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A Report from the 2014 MANA Convention: Why Midwives Matter to Reproductive Justice Midwives are not important to by , JD to add one more choice The following is an excerpt from Dorothy Roberts’ keynote address at the to maternity care for women. 2014 Midwives Alliance of North America (MANA) convention in St. Lou- is, MO. You can listen to the full address at www.midwiferymatters.org. Midwives matter fundamentally to WHOOLQJDVWRU\/RUL*ULIÀQZDV achieving justice in childbearing. efore I began my career 8 weeks pregnant at the Medi- Bin reproductive justice, I cal University of South Caro- was an advocate for midwives. lina in 1989 when she tested safely for their children in an 0LGZLYHV ZHUH WKH ÀUVW UH- positive for crack-cocaine. At and newly delivered women equitable society. productive justice activists I all over the country, which the time, the hospital had a &DVHV OLNH /RUL *ULIÀQ·V knew, and that was because collaboration with the police continues to this day. still occur, and we need to ,KDGP\ÀUVWWKUHHEDELHVDW and prosecutors so that nurs- :KLOHWKLVFDVHUHÁHFWVUH - continue expanding the way home attended exclusively by es and doctors would turn in strictions on women’s repro- we think about reproduc- midwives. My midwives were for arrest pregnant patients ductive freedom, it doesn’t tive freedom. In July, 2013, a two Puerto Rican sisters who testing positive for drugs and ÀWWKHGRPLQDQWYLHZRIZKDW reporter, using work by the were very politically active patients who gave birth to ba- reproductive freedom means, organization Justice Now, re- and rebellious in New York bies testing positive for drugs. because for most people in ported on an on-going illegal City. I connected my home /RUL*ULIÀQZDVDUUHVWHGDQG the United States and the US campaign to sterilize incar- births to my awareness of the held in the Charleston County Supreme Court, reproductive cerated women in the Califor- commercialization of medical -DLO ZKLFK LV D KRUULÀF SODFH freedom just means a very nia women’s state prison sys- practice and injustice in the to be, pregnant or not. She limited right to be free from tem. There are debates about health care system. I thought was carried shackled, with leg certain kinds of government whether it’s even ethical to that my home births would be irons, and transported back interference. But there is no sterilize a who’s in- not only less risky than hav- and forth to the hospital for positive right as our Constitu- carcerated – whether one can ing a baby in the hospital, but . And she was tion is interpreted to be able give informed consent under also more in line with my fem- shackled to the bed, as many to have children or to termi- those conditions. That aside, inist and anti-racist politics. incarcerated women still are, nate a freely. States these sterilizations were not But I’ve never put into words during her entire delivery. are passing laws right and approved by an ethics board why I think midwives matter This arrest policy was enact- left to put roadblocks in front as required by California law. to reproductive justice, and ed in a hospital that served of women limiting access to There is also evidence that a that’s what I want to share primarily low-income, black services, as well as large number of the almost with you today. ZRPHQ DQG UHÁHFWHG D ZDYH roadblocks to women’s ability 150 women who were steril- Let me say a bit about what of prosecutions of pregnant to have children in ways that ized either didn’t know they reproductive justice means by allow them to care freely and

4 / MATTERS were being sterilized, or didn’t only for them and their com- point out two im- consent to the . To munities, so the message goes, portant aspects make matters worse, the doc- but for the entire country. And of the structur- tor in charge of the steriliza- so there should be an effort to ing of power in tions said that it was a cost- keep these women from hav- healthcare are saving measure for the state ing children – that is the so- demedicalization of California, because taxpay- lution to poverty and crime. and democrati- ers wouldn’t have to pay wel- Having control over women’s zation. I want to fare for these unwanted chil- childbearing becomes a way of add to that de- dren if the women went on to answering political problems. FRPPRGLÀFDWLRQ have babies. So reproductive freedom of healthcare, And in September, 2014, isn’t about women picking and use those the now former vice-chair of from an array of choices. Re- three aspects Arizona’s Republican party productive justice recognizes of justice – de- stated on his radio show: “You that the women I’ve been medicalization, put me in charge of , talking about don’t have an democratization, WKH ÀUVW WKLQJ ,·G GR LV JHW array of choices from which and decommodi- [women who rely on Medic- they can freely pick. Simply ÀFDWLRQ²DVWKHPHVWRH[DP - ceptive services, because in aid] Norplant, protecting imaginary choices ine why midwives are impor- a reproductive justice lens, implants, or tubal ligations.” does neither these women tant to justice in childbearing. they are part of a continuum This is explicitly eugenic nor any woman any good. Re- Part of why I birthed my of the kinds of childbearing talk – if you rely on Medic- productive justice recognizes babies at home attended by and pregnancy experiences aid, you take your pick of ei- that women make childbear- midwives was that I was that women have. I think that WKHUJRYHUQPHQWEHQHÀWVDQG ing decisions in a social con- afraid to have my baby at the recognizing abortion and sterilization, or no coverage text involving interlocking hospital. Every friend of mine birth as related and ordinary of medical care at all. This is systems of sex, race, ability, who had a baby in the hospital aspects of women’s reproduc- part of a long history of ster- sexual orientation, and reli- had a c-section. I was afraid of tive lives can help challenge ilization abuse that was based gion, and that systems of op- the technological, pharmaceu- the medicalization