for Black women and birthen people. We need to understand more. So we ask doctor Benettar, what is going on?
So many people who become pregnant and are then engaging in prenatal care have not necessarily had access to high quality care prior to that. And I have also experienced all kinds of discrimination care. But you know, we're talking about people coming into pregnancy maybe haven't had, especially prior
to the ACA, any medical insurance or coverage prior. Because Medicaid pays for over forty percent of all births in the United States, and for black women and breathing people is hired more like sixty five percent of births.
Medicaid is a federal and state program that helps with health care costs for Americans with limited income and resources, and it's the largest source of funding for medical and health related services for people with low income in the United States. So Medicaid is such an important program to have because it provides healthcare to a portion of the
population that wouldn't have it otherwise. But because it is regulated at the state level as well as the federal level, there are some parts of it that, you know, depending on the state that you're in, have some pitfalls. Insurance, I think is one of the trickiest things in adulting, don't you think, Like for real, for real, it's really wild. Doctor Benattar mentioned the ACA, or the Affordable Care Act, which was passed in twenty ten under the Obama administration.
The ACA was meant to expand health care coverage for millions of uninsured Americans. It also expanded Medicaid eligibility and created the marketplace where people can purchase private insurance. And that private insurance is very expensive, by the way, very But before the Affordable Care Act, you had to basically
have a job if you wanted good health care. And isn't that kind of wild when we stepped back from it, Like it's like, Okay, you only have the right to live if you are working, working, and not all jobs provide health care. Exactly. I have health I have a body whether I'm working or not, exactly, And that's something that's unique to the United States. Because universal health care is something that they have in Europe and Canada and
we're just slow to get on it. People are still fighting the Affordable Care Act, also called Obamacare by folks who want to make it seems like it's something that is partisan, like people getting quality healthcare as a partisan thing. It's not well. In my opinion, it shouldn't be. But here we are. Here, we are at this big age, this country, at this big age set up having a temperate tantrum around healthcare. Get it together or you're not
getting anything. Yeah. Another answer to the question how did we get here is what doctor Benattar calls a very medicalized approach to pregnancy, one that values profit over people.
Many other places approach pregnancy from a perspective that's much more normalized, where this is a natural process that maybe sometimes requires a little bit of help, but most of the time we can support women through it and have a healthy outcome. The medicalized model also maximizes profit. Many times,
these visits are very short, maybe fifteen minutes. Like if you think about a hospital based clinic where we're trying to get as many people in, especially because Medicaid is one of the largest payers there are often high nose show rates.
And that could be because of the factors we talked about last week with simone, lack of access to childcare and transportation, no telehealth options, and maternal health care deserts.
So there are these short visits in which maybe there's been no pre existing relationship, and many people will express that they aren't being listened to. And lots of people have all kinds of other social determinants that are affecting their health like housing, insecurity, food and security, anxiety, depression. The list is long.
Another trend that directly correlates to worsening prenatal care in the United States is the growing OBGYN shortage, and we mentioned that last week, but to help you understand it a little bit better, let's think about it from the entire national perspective. So not just rural areas. If you look at all the counties in the United States, half of them do not have a single obgyn. That's major.
That's wild, that is major. My whole county. Yeah, when I think about going to another county for anything, a specific grocery store because of a specific shop that I like, Oh my gosh, so far, so far, this is going to be a trek. Now, imagine doing that pregnant mm hm ugh. In part one of this series, Simone said that fifty percent of the birthing population is on Medicaid.
And now we know that Medicaid is one of the largest payers of maternal healthcare in the United States, covering about forty percent of all births in the United States and sixty five percent of births for Black women and birthing people. So let's break down Medicaid more in the context of maternal health.
In the nineteen eighties, Medicaid expanded to include pregnant people. So prior to that, Medicaid was almost exclusively a program for children and for adults with very, very low incomes, so it was really pretty restrictive.
Eligible to receive Medicaid, most people have to meet an income requirement.
Each state decides how high the income threshold goes for pregnancy related Medicaid coverage. So in one state, you could make a certain amount of money and qualify for pregnancy related Medicaid, but in another state you could make thirty percent more and still qualify for pregnancy related Medicaid.
