As the United States plunges toward the 2024 presidential vote, it is clear that millions of citizens no longer trust an essential element of American democracy: elections.

Electoral trust has been gradually declining in the U.S. for over two decades, according to polls. The slump’s roots go as far back as Democratic anger over the Supreme Court essentially deciding the 2000 vote for George W. Bush. More recently it has been accelerated by Republican voters’ acceptance of former President Donald Trump’s false narrative that the 2020 election was stolen and parts of the nation’s electoral process are rife with fraud.

Today, sustained attacks by Mr. Trump have helped turn electoral trust into one of the most polarized issues in America’s polarized politics. Only 22% of Republicans have high confidence that votes will be counted accurately in 2024, according to an Associated Press-NORC Center for Public Affairs Research poll from last year, compared with 71% of Democrats.

Overall, only 44% of Americans have a “great deal” or “quite a bit” of confidence the vote count will be accurate in 2024, according to the AP survey.

Whatever the cause, such low levels of trust threaten to erode the U.S. democratic system, experts say. Citizens who don’t think votes are counted accurately are less likely to vote at all. They have less confidence in their leaders and can be more prone to violence – such as the insurrection at the Capitol on Jan. 6, 2021.

“The danger that I see to American democracy is if one side consistently mistrusts elections. That’ll threaten this concept of loser’s consent, where the side that loses agrees to go along with the outcome and try again next time,” says Thad Kousser, a professor of political science at the University of California, San Diego.

From Boss Tweed to the Voting Rights Act

To some degree, distrust in U.S. election outcomes has been part of the nation’s political culture for centuries. It was fed in the late 1800s by the blatant fraud schemes of Democratic urban machines, which included stuffing vote boxes with reams of ballots pre-printed with approved slates of candidates. “I don’t think there was ever an honest election in the City of New York,” the notorious Tammany Hall leader William “Boss” Tweed once testified before the Board of Aldermen.

Reforms meant to rein in some of these abuses were an important part of the Progressive Era of the early 1900s. They included laws establishing the direct election of U.S. senators, processes for referendums whereby citizens vote on some issues directly, and a movement for women’s voting rights.

Moves to ensure more citizens could vote continued during the rights revolution of the 1960s. The Voting Rights Act of 1965 aimed to end the suppression of Black citizens’ ballots. Later, the enactment of the 26th Amendment to the Constitution in 1971 lowered the voting age for all U.S. elections to 18.

Carlos Osorio/AP

Election workers sort through absentee ballots in Warren, Michigan, Feb. 27, 2024.

The 1980s saw states begin to ease rules on absentee ballots, allowing citizens to cast votes in person prior to Election Day, or for ballots to be mailed to all eligible voters. This trend peaked in the 2020 election with a raft of accommodations designed to ensure people could vote during the COVID-19 pandemic.

By measures of access, U.S. elections in the 21st century have become more open than ever. That is an important component of trust for Democratic-leaning citizens, polls show. But at the same time, in recent decades, a number of factors began pushing public opinion, on both the left and right, in the other direction, toward a crisis of confidence in elections.

Though that crisis is currently more widespread on the right side of the political spectrum, it is not hard to see how events in the 2024 election cycle could engender similar feelings on the left, according to a report by two dozen experts on law, elections, and information security. 

“No longer can we take for granted that people will accept election results as legitimate,” stated the report, titled “24 for ’24: Urgent Recommendations in Law, Media, Politics, and Tech for Fair and Legitimate 2024 U.S. Elections” and produced under the auspices of the Safeguarding Democracy Project at UCLA’s School of Law.

“Did your team win?”

It’s difficult to measure the loss of trust in elections accurately with traditional public opinion methods, experts say. “Trust” is a broad concept that covers many different emotions.

But one major reason is the winner-loser effect: the well-documented phenomenon whereby a party or person’s trust in an election tends to rise if their candidate wins, and fall if they lose.

It’s human nature. A fan watching a baseball game is less likely to trust a close call that goes against their team. A close call against the opposing team, however, seems fair. When it comes to elections, trust and mistrust often come and go, rising and falling for one party or the other over the years.

“These ebbs and flows are usually determined by, ‘Hey, did your team win or lose?’” says Professor Kousser.

Nor is electoral trust a long-studied subject. It was only after the Bush-Gore election of 2000 that political scientists began to look at it in a systematic way.

As an election, the razor-close contest between Republican Texas Governor Bush and Democratic Vice President Al Gore was a mess.

