“Reproductive justice” was first coined in 1994 by the Women of African Descent for Reproductive Justice and defined in 1997 by Sister Song (a formal outgrowth of that group) as “the human right to maintain personal bodily autonomy, have children, not have children and parent the children we have in safe and sustainable communities.” To that end, reproductive justice is a human rights focused frame for examining the “economic, social, and political power and resources” available for people with the capacity to birth to “make healthy decisions about their bodies, families, and communities in all areas of their lives.”
While the emphasis of late has been hyper-focused on protecting the right of people to not have children, those who choose to experience pregnancy, birth, and parenthood deserve protection and advocacy as well.
The Black maternal health crisis in the United States refers to the fact that Black women are now four to five times more likely to die from adverse pregnancy complications than white women. However, there is a maternal health crisis in this country that affects all birthing people regardless of race, ethnicity, age, education or socioeconomic status. Among developed nations, a report from the Commonwealth Fund found the United States spends the most money on maternal health yet has the highest rate of maternal mortality.
The CDC breaks it down like this:
Every year hundreds of people die during pregnancy or within one year postpartum
Thousands more have unexpected outcomes of labor and delivery with serious short- or long-term health consequences
More than 80% of pregnancy-related deaths in the U.S. are preventable
Against this stark backdrop the Black Maternal Health Caucus in the U.S. House of Representatives introduced the Black Maternal Health Momnibus Act in January of 2020. The collection of 12 bills were designed to address the maternal health crisis. To date, ten of the twelve bills have been passed and signed into law, including nine which were part of the Build Back Better Act. But top down policy change is only part of the solution when it comes to addressing the reproductive care options for those who choose to parent. Long-term change must be systemic within the medical infrastructure and that requires education, advocacy, and equity.
Equity
Equity demands the dismantling of bias, discrimination and racism inherent within medical institutions. The system of thought endemic to medical programs is fostered by its hazing culture, said Latham Thomas, world renowned doula and founder of Mama Glow.
“People get adapted to . . . [the] break down of their egos and self esteem and their ability to speak up for themselves. And this is one of the tenants of white supremacist patriarchy. People are adopting and adapting to a culture that is unhealthy, that is unethical, that is unsafe. And so then when you think about all of the harms that take place, why is it that these harms aren’t accounted for? Why is it that our medical system functions institutionally, like the carceral state?”
The study of gynecology and obstetrics began as an outgrowth from chattel slavery after the United States abolished the trans-Atlantic slave trade in 1808. Since importing people from another continent to labor for free was now illegal, the antebellum South turned its focus to breeding and other forms of reproductive control.
Thomas, who is a professor at Brown University, where the Mama Glow doula training program is embedded, said the focus for her within the institution of medicine from school to hospitals, is on decolonizing the mind and becoming self-aware of the racial and power dynamics at play.
“The invitation for the students is really to be self aware, to bring soft skills into these spaces,” Thomas said. “I’m teaching bioethics students, folks who are doing MPA, MPH, OB GYN, pre-med, and also folks who are doing medical anthropology and that’s teaching and mentoring. Then we also have nurses, you know, people 25-30 years doing this work, who’re in our classes, doctors, like full on physicians who are in the classes, because they know, they didn’t learn these things in medical school.”
Thomas said the response from her students has been positive because it gives them insight to understand the framework of how the harms within the medical system came to be, and a safe space to share, reflect, and process together.
Education
The infusion of equity into a harmful system to enact change is closely bound to education. Mama Glow’s education component is helping to train a new generation of physicians, practitioners, nurses, doulas, and more by examining the harms of the current system. It has also been integrated into programs at colleges and universities across the country, including HBCUs like Tougaloo in Mississippi and Albany State University in Georgia.
In the deep South, where maternity care deserts (areas where there is low or no access to a hospital or birth center) abound, Thomas said birth workers must rely on skills they were not taught in medical school.
“A lot of what we do . . . has really been to fortify people with tools for self care and mindfulness, emotional self regulation, these techniques that do help us when we’re experiencing stressful situations. It’s teaching people about our ancestral technology, and Blackness and, and the important contributions that our communities have made, and particularly the Black community and the Black body as a site of study and violence in medicine.”
In teaching an ethic of care for the body, and the Black woman’s body specifically, Thomas emphasized the necessity for people–all people not just physicians–to witness and understand healthy, non-violent, physiologic birth.
