Birth Justice

In my last post, I mentioned that I was listening to this radio broadcast talking about homebirth and midwifery in communities of color both in Miami and internationally. The broadcast features Tamika Middleton a doula who is also a co-founder of Black Women Birthing Resistance and the two midwives from the brand new nonprofit Mobile Midwife, Jamara Amani and Anjali Sardeshmukh. The entire program is worth a listen, but I transcribed a few pieces that I found to be particularly interesting dealing with race and birth outcomes. I’ve been talking and thinking about this topic for awhile, but I think these women said it particularly eloquently. (Emphasis below is mine.)

Jamara Amani: Locally here in Miami Dade county one of the things that we’re really concerned about, and it is a problem across the nation, is the high rates of maternal and infant mortality. And it really does impact Black communities disproportionately. There’s huge disparities. Black women are four times as likely as White women to die in childbirth or in a cause related to childbirth, and Black babies are twice as likely to die in the first year of life as White babies. And there’s several factors that are involved in that. Tamika talked about the generational trauma around birth, around raising our babies. You know, there’s lack of access to resources, there’s the stress of living in a racialized society, there’s economic injustice, lack of access to healthcare, and one of the major issues that we’re raising is lack of access to midwifery care. And we know from research and studies that have been done that midwives can help to greatly reduce these disparities by helping women to stay healthy during their pregnancies, to work through some of those traumas, to develop a relationship with trust and a rapport that is individualized for that particular woman’s experience, to provide her with education that she needs to have a healthy outcome, and then to provide birth support that is natural, that is not full of unnecessary interventions that happen in hospitals such as medications and surgeries. And so what we’re working to do is to raise awareness about midwifery as a solution to these glaring health disparirites…

Anjali Sardeshmukh: Midwives do provide a lot of care afterwards too, and that’s a really important time. So when Muhammed talked about this isolation that happens I think one of the gems of midwifery care is that it really does look at … who is this person and who is in her community and where is she from and to honor that too…

And finally:

Jamara: I want to just say too that some folks may feel like, “Well, this issue doesn’t really apply to me ’cause I’m not pregnant or I don’t have kids or I’m a man or I’m too old to have kids” or whatever reasons but this is really a community issue. It’s an issue of justice. If you were born, then this affects you so it affects all of us. And healthy mothers and healthy babies are everybody’s business. Because at the end of the day if we want to have a healthy community, we really have to take care of our moms and babies and this is an issue of justice, of liberation. Because how we birth has a lot to do with how we live …where do we enter. And there’s a saying that a lot of midwives like to say which is “peace on earth begins with birth.” So if you have a peaceful, gentle birth experience where your mother feels empowered, feels like she can do anything, feels like … her rights are being respected, then how does that affect how she mothers you? How does that affect how you’re raised? How does that affect how she interacts with, you know, other aspects of mothering? I think it’s just … such a initiation point and a transformation point for women … entering motherhood. It’s a place where I feel like we have to have justice.

Teaching Diversity at Midwifery School

Recently, I was asked to teach the diversity course to the first year students at my midwifery school. I was completely surprised and honored to be asked to do so. At my school, the diversity class is a brief 3-hour seminar. That, coupled with one other brief seminar on cultural competency in the second year is the full extent of time we spend talking and thinking about anything that amounts to reproductive justice in my book. It is the only time we have to explore and examine providing birth services to folks who are not White, middle or upper class, straight, Christian, able-bodied, English-speaking, American citizens (etc. etc. etc.) clients. It is something I think homebirth midwives on the whole do not talk enough about, but that’s a whole other post meant for another day. However, I do think it’s crucial to give all midwifery students a good basic understanding of the issues at play here and some tools to keep exploring.

As far as I could tell, the class went over fairly well. It definitely was a good learning ground for myself and how I might design future trainings. I started the class by telling the students that I hoped they walked out of the class with their interest piqued, curious to learn more. Basically, we talked about the meanings of prejudice and oppression, broke down the ways in which oppression is systemic, and then talked about the ways in which we can change things, both on an individual and a systemic level. There’s not a whole lot you can learn about anti-oppression work and reproductive justice in 3 hours, so I viewed this as just the tippy tippy top of the iceberg. My hope was that if I gave them just a taste that they would go home wanting more and delve into more learning on their own.

The next exciting part of this story is that just today I volunteered to offer this training to my class and it looks like it might be offered to local midwives who are interested as well. This seems like a good place for me to get started and hopefully keep talking to folks about these issues. My hope is that some more awareness of anti-racism, anti-oppression, and reproductive justice work can truly transform midwifery.

Reproductive Justice

Do you remember a while ago when I posted about Mia Mingus and Sebastian Margaret’s Disability Justice workshop at the 2010 CLPP Conference? Mingus went through an incredible graphic utilized by Spark Reproductive Justice to help flesh out all of the nuances and aspects to reproductive justice and showed how this same framework could be applied to other social justice focuses such as disability justice and environmental justice. About a month ago, Spark posted that same graphic on their blog and I’m happy to share it with all of you! Check it out.

Reproductive Justice and Immigrant Rights

I’m spending plenty of time thinking about my upcoming blog series about midwifery and reproductive justice. However, when I’m honest with myself, I know that it’s a project I will probably be able to delve deeply into until school is out for the summer. In the meantime, check out other awesome folks who are already making the reproductive justice link, like Misma.

So, How Do Immigrant Rights and Reproductive Justice Connect?

The human rights, well-being, and livelihood of all people–regardless of documentation, status, or country of origin–is what reproductive justice is all about. Immigrant rights activists and reproductive justice activists are advocating for many of the same things: the right to live in and fully participate in society free from violence and discrimination, the right to fully access high-quality social services, including education and health care, and the right to self determine the course of their lives.