Let's break that down. So when doctor Benetar mentions qualifying. What she's talking about is the income level, how much income you make as it relates to the federal poverty level. And so the federal poverty level is thirteen thousand, five hundred dollars annually for individuals and around eighteen k for families of two. And the gotcha, gotcha with all of this is exactly what doctor Benattar said. It changes between states. So we looked up what it would be for Maryland.
So let's say it's you and your partner and one of you is pregnant. You qualify for Medicaid if you make up to four thousand, twenty nine dollars per month. Okay, so that's for Maryland. For Alabama, same situation, you your partner, one of you is pregnant, You qualify if you make up to two two and twenty eight dollars per month. That's a lot lower. That is a lot lower. I
would want to move to Maryland if I could. Right, You think about the quality of life of the pregnant folks in Alabama who are looking to qualify for Medicaid. That annual income, when you do the math, that's not a lot of money. I mean, I think that's the interesting thing that this is state by state, you know, and this is a much higher percentage of the federal poverty level that's allowed, and so this is gracious for
maternal health care. We won't even get into what it looks like how little income you can make if you want to qualify for Medicaid and you're not pregnant right now. And this is where I think we see these insurance gaps, and when people are pregnant, they show up and they haven't had good health care leading up to this. Absolutely, I think this is how we get that vicious cycle
of complications and increase morbidity and mortality. Absolutely, because all of these things touch Every aspect of your life is touching this. So if you have to make below a certain amount, that means that's going to affect do you have a car, do you have access to technology, The quality of your food, and all of these will affect your pregnancy, all of it. Where you can live, air
quality because of where you're living. Yes, yes, I was gonna say, this is just tying back to so many episodes what doctor Tate said about if you're living with somebody else, if they make a little bit more income, it may not even be yours to spend. But what does that mean for your household amount? Right? And if you qualify or not, and then what does that mean for your support throughout your pregnancy? Absolutely, it's just oh my goodness, there are so many, so many ways to
look at this. Yeah, because I mean even when we think back to our sleep episodes with doctor Jean Louis mm hm and talking about the quality of your health is dependent on your zip code. Now, compound that with access to proper health care, access to maternal health care exact A is also dependent on your existence, dependent on your zip code. You're just stacking those things up.
In many states now, the threshold for eligibility is pretty high. You could be to two hundred ish percent of poverty and qualify for pregnancy related Medicaid coverage, and then Medicaid covers all of your pregnancy related healthcare needs. It also covers any other healthcare related needs you have.
Since nineteen eighty nine, pregnant women with incomes at or below one hundred thirty three percent of the federal poverty level have been a mandatory Medicaid eligibility group. So that means you can make up to one hundred percent of the poverty level plus an additional thirty three percent. They're
giving you a little bonus area there, you know. So if you may up to one hundred thirty three percent of the poverty level, then your mandatory, like it's mandatory that you are included in Medicaid coverage.
Every pregnant individual in the United States who becomes pregnant should qualify for either Medicaid or the Children's Health Insurance Program.
The Children's Health Insurance Program OR was part of the Balanced Budget Act of nineteen ninety seven, and so this program was created to provide low cost health coverage for children who wouldn't qualify for Medicaid but are still relatively low income. Like Medicaid, each state is still determining the eligibility requirements for CHIP, so really it's plugging a gap.
If the Children's Health Insurance Program covers some pregnancies that undocumented people are experiencing because it is focused on the unborn child in that situation because they would not otherwise qualify for a federally funded health insurance program.
It's like, we have some stop gaps, but it's not one hundred percent. So in the case of CHIP, you know, if you imagine an undocumented person that's pregnant, they're not eligible for Medicaid, but their unborn child is eligible for CHIP, the Children's Health Insurance program, Right, but the birthing parent still isn't covered by either of those two things. Right, So we have some stop gaps, but it's still leaky.