not only of on eugenicist thinking about pression hinder women’s abil- tical, and medical interven- labor and delivery, but also of both women of color and ity to even have choices at all, tions that I thought I would abortion, both of which have poor white women. Begin- let alone pick among them. It be at risk of if I went in a hos- restricted women’s autonomy. ning at the turn of the twen- also recognizes that procre- pital. in the United The women’s self-help move- tieth century, was a ation has a role in politics, re- States is profoundly shaped ment, and groups like the mainstream science and gov- ÁHFWHG LQ SROLWLFDO FRQWURYHU - by a view that it is so patho- Black Women’s Health Imper- ernment policy in this coun- sies aimed at keeping certain logical it always requires ex- ative and the Boston Women’s try, and it continued into the women from having children treme measures in order for it Health Collective have long 1970s when the North Caro- and others from having abor- to be safe. And yet, it’s these recognized the importance lina Eugenics Board was still tions. Reproductive justice extreme measures that place of demedicalizing all parts ordering the sterilizations of recognizes, then, the right to women at risk, and we know of women’s maternal experi- mostly black women who were have or not to have children. that women are at undue risk ence, rejecting a faith in main- welfare recipients. It includes both the right to of unnecessary medical inter- stream medicine to determine For women of color and terminate a pregnancy and ventions because of the rate of what is best for women. poor white women in this the right to have a child, and cesarean sections in the Unit- Midwives are also crucial to country, childbearing is seen also the right to be able to par- ed States. Almost a third of all the democratization of mater- as a social problem that soci- ent that child. births in the United States are nity care and healthcare more ety must correct. And there One reason why midwives performed by cesarean sec- broadly. Everything I say are multiple stereotypes about matter to reproductive justice tion, and the World Health Or- about maternity care is also the sexual and reproductive is that part of having control ganization has said that 10% a message for the way health- irresponsibility of women of and freedom over childbear- to 15% is the optimal rate. By care and medicine generally color and poor women that ing is how, where, and with that measure, there are many are practiced in the United support the view that they whom you have your baby. unnecessary, risky surgical States, and midwives with a shouldn’t be having children. I’m not talking about picking procedures being performed reproductive justice perspec- I’ve given examples of law en- among choices – home birth on women in this country. tive are at the forefront of forcement policies that seek versus hospital birth. Mid- Christa Craven in Push- changing the way healthcare to deter these women from wives are not important to re- ing for Midwives writes, “Many is delivered, making it more having children, but there are productive rights to add one midwifery supporters have just. By democratization I also welfare reform, child wel- more choice to maternity care initially been hesitant to de- mean creating more equitable fare, and policies for women. Midwives matter scribe their struggle as one power arrangements between that seek to deter reproduc- fundamentally to achieving for reproductive rights be- doctors and patients, or health tion. Identifying procreation justice in childbearing. cause of associations with professionals and patients, as the cause of social prob- Feminist philosophers feminist efforts for women’s midwives and doctors, and lems blames the most disad- Hilde and James Lindemann choice regarding abortion women of different social sta- vantaged women, who are the Nelson write that “ and contraception.” When tuses. Midwives help democ- victims of social inequalities is concerned not simply with I read that, I was intrigued ratize the healthcare provider- and state violence, for social the just distribution of so- that there would be a separa- patient relationship by giving inequality. It’s their childbear- cial goods, but with the just tion between what midwives care that involves a more eq- ing that is the problem not structuring of power.” They do and abortion and contra- uitable sharing of information

WINTER 2015 / 5 POLITICAL UPDATES and power. This is a model for die from pregnancy-related protections were enacted af- than we are already. how all health professionals complications. Amnesty In- ter it was discovered that And is genetic testing free- can relate to their patients. ternational’s report Deadly many thousands of women on dom? In a study of women Midwives also help democ- Delivery found black women in welfare had been coercively who had babies with Down ratize healthcare by challeng- the United States are 4 times sterilized in the 1960s and syndrome, women reported ing the power that doctors more likely than white women 1970s. These physicians ar- that if they didn’t do genetic wield over maternity care. to die from pregnancy-related JXH WKDW WKH ÀUVW WLPH PDQ\ testing and terminate a preg- The marginalization of mid- complications. That is a re- of these women see a doctor nancy deemed to be one that wives today is related to the productive caste system. The is when they’re about to give would produce a child with historic campaign that doc- gap between black and white birth in the hospital, and since disabilities, they were pun- tors have waged against mid- infant mortality in the US we don’t know when we’ll see ished in various ways, with wives’ involvement in health- has increased since the 1950s them again, the doctors chastising them for care for women, stretching and is getting worse in recent should be done immediately. either not doing the testing or from abortion to childbirth. years in states like Missis- My answer is, why do we have not terminating the pregnan- To consolidate their hold