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Maxeon Solar Technologies Announces Fourth Quarter and Fiscal Year 2020 Financial Results

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SINGAPORE, April 6, 2021 /PRNewswire/ — Maxeon Solar Technologies, Ltd. (NASDAQ:MAXN) (“Maxeon” or “the Company”), a global leader in solar innovation and channels, today announced its financial results for its fourth quarter and fiscal year ended January 3, 2021.

Maxeon Chief Executive Officer Jeff Waters commented, “In our first full quarter as an independent public company we delivered financial results consistent with our guidance while making progress on each of the three pillars of our strategy: our differentiated global brand and channel, our panel technology, and our focused approach to the large-scale market. In the fourth quarter we saw strong growth in both distributed generation and our large-scale businesses, with sequential revenue increases of 12% and 35%, respectively. Gross profit in Q4 was slightly higher than anticipated due primarily to higher than planned ASPs and improved product mix.”

Discussing brand and channel, Waters noted: “Leveraging our industry-leading brand, channel, and solar panel technology, we took the first steps in our ‘Beyond the Panel’ strategy by introducing AC Modules with factory integrated micro-inverters. These Maxeon AC modules are currently shipping into seventeen European countries and Australia. We expect this initiative to drive significant margin uplift in the quarters ahead. To further drive our distributed generation effort, we announced that Ralf Elias will join our executive team to lead our distributed generation product initiatives. Ralf will solidify our strategy to build incremental revenue from integrated energy products and services on top of our current business.”

Turning to technology, Waters elaborated: “We met key objectives on our next generation Maxeon 7 technology roadmap, achieving meaningful progress in efficiency and product safety attributes. These R&D successes further solidify our confidence that we can commercialize and ramp Maxeon 7 starting in late 2022.”

Regarding the Company’s large-scale focus, Waters remarked: “We are launching a strategic initiative to broaden our engagement in the U.S. market with our Performance line. We plan to leverage our large and growing sales pipeline and North American manufacturing assets to drive significant incremental sales in the region beyond our current rooftop distributed generation sales through SunPower.”

Selected Q4 and Fiscal Year Financial Summary

($ Thousands)

Fiscal Q4
2020

Fiscal Q3
2020

Fiscal Q4
2019

Fiscal Year
2020

Fiscal Year
2019

Module shipments, in MW

655

531

740

2,145

2,430

Revenue

245,564

206,620

368,128

844,836

1,198,301

Gross profit (loss)1

7,313

(12,302)

27,606

(9,781)

(2,309)

Net income (loss)
attributable to stockholders1

3,458

(67,755)

(32,039)

(142,631)

(183,059)

Adjusted EBITDA1,2,3

26,943

(38,808)

(2,529)

(44,067)

(83,138)

Capital investment

13,301

4,889

10,382

27,689

41,905

1

The Company’s GAAP and Non-GAAP results were impacted by the effects of certain items. For the fourth quarter 2020 results, these items include a $44 million gain on its stock borrowing facilities, and a $21 million loss on its long-term polysilicon contract. Refer to “Use of Non-GAAP Financial Measures” below.

2

The Company’s use of non-GAAP financial information, including a reconciliation to U.S. GAAP, is provided under “Use of Non-GAAP Financial Measures” below.

3

In addition to the reconciliation provided here, please also refer to “Reconciliation of Non-GAAP Financial Measures” in Maxeon’s Form 6-K furnished on November 19, 2020 for the reconciliation of Adjusted EBITDA for fiscal Q3 2020.

Information presented is for continuing operations only and excludes results of lines of business retained by SunPower after the spin-off for all periods presented.

First Quarter 2021

The solar industry faces pervasive upstream supply chain cost challenges, which did not improve in the first quarter of 2021.  The Company expects that elevated costs for glass, solar cells, freight, and other items may persist well into the second half of 2021.  In addition, the distributed generation business is traditionally very seasonal with the first half volumes typically delivering only 40% of the annual total, and the first quarter being the lowest. For the first quarter of fiscal year 2021, the Company anticipates the following results:

  • Module shipments of approximately 375 MW.
  • Revenue of approximately $160 million.
  • Gross profit in a range of a loss of $5 million to a loss of $15 million. This includes out-of-market polysilicon cost of approximately $15 million.
  • Operating expense of approximately $38 million.
  • Capital expenditures for the first quarter will be around $10 million, directed mainly to upgrading Maxeon’s manufacturing facilities. For fiscal year 2021, previously planned capital expenditures of $90 million are expected to be increased by another $80 million for the U.S.-focused Performance line initiative, subject to obtaining financing.

CEO Waters summarized: “Against a backdrop of strong and growing global distributed generation market demand, we are excited about the opportunity to expand and extend our leading go-to-market channel platform. In our large-scale business, we believe that the upstream supply chain disruptions will ease, although the exact timing is difficult to predict. We are well positioned to begin converting our 38 gigawatt global sales pipeline into orders as this occurs. Finally, we are excited by the prospect of becoming even more broadly engaged in the U.S. market with our Performance line.”

The Company’s business outlook is based on management’s current views and estimates with respect to market conditions, production capacity, the uncertainty of the continuing impact of the COVID-19 pandemic, and the global economic environment. Please refer to the Forward-Looking Statements section below. Management’s views and estimates are subject to change without notice.

For More Information

Maxeon’s fiscal year 2020 financial results and management commentary can be found on Form 20-F by accessing the Financials & Filings page of the Investor Relations section of Maxeon’s website at https://www.maxeon.com/investor-relations. The Form 20-F and Company’s other filings are also available online from the Securities and Exchange Commission at www.sec.gov.

Conference Call Details

The Company will also hold a conference call on April 6, 2021, at 6:00 PM U.S. EDT / April 7, 2021, at 6:00 AM Singapore Time, to discuss results and provide an update on the business. Conference call details are below.

Dial-in:

North America (toll-free): +1 (833) 301-1154
International: +1 (914) 987-7395
Conference ID: 7896717

A simultaneous webcast of the conference call will also be available on Maxeon’s website at https://www.maxeon.com/events-and-presentations.

Listeners should dial in or log on approximately 10 minutes in advance. A replay will be available online within 24 hours after the event.

