a Better Bubble™
Intimate, infuriating and ultimately hopeful, “Before a Breath” braids together the stories of three mothers determined to make pregnancy safer after losing children to stillbirth.
After the loss of her daughter Autumn, Debbie Haine Vijayvergiya discovers that more than 20,000 stillbirths occur every year in the U.S. — and at least 1 in 4 is likely preventable. She goes to Washington, battling political inertia as she fights to make stillbirth research and prevention a federal priority. Kanika Harris, a maternal health advocate and doula, tells the story of her twins, Kodjo and Zindzi, as she trains a new generation of Black birth workers. And Stephanie Lee, a nurse leader at a Manhattan hospital, seeks answers about what might have led to her daughter Elodie’s stillbirth as she takes a leap of faith and becomes pregnant again.
Inspired by ProPublica’s groundbreaking reporting on the stillbirth crisis, which was a finalist for a 2023 Pulitzer Prize, the film is a powerful story of grief, healing and three mothers demanding that the U.S. do better by expecting parents.
Watch “Before a Breath” on YouTube
FEATURING Debbie Haine Vijayvergiya is a stillbirth parent advocate and the mother behind the SHINE for Autumn Act, named in honor of her daughter, Autumn, who was stillborn in 2011. Kanika Harris is a birth justice advocate and doula. She holds a doctorate in health behavior and health education and is the executive director of the National Association to Advance Black Birth. Stephanie Lee is an associate director of nursing in critical care at a New York City hospital. She was also a patient at the Rainbow Clinic at Mount Sinai. JOIN THE CONVERSATION“Before a Breath” is free to stream on YouTube. If you’d like to host a screening or conversation in your community, please sign up here and use these guides to help you get started.
Download the guide for a community screening
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WATCH MOREYou can find our trailer, sneak peek scenes and additional videos on the “Before a Breath” playlist on YouTube.
LEARN MORERead ProPublica’s reporting and participate in our stillbirth memorial.
Get more information about stillbirths and care for parents of loss.
ProPublica is a nonprofit newsroom that investigates abuses of power. This story was originally published in our Dispatches newsletter; sign up to receive notes from our journalists.
In late October, ProPublica published one of its most prophetic stories in our history. You can be forgiven if you missed it at the time. There was a lot going on in the days before the election, and the headlines were dominated by seemingly consequential issues like the racist humor of a comedian who addressed Donald Trump’s rally at Madison Square Garden.
But if you weren’t among the several hundred thousand people who read our story, “‘Put Them in Trauma’: Inside a Key MAGA Leader’s Plans for a New Trump Agenda,” in real time, you may have seen it referenced since Trump took office in January.
The story drew on private recordings of a series of speeches given in 2023 and 2024 by Russell Vought obtained by our colleagues at Documented, a news site with a remarkable knack for uncovering information powerful interests would prefer remained secret.
Vought, a self-described Christian nationalist who served as the director of the Office of Management and Budget in Trump’s first term, was known for his provocative public pronouncements. But he went even further in private, envisaging a Trump presidency in which regulatory agencies would be shut down and career civil servants would be too depressed to get out of bed.
“We want the bureaucrats to be traumatically affected,” Vought said in one recording. “When they wake up in the morning, we want them to not want to go to work because they are increasingly viewed as the villains. We want their funding to be shut down so that the EPA can't do all of the rules against our energy industry because they have no bandwidth financially to do so.
“We want to put them in trauma.”
Vought spoke openly about the ongoing planning to defund independent federal agencies and demonize government scientists. “We have detailed agency plans,” he said. “We are writing the actual executive orders. We are writing the actual regulations now, and we are sorting out the legal authorities for all of what President Trump is running on.”
Vought argued that the radical steps were necessary because Trump’s opponents were themselves attempting to end democracy. “The stark reality in America is that we are in the late stages of a complete Marxist takeover of the country,” he said in one speech. “Our adversaries already hold the weapons of the government apparatus, and they have aimed it at us. And they are going to continue to aim it until they no longer have to win elections.”
It’s hard to imagine a more prescient piece of journalism. The story captured, as few did, the breadth and ferocity of the coming attack on the federal government. Vought has returned to his post as the budget office’s director, and his plans for eviscerating entire agencies and decimating the morale of federal workers have turned into reality. Trump 47 looks very different from Trump 45, just as Vought told his audiences that it would.
So why didn’t this story drive more of a national conversation when it appeared?
As a news organization that tries to spur change by bringing new facts to light, we think about this question a lot. Our job at ProPublica is to both get the story and get it into the heads of a critical mass of citizens and elected officials.
I’ve been an investigative reporter and editor for nearly three decades, and I still struggle to predict which of our stories will catalyze national conversations. Our 2018 story about the recording of a young girl in a immigration detention center prompted the Trump administration to end its policy of family separation at the border. Many other powerful stories fail to break through.