It's still leaky. Yeah, let's take a break and when we come back, we'll talk about postpartum care and some legislation that's coming out to hopefully improve maternal health in the United States. Plus stick around to hear about a special episode that we're working on. We're back, but before we get back to the lab, two things. Next week, we're talking all about our therapy and how art can be utilized to help us in our mental health journeys. And we're also reaching out to ask for your input
and feedback. We are doing a special episode calling out the lgbt QIA community in stem. If you are a member of this community, we want to hear from you. Call us at two zero two five six seven seven zero two eight and tell us about your work, what you do. We want to hear it all. Let's get back to the lab. We've been talking with doctor Benattar about Medicaid CHIP, which is the Children's Health Insurance Program.
And these are two programs meant to expand maternal health care coverage in the United States, and how complicated it can be to qualify for these programs. So let's say you do qualify, You've jumped through all the hoops to get there. Medicaid coverage includes, you know, pregnancies with complications and postpartum healthcare. Two. So remember how simone said that typically there is a six week post birth follow up
and then that's it. If you have Medicaid. The minimum requirement is that pregnant people remain covered for up to sixty days postpartum. Now I'm gonna let you do the math. For six weeks time seven days. That's not giving you a lot of room if you miss that right hitting on the nose at six weeks, you know what I'm saying. Tt Yeah. And so in many states there are now postpartum extensions of Medicaid that would let you stay covered
up to a year after giving birth. And we want to pause and really take a moment to talk about postpartum care.
Sometimes we'd refer to the first three months postpartum as a fourth trimester, and I think that more attention paid to that fourth trimester would be really valuable.
When it comes to maternal health. So much focuses on the time leading up to birth and then the birth itself, and then there's just a huge drop off in care. But having good medical care and a strong support system is just as crucial, if not more so, after birth when the baby is here.
Yes, there are a few things to think about. One is the safety of the mother or the birthing parent, because there are a number of sequela that could happen that could really endanger the life of the person who just delivered a baby, and that is generally around hemorrhage and basequela.
She just means a condition resulting from a previous condition, so think of it as like another domino in a sequence of conditions or effects. Hemorrhage is a rare but very serious condition when a person has heavy bleeding after giving birth. It's usually treatable as long as you have access to good medical care, and if you don't and it's not treated, it can be fatal.
Then there's support around breastfeeding if that is a choice that has been made and even if it's not, then there's like making sure that there is enough formula available. It's the wrong formula if it doesn't taste good. If your child has allergies, it can be a real struggle. And not being able to provide adequate food for your child is just heartbreaking. And diapers the same thing.
If you make the decision to breastfeed, there are all kinds of things to deal with, like getting a newborn to latch, sore chapped nipples, really painful infection of milk ducks called mestitis, just to name a few. And with formula. Next time you go to the pharmacy, go look at those formula prices and diapers. All of it is so expensive. They even have in formula behind those little clear cases so that you have to call a salesperson over to
unlock it for you. And so there are some programs like Women Infants, Children or WICK that will cover the cost of formula for low income families. Postpartum depression is also a huge health risk during the fourth trimester. Remember someone said that according to the CDC, about one in eight women experience symptoms of postpartum depression.
Of course, all the other things that a new parent might need like housing, and there could be intimate partner violence. So there are programs out there that are designed to help support new parents, and sometimes duela care will extend to the postpartum period as well.
All of this on top of very little sleep and pressure of keeping this little animal alive. It's no wonder that postpartum care is advised for up to a year after giving birth. That single six week appointment just doesn't cut it. And you know, all of this information is really powerful, and it's important to remember that even though we're seeing this really concerning trend of increasing mortality rates among pregnant people, we're also now talking about it in a way that we haven't seen before.
There's a lot more attention to this topic now than there has been for many, many decades.
So what are some elements of maternal healthcare that might help improve these statistics? Doctor Benettar and our colleagues at the Urban Institute did a project that looked at some different interventions or enhancements to existing maternal care and there were some positive results.
Ultimately, what we found is that models of care in which there is more time to spend with patients and where there's a relationship that is built tended to be associated with better outcomes. From an impact standpoint, we found that birth center care was positively associated with improved birth
weight and gestational ages and reduced c sections. If you feel like your provider understands you, listens to you, and cares about you, the quality of the care will be improved and as a result, so will the outcomes.