It all came down to Florida. Palm Beach’s “butterfly” ballot, in which the name of the candidate was misaligned with the space voters pressed to mark their choices, confused many people. Other locales used punch-out ballots, which were difficult for some voters to punch out cleanly, leading to the “hanging chads” of paper that weary election officials were tasked with evaluating.

A five-week legal battle followed. Democratic lawyers pushed for recounts, while Republicans sued to block them. Finally, after legal twists and turns in the state courts, the U.S. Supreme Court ruled 5-4 to stop the process. The ruling effectively delivered the state, and the presidency, to Governor Bush by a margin of some 500 votes.

Bush v. Gore remains one of the most politically consequential Supreme Court decisions in American history.

“Bush v. Gore was a turning point, not only in marking elections as something to be trustful or mistrustful about, but also in marking the Supreme Court as something to be trustful or mistrustful about,” says Charles Stewart III, professor of political science and director of the Election Data and Science Lab at the Massachusetts Institute of Technology.

Wilfredo Lee/AP/File

Canvassing board member Judge Robert Rosenberg examines a challenged vote during recount efforts at the Broward County Emergency Operations Center in Plantation, Florida, Nov. 22, 2000.

On Jan. 6, 2001, then-Vice President Gore had the painful duty of presiding over his own loss in his role as president of the Senate.

As Congress voted state by state to certify the election, 20 members of the House, most of them members of the Congressional Black Caucus, rose one by one to file objections to Florida’s electoral votes.

No senators joined them – a requirement under federal law for their challenge to be considered. So Mr. Gore, as presiding officer, slammed down his gavel to rule them out of order.

“We did all we could,” Florida Democratic Rep. Alcee Hastings said to Mr. Gore as the protest fizzled.

“The chair thanks the gentlemen,” Mr. Gore replied with a smile.

Rising distrust on the right

By 2004, Democrats were watching closely for any signs that election integrity might be compromised and affecting outcomes. Two congressional Democrats filed an objection to certifying Ohio’s Electoral College votes, citing alleged irregularities in both vote counting and public access to voting stations.  

After President Bush’s reelection that year, Republicans had considerably more trust in the election system than Democrats did. Eighty-seven percent of self-described Republicans were very or somewhat confident that votes were counted accurately in the election, according to Gallup polling. Fifty-nine percent of Democrats felt the same way, as well as 69% of independents.

But by the eve of the midterm elections in 2022, GOP electoral trust had fallen to 40%, according to Gallup. Democratic trust had risen to 85%.

What happened?

Former President Barack Obama, for one thing. Mr. Obama’s 2008 victory and 2012 reelection led to a sharp slump in the Republican trust figure, and a gradual rise for the Democratic one. The factors at work, many analysts say, included latent racism surrounding the nation’s first Black president, intertwined with a “birther” movement falsely questioning his citizenship.

Then Donald Trump came onto the scene. Mr. Trump’s 2016 election did cause Republican trust in voting to increase. But then came his defeat in 2020 – and his dogged insistence that the vote had been rigged, despite a lack of evidence and repudiations by the courts – as well as a less-than-impressive showing for the party in the 2022 midterms. It all drove GOP approval of the U.S. election system to historic lows in Gallup’s polling series.

Generally, individuals will say they approve of their own voting experience, and think their ballot was accurately tallied, unless they deal with unexpectedly long lines or face some sort of equipment malfunction. Far more common is suspicion about what happens in other precincts or states.

In that context, what party leaders and authority figures say matters. Mr. Trump spoke darkly of fraud and cheating in elections even prior to his 2016 win. In 2020, he claimed on Election Day that he had actually won. His followers stormed the U.S. Capitol on Jan. 6, seeking to stop the Electoral College counting. Since then, his false insistence that the election was rigged has become an article of faith among not just his most ardent supporters but Republicans in general – and something that other GOP leaders question at their peril.

Trust in elections has long been an elastic issue – one that U.S. political parties change their minds about, and flip positions on. But it is now possible that it has been polarized, like abortion or immigration, with fixed views on the GOP side, at least.

“I think there is going to be this persistent, organized distrust of a lot of elements of the election system among Republicans,” says Professor Stewart. “It could [also] be among Democrats under the right circumstances, but right now it is among Republicans.”

This dynamic has driven calls for hand-counting of ballots, withdrawals from a multistate partnership that checks registrations to clean up voter rolls, and anger toward local election officials, says Professor Stewart.

“It could also potentially lead to violence,” he says.