Read the full blog post here.

One Year Anniversary

I started this blog one year ago this month as I was gearing up to become a midwifery student. How exciting. Happy anniversary to us!

Earlier this month, I attended the CLPP (Civil Liberties and Public Policy) conference at Hampshire College, which was amazing. I learned all sorts of stuff that I’m still processing and got great feedback at a panel discussion on empowering birth about bringing reproductive justice into midwifery even more. I also got a chance to sit in on a long workshop with Mia Mingus and Sebastian Margaret about disability justice.

Mia Mingus and Sebastian Margaret’s workshop was absolutely fantastic. The most exciting part for me was  when we broke down disability justice into all of its myriad components and learned how to analyze each piece. I’ve long been a fan of the environmental and reproductive justice movements, but it was the first time I was given the tools to be able to analyze and understand all of the moving parts and interactive pieces of what makes a movement about social justice for all, and not just an anti-ableism movement, a pro-choice movement, or a green the environment movement. As Margaret said, no one is going anywhere unless we can move all of the pieces of this sticky wicket forward together. That means that if we are to achieve disability justice, we can’t just fight against ableism or for accessible buildings, but we have to look at how that interacts with racism, sexism, homophobia and transphobia, the top-down power structures of the school system, the prison industrial complex, etc. etc. etc.

Over the course of the coming year, I will begin writing pieces that take a look at reproductive justice, piece by piece, and finding ways to incorporate that into midwifery – both in my individual practice and learning, and as a broader part of the homebirth movement as a whole. I welcome your thoughts, questions, disagreements, and discussions. We certainly aren’t going to be successful at incorporating reproductive justice with midwifery unless there are a lot of us talking about and thinking about and doing this work. Together.

What should we talk about first? Let’s get this discussion started!

Anti-Oppression Work and Midwifery

Anti-oppression work, diversity work, and a open-eyed look at our own areas of privilege is a crucial part of midwifery education, not only for working with clients across the board but for forging successful ties with fellow midwives and other colleagues. In the direct-entry midwifery world I feel that it’s a topic that is not often explicitly talked about, which leads to problems. When we don’t talk about it, we assume it doesn’t exist. If it doesn’t exist, why would we need to examine ourselves and our own beliefs, behaviors, and interactions with others?

And when that happens, you get a situation like we currently have. Direct-entry midwifery in the US is the domain overwhelmingly of white, middle class, straight women serving largely white, middle class straight women. How can we pretend that we serve all women when this is the case?

To be fair, some of this is beyond our control. Until we have a healthcare system in the US that allows for insurance reimbursement for the services of direct-entry midwives, we will be understandably limited in who we can serve based on their incomes and financial status.

But when it comes to who feels comfortable, safe, and welcomed in a homebirth midwifery practice we start to get into questions of race, racism, and privilege (not to mention class and heterocentrism). Serving all women is not just making yourself available to them, but also means working to make sure that your practice is actively inclusive.

I don’t have the answers, but I do have some ideas on what needs to happen:

  • We need to serve more women of color
    • This means that we need to have practices that feel welcoming to women of color
    • This also means we need to understand and practice cultural competency
    • We need to help women of color view direct-entry midwifery as a valid choice for their prenatal and intrapartum care. This is a big hurdle in some locations particularly because of some shady and racist dealings beyond our control – like the government providing midwives (largely white CNMs) in the rural south to poor Black women because they believed midwives to be less well trained (and therefore cheaper) than doctors. Or the government giving depo provera to Black women as a form of temporary sterilization because it viewed these women as A) unworthy of reproducing and B) not competent enough to make their own choices about their own care. Shitty things our government has done that may not be our fault but that we nonetheless need to actively work to combat in order to stop being complicit with these actions. Start by learning about the reproductive justice movement.
  • We need more midwives of color
    • One of the first ways we can change this is by being more inclusive of the way we educate direct-entry midwives.
  • We need to radically change our midwifery education system:
    • Raise the levels of women of color enrolling in midwifery education programs
      • I look around at the class pictures of previous classes at my school and am shocked to see almost entirely white women (or women of color passing as white, hard to tell from just a photograph). I know my class is more diverse than previous classes, but only just. And while Maine is no Los Angeles, it’s not as white as you might think.
    • Raise the levels of women of color graduating from midwifery education programs
      • When I can count on one hand the number of women of color the oldest direct-entry midwifery school in the nation has graduated, we’re talking about a serious problem. One that is insidious in midwifery education and has been a problem for a long time.
    • Ensure that all midwives graduating from MEAC-accredited institutions participate in in-depth anti-oppression training by trained and skilled facilitators. Most of the trainings currently available are insufficient, poorly taught, and/or irrelevant to the work we need to do. This needs to change so that we can:
    • Turn (white) midwives into anti-oppression activists. Get them involved with the reproductive justice movement. When midwives understand oppression on an institutional level and can examine their own privileges, they will understand why it is so critically important that we tackle this issue as a group.
    • Help midwives understand that by becoming radically inclusive, they are putting one more chink into the armor of the allopathic, western medical system that works on an oppressive sexist, racist, top-down power structure. To be a midwife in the US is to be an activist. Period. To be a midwife should also include being a reproductive justice activist.

So those are my few ideas. I hope to continue to deepen and flesh them out in the coming years of my training and practice. I hope to be able to make some real change in the right direction. What do you think? What are your ideas? How can we come together to make a better and more inclusive Midwifery Model of Care for all women?