JOHN YANG: Tonight on PBS News Weekend, how the holiday shopping season is unfolding with consumers still feeling the squeeze of inflation.

Then, one womanús fight to end hunger for tens of millions of malnourished children around the world.

WOMAN: The first time that I saw a two-year-old that looked like my newborn at home, I realized that this is an incredibly urgent situation that is something that I could never unsee or forget about.

JOHN YANG: And why black women are more likely to have unnecessary C-sections, putting them at risk for surgical complications.

(BREAK) JOHN YANG: Good evening.

Iúm John Yang.

Rebel forces are spreading further into Aleppo today, taking control of landmarks in Syriaús second largest city and encountering little resistance from government forces.

A war monitoring group said airstrikes late Friday killed 20 insurgent fighters.

Syriaús army said dozens of its soldiers have been killed since the surprise offensive was launched on Wednesday.

Rebels celebrated outside the cityús historic citadel.

MOHAMMAD AL ABDO, Insurgent Fighter (through translator): It is an indescribable feeling.

My older brother was martyred here in Aleppo 13 years ago.

Praise to God.

Praise to God.

JOHN YANG: Opposition forces hadnút attacked the city since 2016, when President Bashar al Assad regained full control.

An Israeli airstrike in a car in Gaza today has killed five people, including charity workers.

The World Central Kitchen, which provides food relief, says itús pausing operations in Gaza for the second time this year.

In April, seven of its workers were killed in an Israeli strike.

Israel says one of the charities employees killed today was involved in the October 7 Hamas attack on Israel.

In Khan Younis, another airstrike hit a vehicle next to a food distribution site, killing 13, including children.

And in Gaza City, seven died when an Israeli strike Get a house.

MOHAMMED AL-ZAYTOUNIYEH, Gaza Resident (through translator): There is no safe place.

Residents are being bombarded.

Explosive barrels are thrown down at them at their houses, markets, streets, shelters, schools.

There is no safe place.

Where should these people go?

JOHN YANG: Overnight and into Today, more than 30 people have been killed in Gaza.

The ceasefire agreement between Israel and Hezbollah appears to be holding, despite sporadic incidents.

In southern Lebanon, an Israeli drone strike killed two and wounded two others.

Another strike hit a vehicle, wounding three, including a seven-year-old.

And the IDF says it hit a weapons smuggling site near the Syrian border.

And the Georgian capital of Tbilisi has been rocked by a third straight night of protests against the governmentús decision to suspend talks to join the European Union.

Thousands rallied outside parliament.

Some launched fireworks.

There have been major demonstrations since the ruling partyús disputed victory in last monthús parliamentary elections.

Georgiaús Interior Ministry says police arrested 107 people on Friday.

Still to come on PBS News, how one woman is rethinking the way hungry children are fed around the world and why black women are more likely to get unnecessary C sections, risking surgical complications.

(BREAK) JOHN YANG: This weekend is the traditional start of the holiday shopping season, beginning with Black Friday.

By one estimate, online spending yesterday was more than 14 percent higher than last year, and in store purchases were up a modest 0.7 percent.

Some retailers have been offering discounts since shortly before Halloween in hopes of encouraging shoppers squeezed by inflation to open their wallets.

We asked people to tell us about their shopping plans this year.

JOHN FERVER, Sacramento, California: My name is John Ferver and I live in Sacramento, California.

SHERRY SHERRY, Centerville, Virginia: My name is Sherry and Iúm in Centerville, Virginia.

SUSEN POPE, Wapaka, Wisconsin: I am Susan Pope and I live at Wapaka, Wisconsin.

SHERRY SHERRY: My main shopping usually starts in July.

SUSEN POPE: I started my holiday shopping for this.

Year last year.

JOHN FERVER: September and October, I always be thinking about what I shouldnút be spending then so I can spend a little more around the holidays.

SUSEN POPE: I donút really budget for my gifts.

It just works out in the end.

SHERRY SHERRY: I usually have kind of a budget in mind.

I canút say I stick to it because if I find something I think itús really great for someone and it exceeds the budget I planned, I go ahead and get it because I want them to have it.

JOHN FERVER: Whatever I need to get for the holidays, Iúll look online a little bit more to make sure Iúm stretching my budget.

SHERRY SHERRY: I used to love Black Friday.

I would be the one getting up at five in the morning to go buy toys.

But in the past few years I havenút done it because there arenút a lot of things on those sales that Iúm really looking for as gifts.

SUSEN POPE: I donút think price matters.

I can give a bit of joy for $12 as easily as I can give something for $100.

JOHN FERVER: I found my friends love if I make something for them or if we just catch up and have time to hang out and relax.

We donút tend to do that enough during the year and so itús nice to make that a part of the holidays.