As the 2024 campaign gears up, Mr. Trump has only intensified his dark rhetoric about the American electoral system. He routinely promises to pardon those convicted of crimes on Jan. 6, though hundreds were charged with assaulting police. These “hostages” are “unbelievable patriots,” he often says.

He continues to demean mail-in voting despite lack of evidence, telling Laura Ingraham earlier this year that “you’re going to automatically have fraud” if it is allowed.

Job applicants at the Republican National Committee are now reportedly asked whether they agree the last presidential election was stolen. At rallies, Mr. Trump continues to insist he was robbed, though he wasn’t.

“Radical left Democrats rigged the presidential election of 2020, and we’re not going to allow them to rig the presidential election of 2024!” Mr. Trump said in Portsmouth, New Hampshire, earlier this year.

He portrays the coming election not as a civic choice that is part of a centurieslong tradition of parties losing and winning but as an apocalyptic event.

President Biden’s administration seeks “to collapse the American system, nullify the will of the actual American voters, and establish a new base of power that gives them control for generations,” Mr. Trump told a North Carolina audience in March.

The task of rebuilding trust

GOP election denialism is not all-encompassing. Republican officials such as Georgia Secretary of State Brad Raffensperger were key defenders of the system’s integrity in 2020, after all. 

In the aftermath of the 2022 midterm elections, there were not widespread complaints about alleged fraud, despite the fact that an anticipated “red wave” of GOP gains didn’t happen. Defeated Arizona GOP gubernatorial candidate Kari Lake did pursue fraud charges in court, without success, but she may have been the exception that proved the rule. Like Mr. Trump, she had made warnings of a possibly stolen result a core part of her political identity prior to the election.

Recent polls have also shown some bounce-back from the lows of GOP electoral trust following 2020, even in many hotly contested swing states.

About one-quarter of Republicans say they believe President Biden fairly won election in 2020, according to a survey taken late last year by the Johns Hopkins SNF Agora Institute and Gallup. Another 12% say they are unsure about the outcome.

This group is a moveable section of the GOP electorate that is open to messages that U.S. elections are secure and the system is not rife with fraud, says Scott Warren, a fellow at the Agora Institute, via email.

Still, rebuilding trust in U.S. elections will require a bipartisan effort, according to Mr. Warren. Too many democracy reform initiatives don’t involve conservatives in any substantive way.

Increased public outreach and more transparency on the part of election officials about how the system works are important first steps, according to a set of conservative principles for building electoral trust produced by the Agora and the R Street institutes last year.

“It definitely won’t solve everything, but is a needed step,” says Mr. Warren via email. “The more work that can be done in this sector, the better.”

Butch Dill/AP/File

Alabama Secretary of State Wes Allen, a Republican, says that President Joe Biden could be left off his state's ballot because Alabama’s certification deadline is before the Democratic Party’s August convention. Mr. Allen is pictured during his inauguration at the Alabama State Capitol in Montgomery, Jan. 16, 2023.

The Republican secretaries of state in Ohio and Alabama sent letters to local Democratic party chairs this past week with a warning: President Joe Biden, as the law stands now, won’t appear on their states’ ballots in November.

Both secretaries say the president’s nomination at the Democratic National Convention in Chicago between Aug. 19 and 22 won’t meet their states’ ballot access deadlines, which require candidates’ party certification 82 to 90 days before Election Day.

The Biden campaign has seemed relatively unfazed by the news, assuring reporters that the president will appear on the ballot in all 50 states. Its confidence may be based on recent history. Just four years ago, the Ohio legislature approved changing its deadline to 60 days before the election to accommodate Mr. Biden as well as Donald Trump, when both the Republican and Democratic conventions were held in late August. Similarly, a one-time exception for Mr. Trump passed the Alabama Legislature unanimously in 2020 (with a vote from current Secretary of State Wes Allen, who was in the Alabama House at the time). 

But this year could prove to be more of a struggle. 

Ohio’s and Alabama’s declarations have been seen by some as a partisan reaction to the effort supported by Colorado’s Democratic secretary of state to keep Mr. Trump off her state’s ballot because of his role at the Capitol on Jan. 6, 2021 – a decision that was unanimously overruled by the U.S. Supreme Court. In response, Republican lawmakers in Colorado attempted to impeach Secretary Jena Griswold for “abuse of the public trust,” but their effort failed in committee on Tuesday.