A replay of the conference call is also available by phone at the following numbers until April 13, 2021. To access the replay, please reference the following numbers:

North America (toll-free): +1 (855) 859-2056 or +1 (800) 585-8367
International: +1 (404) 537-3406
Conference ID: 7896717

About Maxeon Solar Technologies

Maxeon Solar Technologies, Ltd. (NASDAQ:MAXN) is Powering Positive ChangeTM. Headquartered in Singapore, Maxeon designs, manufactures and sells SunPower® brand solar panels in more than 100 countries, operating the SunPower brand worldwide except the United States and Canada. The Company is a leader in solar innovation with access to over 900 patents and two best-in-class solar panel product lines. With operations in Africa, Asia, Oceania, Europe and Mexico, Maxeon’s products span the global rooftop and solar power plant markets through a network of more than 1,100 trusted partners and distributors. A pioneer in sustainable solar manufacturing, Maxeon leverages a 35-year history in the solar industry and numerous awards for its technology. For more information about how Maxeon is Powering Positive ChangeTM visit us at https://www.maxeon.com/, on LinkedIn and on Twitter.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including, but not limited to, statements regarding: (a) our expectations regarding pricing trends, demand and growth projections; (b) potential disruptions to our operations and supply chain that may result from epidemics or natural disasters, including the duration, scope and impact on the demand for our products and the pace of recovery from the COVID-19 pandemic; (c) anticipated product launch timing and our expectations regarding ramp, customer acceptance and demand, upsell and expansion opportunities; (d) our expectations and plans for short- and long-term strategy, including our anticipated areas of focus and investment, market expansion, product and technology focus, and projected growth and profitability; (e) our liquidity, substantial indebtedness, and ability to obtain additional financing; (f) our upstream technology outlook, including anticipated fab utilization and expected ramp and production timelines for the Company’s Maxeon 5 and 6, next-generation Maxeon 7 and Performance line solar panels, expected cost reductions, and future performance; (g) our strategic goals and plans, including partnership discussions with respect to the Company’s next generation technology, and our relationships with existing customers, suppliers and partners, and our  ability to achieve and maintain them; (h) our expectations regarding our future performance based on bookings, backlog, and pipelines in our sales channels; (i) our first quarter fiscal 2021 guidance, including GAAP revenue, gross profit, and MW deployed, and related assumptions; (j) expected demand recovery and market traction for Maxeon as a result of anticipated product launches; (k) our expectations regarding the potential outcome, or financial or other impact on our business, as a result of the Spin-off from SunPower Corporation; (l) our projected effective tax rate and changes to the valuation allowance related to our deferred tax assets. The forward-looking statements can be also identified by terminology such as “may,” “might,” “could,” “will,” “aims,” “expects,” “anticipates,” “future,” “intends,” “plans,” “believes,” “estimates” and similar statements.

These forward-looking statements are based on our current assumptions, expectations and beliefs and involve substantial risks and uncertainties that may cause results, performance or achievement to materially differ from those expressed or implied by these forward-looking statements. These statements are not guarantees of future performance and are subject to a number of risks. The reader should not place undue reliance on these forward-looking statements, as there can be no assurances that the plans, initiatives or expectations upon which they are based will occur. Factors that could cause or contribute to such differences include, but are not limited to: (1) challenges in executing transactions key to our strategic plans, including regulatory and other challenges that may arise; (2) potential disruptions to our operations and supply chain that may result from damage or destruction of facilities operated by our suppliers, epidemics or natural disasters, including impacts of the COVID-19 pandemic; (3) the success of our ongoing research and development efforts and our ability to commercialize new products and services, including products and services developed through strategic partnerships; (4) competition in the solar and general energy industry and downward pressure on selling prices and wholesale energy pricing; (5) our liquidity, substantial indebtedness, and ability to obtain additional financing for our projects and customers; (6) changes in public policy, including the imposition and applicability of tariffs; (7) regulatory changes and the availability of economic incentives promoting use of solar energy; (8) fluctuations in our operating results; (9) appropriately sizing our manufacturing capacity and containing manufacturing and logistics difficulties that could arise; (10) unanticipated impact to customer demand and sales schedules due to, among other factors, the spread of COVID-19 and other environmental disasters; (11) challenges in managing our acquisitions, joint ventures and partnerships, including our ability to successfully manage acquired assets and supplier relationships; and (12) unpredictable outcomes resulting from our litigation activities. A detailed discussion of these factors and other risks that affect our business is included in filings we make with the Securities and Exchange Commission (“SEC”) from time to time, including our most recent report on Form 20-F, particularly under the heading “Risk Factors”. Copies of these filings are available online from the SEC at www.sec.gov, or on the SEC Filings section of our Investor Relations website at https://www.maxeon.com/investor-relations. All forward-looking statements in this press release are based on information currently available to us, and we assume no obligation to update these forward-looking statements considering new information or future events.

MAXEON SOLAR TECHNOLOGIES, LTD.
CONSOLIDATED AND COMBINED BALANCE SHEETS
(unaudited)
(In thousands, except for shares data)

As of

January 3, 2021

December 29, 2019

Assets

Current assets

Cash and cash equivalents

$

206,744

$

120,956

Restricted short-term marketable securities

1,359

6,187

Accounts receivable, net

76,702

150,365

Inventories

169,240

194,852

Advances to supplier, current portion

43,680

107,388

Prepaid expenses and other current assets

49,470

38,369

Total current assets

$

547,195

$

618,117

Property, plant and equipment, net

246,908

281,200

Operating lease right of use assets

13,482

18,759

Intangible assets, net

456

5,092

Advances to supplier, net of current portion

49,228

13,993

Other long-term assets

123,074

53,050

Total assets

$

980,343

$

990,211

Liabilities and Equity

Current liabilities

Accounts payable

$

159,184

$

286,464

Accrued liabilities

77,307

92,570

Contract liabilities, current portion

20,756

78,939

Short-term debt

48,421

60,383

Operating lease liabilities, current portion

2,464

2,365

Total current liabilities

$

308,132

$

520,721

Long-term debt

962

1,487

Contract liabilities, net of current portion

33,075

35,616

Operating lease liabilities, net of current portion

12,064

18,338

Convertible debt

135,071

Other long-term liabilities

51,752

46,526

Total liabilities

$

541,056

$

622,688

Commitments and contingencies

Equity

Common stock, no par value (33,995,116 issued and outstanding at
January 3, 2021)

$

$

Net parent investment

369,837

Additional paid-in capital

451,474

Accumulated deficit

(8,441)

Accumulated other comprehensive loss

(10,391)

(7,618)

Equity attributable to the Company

432,642

362,219

Noncontrolling interests

6,645

5,304

Total equity

$

439,287

$

367,523

Total liabilities and equity

$

980,343

$

990,211

MAXEON SOLAR TECHNOLOGIES, LTD.
CONSOLIDATED AND COMBINED STATEMENTS OF OPERATIONS
(unaudited)
(In thousands, except per share data)

Three Months Ended

Fiscal Year Ended

January 3, 2021

December 29, 2019

January 3, 2021

December 29, 2019

Revenue

$

245,564

$

368,128

$

844,836

$

1,198,301

Cost of revenue

238,251

340,522

854,617

1,200,610

Gross profit (loss)

7,313

27,606

(9,781)

(2,309)

