THE FULL-PAGE AD that ran in a recent issue of the Star Tribune showed a closeup of a woman’s dark brown hand with a dot of white cream on it. “Dangerous. Racist. Illegal,” read the copy.

The ad, which targeted Amazon, was in response to the online retailing giant carrying skin-lightening creams that had tested positive for mercury. Those mercuryladen creams—which are illegal in the U.S. but still sold in other countries— are not only toxic, critics say, but promote racist standards of beauty.

“That was the whole thing, to raise more awareness,” says Amira Adawe (B.S. ’07, M.P.H., ’15), founder of the Beautywell Project, the St. Paul-based nonprofit which, in conjunction with the Sierra Club, was responsible for the ad. The Beautywell initiative wants to stop the practice of using such creams to lighten naturally darker skin—and in particular, to protect women from using creams that contain toxic chemicals.

It’s a problem Adawe says is rampant in many communities of color, where people—usually women—have been conditioned to associate lighter-colored skin with beauty. By using these toxic creams, women can lighten their skin, but at great risk.

Adawe takes issue with these creams for a number of reasons: She says many skin-lightening creams sold over the internet contain toxic but unlisted chemicals, including mercury. Mercury has been found to cause a host of serious health problems, especially for babies and children. At the time the ad ran in November 2019, Adawe says her group had found Amazon was selling 15 products that tested positive for mercury.

In a more global sense, Adawe also believes the idea that lighter skin is somehow more attractive than darker skin is inherently racist, and skin-lightening creams can perpetuate that. The root of Adawe’s activism on this issue started early, in her home country of Somalia. With dark-caramel skin, Adawe says she has the darkest complexion in her family, and in Somalia, she adds, dark skin is considered less attractive. Fortunately for Adawe, her late mother, a nurse, actively discounted the idea that darker skin was in any way “less beautiful” than lighter skin and Adawe never felt pressured to change her natural color.

When Adawe moved to the U.S. in 2000, she found the issue of skin-lightening creams was a cause that called to her. While pursuing her master’s degree in the School of Public Health, she conducted her own research with members of the Somali community about the products. She later coauthored a study, Skin-Lightening Practices and Mercury Exposure in the Somali Community, along with now-retired U of M Professor Charles Oberg (B.A. ’75, M.D. ’79, M.P.H. ’84). As part of the duo’s work, they asked the Minnesota Department of Health to test 27 such products purchased at local markets and found 11 contained mercury.

Adawe, who has served as the manager of former Governor Mark Dayton’s Children’s Cabinet, and was one of the founders of the Somali, Latino and Hmong Partnership for Health and Wellness, had found her calling.

The day the ad targeting Amazon ran, Adawe partnered with Mary Blitzer (M.A. ‘11), the engagement manager for the Sierra Club’s Minnesota North Star Chapter, to deliver 23,000 signatures to the company’s fulfillment facility in Shakopee, Minnesota, calling for them to stop selling those creams. Adawe and Blitzer also sent an electronic version of the petition to Amazon’s main headquarters.

Within days, the corporate office at Amazon announced it would no longer sell the items. However, the offending products can still be found on other sites, including eBay.

While Adawe was pleased by Amazon’s response, she knows stopping the sale of these products both in the U.S. and internationally is a much thornier issue.

In December 2018, the Sierra Club published an article in Sierra magazine titled “The Rise of Toxic Skin Lightening Creams,” in which Adawe was interviewed. It said the global industry for these creams “exceeds $10 billion and is projected to grow to $23 billion by 2030.” The article also noted the biggest markets for these creams are in the Asia-Pacific, but they’re also widely used in Africa, Latin America, and the Middle East. After testing products then available on both Amazon and eBay, the Sierra Club identified 19 with mercury levels “up to 30,000 times greater than the legal limit.” The Sierra Club also noted in late 2018 that testing by the Zero Mercury Working Group, a coalition of nongovernmental organizations, had found 34 mercury-containing creams for sale in six countries alone: Bangladesh, Mauritius, Dominican Republic, Philippines, Indonesia, Trinidad, and Tobago.

Blitzer, who holds a master’s degree in urban and regional planning from the Humphrey School, says part of the work of the Sierra Club’s 3.8 million-member organization is to combat environmental contaminants in every form.

“The Sierra Club really thinks about how we can keep our communities healthy through environmental protection,” she says. The organization’s Gender, Equity and Environment Program worked with Adawe and the Beautywell Project, along with the Zero Mercury Working Group, to take on these toxic products. “We’ve been thinking about how we do good environmental work and that includes overlaps with social and racial justice through partnerships,” Blitzer says.

In April 2019, the Minnesota Department of Health’s Family Environmental Exposure Tracking (MN FEET) project looked at 400 Twin Cities women and their babies—most from communities of color—and tested for mercury, lead, and cadmium, all toxic chemicals. Women who had previously used skin-lightening creams had more mercury in their urine than other participants, and in some cases, the air in their homes also contained mercury, putting their entire household at risk. Of those studied, Asian women had the highest levels of detectable mercury, and Hmong women had the highest levels of all—which researchers said might be attributable to those groups also eating fish contaminated with the heavy metal.

Used correctly and for specific reasons—such as treating melasma, a skin problem that results in discolored patches or to treat old scars—prescription skin-lightening creams do play an important role in health care, according to Ronda Farah (B.S. ‘06, M.D. ‘10), an assistant professor in the U of M’s Department of Dermatology. However, she says, those creams are always used to treat a diagnosed skin disorder and are sourced from reputable providers. They don’t contain mercury, and are usually used only on a small area for a defined time. Farah says the fact that such creams can be misused to lighten people’s natural skin color is a well-known topic in dermatology.

“This is affecting a lot of communities, but in the mainstream, people don’t have this as a lived experience, so they don’t know about it,” says Adawe. “We have a very weak regulatory system in the United States when it comes to cosmetics. Most of the FDA’s [Food and Drug Administration] time goes to medications, and … very little time goes to cosmetics.”

That lack of oversight is one of the reasons Adawe is working with Congresswoman Betty McCollum’s office to ensure that the FDA maintains effective regulatory systems, especially when it comes to skin-lightening products. McCollum, the DFL representative from Minnesota’s 4th District, sits on the House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies, which oversees the FDA. 

“Amira is an innovative changemaker working on issues directly affecting the health and well-being of women and girls in communities of color,” McCollum says. “Her voice is an important contribution to the federal debate around the effects of skin-lightening cosmetic products on public health. Strengthening oversight on these matters is so important and I’m glad to have Amira’s help as a partner in this work.”

Kelly O’Hara Dyer is the editor of Minnesota Alumni.