Part of the problem, of course, is the proliferation of media. Every day, dozens of important-sounding stories vie for readers’ attention along with the flood of posts on social media and texts from friends and colleagues. And that’s not to mention all the podcasts and multipart dramas on Netflix and HBO.
This was an issue long before Trump and his allies adopted a “flood the zone” strategy with multiple norm-challenging actions, but it seems even more acute right now.
It is often said of journalists that we write the rough draft of history. But our work differs from historians in a crucial aspect: Scholars typically are chronicling events after the outcome is clear. As journalists, we face a tougher challenge as we try to find the stories in the cacophony of daily events that tell us something about where we’re going.
A lot of what we do as reporters is akin to squinting through opaque windows at events unfolding in a very dimly lit room. We can see who is inside and how they’re moving, but our lack of context often prevents us from understanding what’s really happening. We default to assuming that the future will be roughly like the past, guessing that, say, Trump 47 will be roughly like Trump 45 with fewer guardrails.
Vought could not have been clearer that this was not the case, and he had the credentials that should have made what he was saying entirely credible. After all, Vought was the author of the plan in Trump’s first term to make it easier to fire large numbers of civil servants. He was a key member of Project 2025, the Heritage Foundation project that described in copious detail how a second Trump administration might unfold.
Still, there was at least one data point that perhaps prevented readers from viewing his speeches as predictive as they turned out to be. As our story made clear, Vought despises the Federalist Society for Law and Public Policy Studies, a core Republican ally in bringing conservative voices into the judiciary and federal law enforcement. We quoted him as asserting that “the vaunted so-called Federalist Society and originalist judges” were serving as a “Praetorian Guard” for the Democrats.
That view would seem to make him something of a fringe thinker in MAGA world, which relied on the Federalist Society to pick the judges who make up the conservative supermajority on the high court.
Things look different today. Seen against the backdrop of recent events, Vought’s disdain for the rule-of-law scruples of Federalist Society legal thinkers seems entirely in line with Trump’s recent post suggesting a federal judge shouldn’t have authority over his administration.
Just a few weeks ago, Danielle Sassoon, one of the Federalist Society’s bright lights, a Yale Law graduate who had clerked for conservative icon Antonin Scalia, resigned as acting U.S. attorney in the Southern District of New York rather than carry out orders from the Trump Justice Department. In refusing to drop the corruption case against New York Mayor Eric Adams, Sassoon wrote that she understood her duty as a prosecutor to mean “enforcing the law impartially, and that includes prosecuting a validly returned indictment regardless of whether its dismissal would be politically advantageous, to the defendant or those that appointed me.”
Many years ago, a New York Times investigative reporter and I were discussing a story we had worked on that had been sharply and justifiably criticized as new facts emerged. “I can be fair and accurate,” he said. “But fair, accurate and prescient is beyond me.”
It seems appropriate to give Vought the last word since the worldview he described has proven so accurate. What sounded grandiose in the preelection days seems today like a reasonable summary of the path Trump and his allies have chosen.
“We are here in the year of 2024, a year that very well [could] — and I believe it will — rival 1776 and 1860 for the complexity and the uncertainty of the forces arrayed against us,” Vought said, citing the years when the colonies declared independence from Britain and the first state seceded over President Abraham Lincoln’s election.
“God put us here for such a time as this.”
I’m not sure about the role of the almighty in ProPublica’s work in the coming years. But we feel equally strongly that we’re here for a “time such as this.”
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The Food and Drug Administration has found problems at an Indian factory that makes generic drugs for American patients, including one medication that was manufactured there and has been linked to at least eight deaths, federal records show.
The agency inspected the factory after a ProPublica investigation in December found that the plant, operated by Glenmark Pharmaceuticals, was responsible for an outsized share of recalls for pills that didn’t dissolve properly and could harm people. Among the string of recalls, the FDA had determined last year that more than 50 million potassium chloride extended-release capsules had the potential to kill U.S. patients.
Still, ProPublica found, the FDA had not sent inspectors to the factory in Madhya Pradesh, India, since before the COVID-19 pandemic.
When FDA inspectors went to the Glenmark plant last month — five years after the agency’s prior inspection — they discovered problems with cleaning and testing that they said could affect medicines that were shipped to American consumers.
In a report detailing their findings, the inspectors wrote that Glenmark failed to resolve why some medicines weren’t dissolving properly, and they raised concerns about the factory’s manufacturing processes.
“Equipment and utensils are not cleaned at appropriate intervals to prevent contamination that would alter the safety, identity, strength, quality or purity of the drug product,” the inspectors wrote.
The FDA redacted large swaths of the inspection report, making it impossible to tell whether inspectors uncovered the reason for the pills not dissolving correctly or which Glenmark drugs sitting in American medicine cabinets were potentially at risk of contamination.
ProPublica obtained the report through the Freedom of Information Act. To justify censoring the document, an FDA attorney cited trade secrets “and/or commercial or financial information that was obtained from a person outside the government and that is privileged or confidential.”