Operating expenses

Research and development

8,763

11,584

34,194

36,997

Sales, general and administrative

24,051

26,824

86,202

96,857

Restructuring (benefits) charges

(9)

41

(517)

Total operating expenses

32,805

38,449

120,396

133,337

Operating loss

(25,492)

(10,843)

(130,177)

(135,646)

Other income (expense), net

Interest expense

(8,127)

(6,782)

(31,859)

(25,831)

Other, net

44,443

(6,291)

36,349

(1,961)

Other income (expense), net

36,316

(13,073)

4,490

(27,792)

Income (loss) before income taxes and equity in losses of unconsolidated investees

10,824

(23,916)

(125,687)

(163,438)

Provision for income taxes

(4,737)

(2,954)

(12,127)

(10,122)

Equity in losses of unconsolidated investees

(2,612)

(4,001)

(3,198)

(5,342)

Net income (loss)

$

3,475

$

(30,871)

$

(141,012)

$

(178,902)

Net income attributable to noncontrolling interests

(17)

(1,168)

(1,619)

(4,157)

Net income (loss) attributable to stockholders

$

3,458

$

(32,039)

$

(142,631)

$

(183,059)

Net income (loss) per share attributable to stockholders:

Basic

$

0.11

$

(1.51)

$

(5.82)

$

(8.61)

Diluted

$

0.11

$

(1.51)

$

(5.82)

$

(8.61)

Weighted average shares used to compute net income (loss) per share:

Basic

30,267

21,265

24,502

21,265

Diluted

30,963

21,265

24,502

21,265

MAXEON SOLAR TECHNOLOGIES, LTD.
CONSOLIDATED AND COMBINED STATEMENTS OF CASH FLOWS
(unaudited)
(In thousands)

Fiscal Year Ended

January 3, 2021

December 29, 2019

Cash flows from operating activities

Net loss

$

(141,012)

$

(178,902)

Adjustments to reconcile net loss to net cash used in operating activities

Depreciation and amortization

47,328

53,448

Stock-based compensation

7,250

7,135

Non-cash interest expense

19,851

23,841

Equity in losses of unconsolidated investees

3,198

5,342

Gain on retirement of property, plant and equipment

(641)

Deferred income taxes

(1,330)

804

Gain on equity investments

(1,822)

Remeasurement gain on physical delivery forward and prepaid forward

(38,236)

Other, net

3,078

249

Changes in operating assets and liabilities

Accounts receivable

71,231

(77,830)

Contract assets

(1,806)

264

Inventories

25,212

28,415

Prepaid expenses and other assets

(5,590)

960

Operating lease right-of-use assets

2,264

2,449

Advances to suppliers

28,473

50,163

Accounts payable and other accrued liabilities

(143,462)

53,451

Contract liabilities

(61,344)

6,460

Operating lease liabilities

(1,804)

(2,589)

Net cash used in operating activities

$

(189,162)

$

(26,340)

Cash flows from investing activities

Purchases of property, plant and equipment

(27,689)

(41,905)

Proceeds from disposal of short-term investments

6,572

Purchase of short-term investments

(1,340)

Proceeds from sale of assets

1,283

265

Purchases of intangibles

(231)

Installment payment for acquisition of subsidiary

(30,000)

Proceeds from sale of unconsolidated investee

3,220

Proceeds from dividends and partial return of capital by an unconsolidated investee

2,462

Net cash used in investing activities

$

(45,492)

$

(41,871)

Cash flows from financing activities

Proceeds from debt

236,446

253,314

Repayment of debt

(226,664)

(254,649)

Net proceeds from issuance of convertible debt

190,330

Net proceeds from issuance of common stock

296,765

Payment for realized amount on underwriting physical delivery forward

(1,606)

Payment for prepaid forward

(40,000)

Distribution to noncontrolling interest

(278)

Repayment of finance lease obligations & other debt

(651)

(1,190)

Net parent (distribution) contribution

(133,996)

92,409

Net cash provided by financing activities

$

320,346

$

89,884

Effect of exchange rate changes on cash, cash equivalents, restricted cash and restricted cash equivalents

77

381

Net increase in cash, cash equivalents, restricted cash and restricted cash equivalents

85,769

22,054

Cash, cash equivalents, restricted cash and restricted cash equivalents, beginning of period

123,803

101,749

Cash, cash equivalents, restricted cash and restricted cash equivalents, end of period

$

209,572

$

123,803

Non-cash transactions

Property, plant and equipment purchases funded by liabilities

$

27,736

$

13,377

Right-of-use assets obtained in exchange for lease obligations1

$

4,791

$

21,209

Interest expense financed by SunPower

$

11,333

$

17,000

Aged supplier financing balances reclassified from accounts payable to short-term debt

$

23,933

$

45,352

The following table reconciles our cash and cash equivalents and restricted cash and restricted cash equivalents reported on our Consolidated and Combined Balance Sheets and the cash, cash equivalents, restricted cash and restricted cash equivalents reported on our Consolidated and Combined Statements of Cash Flows for fiscal years 2020 and 2019:

As of

(In thousands)

January 3, 2021

December 29, 2019

Cash and cash equivalents

$

206,744

$

120,956

Restricted cash and restricted cash equivalents, current portion, included in prepaid expenses and other current assets

2,483

2,845

Restricted cash and restricted cash equivalents, net of current portion, included in other long-term assets

345

2

Total cash, cash equivalents, restricted cash and restricted cash equivalents shown in statement of cash flows

$

209,572

$

123,803

1 

Amounts for fiscal year 2019 include the transition adjustment for the adoption of ASC 842 and new Right-of-Use (“ROU”) asset additions.

Use of Non-GAAP Financial Measures

We present earnings before interest, taxes, depreciation and amortization (“EBITDA”) and EBITDA adjusted for specified additional items identified below (“Adjusted EBITDA”), which are non-GAAP measures to supplement our consolidated and combined financial results presented in accordance with GAAP. We believe that EBITDA and Adjusted EBITDA are useful to investors, enabling them to better assess changes in our results of operations across different reporting periods on a consistent basis, independent of certain items as presented above. Thus, EBITDA and Adjusted EBITDA provide investors with additional methods to assess our operating results in a manner that is focused on our ongoing, core operating performance, absent the effects of these items. We also use EBITDA and Adjusted EBITDA internally to assess our business, financial performance and current and historical results, as well as for strategic decision-making and forecasting future results. Given our use of EBITDA and Adjusted EBITDA, we believe that these measures may be important to investors in understanding our operating results as seen through the eyes of management. EBITDA and Adjusted EBITDA are not prepared in accordance with GAAP or intended to be a replacement for GAAP financial data, should be reviewed together with GAAP measures and may be different from non-GAAP measures used by other companies.