The secretary of state role has become increasingly fraught since the 2020 election, when the Trump campaign made many previously under-the-radar election officials the focus of election integrity accusations, causing some to face death threats. Now it may be harder than ever for these statewide election officials, who play a referee-type role that calls for impartiality, to be seen as operating in a nonpartisan manner.

“[Secretaries of state] are elected to oversee elections, but they are a partisan member of one party, so these types of tensions shouldn’t be surprising,” says Daniel Schnur, who teaches political communication at the University of California, Berkeley and the University of Southern California and who lost a campaign to be California’s secretary of state in 2014. “It’s never been easy for someone in a job like this one to balance those obligations, but there’s no question that it’s becoming even harder.”

Pete Cosgrove/AP/File

Katherine Harris, then-secretary of state for Florida, speaks with reporters during a news conference at the Capitol in Tallahassee, Nov. 15, 2000. Ms. Harris was criticized for several decisions in the state’s recount that called Florida – and the presidency – for George W. Bush. She had campaigned for Mr. Bush.

Ideals of impartiality under pressure

The encroachment of partisanship on secretaries of states’ duties, or accusations of it, is not a new phenomenon. In the 2000 election Katherine Harris, then-secretary of state for Florida, who had campaigned for George W. Bush, was criticized for several decisions in the state’s recount that called Florida – and the presidency – for Mr. Bush.

Dan Tokaji, dean of the University of Wisconsin Law School and an expert on election law, also cites the 2004 election in Ohio. Then-Secretary of State Ken Blackwell, a Republican and co-chair for President Bush’s reelection campaign in the state, took steps to restrict voting access in Ohio (including rejecting any voter registration form that wasn’t printed on thick card stock). Mr. Bush won the state by 2 percentage points. 

“There is a conflict of interest built into this job,” says Mr. Tokaji. “But the pressures have definitely become more intense over the past four years.”

Brynn Anderson/AP/File

Georgia Secretary of State Brad Raffensperger, a Republican, drew fiery insults from former President Donald Trump and threats from his supporters for pushing back against false claims of voter fraud in the 2020 election. Mr. Raffensperger speaks during a news conference in Atlanta Nov. 11, 2020.

When Mr. Trump asked Georgia’s GOP Secretary of State Brad Raffensperger to “find” votes to overturn Mr. Biden’s win in a now-infamous phone call in 2021, that call “brought things up to a different level than what we had seen previously,” says Mr. Tokaji. Since then, many election officials have left their jobs out of frustration. Elections to fill those roles have taken center stage. According to a report from the Brennan Center, six secretary of state candidates in battleground states raised over $26 million in 2022, more than double the amount raised in 2018. 

Will ballot access end up in court?

The intensified polarization of the position is evident in this week’s ballot access statements, says Richard Winger, founder of Ballot Access News. A few states have had to temporarily change ballot access deadlines to accommodate major-party presidential candidates in almost all recent elections, says Mr. Winger, “and they always do.” In 2020 alone, five states, including Ohio and Alabama, temporarily changed their deadlines. 

“All previous times, before the secretary of state put out a press release, he or she would have also said, ‘I’m working with the legislature to fix this,’” he adds. “This year is different.”

But like the Biden campaign, Mr. Winger isn’t worried about this year making history as the first time a major party’s presidential candidate is kept off a state ballot.

If Democrats are unable to fix their Ohio and Alabama challenge through traditional means, they could choose to sue, and Mr. Winger has “no doubt” that the deadlines would fall in court. Federal courts, including the Supreme Court, have already overturned ballot deadlines several times, even for minor-party candidates.

Manuel Balce Ceneta/AP

Colorado Secretary of State Jena Griswold faced an impeachment attempt by state Republican lawmakers for her support of an effort that tried to keep Donald Trump off the state ballot because of his role in the Capitol riot on Jan. 6, 2021.

State officials so far aren’t showing signs of compromise.

“I am left to conclude that the Democratic National Committee must either move up its nominating convention or the Ohio General Assembly must act by May 9, 2024 (90 days prior to a new law’s effective date) to create an exception to this statutory requirement,” wrote Paul DiSantis, chief legal counsel for Ohio Secretary of State Frank LaRose, in a letter last week to Ohio Democratic Party Chair Liz Walters.

On Monday, Alabama’s Secretary Allen sent a similar letter to state Democratic Party Chair Randy Kelley that was copied to Democratic National Committee Chair Jaime Harrison. 