SHERRY SHERRY: Iúm hoping that thereúll be more time to get together this holiday and spend time together because to me thatús more important than the presence or anything else.

Is the presence of the people, not the presence or from the people.

JOHN YANG: The National Retail Federation forecasts sales in November and December will be as much as three and a half percent higher than last year.

That would be the slowest growth since 2018.

Dana Telsey is CEO of Telsey Advisory Group, which tracks both consumer and retailer behavior.

This year, Barronús named her one of the 100 most influential women in finance.

Dana, I know you and your team go out every Friday, every Black Friday, and walk the stores.

What did you see yesterday and what does it tell you about this yearús shopping season?

DANA TELSEY, CEO, Tesley Advisory Group: So thank you very much for having me.

I was in the stores yesterday and what I saw is traffic built as time went on.

No longer do we have the 6:00 a.m. starting points with the rush into the stores, but overall as the afternoon comes, it gets busier.

Whatús also different this year than last year?

More promotions this year than last year.

In order to bring the consumer in, the consumer of almost all different income levels are being more choiceful, discerning, selective in their goods and promotions are a way to drive the sale.

So I think itúll be a three to three and a half percent increase this year and I think this Black Friday weekend so far is matching those type of increases.

JOHN YANG: You say the stores have promotions to get people in, the stores get people spending.

Do you expect those promotions to continue as the season goes on and prices to be cut more and more?

DANA TELSEY: I think we will have promotions as the season goes on.

Keep in mind we have a shorter holiday season this year than last year.

Given that Thanksgiving is later, with five fewer days between Thanksgiving and Christmas.

The deal started earlier.

They will continue.

But retailer inventories are lean.

So I think the level of promotions, which seems to be now around 30 percent off for black Friday weekend on average, they may step up, but everyoneús going to want to hold those discounts to maybe that 30 or 40 percent off.

I donút see it like years past when it was 60, 70 percent off plus.

JOHN YANG: The consumers looking for deals, looking for value.

Is this because of inflation and high interest rates?

DANA TELSEY: Yes, it is.

It is because of inflation.

We know that pricing is elevated this year compared to what it had been in years past, partially because of the inflationary headwinds.

But also consumers want to spend on experiences that create memories.

So the bifurcation between spending on goods and spending on services is there.

And in order to attract consumers to buy goods, you have to have new and whatús new this year, whether itús the closed toed shoe at Birkenstock, whether it is also the on sneakers or the HOKA running shoe, those are some of the new things in footwear thatús driving appeal.

JOHN YANG: Could people be shopping for themselves as well as for others right now because theyúre worried about the effect of President Elect Trumpús tariffs?

DANA TELSEY: Letús just say Black Friday weekend is always about shopping for others and shopping for yourself.

Because some of those deals that are out there, consumers are purchasing for themselves.

Definitely with a lower interest rate environment that is certainly something that consumers will benefit from but with this expectation for tariffs that could be coming.

Overall, that could be a headwind, particularly to apparel prices that should show a double digit increase, which is concerning.

But when would that show up?

Later rather than sooner.

But itús something thatús being watched very carefully because retailers and brands canút diversify their sourcing fast enough.

JOHN YANG: You mentioned that the sales youúre expected about around 3.5 percent.

Thatús not much more than inflation.

What does that tell you about the retail economy and the retail situation?

DANA TELSEY: When you think about the retail economy and the retail situation overall, we have a time period right now where essentials is whatús driving a lot of the gains.

We have prices still higher than what it was a few years ago.

We have luxury and sales moderating, beauty sales moderating.

And youúre looking at innovation and apparel that could drive some increases.

Whether itús the wide leg denim jeans, weúre still having categories like the home, still basically moderate also because the higher interest rates from home is not driving increased sales of new homes out there.

Thatúll be a wait and see if anything.

What weúve been saying out there is the expectation that whether itús collaborations or influencers, marketing is necessary to drive interest.

And I think the consumer overall is being very choiceful in what they spend.

JOHN YANG: Very choiceful in what they spend.

Could that mean winners and losers among the retailers?

DANA TELSEY: Of course it does.

And when you think about some of the winners, it could be the off pricers who offer value like the TJX, Burlington and Ross Storrs.

It could be brands that are showing product that consumers donút have in their closet already.

Whether itús Birkenstock, whether itús Ralph Lauren or whether itús Abercrombie and Fitch.

And then there are those where there are concerns.

You take a look at companies like Kohlús overall, who has been weaker given the increased competition even from some of the off pricers.

You have some of the brands where you need to see acceleration, like Guess.

They get a lot of their sales from Europe and weúre watching what they do carefully.

So overall you always have winners, you always have those that need to show improvement.

And this year luxury doesnút have the same growth that it had in the past.