We adjust our EBITDA for the following items in arriving to the Adjusted EBITDA:

  • Stock-based compensation expense. Stock-based compensation relates primarily to equity incentive awards. Stock-based compensation is a non-cash expense that is dependent on market forces that are difficult to predict. Management believes that this adjustment for stock-based compensation expense provides investors with a basis to measure our core performance, including the ability to compare our performance with the performance of other companies, without the period-to-period variability created by stock-based compensation.
  • Restructuring charges (benefits). We incurred restructuring expenses related to reorganization plans implemented by our former parent, SunPower, aimed towards realigning resources consistent with SunPower’s global strategy and improving its overall operating efficiency and cost structure. Restructuring charges are excluded from Adjusted EBITDA financial measures because they are not considered core operating activities and such costs have historically occurred infrequently. Although we have engaged in restructuring activities in the past, past activities have been discrete events based on unique sets of business objectives. As such, management believes that it is appropriate to exclude restructuring charges from our Adjusted EBITDA financial measures as they are not reflective of ongoing operating results nor do these charges contribute to a meaningful evaluation of our past operating performance.

Reconciliation of Non-GAAP Financial Measures

Three Months Ended

Fiscal Year Ended

(In thousands)

January 3, 2021

September 27, 2020

December 29, 2019

January 3, 2021

December 29, 2019

Selected GAAP Financial Data

Revenue

$

245,564

$

206,620

$

368,128

$

844,836

$

1,198,301

Cost of revenue1

(238,251)

(218,922)

(340,522)

(854,617)

(1,200,610)

Gross profit (loss)1

7,313

(12,302)

27,606

(9,781)

(2,309)

Operating loss1

(25,492)

(39,163)

(10,843)

(130,177)

(135,646)

Provision for income taxes

(4,737)

(5,043)

(2,954)

(12,127)

(10,122)

GAAP net income (loss)1

3,475

(67,208)

(30,871)

(141,012)

(178,902)

GAAP net income (loss) attributable to stockholders1

$

3,458

$

(67,755)

$

(32,039)

$

(142,631)

$

(183,059)

Selected Non-GAAP Financial Data

GAAP net income (loss) attributable to stockholders1

$

3,458

$

(67,755)

$

(32,039)

$

(142,631)

$

(183,059)

Interest expense

8,127

11,509

6,782

31,859

25,831

Provision for income taxes

4,737

5,043

2,954

12,127

10,122

Depreciation

9,068

9,182

11,939

42,332

46,007

Amortization

39

1,290

1,805

4,996

7,290

EBITDA1

$

25,429

$

(40,731)

$

(8,559)

$

(51,317)

$

(93,809)

Additional adjustments

Impairment

4,053

4,053

Stock-based compensation

1,514

1,923

1,889

7,250

7,135

Restructuring charges (benefits)

88

(517)

Adjusted EBITDA1

$

26,943

$

(38,808)

$

(2,529)

$

(44,067)

$

(83,138)

1 

The Company’s GAAP and Non-GAAP results were impacted by the effects of certain items. Refer to supplementary information in the table below.

Supplementary information affecting GAAP and Non-GAAP results

Three Months Ended

Fiscal Year Ended

Financial
statements
item
affected

January 3,
2021

September 27,
2020

December 29,
2019

January 3,
2021

December 29,
2019

Incremental cost of above market polysilicon1

Cost of
revenue

18,202

38,138

20,682

77,950

88,658

Loss on ancillary sales of excess polysilicon2

Cost of
revenue

2,544

1,993

14,322

8,517

56,479

Remeasurement (gain) loss of physical delivery forward and prepaid forward3

Other, net

(43,969)

5,734

(38,236)

Accommodation fee associated with the long-term polysilicon supply contract4

Other, net

5,900

5,900

1

Relates to the difference between our contractual cost for the polysilicon under the long-term fixed supply agreements with supplier and the price of polysilicon available in the market as derived from publicly available information at the time, multiplied by the volume of polysilicon we have consumed.

2  

In order to reduce inventory and improve working capital, we have periodically elected to sell polysilicon inventory procured under the long-term fixed supply agreements in the market at prices below our purchase price, thereby incurring a loss.

3  

Relates to the mark-to-market fair value remeasurement of privately negotiated prepaid forward and physical delivery forward transactions. For the three months ended January 3, 2021, the gain for the prepaid forward and physical delivery forward was $31.6 million and $12.4 million (three months ended September 27, 2020: loss of $1.8 million and $3.9 million) respectively. For fiscal year 2020, the gain for the prepaid forward and physical delivery forward was $29.7 million and $8.5 million. The transactions were entered in connection with the issuance of the $200.0 million aggregate principal amount 6.50% Green Convertible Senior Notes due 2025. The prepaid forward is remeasured to fair value at the end of each reporting period, with changes in fair value booked in earnings. The fair value of the prepaid forward is affected by the Company’s share price and other factors impacting the valuation model. The physical delivery forward was remeasured to fair value at the end of the Note Valuation Period on September 29, 2020, and was reclassified to equity after remeasurement, and will not be subsequently remeasured. The fair value of the physical delivery forward was affected by the Company’s share price and other factors impacting the valuation model.

4 

Relates to long-term fixed supply agreements with a polysilicon supplier which is structured as “take or pay” contract, that specify future quantities and pricing of products to be supplied. We negotiated an extension of our long-term fixed supply agreements with the supplier which resulted in a one-time accommodation fees recognized during fiscal year 2020.

©2021 Maxeon Solar Technologies, Ltd. All rights reserved. MAXEON is a registered trademark of Maxeon Solar Technologies, Ltd. Visit www.maxeon.com/trademarks/ for more information.

SOURCE Maxeon Solar Technologies, Ltd.

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The retirement of Harbhajan Singh from all forms of competitive cricket in December 2021 brought to close the career of a gifted cricketer who courted controversy at every turn of his career. During the first years of the 21st century, he was arguably the best spin bowler in the world and though his wicket-taking abilities hit a plateau after that, he sustained himself by the versatility that saw him play all formats of the game at the highest level with reasonable success. He was a regular in the national side and part of the team that won the International Cricket Council (ICC) T20 World Cup in 2007 and the ICC World Cup in 2011. Though he lost his place in the national squad in 2015, he continued playing in Indian Premier League (IPL) till he chose to hang up his playing boots last month.

Harbhajan Singh

Chennai Super Kings bowler Harbhajan Singh bowls during the 2019 Indian Premier League (IPL) match. Photo by Sajjad Hussain/AFP


Harbhajan kickstarted his career during the 1997-98 season when he found himself playing for the national side in March 1998 within four months after making his debut for Punjab in Ranji Trophy. His performances at the junior level and the absence of top quality off-spin bowlers were factors that prompted the selectors to try out this rookie bowler, then still in his teens. He did not set Kaveri on fire on his Test debut, which took place against Australia at Bangalore. Within one month, he made his bow in One Day Internationals (ODIs) as well but a string of below-par performances saw him lose his place in the side soon thereafter.