“If this Office has not received a valid certificate of nomination from the Democratic Party following its convention by the statutory deadline, I will be unable to certify the names of the Democratic Party’s candidates for President and Vice President for ballot preparation for the 2024 general election,” Mr. Allen wrote.

Takehiko Kambayashi

Orzugul, a naturalized Japanese citizen originally from Uzbekistan, greets the crowd at a recent ethnic food festival held in Kawaguchi, near Tokyo, Japan. She has served as a city councilor in Tokyo’s Setagaya Ward for less than a year.

A former swimming instructor from Egypt is helping revive the sleepy mountain town of Shonai, Japan. About 200 miles away, a Canadian polyglot is singing the praises of Tsukuba city. And Orzugul Babakhodjaeva is standing onstage at a food festival outside Tokyo, decked in a traditional Uzbek dress, expressing her desire to “create a society where diversity is accepted.”

The first-term city councilor in Tokyo’s Setagaya Ward – who does not use her family name, and campaigned simply as “Orzugul” – is one of a small but growing number of foreign-born local government members bringing fresh perspectives to an island nation long known for its homogeneity. These lawmakers are often multilingual and have rich international work experience. Their platforms have resonated with many Japanese voters, as well as with a growing population of non-Japanese residents.

The number of non-Japanese residents jumped 10.9% from 2022 to 2023, reaching a record 3.4 million, as the country struggles to address a chronic labor shortage driven by its aging population. Last year, 8,800 residents were naturalized as citizens, allowing them to vote in elections.

Arudou Debito, author of the book “Embedded Racism: Japan’s Visible Minorities and Racial Discrimination,” says the election of immigrants to local government is “very important” for Japan’s democracy.

“Non-Japanese residents’ viewpoints are woefully unseen in Japanese society. They’re treated as ‘guests,’” explains Mr. Arudou, who is a U.S.-born naturalized citizen. “The fact that former non-Japanese residents are getting elected means they aren’t ‘guests,’ meaning Japanese society can trust immigrants with public policymaking power.”

Outsiders’ lens

About 30 miles northeast of Tokyo, first-term Ibaraki Prefectural Assembly member Heese Jon cuts a dapper figure as he drives a reporter around the city of Tsukuba, boasting about its 360 parks and its culinary delights. The city also hosts the University of Tsukuba, the headquarters of the Japan Aerospace Exploration Agency, and other leading institutes.

Takehiko Kambayashi

Canadian-born Heese Jon, a first-term Ibaraki Prefectural Assembly member representing Tsukuba, Japan, prioritizes environmental issues and women’s rights.

“We are sitting at the heart of Japanese research,” says the native Canadian from the driver’s seat of his electric vehicle.

About 12,700 non-Japanese residents from 144 countries live in Tsukuba, making up 5% of its population, nearly twice the national rate of 2.8%.

Before his victory in the 2022 assembly election, Mr. Heese had already served four terms as a Tsukuba city councilor and won the most votes for three straight elections. He credits his popularity to his passion for women’s issues and the environment, as well as to his fresh face. 

“The incestuousness of the political scene is really stunning,” he says. Especially in smaller cities, politicians “are almost all related to each other.” On billboards displaying local candidates, he stands out. 

“One thing they can say is, ‘This is not someone who can be bribed,’” he says.

Tsukuba resident Sciortino Atsuko, who is married to an immigrant, believes that local government needs to reflect the city’s diversity. She says Mr. Heese, being married to a Japanese woman and raising kids in Tsukuba, understands the experience of being in an interracial family. 

“Jon has long supported a non-Japanese community here, and played a role as a bridge with the government,” she says. “When non-Japanese speakers were in trouble at shops or gyms, Jon was the one who helped them out. ... Jon has brought the needs of the minority to the table.” 

Mr. Heese, who speaks five languages, says his long-term goal is to “bring politicians from all over Japan to foreign countries and be their guide. They do not look beyond their communities very far.” 

Bolivian-born Inoue Noemi, a fourth-term member of Tokyo’s Sumida City Council, agrees that Japan can be an inward-looking country. “We need to go global,” she says.

Ms. Inoue worked at Bolivia’s central bank and the United Nations Development Program before moving to Japan in the late 1990s with her husband, a former member of parliament. 

Takehiko Kambayashi

Inoue Noemi, a fourth-term member of Tokyo’s Sumida City Council, is from Bolivia. When she first came to Japan in the 1990s, women’s low social status was “the most shocking issue,” she recalls.