On that topic, Lisa Price, founder of global hair, skin, & body care company Carol’s Daughter said, “So much of the training for a labor and delivery doctor for an OBGYN is the surgical part of things. And yes, that is important because there are circumstances where surgery is necessary to save lives. But if you don’t have the experience of what it looks like the other way, the non medicine way, the non epidural way, the more peaceful way, if you will, you just don’t have a perspective of what else it can be. And you default to what you know, and what you’ve practiced and what you’ve been taught.”
According to the March of Dimes, 32% of live births were Cesarean deliveries in the United States. Black women have the highest rate of Cesarean deliveries at 36%. A C-section is an emergency surgery. One to be utilized when the parent or child is at risk. But risk factors include adverse pregnancy outcomes like gestational diabetes, pre-eclampsia, and eclampsia which are all leading drivers of maternal mortality and the maternal care crisis in the United States. Not all difficult births require emergency surgery and knowing the difference between the inconvenience of a long labor period and the need for surgical intervention is where doulas thrive.
Advocacy
In 2020, Thomas and Price teamed up and co-launched the Love Delivered campaign through Carol’s Daughter and the Mama Glow Foundation–the advocacy arm of Mama Glow. Launched during Black Maternal Health Week the goal was to activate 10,000 advocates and touch 100-million people over three years. At that three year mark, Love Delivered is now at work in five major U.S. cities (New York, Atlanta, Miami, Los Angeles, Washington D.C.) as a service program offering doula support to those in need.
“We don’t do income verification,” Thomas said. “There’s no barrier. If someone is black and birthing and just looking for prenatal or postpartum support, they can access that support through this program.”
There are also multiple programs that allow the doulas to stay active and make a living. Globally, Mama Glow has 2,500 doulas who do private work. However, doulas can also do pro bono work underwritten by a city, a program like Love Delivered, or eventually Medicaid as access is expanded across the country for the work of doulas to be covered through the government program as well as affording birthing people to maintain that coverage for a full year post partum as opposed to being dropped 60 days after delivery.
The Love Delivered program is wildly popular, oversubscribed, and always looking for new donors, which makes the work of the Mama Glow Foundation that much more important. Operating under the mission of advancing reproductive justice and birth equity through the pillars of education, advocacy, and the arts, the foundation provides scholarship support to doulas, nurse practitioners, and lay people who feel called to do this work.
At the center of the Love Delivered is their 64-page “Birthing While Black Prep Guide.” “It is a guide that allows people to, through a very easeful and bountiful and supportive lens, [explore] their care options,” Thomas said.
By giving birthing people the tools to understand the role of everyone from a doula to an OB GYN, Thomas said they can envision birth differently and have the experience grounded in joy, uplift, and triumph.
Protecting the experience of birth, for Black women, is Afrofuturism at its best. But it’s also steeped in the ancestral knowledge; the art and technology of birth.
“If you think about our people,” Thomas began, “they were grand midwives, Black women and African [women] midwives doing all this work . . . we have found ways to carry these traditions forward and to reach back and grab our things number one. Number two, I think that it has become very difficult for us to practice in certain ways, because care providers, the medical system at large, is one that is extractive.”
In addition to the racism rampant in the U.S. medical system, it is also an institution built on a for-profit model. A model and system, Price said, is not up to Black and Brown patients to solve.
“That problem is bigger than us. What our job is, is to say, ‘No, you’re not going to do that to me. No, I don’t want that. No, I don’t need that.’ Our job is to help you have that voice to advocate for yourself.”
As Thomas and Price continue to expand the Love Delivered campaign the next frontier is advocacy through policy. The legislative priorities include passing and signing the final bills of the Momnibus Act, expanding Medicaid access nationwide, as well as implementing a paid federal leave policy.
“We have to get there.” Thomas said. “We are the only country in the industrialized world . . . that doesn’t have paid leave. . . If you think about Black folks, specifically, one in four women are headed back to work 10 to 14 days after giving birth . . . after having a baby.”
Price is happy to use her platform at Carol’s Daughter to advocate and increase conversation around these harsh realities, so that the narrative around Black maternal health shifts from constant talk of crisis to the consistent emphasis of joy, abundance, and thriving.
“Most of my consumers are people who would be in a birth process. So it helps to start dialogue, change the conversation.”