Earlier in the semester, we have had class discussion about racial health disparities. We’ve discussed many of the ways racial experiences determine biological and social health of pregnant women, mothers, and infants. I briefly mentioned in class that the killing of black youth and young men by police officers could be a direct stressor to black mothers or soon-to-be mothers. The recent murders of black men and children (including Tamir Rice, age 12) and the failure of the justice system to indict their murderers is a violation of reproductive freedom, which includes the ability to choose to parent. Every mother is entitled to raise her child a safe environment. No mother should ever have to watch her child be murdered for existing and then watch his killer walk free. No woman should be afraid to become a mother out fear of bringing a child into a racist, violent system that will target him as a thug, a predator or a criminal.

Reflecting over the failure to indict Darren Wilson over the past week has caused me to wonder why some lives matter and why some don’t matter to our government. This question is connected to our last class discussion about what causes a political issue to receive attention or not. The murder of Michael Brown and the Ferguson protests have certainly gained attention in the media. But action against racial police violence has not received agency in our government. People are putting themselves in danger to protest racial injustice just as they have been doing for decades, but the government is taking little action. I believe that the answer to my initial question lies in century-old institutional racism that values white lives over black lives.

This article was posted in August, five days after Michael Brown was fatally shot. The following quote resonates with me conceding the connection of reproductive justice to racial justice:

It is here where the question of “Whose lives are valued?” enters into the picture, for how cheap must a life be if millions of onlookers can think that stolen cigars justify a murder? Can we have reproductive justice if the children of some are considered inherently less valuable by several orders of magnitude? If the life of a child or a young man or woman is so cheap that misunderstandings, small mistakes, or false accusations justify their deaths, what can then be said about the rights they enjoyed in life and how valuable they turned out to be?

Reproductive justice is about more than the right to choose whether or not to be pregnant. It includes ensuring that all lives are valued and each person has access to safety- free from violence against the body or livelihood. This can be applied globally; people deserve the right to reproductive justice no matter where they live, how much money they have, or where they stand in society. To ensure that reproductive justice is reached, we must work to dissolve the disproportionate violence faced by people of color and poor people. We must dissolve the devaluation of lives based on color. In America, we must start by protecting black lives from systematic violence and attaining justice for the lives that have already been lost.

Last Thursday, President Obama announced an executive order that will protect approximately 4 million United States immigrants from deportation. The executive action will also grant those protected- those who have lived in the country for 5 years or more or who are parents to American citizens- temporary visas, which will allow them to legally work in the country.

What does this mean for reproductive health of immigrant women in the U.S.? Well, it increases the likelihood that immigrants will receive insurance benefits, if they have an employer who provides health insurance to employees. Hopefully, it will mean that many more immigrant women have access to affordable contraception, gynecological care, and maternal care.

However, I don’t think this executive order does enough to protect immigrant women’s sexual and reproductive health. The 4 million immigrants that are protected will still not be eligible for Obamacare. Although able to legally work, many of them will have low-wage jobs that do not offer insurance benefits. Although this order will improve the lives of the immigrants it protects, it does not fully address their right to healthcare. As the National Latina Institute for Reproductive Justice commented, Obama “can and should do more” to protect immigrants as he seeks to expand universal healthcare.

Since my view on this issue is pretty clear, I was wondering what you all think. Do you think universal healthcare should apply to immigrant women? Why is it important (or not) to provide healthcare to immigrant women?