Before her first stint in local government in 2011, Ms. Inoue founded the Japan-Latin America Friendship Association in Tokyo to develop cultural, social, and business relations overseas. She also taught Spanish and still sees language barriers as a big problem. 

Non-Japanese residents often have trouble communicating with police and hospital staff, she says. When facing problems from bullying to domestic abuse, few know what to do or where to go. Such information is not readily available in their languages.

Universal problems

Back in 2021, Sultan Nour was seriously considering leaving the northern town of Shonai, where he’d moved five years prior to be closer to nature. Like many rural areas in Japan, Shonai had struggled with severe depopulation, and no longer had any pediatricians. Mr. Sultan, who was born in Syria and grew up in Egypt, had two small children to care for.

But then he stumbled upon news of an upcoming by-election for the Shonai Town Assembly, and decided to go for it. He won that race and the next one, securing reelection with the highest vote count of all the candidates.

“I have long wanted to contribute to society,” says Mr. Sultan, who had taught English, managed an Arabic restaurant, and worked for a construction company in Japan before running for local office. He also works as an Arabic interpreter for authorities. 

Change came in December 2023: Thanks in large part to continued pressure from Mr. Sultan and other parents, Shonai’s main hospital now has a pediatrician four days a week. 

It’s not the end of Mr. Sultan’s mission in Shonai. 

Japan’s population is aging rapidly, and like other policymakers who face the daunting task of reinvigorating Japan’s rural towns, Mr. Sultan emphasizes the need to “put more efforts into child care support, measures for the falling birthrate, and job creation.”

Ms. Inoue sees immigrants as a key part of the solution – but they need support. “Japan needs to have good immigration law to support foreigners to find a job and live a decent life,” Ms. Inoue says. “Now foreigners come, but nobody wants to rent a house to them.” 

Her comments echo the experience of Orzugul, who was rejected by 53 companies when she first arrived in Japan, mainly because she did not graduate from a Japanese university. Later, she found it almost impossible to rent an apartment or business space in Tokyo without her Japanese husband present.

Despite the discrimination she faced, “I love Japan deeply,” says Orzugul. “That’s why I cannot look the other way. I would like to help open up doors to those who seek opportunity in this country.”

Marquisa Gaines-Nickelson’s labor was accompanied by an unexpected soundtrack: the voices of R&B titans like Mary J. Blige, Al Green, and Anita Baker. Her husband and “labor DJ” Mazi Nickelson diligently curated the music that reverberated through the delivery room in Cambridge, Massachusetts. The playlist was part of a birth plan that they prepared with the help of their doula, Melody Cunningham.

For the first-time parents, those details mattered a great deal, and Ms. Cunningham was essential to making them a reality. The pair wanted their daughter, Sanaa, to get a taste of their personalities even as she drew her first breath. “Some of the smallest details can turn out to be big ones,” Mr. Nickelson says. “Having Melody there to help us navigate that space … we appreciated that a lot.” 

Empowering expectant parents to ask for what they want is just one, albeit important, piece of what Ms. Cunningham does as a birthing doula, an advocate trained to provide guidance and support to pregnant people and their families. The care doulas offer isn’t like that given by an OB-GYN or midwife. Instead, they provide nonmedical help: counsel on what to expect; advocacy during delivery and doctor’s appointments; and a place to express emotions ranging from excitement, to, for many Black families, fear.

That fear comes with a history. The United States has the worst maternal outcomes in the developed world, driven in part by stark racial inequities. According to the Centers for Disease Control and Prevention, Black women died of pregnancy complications at rates 2.6 times higher than their white peers in 2021, the most recent year for which data is available. 

As Black expectant mothers try to navigate a medical system in which they have little confidence, Black doulas have become trusted members of their pregnancy teams. 

Black Americans across the board eye American health care warily. In a 2020 poll by the Kaiser Family Foundation and The Undefeated, only 56% of Black respondents said they trusted their local hospitals, compared with 70% of white ones. 

Melanie Stetson Freeman/Staff

Stephanie Crawford with her son, Amani, in their home in Boston, April 9, 2024. Stephanie is a birthing doula who offers guidance to Black women navigating pregnancy. She is also a kindergarten teacher and is working toward a Ph.D. in early childhood education.

That mistrust is earned, says Dr. Allison Bryant, an OB-GYN and associate chief health equity officer at Massachusetts General Brigham. She points to a long history of medical mistreatment still felt by Black people and other groups. Indeed, doctors forcibly sterilized Black, Latina, and Indigenous women well into the 1970s. 