Health and Human Services Secretary Robert F. Kennedy Jr., who was sworn in the day before this inspection wrapped up, has vowed to bring “radical transparency” to his agency, which oversees the FDA. ProPublica asked the HHS media team whether Kennedy thinks the heavily redacted inspection record is in line with his transparency promise and whether he believes the names of drugs that inspectors raised safety concerns about are trade secrets. The media team did not respond.
An FDA spokesperson would not say why the agency waited so long to inspect this factory or what, if anything, federal regulators will require Glenmark do to fix the problems. “The FDA generally cannot discuss potential or ongoing compliance matters except with the company involved,” she wrote.
The FDA’s review of the Glenmark plant, she noted, “was a for-cause inspection, which can be triggered when the agency has reason to believe that a facility has quality problems, to follow up on complaints or other reasons.”
Drugs that fail to dissolve properly can cause perilous swings in dosing. Since Glenmark’s potassium chloride recall in May, the company has told federal regulators it received reports of eight deaths in the U.S. of people who took the recalled capsules, FDA records show. Companies are required to file reports of adverse events they receive from patients or their doctors so the agency can monitor drug safety. The FDA shares few details, though; as a result, ProPublica was unable to independently verify what happened in each of these cases. In general, the FDA says these reports reflect the opinions of the people who reported the harm and don’t prove that it was caused by the drug.
The family of a 91-year-old Maine woman sued Glenmark in federal court in Newark, New Jersey, last year, alleging the company’s recalled potassium chloride was responsible for her death in June. In court filings, the company has denied responsibility.
A spokesperson for Glenmark, which is based in Mumbai, declined to answer detailed questions about the inspection, citing the ongoing litigation. “Glenmark remains committed to working diligently with the FDA to ensure compliance with manufacturing operations and quality systems,” the spokesperson wrote.
Glenmark’s managing director told investors and analysts on an earnings call last month that 25% to 30% of its U.S. revenue comes from drugs made at its Madhya Pradesh factory.
Inspectors visited the factory between Feb. 3 and Feb. 14. Like all such reports, this one notes that the inspectors’ observations “do not represent a final Agency determination” about the company’s compliance with the FDA’s drug manufacturing rules.
Glenmark lacked proper cleaning procedures that prevent residues of one medicine from winding up in batches of the next pills produced with the same machinery, the inspectors found. While Glenmark rejected three batches when tests found cross-contamination, the inspectors said that the same equipment was used to make other drugs that were shipped to the U.S. Their report went on to list the “impacted batches,” but it is unclear what those drugs are because the next three pages are censored.
The FDA heavily redacted the first four pages of a report on its visit to a plant operated by Glenmark Pharmaceuticals. (Obtained by ProPublica)ProPublica asked the FDA if the agency was testing any of these medicines for contamination. The spokesperson wouldn’t say and instead referred a reporter to an FDA website that shows past test results but does not include any for Glenmark products since the recalls.
Major production equipment is not decontaminated before the company uses it to make some drug products, a Glenmark vice president in charge of quality told the inspectors. It’s unclear what those drugs are because the FDA censored that part of the report.
The inspectors noted that Glenmark received two consumer complaints about adverse reactions to one of its drugs. When Glenmark investigated the complaints, the company failed to assess the potential problems that can occur when pharmaceutical products are manufactured using shared facilities and equipment, the report said. But the name of the drug and the type of potential contamination that inspectors worried about were not clear due to the FDA’s redactions.
Glenmark also didn’t get to the bottom of why some medicines made at the factory weren’t dissolving properly, the FDA inspectors found. The company’s investigations of some batches of faulty medicine didn’t identify specific root causes, and those that did pinpoint a reason weren’t adequately supported with evidence or didn’t explain all the data, the inspectors wrote.
The inspectors also raised concerns that some drugs made at the factory and the key ingredients that go into them “are routinely released by testing with analytical test methods that have not been adequately validated or verified.” The inspectors listed the ones that are currently on the U.S. market, but the FDA redacted the names of the drugs.
When Glenmark analysts’ tests found problems with a medicine, the company at times declared those results invalid and “retested with new samples to obtain passing results,” the FDA report said. “The batches were ultimately released to the US market.”
Glenmark has been the subject of FDA scrutiny for years. Since 2019, the agency’s inspectors have found major deficiencies at three of the company’s four other factories that have made drugs for American patients. The problems at one plant were so bad that in 2022 the agency barred medicines made there from entering the U.S.
The concerning string of recalls stemming from products made at the Madhya Pradesh factory in central India began in October 2023. Over the next 12 months, that single plant accounted for more than 30% of all FDA recalls for pills that didn’t dissolve correctly and could harm patients, a ProPublica analysis found.
The federal government often doesn’t make it easy for consumers to know where their medicines are manufactured. To identify this pattern, ProPublica had to match drug-labeling records from the U.S. National Library of Medicine with details in two FDA databases.
The majority of the factories making drugs for American patients are in foreign countries, but the investigative arm of Congress has repeatedly found that the FDA has too few inspectors to adequately oversee them.
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