over sippi, where the infant death a healthcare system or a social cy. There is also the question medical care at the turn of the rate for black babies is 3 times system in this country where of whether or not the public twentieth century, the medi- that of white babies. Another WKHÀUVWWLPHDZRPDQVHHVD should pay for children who cal profession engaged in a example is the shackling of in- doctor is when she’s about to are born with disabilities and concerted campaign to drive carcerated women during de- give birth? Obviously there’s illnesses if their parents could midwives out of business. livery, which I think is a form no way that woman is going have avoided it through ge- This was a campaign rife with of torture, and which still goes to have a homebirth except in QHWLFWHVWLQJ,GRQ·WÀQGEHLQJ gender, race, and class bias on in some states. Fortunately an emergency situation. She’s punished and denied support against midwives who were there’s been a relatively suc- not a candidate for a home- if you don’t do genetic test- more likely than doctors to cessful campaign against it in birth because of the deplor- LQJ D IRUP RI IUHHGRP , ÀQG be women, non-white, immi- recent years, but incarcerated able conditions that she’s in that a form of coercion. And I grants, and low-income. women in this country are also because of social inequality in think that midwives should be Midwives also challenge disproportionately women of this country. at the forefront of a movement the reproductive caste system color. This is an issue where Finally I’d like to discuss against this because midwives in this country and around midwives could be out front, GHFRPPRGLÀFDWLRQ ² ZKLFK democratize the relationship the world that is based on because midwives understand is a response to the way in between health profession- power differences among better than anyone except the which everything about get- als and patients, and among women. By reproductive caste women giving birth them- ting pregnant, having a baby, patients, and treat them and system I mean that childbear- selves – whom nobody wants to not having a baby, has been their babies as valued human ing among women in this listen to – how dangerous it is FRPPRGLÀHG LQ WKLV FRXQWU\ beings, not commodities. country is not valued equally. to shackle a woman while she Babies are increasingly prod- Midwives can push for de- Some women are seen as more is giving birth. We know there ucts that you design, and test, medicalized, democratized, deserving of having children are women who experience and purchase, and there is a DQG GHFRPPRGLÀHG ZD\V RI by virtue of their race and grievous injuries from this. move in this country to make caring for people in general, wealth, while others are seen Out-of-hospital births at- women in particular responsi- with a model based on their as not deserving of having tended by midwives are often ble for a high-quality product work with women in the ma- children at all, and are sub- painted as another option for in their babies. For instance, ternity care context. This is jected to coerced sterilization, the well-heeled women who Apple and Facebook are pay- not just about adding another welfare policies, law enforce- can afford it. But they cannot ing for egg freezing for their choice for women who happen ment policies, immigration be a luxury exclusively for the female employees. Some say to be able to afford it, or are policies – some of which are most privileged, and should this is wonderful and gives us in a social position where they explicitly designed to keep be available to all women, re- more options – the option to can make a range of choices. them from having children. gardless of income and social have our babies in middle age. This is a matter of justice for At one end of the reproductive status. It has to be part of a But is this really an option? all people – in this country caste system we have popula- much larger, radical transfor- Or are corporations pressur- and globally. Reproductive tion control policies, and at mation of access to high-qual- ing young women to work justice is part of a broader the other end we have a multi- ity healthcare and changes in throughout their 20s and 30s struggle to create a more just, billion dollar fertility industry equitable living conditions for nonstop, pushing them not humane, and egalitarian so- in this country that decides to every woman in this country – to have a baby so that they ciety. And I am very grateful facilitate more childbearing for every person in this coun- work constantly during their to midwives for being part of by certain women who tend to try – so that an out-of-hospital most productive years? The that struggle. t be disproportionately middle- birth can be a reality. I’m not companies don’t mention the FODVV DIÁXHQW ZKLWH ZRPHQ naïve to think the reason why health risks involved in egg Dorothy Roberts is a professor Midwives have an important I had problem-free, healthy, freezing, which are not widely of Africana studies, law, and role to play in challenging the wonderful homebirths is just known. I believe that if Apple, sociology at the University reproductive caste system by because there was a midwife Facebook, and other compa- of Pennsylvania, long-time providing equal care to wom- there. It was also because I nies want to provide options reproductive justice advocate, and en who are now at opposite was in good health! for women, they should give author of many books and articles ends of the hierarchy. There is a new call by women and men paid family on the interplay of gender, race, One of the tragic outcomes some physicians to end the leave for at least a year. To and class in law and public policy, of being at the bottom of the informed consent protections me, the option to freeze eggs including Killing the Black Body: reproductive caste system against sterilization abuse of doesn’t add to our choices, it Race, Reproduction, and the is that you’re more likely to women on Medicaid. These FRPPRGLÀHV XV HYHQ PRUH Meaning of Liberty .

6 / MIDWIFERY MATTERS