Sources:

A Washington Post Article with some general information about Obama’s executive action (including a short video of his speech): http://www.washingtonpost.com/blogs/wonkblog/wp/2014/11/19/your-complete-guide-to-obamas-immigration-order/

Center for Reproductive Right’s reaction to the decision: http://reproductiverights.org/en/press-room/administrative-action-on-immigration-provides-relief-to-millions&s_src=E15SOC111419F&s_subsrc=datasync&utm_medium=social&utm_source=twitter&utm_campaign=E15SOC111419F

A Politico “blurb” about the decision: http://www.politico.com/politicopulse/1114/politicopulse16205.html

It is hard to determine how common obstetric violence is because, as we have learned throughout our study of global health, data reporting is not always reliable. Congruent to other forms of violence, victims are not likely to report obstetric violence, and if they do, it is not guaranteed that they will be heard. Additionally, obstetric violence takes many forms, and a patient may not be fully aware that obstetric violence occurred. If she is aware that an act against her autonomy occurred, she may not have the privilege or ability to speak out against it.

Last September, I read an article about traumatic birth titled “In traumatic childbirth, women say healthy baby isn’t the only thing that matters”. The article discussed how women are expected to be joyful about their births when their babies are born healthy and how their feelings about their experiences in birth are downplayed. It also brought a staggering statistic to light; according to the Prevention and Treatment of Traumatic Birth (PATTCh), approximately 30% of births are traumatic, resulting in feelings of helplessness, anxiety, fear, or isolation during labor. Further, one-third of those who describe their birth experience as traumatic will develop post-traumatic stress disorder, an intense, long-lasting psychological syndrome that often consists of anxiety attacks, distressing flashbacks or dreams, and depression. The article discussed the root cause of this staggering statistic to be obstetric violence, specifically in the form of lack of informed consent. The article led me to an organization called Improving Birth’s #breakthesilence campaign, which is a collection of experiences of victims of traumatic birth. As I looked through the submissions to the campaign, it was clear that those who had experienced traumatic birth felt ignored, antagonized, or physically or verbally abused by their caregivers. I’ve included the link the Facebook campaign below, where you can see pictures of people voicing their experiences.

I think the term obstetric violence is appropriate. I like that it includes “obstetric”, indicating that caregivers, likely clinical obstetrics staff, play a role in perpetrating violence against patients. I also like the use of the word “violence”, which carries a lot of weight. I think when analyzing this term it is important to recognize what it stands for beyond the two words. It is important to recognize that obstetric violence is a result of a systematic power structure in obstetric care.  The violence goes beyond physical harm and includes neglect, verbal abuse, refusal of resources, and failure to respect consent. Because many of us in this class are future caretakers or public health workers, we must be aware of the ways systematic violence plays out in a healthcare provider-patient power dynamic.

Sources:

Editorial: “In traumatic childbirth, women say healthy baby isn’t the only thing that matters” – http://www.stltoday.com/lifestyles/health-med-fit/health/trauma-from-childbirth-women-say-healthy-baby-isn-t-only/article_6efe50eb-89e8-517b-bb51-99e12fb06cc9.html

More information about Prevention and Treatment of Traumatic Birth – http://pattch.org

Improving Birth’s #breakthesilence campaign photos – https://www.facebook.com/media/set/?set=a.705655609507930.1073741854.255657527841076&type=3

The word “midwife” has many different connotations depending on perspective. Some see  midwives as healers and helpers. Some see them as skilled and wise. Some see them as agents of women’s empowerment. However, because of the history of midwifery and its relationship with class-perception, many see midwives as uneducated, old, primitive women. Before hospital birth was normalized, “granny” or “traditional” midwives were largely responsible for attending births, which typically took place in the home. This was the case for women of all classes in many different countries, developed and less-developed. As hospital birth became more common in the late nineteenth century, middle and upper class women began delivering in hospitals, but poorer women continued to deliver at home with a midwife. This (along with campaigns by hospitals involving ads like the one at this link: http://tinyurl.com/filthymidwife) led to a stigma against midwives that continues to distort society’s perception of midwives in developed nations, who were most influenced by the hospitalization of birth.