Harbhajan Singh

Indian off-spinner Harbhajan Singh appeals to the umpire at Buffalo Park in East London 19 October 2001. Photo: Tirsa Ellis/AFP


After going through a period of near oblivion when he was also thrown out of a training programme in National Cricket Academy on charges of indiscipline, Harbhajan staged a comeback to the national side in the winter of 2000-2001 with a performance that will be remembered by followers of the game in India for all times. Australia, led by Steve Waugh, had landed in India to conquer the “final frontier”. The visitors were on a high, having won the previous 15 matches on the trot and looked forward to creating a new world record with 17 consecutive triumphs in Tests, while also winning the series. And when they won the first Test at Mumbai by a margin of 10 wickets, everyone thought that they were on their way to attaining both their goals.

Harbhajan Singh

Indian players incluing Sourav Ganguly (R), Harbhajan Singh (3rd L), Shiv Sundar Singh (fourth from L, with helmet), VVS Laxman (2nd from R) run to celebrate India’s victory over Australia. Photo: Arko Datta/AFP


The Kolkata Test against Australia in February 2001 is known as “Laxman’s Test”, for his knock of 281 runs in the second innings which helped India to script a magnificent turnaround and win this game, after trailing in the first innings by 274 runs. Harbhajan also had a crucial role to play in this victory as he took 13 wickets (7 for 123 in first innings and 6 for 73 in the second), including a hat-trick on the first day. In the last Test at Chennai, Harbhajan again played a stellar role, bagging 15 wickets for 217 runs (7 for 133 in first and 8 for 84 in second innings) to finish the series with a tally of 32 wickets. Aussie batsmen did not have any answer for his wiles and even such accomplished performers as Rickey Ponting and Adam Gilchrist appeared shell-shocked while facing him. Australian media nicknamed him as “Turbanator”- a tribute to his destructive capacity with the ball.

Harbhajan Singh

Indian spinners Anil Kumble (L) and Harbhajan Singh at the Ferozeshah Kotla ground in New Delhi. Photo: Ravi Raveendran/AFP


Harbhajan’s career did not ever attain the stratospheric heights that this performance promised. The surfeit of limited overs’ cricket made him focus more on restricting runs than on “buying” wickets. This resulted in bowling a flatter line without “giving the ball air”; the classic loop which is the hallmark of a top-class off-spinner also disappeared. This made him a less destructive bowler except on helpful surfaces and the returns also started growing thinner. When Anil Kumble returned to the side after recovering from an injury, Harbhajan moved into the slot of support spin bowler.

Harbhajan Singh

Injured spinner Harbhajan Singh watches the action on the first day of the third Test Match being played at the MCG in Melbourne 26 December 2003. Photo: William West/AFP


A finger injury caused Harbhajan to return home during the tour to Australia in 2003-04. He returned to the side the next season and was amongst wickets with most of the games being played at home. However, the arrival of Greg Chappell as coach and the exit of Sourav Ganguly as captain of the national side in 2005 caused hiccups in Harbhajan’s career. He was the first Indian cricketer to publicly criticise Chappell and his methods and said that the coach was “instilling fear and insecurity” in the side. Though his explanation was called for, Harbhajan managed to escape action and issued a statement lauding Chappell soon thereafter!

Harbhajan Singh

Gerg Chappell (L), talks with Harbhajan Singh (R), during a net practice session at The Punjab Cricket Association (PCA) stadium in Mohali. Photo: Raveendran/AFP


Harbhajan found himself in the midst of one of the biggest controversies in cricket when India toured Australia in 2007-08. In the second Test at Adelaide, Australia lodged a formal complaint that he indulged in racial abuse against Andrew Symonds. The relations between the two sides were at a low ebb and this incident even threatened to disrupt the conduct of the remaining part of the tour. Harbhajan vehemently denied the charges and the Indian team management supported him. But Mike Proctor, the match referee, found him guilty and slapped a punishment. India promptly appealed against this verdict and got a stay, which allowed the tour to go on. Eventually, the ICC appeals Commissioner Justice John Hansen overturned the verdict of the match referee and absolved Harbhajan.

Harbhajan Singh

(L to R) Australian players Ricky Ponting, Michael Clarke, Andrew Symonds and Matthew Hayden are seen along side Indian player Harbhajan Singh and assistant Indian team manager M.V. Sridhar prior to the start of the appeal hearing against a three-match ban imposed on Indian cricketer Harbhajan Singh by the ICC at the Adelaide Federal Court, 29 January 2008. Photo: Robert Cianflone/Pool/AFP


Controversy continued to dog Harbhajan even after the closure of this episode. During the Indian Premier League (IPL) matches in 2008, he slapped fellow India teammate S Sreesanth after the game between Kings XI Punjab and Mumbai Indians, which the latter side, led by Harbhajan, lost. The slapping of a national player in full view of television cameras drew widespread criticism and Board of Control for Cricket in India (BCCI) moved fast and initiated action against Harbhajan.

Harbhajan Singh

Indian cricketers Harbhajan Singh (L) and S Sreesanth. Photo: AFP


Incidentally, this was not the first time that Harbhajan had got physical with Sreesanth. During the Champions Cup trophy match in 2007, he had shoulder charged the fast bowler when he was walking to the top of his bowling mark. BCCI had chosen to ignore this incident despite it being witnessed across the country. But the “slapgate” was too serious to be brushed under the carpet and Harbhajan was barred from playing the remaining matches of that season of IPL, besides a five-match suspension from ODI’s.

Harbhajan’s international career took a severe reverse when he was injured during the tour to England in 2011. He was not selected for the tour to Australia in 2011-12 and his appearances in international matches became sporadic after that. He played his last Test in August 2015 and his final appearance in an ODI took place two months later, though he continued to play domestic first-class cricket till 2017. Since then, his appearances on the cricket field were limited to playing in IPL, where he picked up 150 wickets in 13 editions.

Harbhajan Singh

Harbhajan Singh hold his Man of the Series trophy after India defeated Australia by two wickets in the the third test, hence winning the series in Madras 22 March 2001. Photo: Ravi Raveendran/AFP


A tally of 417 wickets in Tests and 269 scalps in ODI’s makes Harbhajan the second most successful off-spinner to play for India, after Ravichandran Ashwin. He could also wield the willow effectively as evident from a total of 2,224 runs in Tests with 2 centuries and 9 fifties. He was also the first spin bowler from India to adjust to the demands of all versions of cricket effectively. But his tendency to create controversies and lack of amenability to discipline cast a cloud over his career which could have reached much greater heights given the prodigious talent he was blessed with.