“We in the medical system have not done a great job of earning that trust back,” Dr. Bryant says. “So people come into the delivery rooms with that sort of context.”

Research shows that doulas can significantly reduce negative outcomes and lower anxiety among expectant mothers.

Doula work is steeped in a deep sense of community and a history that stretches back hundreds of years. Dr. Bryant points to “granny midwives” – highly skilled Black women who, for centuries during slavery and following emancipation, provided obstetric care for women living in the rural South. Though they laid the foundation for modern doula work and midwifery, they were pushed out as obstetrics became institutionalized in hospitals.  

To Stephanie Crawford, a Boston-based doula, part of that model’s success came from the women’s deep connections to the people for whom they cared. The midwives were familiar members of their communities – mothers, sisters, friends, and cousins. Ms. Crawford says that sense of collaboration is an essential building block for the deep, trusting relationships she relies on to care for her clients. 

During the initial meeting, the first thing she does is listen. It’s not her job to tell mothers and their families how a pregnancy should go, she says. Her job is to work with them, to guide them, and to make them feel informed enough that they can make decisions about their own care.

Melanie Stetson Freeman/Staff

Doula Stephanie Crawford holds items she uses to teach pregnant women what to expect during a birth, April 9, 2024.

Ms. Crawford understands the importance of feeling ownership over a pregnancy. She’s been in her clients’ shoes. She’s Black. She’s given birth twice. She knows that hospitals and doctor’s offices can feel intimidating, that it can sometimes feel as if decisions are not yours to make. More than that, she understands how heartbreaking a pregnancy can be. Her first one, in 2011, ended in a stillbirth.

In some ways, her second pregnancy was remarkably similar to her first. It was another boy, and his birthday ended up being a mere three days from her first son’s. But having a doula made all the difference – so much so that she became one herself.

“I would do the birth 10 times again,” she says. Her son turned 5 in February. “My goal as a doula is just creating that same kind of experience for others, so that people can be more informed, intentional, and just own their journey a little bit more.”

Ms. Crawford says it comes down to the details. Mothers and their families don’t always know what they can ask for in the delivery room. But those small things – like not wearing a hospital gown or playing a favorite song during labor – can make people feel empowered. “That means something to people,” Ms. Crawford says. “Being able to have things that feel good to you.”

Joanne Dorgilus, another Boston-based doula, wants clients to feel as if they’re talking to a family member or a close friend. “I’m one of your girlfriends,” she says, chuckling while she talks about her work. Letting her clients see her naturally cheerful, “jokey-joke” personality is her way of easing anxiety and creating camaraderie.

Beyond that intentionally cultivated closeness, having a knowledgeable Black advocate in the room can be comforting. Research has shown that people are more satisfied with care from doctors who share their race. 

“Cultural competency cannot be bought,” says Ms. Cunningham. “It cannot be taught. It’s just something that is there. And it makes for a more comfortable experience, which makes for … the increased likelihood of a healthy and happy birth.” 

Sanaa, Mrs. Gaines-Nickelson and Mr. Nickelson’s daughter, will be 2 in July. The couple is hoping to have a second child soon, perhaps without the help of a doula this time. “I feel more confident in knowing what I know a little bit now,” Mrs. Gaines-Nickelson says. “I think I can guide myself.” 

Ms. Cunningham and other doulas interviewed emphasize that they value the expertise of physicians. The issues are more systemic than any one doctor. And even when clinicians are treating their patients equitably, they can sometimes struggle to break through entrenched power dynamics that make it difficult for Black women to speak up. 

Even though they don’t “catch the baby,” Ms. Dorgilus says, doulas are “putting their feet down and making the changes that we need to do to help women around the world.”

Black women “feel like they hadn’t been heard, and their voices haven’t been included in some of the decision-making process,” Dr. Bryant says. “In some instances that I’ve seen with my own eyes, the doula can sort of understand where the patient is coming from, and sometimes be able to be an advocate and a voice for that individual.”

Dashanna Hanlon, a doula based in the Greater Boston area, hopes that she can leave a legacy that leads to more joyful births, like Sanaa’s. “We talk so often about the awfulness of, you know, Black maternal health,” she says. “But there is so much joy in those rooms.”

Bringing cheer and color to chilly, gray skies, more than 1 million migratory birds flocked this past winter to the Kashmir Valley. Their primary destination: Hokersar, the region’s second-largest wetland reserve, which spans 8 square miles on the outskirts of Srinagar.