This reminds me of the hybrid remote in person model Simone was talking about. Spending more time talking to healthcare providers can be really beneficial in some cases, and for some people, you don't have to be in person to do it. It can be online or telephone appointments. Those are all options for talking through things like what to expect from labor, measures to maintain your health during pregnancy, and just fielding up any questions that are arising throughout
your pregnancy. And it doesn't even have to be with a doctor or a midwife. Doctor Benatar mentioned doulas and care coordinators as other potential support systems.
JULA care is like an ingredient that you can add to prenatal and delivery care. It's the lay person who comes and can be your advocate during the birthing process.
And this is such a great option for additional coaching through all these different stages of pregnancy, labor, and beyond. Another type of support role that doctor Benatar mentioned is being part of group prenatal care.
You have a short interaction with your obstetric provider, who could be a midwife or a nurse practitioner or an obgion, but you're also part of a group of people who are approximately at the same stage of pregnancy as you are. You always meet together. It's a two hour block of time. You learn, you talk about what your concerns are. You have social support in addition to the education and then the medical support.
A major part of improving outcomes is collecting data understanding where we are now. We ask doctor Binettar about how we collect data around births.
We have birth certificate data and that's pretty well collected, although there are some things on the birth certificate that are really highly reliable and some things that aren't. We have data from Medicaid claims, but there's like no race, ethnicity data on Medicaid claims, so that makes it really hard to disaggregate and see how the disparities are entrenched. I think we need to get more data on how people actually feel about the care that they're getting.
And with all of this new data that we might be able to get our hands on, that will inform the laws and policies that aren't put in place.
I can't remember a time when maternal health had so much attention in Congress.
Recently, we've seen some stories about the racial inequities for Black women in maternal health care, and those stories have prompted many of these conversations that are now happening in Congress and on a larger stage, and they've mobilized a lot of these new policy proposals. When things happen to rich people, they listen, also known as yes.
We're not just talking about people who haven't had access to care. We're talking about people who exist in more privileged spaces. I mean, Serena Williams has access to the highest quality care and still almost died.
This is such a good point. So if you don't know Serena Williams. The Serena Williams delivered her baby by emergency sea section in September of twenty seventeen. The sea section went smoothly, but then she felt short of breath, and immediately worried because she has a history of blood clots.
She advocated for herself and asked for a c T scan and blood thinners, and the nurse just thought that she was kind of just like confused because of the pain medication that she was on from the sea section. Serena Williams then went on to develop blood clots in her lungs and her sea section incision ruptured because of the coughing from the clots that she had in her lungs. When the doctors went to close the sea section wound again,
they discovered a hematoma in her abdomen. She also had another procedure to insert a filter in a vein to prevent further clots in her lungs. Serena stayed in the hospital for another week and was confined to her bed at home for another six weeks. And this is a world class athlete, right who knows her body with constant monitoring. Can you imagine? I can't. You're going to tell somebody who her body is, her job, that is her livelihood, and you're gonna tell me you think you know better
than she does when she's in pain. It just doesn't make sense. Recently, Congress unanimously passed a bill that authorized sixty million dollars over the next five years to prevent maternal mortality in the United States. That money is going to go to funding maternal health review committees in all fifty states, and that helps them to collect that data that we were talking about earlier on what is killing
women during or after childbirth. Doctor Bennittar also mentioned another law that was introduced last month during Black Maternal Health Week by Senator Corey Booker and others, called the Mama's First.
Act, and that is also designed to address the maternal mortality crisis. Maternal mortality is tragic and preventable in almost all cases, but maternal morbidity happens to way, way way
more pregnant people. And that's like gestational diabetes, hypertension, preclampsy, postpartum hemorrhage, you know, things that don't kill pregnant and birthing people, but are still very serious and can have long term So I think Senator Booker's legislation wants to expand Medicaid to include Dulah midwiffree and tribal midwif freecare.
It's clear that a combination of all these things, better care, more data, and more legislation is going to be required to make the transformative change that we need. In the United States.