Sreesanth

S Sreesanth with teammate Harbhajan Singh. Photo: Alexander Joe/AFP


Followers of the game from Kerala could be forgiven for not harbouring a soft spot towards this highly competitive cricketer as he is considered to be the bugbear of Sreesanth and the source of all troubles that the Kochi born pacer found himself in. News reports indicate that the two cricketers subsequently spoke to each other and resolved their differences. But it would be difficult for the fans to forgive so easily as the bad taste created by those incidents does not vanish quickly. The same is the case with cricketers and cricket-loving public of Australia, as could be understood from the observations in the autobiography of Gilchrist, despite Harbhajan and Symonds sharing the same dugout in IPL.

In retrospect, one is forced to conclude that it would have been better for Indian cricket if the aggressive instincts of Harbhajan Singh were channelled properly on the cricket field and outside.

(The author is a former international umpire and a senior bureaucrat)

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Sports Betting’s Next Big Election Battles Are in California

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Sports Betting’s Next Big Election Battles Are in California

TEMECULA, Calif. — Legal sports betting in the United States accelerated in 2021 as a flurry of states either overcame legislative logjams, as Ohio did just before Christmas, or signed off on online wagering, as New York did just after Election Day.

But those efforts are likely to pale in comparison to the all-out lobbying, campaigning and legal jousting in 2022 involving what a DraftKings executive recently called “one of the holy grails” in sports betting: California.

By November, Californians may be asked to vote on as many as four sports betting initiatives. That’s why deep-pocketed interests, including national sports books and Native American casinos, have been gearing up to spend $200 million to persuade voters in California to support their particular proposal — or to reject the others.

One measure that has already qualified for the state ballot, sponsored by powerful tribes in California, would add sports wagering, but only in person, at tribal casinos or horse racing tracks. Online betting initiatives, now gathering signatures, dangle the prospect of making bets anywhere through the internet. Others offer a middle ground.

If one of the measures passes, nearly two-thirds of Americans will live in states that allow or regulate sports betting. And with California and New York on board, sports wagering would essentially be national in scope, fueling a market that Goldman Sachs recently estimated could grow to $40 billion in revenues in a decade from $900 million now.

Yet gambling expansion in California has often fallen short or been torpedoed by competing interests. Indeed, California’s card rooms, which primarily operate around larger cities and offer a more limited range of games, just filed a lawsuit to invalidate the qualified tribal measure.

“We’re never going to get sports betting figured out at any level unless California comes on board,” Jason Giles, executive director of the National Indian Gaming Association, said at a recent sports betting conference at the Pechanga Resort and Casino in Temecula. “That will be the game changer for the United States.”

Since the Supreme Court’s decision in 2018 to strike down a federal law banning commercial sports betting in states other than Nevada, more than 30 states have authorized sports wagering, including about a dozen in the last year. More than 20 states have gone live.

New York just started mobile sports betting after awarding licenses for it to two coalitions featuring marquee names, Caesars Sportsbook and Bally’s Interactive. Gov. Mike DeWine of Ohio signed a bill legalizing sports betting in late December. And legislators in Wyoming and Arizona, among others, quickly approved sports betting.

“Look at this massive expansion across the country and where we are — it’s becoming very mainstream,” said Brandt Iden, a former state representative in Michigan who pushed to legalize sports betting in his home state. Iden is now head of government affairs for Sportradar, which collects and analyzes data for sports books. “I talk to legislators who say, you know what, I don’t support gambling, but everybody is doing it.”

Of the holdouts, Texas considered several bills in 2021, and some lawmakers expect momentum when the legislature reconvenes in 2023. Florida, meanwhile, is a mess: A federal judge recently blocked the Seminole Tribe’s new sports betting app, and DraftKings and FanDuel are racing to gather enough signatures to get a referendum on the 2022 ballot.

In California, gambling — mostly on slot machines and blackjack — has been legal for two decades on tribal lands under compacts negotiated with the state. The state also permits gambling at horse racing tracks, which was legalized in 1933, and card rooms, which trace their lineage to poker-playing miners during the Gold Rush.

Any changes would require constitutional amendments through a voter referendum, or legislation backed by the voters.

Previous attempts have bogged down; online poker, for instance, failed in part because the tribes themselves were split. But now there appears to be less resistance on moral and philosophical grounds.

“If we think about progressive legislation, or legislation to protect consumer welfare, California lies at the forefront, whether we want to talk about minimum wage or privacy protection,” said Marc Edelman, a law professor at Baruch College who has written extensively on sports gambling. “If California legalizes sports gambling it becomes very unlikely that another state would arise as the consumer-oriented opposer of sports gambling.”

This time, the push to expand gambling began before the pandemic, from a coalition of 18 tribes that have dominated casino gambling in the state.

Across the United States, tribal gambling generated $27.8 billion in revenue in its fiscal year from Oct. 1, 2019, to Sept. 30, 2020, despite the pandemic. California is the biggest state, with 66 tribal casinos on federally recognized lands, mostly far from the coast, yielding about $8 billion, with much of that coming from slot machines.

Under the tribes’ initiative, which is backed by a political action committee that has raised more than $13 million, sports wagering would be permitted at tribal casinos and horse tracks. Roulette and games played with dice, such as craps, would also be allowed under the proposal, which qualified for the ballot in May 2021 after collecting more than one million valid signatures.

One thing that is not included is online betting, because the initiative is intended to be “a very measured, incremental step,” said Mark Macarro, tribal chairman of the Pechanga Band of Luiseño Indians in Riverside County.

“We think this is the right thing to do for tribes and tribal sovereignty,” he said at the conference here. “There’s enough skittishness out there about what could happen to brick-and-mortar facilities.”

The initiative would also create a new civil enforcement tool allowing anyone suspicious of any illegal gambling operations to file lawsuits. It is this provision that has fueled two separate but related efforts by California’s card rooms to defeat the tribes, and to get their own sports betting measure passed.

California has more than 80 card rooms ranging from pub-like places with a few poker tables to sleek behemoths with 270 tables accompanied by restaurants and plentiful A.T.M.s. Collectively, they employ 23,000 people in urban areas, many of them Asian, Black and Hispanic, and pump in $300 million in federal, state and local tax revenues each year, according to the California Gaming Association, a trade group.

Many municipal budgets rely heavily on the card rooms to finance vital services and bolster juvenile justice and other programs, said Mayor Tasha Cerda of Gardena, which has two card rooms. She has backed an initiative that would permit sports betting at the card rooms, tribal casinos and racetracks, as well as allow for internet sports betting. That initiative has raised $450,000 to date. Meanwhile, some of the bigger card rooms have poured more than $24 million into a “No” campaign against the tribes’ initiative.

