Equity and Birth

The conversations about race and equity in our culture are often awkward and uncomfortable. Since I got back from the Home Birth Summit, this theme of equity and race as it relates to birth continues to come up. 

Although historically midwives in the US were largely immigrants and Blacks, non whites are underrepresented among midwives currently practicing in America. Similarly, the women having home births in the US are disproportionally white, educated, and upper middle class.

You may have noticed the lack of cultural diversity in the trailer.

I had the opportunity to meet two Black midwives whose work I have great respect for at the Home Birth Summit, Jennie Joseph and Claudia Booker (more on Claudia another day).

I have been following Jennie's innovative model in Florida working with low income and underserved women for some time. I wanted to interview her for the film, but wasn't going to make it down to Florida. The Summit was my big opportunity.

I listened.

We talked.

I was challenged.

Up until that time I had been operating under the assumption that if women and families had access and information, they could make a decision that was in line with their priorities and their specific circumstance.

"If only insurance covered it and our systems were integrated, women of all colors would have the opportunity to make informed choices about place of birth," I thought, my idealism getting the best of me. 

I wasn't unaware of the inequalities in our healthcare system, I face it every day in my work in a community health center. I know it's not that simple, but somehow in birth I really wanted it to be. 

Jennie adds a valuable perspective at the Ethics Forum.

Jennie adds a valuable perspective at the Ethics Forum.

Jennie brought me back to reality.

African American women are 3-4 times more likely to die during pregnancy or childbirth and their infants are twice as likely to die in their first 28 days of life compared to whites.

There are deep racial inequalities that can't be solved by telling a woman home birth is safe and her insurance will cover it. 

We have to talk about equity and about creating safe places for pregnant women and their families. By virtue of just living in certain zipcodes in America you and your baby are more likely to die. 

This film isn't about racial inequality, but to talk about birth, at home or in the hospital, without addressing equity would be a shallow misrepresentation.

I didn't end up getting that interview with Jennie, but I really hope I have another opportunity. I think I'm ready now.