JOHN YANG: Dana Telsey, thank you very much.

DANA TELSEY: Thank you for having me.

JOHN YANG: Armed conflicts and climate change are fueling a global hunger crisis.

Tens of millions of children under the age of five are malnourished.

Pamela Watts of Rhode Island PBS Weekly introduces us to a woman on a mission to change that.

NAVYN SALEM, Founder, Edesia, Inc.: Our most basic need in life is food and nutrition.

So without that, we really arenút setting children up for their best chance that they would have in life.

PAMELA WATTS (voice-over): Giving a child a chance in life serves as the compass for Navyn Salem.

Sheús on a quest to end malnutrition for children around the globe under the age of five.

Her company, Edesia, named after the Roman goddess of food, manufactures these squeezed packets of a fortified peanut butter called Plumpy Nut.

The nutrient enriched paste doesnút need water or refrigeration and is easy for kids to feed themselves.

It has been proven to take a child from the brink of starvation to salvation in just six to eight weeks.

Salem has traveled the world witnessing the results of Plumpy Nut firsthand.

NAVYN SALEM: They have to eat one packet in the clinic in order just to prove that they can eat it and they donút have complications.

These children donút look anything like the ones that you just saw in the severe acute malnutrition space.

They are already being interactive.

Theyúre laughing, theyúre playing with you.

PAMELA WATTS: Whatús the magic?

Itús fortified.

It has nutrients and calories.

NAVYN SALEM: And tastes good.

I mean, even if youúre a very hungry child, the food needs to taste good because children, no matter where they are, they can all be picky.

PAMELA WATTS (voice-over): Salem says volunteering for a clinic like this one in Chad is where her nutrition mission was born.

NAVYN SALEM: The first time that I saw a two-year-old that looked like my newborn at home, I realized that this is an incredibly urgent situation that is something that I could never unsee or forget about.

It stayed with me all the time.

PAMELA WATTS (voice-over): The United Nations Childrenús Fund found that 155 million children under age 5 are malnourished.

And the World Health Organization estimates that almost half of the deaths of children in that same age group are linked to malnutrition.

Itús a crisis Salem says is being fueled by two things.

NAVYN SALEM: Climate change is causing droughts, years long droughts and floods that are catastrophic.

Theyúre biblical, right?

Like weúve never seen before.

So this is forcing huge amounts of people to migrate.

PAMELA WATTS: Andrew Camara, vice president of operations at Edesia, was once one of those affected by conflict.

His family had to flee Sierra Leone during its long civil war.

ANDREW KAMARA, VP of Operations, Edesia Inc.: My two sisters and I ended up in Guinea, West Africa, as refugees.

So we had to learn how to survive, how to stay resilient, how to fight to really make it another day.

I think that experience prepared me for the work that Iúm doing today.

I felt like during my many years of living in a refugee setting and seeing suffering, human suffering, hunger and starvation and malnutrition and all kinds of difficulties.

PAMELA WATTS (voice-over): And Kamara is not the only one working here who has lived that experience.

ANDREW KAMARA: Many, many of my colleagues have been through the same path as me.

Theyúve lived in refugee camps.

They were once hopeless, and today theyúre in a position of giving back to those same refugee camps.

They take that job very seriously.

A life is saved for every time you produce a box.

PAMELA WATTS (voice-over): Kamara sees each package as a box of hope.

The plumping nut inside provides meals for two months, enough to rescue a severely malnourished child.

ANDREW KAMARA: These could be your children.

These are the worldús children.

And we all have to be part of the fight to give them a life that is full.

PAMELA WATTS (voice-over): Salem is now developing a product for pregnant women.

She says itús not about treating malnutrition.

Prevention is the priority.

NAVYN SALEM: We donút have the luxury of saying, this isnút working so well today because, yes, weúre going to get interrupted everywhere on a government level, a policy, a war zone that a truckús trying to get through, pirates in Somalia, you name it, weúve had it.

Right?

But how do you get around that?

And how do you make sure?

Because every minute counts.

PAMELA WATTS (voice-over): For PBS News Weekend, Iúm Pamela Watts in North Kingstown, Rhode Island.

JOHN YANG: Cesarean section surgeries or C-sections to deliver babies are the most common surgical procedures in U.S. hospitals.

Now, a new study of nearly 1 million births from 2008 to 2017 finds that black women are almost 25 percent more likely than white women to have unnecessary C-sections, needlessly putting them at risk of surgical complications.

The study is from the National Bureau of Economic Research and was done by three economists.

Sarah Kliff is an investigative healthcare reporter for the New York Times.

Sarah, your story, writing about this, you had a wonderful way of describing it.

You had an example of, or a hypothetical, a black Mother and a white mother.

Same medical history, same doctor, same hospital.