During a recent tour of Hollywood Park Casino in Inglewood, adjacent to SoFi Stadium, the host of the Super Bowl next month and the College Football Playoff national championship in 2023, Deven Kumar, the casino’s general manager, estimated sports betting could increase revenues — already hurt by the coronavirus pandemic — by 20 percent to 25 percent. He and James T. Butts Jr., Inglewood’s mayor, warned that the tribes’ civil enforcement provision could drain their existing business by up to 75 percent, compounded by the inevitable legal costs.

“They are attempting to make gambling a monopoly at the expense of others,” Butts said. “They are not the disenfranchised group they once were. The minority majority cities deserve the opportunity for equity as well.”

In the city of Hawaiian Gardens, where the Gardens Casino supplied 68 percent of the tax revenues in the 2019-20 municipal budget, Keith A. Sharp, the casino’s general counsel, said sports betting could transform Sundays at the casino — now mostly empty — into bustling periods where customers could wager on N.F.L. games while also playing baccarat or other games.

If the card rooms were hobbled, however, Nary Chin, a longtime card dealer and single mother of four, said she feared for her future.

“I learned English in the card room, not school,” said an emotional Chin, who immigrated from Cambodia in 1984. “I am very grateful. This is my home. If I didn’t have this job, I don’t know what I’d do.”

The third initiative comes from online sports books, including DraftKings and FanDuel, that want to enter California for the first time and offer online betting.

The measure requires those companies to partner with tribes, and its supporters say voters can pass both their initiative and the tribes’ in-person one. Most of the state’s profits would be dedicated to homelessness measures, and to the tribes themselves. It would also allow betting on nonathletic events, like award shows and video game contests, but not youth sports or elections, according to the nonpartisan Legislative Analyst’s Office.

“We view brick-and-mortar as very complementary to mobile,” Jonathan Edson, FanDuel’s senior vice president for business development, said at the sports betting conference.

“California is one of the holy grails in sports,” added Jeremy Elbaum, senior vice president for business development at DraftKings.

The supporters, buffeted by an initial $100 million from seven sports books, have lined up mayors in Long Beach, Oakland, Fresno and Sacramento, plus advocates working to combat a homeless crisis. They are confident they will collect enough signatures to be certified by the June ballot deadline.

“We are focused on ongoing stable revenue to fund the key programs that we know we need,” said Tommy Newman, vice president for engagement and activation at the United Way of Greater Los Angeles. “If we’re honest, this is regulating and capturing value from something that is happening, for people in communities that absolutely need the investment.”

In November, a fourth initiative arrived supporting both online and in-person betting, backed by a different group of tribes, including the Rincon Band of Luiseño Indians and the San Manuel Band of Mission Indians.

“Out-of-state and international gaming operators want to rewrite the balanced system California has created so that the future belongs to them, paying a pittance to serious local and statewide social problems, and trying to divide the Tribes by offering temporary riches to a few while taking future growth opportunities away from the rest,” the tribes wrote in their application to the California attorney general.

A lawyer for the tribes, Scott Crowell, did not respond to messages seeking comment.

Some gambling analysts believe that a plethora of initiatives may confuse voters, who may just say no to everything. Another wild card is a lawsuit filed in December by two card rooms claiming that the qualified tribal initiative violates the state constitution, which says initiatives can focus only on one subject, because the tribes are trying to add retail sports betting as well as add more table games.

Still, no matter the outcome of the lawsuit or the ballot measures, many sports and technology companies are building audiences through free-to-play games, contests, fantasy sports and national marketing campaigns, even in states where sports betting has not yet been cleared, said Rob Phythian, founder and chief executive of SharpLink Gaming, a technology company.

Teams like the Minnesota Vikings have hired companies like SharpLink to build fantasy games. That could be consequential in California, where there are 19 teams in the N.F.L., M.L.B., N.B.A., N.H.L. and W.N.B.A. — by far the most of any state.

“We’re just a bridge to betting,” Phythian said. “It’s sort of like training the muscle.”

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Addressing maternal health inequities | AAMC

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Addressing maternal health inequities | AAMC

Kysha Shaw lives with a lot of uncertainty. Among other things, the 42-year-old single mother of three worries about COVID-19, schools closing, and drug use and crime in her West Baltimore neighborhood.

“I love this community, but it can be really sad,” she says. “You see people begging for shoes and clothes. You might see someone slumped over with a needle in their arm. People sell drugs in front of the convenience stores.”

But Shaw is determined to keep herself and her children healthy, which she’s done thanks in part to an innovative effort called B’more for Healthy Babies Upton/Druid Heights (BHB U/DH). Founded in 2011, the program is part of a citywide initiative and is a partnership between the local community, the University of Maryland Medical Center, and the University of Maryland, Baltimore.

BHB-U/DH supports mothers and babies in West Baltimore, where 92% of residents are Black and 66% of children live below the federal poverty level. It provides prenatal education, support groups, smoking cessation, some rental assistance, and connection to a range of social services. Among other achievements, the effort has reduced infant mortality by 75%.

Experts believe that programs like BHB U/DH are essential if the United States hopes to address the inequities in maternal health found in so many crowded cities and remote rural towns.

The statistics are striking: Black and American Indian/Alaskan Native women are two to three times more likely to die from pregnancy-related causes than White women. Black women are twice as likely to experience serious perinatal complications. And early indicators suggest that COVID-19 is only exacerbating such inequities.

What’s more, advanced degrees and full bank accounts don’t close the gap. In fact, a college-educated Black woman faces a 60% greater risk of maternal death than a White woman with no high school diploma. Why is that? Experts point to the effects of subtle and explicit racism as well as weathering, the biological fallout of ongoing stress that can cause premature aging and related health problems.

Faced with this worrisome reality, researchers and providers are working to improve the health of vulnerable pregnant people before, during, and after childbirth.

“It’s incredible, some of the things I’ve heard our moms go through when they’re seeking care. It’s heartbreaking.”

Kamilah Dixon-Shambley, MD
Medical director of Moms2B

“Inequities are so pervasive and persistent that they require multisector efforts,” says AAMC Health Equity Research Analyst Funmi Makinde, MPH. “We need to address transportation, employment, and housing as well as physician shortages, and we need more diverse providers. We need high-quality data that are shared publicly to ensure accountability. The list goes on.”

Throughout all this work, it’s crucial to include the perspectives of patients who are often overlooked, experts say. In one recent survey, 20% of Black, biracial, and Latinx people felt their medical requests were refused or ignored, compared with 11% of White people.

“It’s incredible, some of the things I’ve heard our moms go through when they’re seeking care. It’s heartbreaking,” says Kamilah Dixon-Shambley, MD, medical director of Moms2B, an Ohio State University Wexner Medical Center program that provides yearlong supports and health education to low-income new and expectant mothers. “It’s crucial that patients and the community can trust their providers.”

Below, AAMCNews profiles multifaceted efforts to address maternal health inequities across the country.

Data that save lives

In 2006, California officials noted a worrisome trend: Maternal mortality was on the rise, even as the state recorded the most births nationwide.