Medicaid is an incredible lever because Medicaid pays for so many pregnancies. I think the opportunity to affect change through Medicaid is pretty remarkable. And there's you know, talk about changing payment structure. You may have heard this term called value based payment, where basically health plans are paid more for good outcomes. This is a conversation that is definitely being had, and I think a lot of people are asking hard questions and that's really important and I'm pretty hopeful.
What concerns me is that what probably needs to happen is something that's really pretty transformative. The US healthcare system does not transform quickly.
It is this behemoth of a system. It kind of feels like when people talk about racism, right, how we're going to change that in the United States. It is huge. It's because the progress is so slow and incremental, and sometimes incremental in the wrong directions. You have to think of these transformative ideas and principle so you can make any movement right. You have to shoot for the next galaxy to move to the move. All right, it's time for one thing TT I want to hear from you.
What's your one thing this week? It is read dying some of my old clothes. Oh, yes, you've been doing that again. I'm too excited. On the show, we talk a lot about reduced reuse, recycle, and it's a really great way for me to give clothes new life. So I've been using writ dye and is it dylan d y l o n dialon dalon dion. But you can search it pretty much anywhere and it's super super easy.
You just put your clothes in really hot water, you put some of the dye in there and it dies your clothes, or you wash it and you got a brand new shirt. I've died about five or six items. You could do genes. I've seen people do sneakers, anything. It's so much fun. And when you're thinking about donating some clothes or cutting up a shirt because you know it's old, now you might be able to give us some new life an old T shirt. You dyet black, you dyet orange, you diet green, you die purple? Ooh,
how's a look. What's your one thing? Z? My one thing this week is a book. So a couple of weeks ago, I asked people, what are you reading? And if you go to my Instagram, you'll still see there's a highlight that says book club. And one of these books was from a friend of the show. Now I say a friend of the show. I don't know if she's listening, but we talk about her a lot because in the past we read things that she wrote about
movies and TV shows that we like. And so I'm reading a book by Brooke Ovi who went to Hampton with me, absolutely and she wrote this book called Book of Artists Cradled Embers. Now it's a novel. It's so good and it really is a testament that talent exists because we went to the same school. I'm not able to write like that. It's so good, Hampton putting out the best mind. I'm highlighting passages. It's so so good and if you're looking for a book to read, I
think it is a great read. It is about love, loss and liberation, but a lot of love and I'm really enjoying it. I can't wait. I'm going to add that to my kindle right now. Yes, if you have Kindle Unlimited. Yes, you can get it for free, Perfect Brook, We love you. That's it for Lap sixty three. This has been a two parter, so we always love being able to tackle these ideas and really pull them apart with a little bit more time. What'd you think? You
like two parters? You like single episodes? Let us know. Call us at two zero two five six seven seven zero two eight and tell us what you thought. You can also call and give us an idea for a different lab you think we should do the semester We like to hear from you. That's two zero two five six seven seven zero two eight. You can also text, and don't forget that there is so much more to
dig into on our website. There'll be a cheat cheap for today's lab, additional links and resources in the show notes. Plus you can sign up for our newsletter. Check it out at Dope labspodcast dot com. Special things to today's guest expert, doctor Sarah Bennett. You can find and follow
her on Twitter at Sarah C. Benattar. That's s A r a h C b E n A t A R. And you can find us on Twitter and Instagram at Dope Labs Podcast TT's on Twitter and Instagram at d R Underscore t s h O, and you can find Zakiya at z said So Dope Labs is a Spotify original production from Mega Owned Media Group. Our producers are Jenny ratlck Mast and Lydia Smith of Wave Runner Studios. Our associate producer from Mega Oh Media is Brianna Garrett.
Editing in sound design by Rob Smerciak, mixing by Hannes Brown. Original music composed and produced by Taka Yasuzawa and Alex Sugier from Spotify. Executive producer Corinne Gilliard and creative producer Miguel Contreras. Special thanks to Shirley Ramos, Jess Borrison, Jasmine A, Fifi Kamu, Elolia, Till krat Key, and Brian Marquis. Executive producers from Mega Own Media Group are us T T Show Dia and Zakiah Wattley taking