In reality, although contemporary midwives do have similar practices and philosophies to traditional midwives, the work of midwives today is largely influenced by the medicalization of birth. Most midwives in developed nations are nurse-midwives, who have had training in a clinical setting (State of the World’s Midwifery Report). Nurse-midwives practicing in the United States and in more remote areas of the world incorporate the philosophy of traditional midwifery with common hospital practices; for example, nurse-midwives attending home births are often equipped with pain medication, pitocin, or other medical supplies. They also often partner with hospitals in case of a need for emergency hospital-transfer. Interestingly, modern midwifery care also mimics the trend of hospital normalization by serving primarily middle to upper-class, white women. This article discusses the midwife-preference among white, affluent women and why it matters: http://nursingclio.org/2012/06/28/designing-women-midwives-class-and-choice/.

A key aspect of the midwifery model of care has stayed the same throughout generations: midwife-attended births result in less prevalence of medical interventions. A midwife’s philosophy is that a woman has the power to labor and deliver in most cases without medical interventions, such as C-sections. Midwives teach their patients to be confident in their ability to labor and are unlikely to recommend a C-section unless it is medically necessary. The World Health Organization recommends that a nation’s C-section rate be 10% or lower. However, a 2010 WHO study determined that only 54 countries out of the 137 countries sampled have C-section rates below 10%. The same study determined that out of 9.38 million C-sections performed in 2008, 6.20 million were medically unnecessary. This resulted in an excess of over $2 billion spent, and thus WHO identified unnecessary C-sections as a barrier to universal coverage of care (http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf). It is no coincidence that WHO recommends midwives as a way to improve global maternal care. Midwives reduce the number of unnecessary C-sections, preventing surgical complications and saving money.

Deciding where to give birth is very personal decision, but it is dictated by societal influences, such as socioeconomic status, availability to different types of care, and geographic location. Oftentimes, women don’t have the freedom to choose where to give birth. For example, women in rural or low-income areas may not have access to hospital birth. On the other hand, many women in places where birth is largely medicalized- such as the United States- do not know that they have options outside of hospital births or do not have access to alternative birth locations. Women should be provided with multiple options during their pregnancy, so they can decide what may be best for them. There are advantages and disadvantages for each birth setting, and because each woman and experience is different, we should not generalize and state that one birth setting is best for all women.

Home birth

Advantages: comfort in one’s own home, ability to eat, drink, and move freely, ability to choose in what room and position to give birth, often more affordable than hospital birth, fewer interventions (http://www.cdc.gov/nchs/data/databriefs/db84.htm)

Disadvantages: possible delay of emergency medical care, limited access to pain-relieving drugs, may not be covered by insurance, not available to women deemed “at risk”

Hospital birth

Advantages: close access to medical care, full staff available to attend the birth, open to patients of all medical backgrounds

Disadvantages: no drinking or eating, movements limited, labor is often rushed, likeliness of intervention increases, standard birth position on back, lack of informed consent, requires travel, expensive

Birth center birth

Advantages: freedom to eat, drink, and move, rooms designed for specific types of birth (water birth, etc.), multiple trained staff available, ability to choose position, fewer interventions, more drugs and technologies on hand than home birth

Disadvantages: requires travel, possibly delay of emergency medical care

Note that many of these disadvantages and advantages depend on the individual birth setting and caregivers and that this is a general composition.

There should not be laws that dictate where women give birth. Instead, women should be trusted to make their own medical decisions based on what is best for them. However, there should be laws (or lack thereof) that ensure that women have access to a variety of types of care during birth. Thus, hospitals should be regulated to ensure that women of all income and geographic settings could access them. Also, currently, 28 states prohibit the practice of Certified Professional Midwives, who most often attend homebirths (http://mana.org/about-midwives/legal-status-of-us-midwives). In addition to legal advocacy, it is important to advocate for a larger change to the system that tells women that 1) they are not competent enough to choose where and how to give birth and 2) medicalized (hospital) birth is the only way to give birth.

Sources and additional information:

http://www.cdc.gov/nchs/data/databriefs/db84.htm

Summary and statistics about home birth in the US

http://mana.org/about-midwives/legal-status-of-us-midwives

An explication of the legal status of midwives in the US