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Birth Justice

Birth centers built like 5-star hotels – each private room complete with a personal jacuzzi, a designer birth ball, whitewashed versions of indigenous Mexican birthing scarves, coconut water on tap, lavender mist, complementary encapsulation to transform your placenta into chewable vitamins, and state-of-the-art life-saving medical technology discretely hidden behind eclectic birth art. I imagine white privilege in birthing to look like this.

Of course, this birthing fantasy is only the reality for a small fraction of low-risk, high-earning expecting families. I have only seen this level of luxury in documentaries, and I don’t know where I could find it even if I could afford it. And yet, there is a much more subtle and nuanced but critical layer of white privilege in birthing that exists. I sometimes have to squint my eyes to remind myself that it’s there.

Despite the problems with pregnancy and birthing during the pandemic that pregnant people universally face, I am privileged to have the advantages that I am afforded. Most significantly, I am 2-3 times more likely to survive childbirth than a Black woman. But how is that even possible? There is a slippery slope of factors that make this statistic a reality.

Having access to health insurance, not being dismissed when I raise concerns about my growing baby and my body, and being profiled as “low risk” are all elements that weigh in my favor in this grotesque statistical game. And I am quite certain that being “low risk” has nothing to do with my genetics or inherent level of health. Rather, it is a consequence of the fact that I can focus my energy on practicing prenatal yoga and reading pregnancy books instead of having to worry how I will afford my next meal.

And because my doctor deemed me “low risk,” I now have access to prenatal care from midwives, who support normal, natural childbirth - one that is not burdened by the unintended consequences of unnecessary medical intervention. I would have even been able to birth in a birth center in a parallel universe without COVID-19.

And yet, being married to a once-undocumented Mexican man may place my daughter at risk simply because of the color of her skin if birthing in America has not changed when it’s her turn to have a child. But sadly, while global maternal mortality rates continue to drop, pregnancy-related mortality in the United States has been steadily inching upward since the 1980s. This despite the United States spending more than any other industrialized country on childbirth.

In a country marked by such shameful health outcomes for birthing people who are Black/Indigenous/People of color (BIPOC), low-income, transgender, or non-citizens, what would birth justice look like?

At its heart, birth justice is social justice. It is a means of achieving reproductive equity and ending social disparities in pregnancy and birth.

In its most radical form, birth justice would mean altogether obliterating the patriarchal techno-medical model of birthing. This model is a definite, dominant player in violence against women and has disempowered all pregnant people, especially those who look different from the privileged norm. But somehow, I don’t think an outright revolution would go down well with most of today’s political leaders.

Instead, there are countless baby steps along the path to birth justice and equity that we can take. Here are a few:

Support access to doulas

Doulas, or trained birth companions, can advocate for pregnant people whose voices are silenced by the system. Currently, doulas are seen as a luxury in the medical model of birthing. The cost of a private doula can range anywhere from $800-$3,500, paid entirely out of pocket. And this rate is actually quite modest when we consider all the work that doulas provide for the families they support – from being on call 24/7 during the final month of pregnancy to providing prenatal and post-partum visits.

For the care that they provide, researchers estimate that doulas would save insurance companies almost $1,000 per birth. This cost-savings is due to their role in advocating for fewer unnecessary medical procedures – and for the wellbeing of the birthing person. Research has also found that pregnant people who have access to doulas have a 22% lower rate of preterm birth, a reduced rate of C-sections, and higher newborn Apgar scores compared to those without access to doulas. These statistics could represent the difference between life and death of pregnant people and their babies.

Support safe access to birth choices

For the health and safety of birthing people, we should be empowered to birth in an environment where we feel comfortable and where we are heard by our providers. Yet the reality is that in our current medical model, who we birth with and where we birth are often wholly determined by the narrow limits of insurance policies.

What is typically available and covered by insurance is paradoxical – prenatal and birthing care from overworked obstetricians who specialize in surgical births, rather than midwives who support birth without excessive intervention; and highly medicalized hospital births rather than natural births in birth centers or at home (the latter of which are often paid entirely out-of-pocket or even illegal in some states).

Support BIPOC birthworkers

Birthing people should have access to birthworkers who have similar lived experiences to them. This would establish a level of trust and understanding that could make birthing people comfortable advocating for themselves and vice versa, it could make birthworkers inherently understanding of birthing people’s true needs. Instead, the typical whitewashed array of medical personnel continues to exacerbate asymmetries in birthing power dynamics.

Support public health research on racial disparities in birthing

We should absolutely continue to track health inequities in birthing, conduct research to determine why these differences exist, and hold hospitals accountable for improving on these statistics.

Support implicit bias training for ALL birthworkers

Everyone who participates in birthing should be mandated to examine their own biases and assess how they might be shaping their interactions with BIPOC birthing people. Enough said.

Undo underlying social and economic health disparities

As is the case with many public health issues, social and economic factors weigh heavily in creating health disparities. In order to close the Black-white gap in birth outcomes, we need to undo racism, reduce poverty, eliminate the race-based education gap, and radically shift gender norms that disempower birthing people.

Understand your own implicit bias

Collective action toward social justice is made of many individual steps. In the wake of the reignited Black Lives Matter movement, a range of lists have been created and shared that aim to educate white people on the needs of BIPOC people and encourage us to examine our own implicit biases. Here are a few of my favorites that have been shared:

I still have so much uncomfortable but necessary work to do in understanding my own privilege, in understanding what it means to advocate for myself and for other women, and in learning to pass the mic when I don’t have the lived experience to speak. Perhaps more importantly, at 39 (!!) weeks pregnant, in a very limited amount of time, I am faced with the seemingly impossible task ahead of me of learning how to be a mother to a half-colored child. Although I am running out of time before motherhood, I am comforted by the fact that learning can be a lifelong journey one that I will no longer have to embark on alone.

I may not always know the right things to say, I may always struggle to learn how best to use my privilege, and I’ll likely never be perfect as a woman or a mother. But one thing is clear in my mind and heart: to all the birthing people out there – regardless of what you may look like, where you may come from, or what your lived experience may be – I am with you now.



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