Hoping to reverse the disturbing death rate, they turned to Stanford University School of Medicine to co-found the multistakeholder group that became the California Maternal Quality Care Collaborative (CMQCC).

Serious number-crunching has fueled much of the CMQCC’s work. For one, it collects and analyzes hospitals’ raw data to quickly identify areas ripe for improvement, including racial and ethnic disparities.

“We send hospitals back reports, and they are flabbergasted when data are broken down by race and ethnicity. They may see that their Black patients have 6 percentage points higher C-section rates than Whites,” says CMQCC Medical Director Elliott Main, MD. “That really spurs them on to look at addressing racism in labor and delivery.”

CMQCC experts also use data to identify the need for and then create step-by-step provider toolkits on key causes of birth-related complications. One on postpartum hemorrhage, which covers such crucial moves as measuring and effectively treating blood loss, reduced disparities between Black and White patients by nearly 80%.

“The standardized protocols in toolkits take away a lot of provider subjectivity,” Main says. “Subjectivity is the entrée for biases that impact patient care.”

And hospitals in the collaborative — there are more than 200 of them — can receive training on implementing the toolkits. “A toolkit that sits on the shelf does nothing,” he adds.

“We send hospitals back reports, and they are flabbergasted when data are broken down by race and ethnicity. … That really spurs them on to look at addressing racism in labor and delivery.”

Elliott Main, MD
Medical director of the California Maternal Quality Care Collaborative

All of these efforts have borne fruit: Since the launch of the collaborative, California’s maternal deaths have dropped by 65%.

Now, the CMQCC is crafting additional equity-related recommendations, such as handing expectant patients a staff-signed commitment promising to treat every patient with dignity and engage them in all birth-related decisions.

Also high on the CMQCC agenda is assessing the approaches of maternal mortality review committees, the bodies that study every pregnancy-related death.

“Often a problem is that review materials are medical-centric, and obviously the patient can’t tell her own story,” says Main. “We’re now exploring interviewing family members who lost a relative for their perspective. I think that’s going to be the future of committee reviews.”

Hands-on help

Pregnancy always brings some stress, but the tension is much higher for patients who struggle to understand English and the intricacies of the U.S. health care system.

That’s why Crista Johnson-Agbakwu, MD, founded Valleywise Health’s Refugee Women’s Health Clinic in Arizona in 2008.

Since then, the Phoenix-based center has served more than 16,000 patients, many from countries across Africa. Arizona, which ranks high on the list of states resettling refugees, is now integrating evacuees from Afghanistan, says Johnson-Agbakwu.

“These are people who have escaped war and gender-based violence and other human rights atrocities,” she notes. “It’s important to understand the communities’ needs and meet the priorities they identify.”

To help do that, the clinic hires cultural health navigators (CHNs) — lay health care workers steeped in the culture and language of those they serve. “CHNs deeply understand patients’ background, religion, and lived experience and can interpret their health care through those lenses.”

CHNs offer patients ongoing supports, from accompanying them to prenatal visits to facilitating a smooth hospital discharge. And they can chart all interactions in electronic health records so that physicians know what’s been done or discussed.

“These are people who have escaped war and gender-based violence and other human rights atrocities. It’s important to understand the communities’ needs.”

Crista Johnson-Agbakwu, MD
Founder of Valleywise Health’s Refugee Women’s Health Clinic

Like Baltimore’s BHB, Ohio’s Moms2B, and similar programs, the clinic’s supports are accompanied by classes on perinatal health. But its offerings include a tour of the hospital labor and delivery unit — a crucial support for participants unaccustomed to Western, medicalized births.

“Things like IV lines and beeping noises and blood pressure cuffs can be very scary for this population,” says Johnson-Agbakwu. “They’re used to being mobile in labor and can interpret what we do as tying them to the bed. The tour helps demystify a lot of this.”

In all its work, the clinic strives to honor patients’ perspectives. “We try to go beyond checking the boxes of ensuring medical care,” she says. “We are engaging in care that’s anchored in mutual respect. That’s a piece that can be missing in achieving maternal health equity.”

Reaching rural patients

Many of the patients treated by Vidant Health in eastern North Carolina face significant pregnancy-related risks. More than half are overweight or obese, and many have diabetes or hypertension. The poverty rate of this population is twice the national average, and nearly all live in remote rural areas.

Black people — who comprise roughly a third of Vidant’s birthing patients — often fare the worst. In one recent nine-year period, they represented nearly 70% of maternal deaths in the region.

And Vidant Medical Center, based in Greenville, is the only large hospital in an expanse covering 29 counties.

Since 2017, Vidant has been working to support providers throughout the region in efforts to ensure high-quality care during obstetrical emergencies.

One major focus is drills in birth-related crises. These simulations — hundreds have been held in 18 hospitals over the past three years — cover emergency cesarean sections, maternal resuscitation, and more.

The scenarios unfold realistically: A Vidant staff member assumes the role of a patient, and the local team races to save her — calling for emergency assistance, rushing to get instruments, and suggesting necessary maneuvers.

“In a small hospital, these emergencies happen maybe once every two or three years,” which makes it tough to keep skills fresh, says James deVente, MD, PhD, medical director of obstetrics at Vidant Medical Center. “We give them a chance to practice skills over and over so that when something actually happens, they’re ready.”

Traveling to provide training is not always the best option, though. So Vidant providers have also logged thousands of hours advising local providers on how to handle their toughest perinatal cases.

Now, in an effort launched in July 2020, Vidant experts also remotely treat high-risk patients, working in collaboration with 15 local obstetricians.

“Patients often need to drive 60 miles or more each way to be seen [at Vidant],” says Alan Sacks, MD, who heads the Maternal Outreach Through Telehealth for Rural Sites (MOTHeRS) Project. “Appointments can be a costly ordeal in wages lost for a day off from work, child care, and transportation. The project is patient-centered. We basically go to them.”

In addition to telehealth services like remote ultrasound, the effort screens all participants for food insecurity. Those in need immediately receive a food package and are connected to a local food bank. All patients with diabetes or obesity also receive ongoing nutrition counseling.

Sacks highlights another key component of the program: mental health care.

“Mental health disorders carry a 50% increase in severe maternal morbidity and mortality. Nearly 9% of maternal deaths are attributable to mental health disorders. All of these figures are higher in African American patients. The situation and statistics are tragic and can fuel a worrisome intergenerational cycle.”

Looking ahead, Sacks hopes to expand the MOTHeRS Project to additional remote locations. Meanwhile, Vidant’s efforts so far have made a difference. For example, the infant mortality rate in the region dropped by 24% in recent years.

“There’s more work to be done,” says deVente. “But we set out to make this region a better place to give birth and be born, and I think we’ve succeeded in doing that.”

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