Over the years, more than 90 species of birds have made the trek to breed and feed at this crucial wintering ground, which is surrounded by freshwater marshes. The birds have taken flight from as far away as Siberia, China, and Eastern Europe. They include mallards, common teals, bitterns, graylag geese, pintails, shovelers, tufted ducks, and cormorants.

Nascent bird-watching clubs and bird-enthusiast tourists took note of the feathered friends, some of which are rare to Hokersar. In 2022, birder Reyan Sofi spotted and photographed a female common goldeneye. It was the first definitive record of the medium-sized duck landing in Kashmir since the turn of the 20th century.

Wetland officials were buoyed by the birds’ lofty numbers amid a long dry spell in the region. “Last year we recorded over 1.3 million birds arriving in Kashmir,” warden Ifshan Dewan says. This winter’s parched conditions were a concern, he adds, but didn't much affect the winged turnout. 

Umer Asif

Employees of Kashmir’s wildlife department tour the Hokersar wetland reserve by boat to feed birds and stop potential poachers.

Umer Asif

The common teal is one of more than 90 species of birds that have come to breed and feed in Kashmir over the years.

Umer Asif

Reyan Sofi is in a bird-watching group. In 2022, he photographed a female common goldeneye, which hadn’t been sighted in Kashmir since 1907.

Umer Asif

Shoveler and pintail ducks frolic in the Hokersar wetland. More than 1 million birds have flocked this winter to Kashmir.

AP

Iranian women wait to watch a soccer match between Iran and Saudi Arabia in Tehran, Iran, Oct. 3, 2023.

Since Oct. 7, the day that Hamas attacked Israel and triggered a war in Gaza, the world has worried that the conflict might spread and become even more violent. Other proxy militias of Iran, such as the Houthis in Yemen, have launched their own attacks. Months of rocket attacks on Israel by Hezbollah in Lebanon led to an Israeli missile strike last week on Iran’s Embassy in Syria, killing a top Iranian commander supporting Hezbollah. That strike in particular raised concerns because Iran has since vowed to retaliate with a direct hit on Israel.

This heightened tension has prompted a rare unity of calls for restraint from the United States, Russia, Europe, and China. Iran may yet make good on its threat, but there are signs that the sort of tit-for-tat logic that has long ensnared the Middle East may be losing its force.

Voices in Iran, for example, are calling for cool heads to prevail. One is Heshmatollah Falahatpisheh, former head of the Iranian parliament’s foreign policy committee. He cautioned, “We should not see the issues emotionally” and must keep “the balance between diplomacy and the battlefield.” Iran cannot risk “a conflict that serves none of its national interests,” he added.

His advice for temperance over vengeance may reflect deeper shifts in the Middle East. Three trends mark that shift.

One is a widespread desire, mainly among young people, for equality and rule of law from their autocratic regimes. Protest movements in both Iran and many Arab states since the 2011 Arab Spring have forced rulers to think twice about igniting a conflict. In Iran itself, 80% of people reject rule by Islamic clerics, according to a Gamaan poll last year. That percentage probably keeps rising as authorities further crack down on women who don’t cover their head.

The second shift is a yearning for peace that is not merely the absence of violence. Before the war in Gaza, the region was alive with deals and dealmaking to expand trade and investment. Saudi Arabia, especially, was eager to appease its restless youth by building non-oil industries and perhaps recognize Israel.

A third shift is an increase in peacemakers. Qatar, a key regional ally of Iran, has sought to build a bridge of peace between Israel and Hamas. Last month, Oman hosted the first direct contact between Iranian and U.S. officials seeking cooperation to end attacks by Yemeni rebels against cargo ships in the Red Sea. Iraq has helped in reconciling Iran and Saudi Arabia.

“We never think about going to war because we know the results,” Iraqi Foreign Minister Fuad Hussein told the Wilson Center last year. His government’s focus, he said, is: “First, laws. Second, implementing laws. And third, changing the culture” of governance.

If Iran does not retaliate against Israel’s attack on its embassy, it may be for internal reasons. The regime has serious social, political, and economic troubles, says Iranian journalist Saeid Jafari in an essay for the Atlantic Council this week. Its military response, in other words, may be more muted than its rhetoric.

The Middle East keeps changing from the violence of major wars that took place more than a half-century ago. It is more interlocked by public demands for better governance, shifts within Islam, trade, the internet, and the rise of norms such as one pushed by Oman – the “ideology of politeness.”  Peace isn’t just a noun for “no violence.” It is a verb defining ideals in action.