SARAH KLIFF, Investigative Healthcare Reporter, The New York Times: Yeah.

So they walk into the same hospital, they have the same doctor.

On paper, their medical records look basically identical.

But the black woman has a 20 percent higher chance of delivering by C-section, which really begs the question, you know, why is this happening?

JOHN YANG: Was there answer to that in this study?

SARAH KLIFF: Thereús not one answer.

There are some theories, and we canút exactly get inside the doctorús heads.

It could be that they are aware that black women have higher rates of maternal mortality.

So theyúre thinking, Iúm going to get this person into surgery faster.

I donút want to risk complications.

It could be that they arenút listening to black mothers as much.

If theyúre pushing back against the idea of a C-section, itús difficult to tell.

But we definitely know that something different is happening for these black women.

JOHN YANG: And we should say that there are reasons why, medical reasons, why a doctor would schedule a C section, that the benefits outweigh the risks.

But what are the risks of an unscheduled, an emergency C-section on a woman who has no complications?

SARAH KLIFF: Yeah, I mean, itús pretty much the risk of adding a major surgery onto the delivery.

C-section is a major abdominal surgery.

Thereús the risk of an infection, of a hemorrhage.

These are rare risks, but they are added on.

When you do a C-section.

There is the increased recovery, which is happening when you have a newborn, which, as any parent knows, is a really challenging time already to have a major surgery youúre recovering from.

Thereús also financial risks.

C-sections are more expensive, so the patient could end up with higher bills from their delivery if that is how they end up delivering.

JOHN YANG: Now, the researchers looked for correlations.

They couldnút find any correlations with medical risk factors with the gender of the doctors or the economic status of the mothers.

But they did find one interesting correlation.

SARAH KLIFF: Yeah, the fascinating thing they were able to look at is what was going on in the rest of the hospital and if the operating room was empty.

And I think this was probably the most interesting finding to me was that when the operating room was empty, thatús when black women were significantly more likely to have C-sections than white women.

When the hospital was busy, people are rushing around, but if someone really needs that C-section, black and white women end up getting C-sections at near identical rates.

Itús when the hospital is less busy, when the OR is sitting there empty.

Thatús really when you see these unnecessary C-sections happening on these black mothers.

JOHN YANG: Knowing what you know about from reporting, covering this, how the hospitals work, the implication is they want to keep that operating room busy.

SARAH KLIFF: Look, most of the American healthcare system, itús paid on what we call a fee for service system.

Every time you do an MRI, every time you do an operation, you are getting paid for that service.

You know, werenút able to talk to the doctors or hospitals.

This is an academic study, and I will say the rates of C-section are higher for both black moms and white moms when the OR is empty, which suggests maybe conscious, maybe unconscious.

But there is more of a propensity to send women to C-section when the capacity is there for them.

JOHN YANG: And black women have long talked about different treatment in their pregnancies.

A feeling like their doctors arenút listening to them, not taking their pain into consideration.

Is this part of that?

SARAH KLIFF: Yeah, certainly.

You know, Iúve written some stories about patients who just feel like they werenút listened to, that they asked for an epidural and it took a long time to get it, that they said, I want to try natural labor longer.

And they were really told, no, you need to go to a C-section.

And I think itús, again, difficult to untangle the role of race in all of this, but it certainly is an experience of a lot of black women that they feel like their providers arenút necessarily listening to what they want.

And they might be listening better if their skin was another color.

JOHN YANG: Is there some thought or an indication that this could be a contributor to the fact that black women have higher rates of maternal mortality and childhood infant mortality?

SARAH KLIFF: Certainly.

I mean, C-section, again, is a procedure thatús generally safe, but it comes with its risks.

So if youúre going to add on a major abdominal surgery, thatús essentially increasing your risk for something to go wrong during childbirth.

And, you know, there are many stories out there you can hear of, you know, black women who tried to raise concerns during their delivery.

They werenút listened to and ended up having a bad outcome.

So that certainly could be a part of this story.

JOHN YANG: All these factors put together, the hospitals wanting to keep the ORs busy, black women disproportionately being sent there.

What does this say or suggest about the state of health care in America right now?

SARAH KLIFF: It suggests that a lot of the things that determine the health care you get, they arenút about your medical records.

They arenút about what you actually need.

Theyúre about all these other factors, the color of your skin, whether the operating room is available, itús sitting empty, that the health care that weúre all receiving, itús not just about what we need, but all these other factors that are completely out of our control are contributing to the care that we get.

JOHN YANG: Sarah Kliff of the New York Times, thank you very much.

SARAH KLIFF: Thank you.

JOHN YANG: And that is PBS News Weekend for this Saturday.

Iúm John Yang, for all of my colleagues, thanks for joining us.

See you tomorrow.