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New efforts to criminalize substance use and pregnancy repeat racist history

July 21, 2014

My latest article for Colorlines is about the new efforts to criminalize pregnant women for substance abuse. Sadly these kinds of efforts are not new, nor are they actually helping moms or kids.

The main problem with these kinds of stories, and prosecutions, is they do nothing to address the very real substance abuse and addiction issues facing many people in the United States today. Despite decades of incredible spending and increased incarceration in response to the war on drugs, addiction and substance abuse continue. Some policy makers have acknowledged this reality and begun looking for a different ways to address substance abuse. “We’ve really tried to reframe drug policy not as a crime but as a public health-related issue, and that our response on the national level is that we not criminalize addiction,” said Michael Botticelli, acting director of the White House Office of National Drug Control Policy. “We want to make sure our response and our national strategy is based on the fact that addiction is a disease.”

There is no evidence that incarcerating women who use drugs during pregnancy will do anything to improve their health, or their children’s health. In fact, these criminalizations actually worsen the health of the newborn, and make access to appropriate drug treatment for the mom unlikely. Mallory Loyola, the woman charged under the Tennessee law, was in jail for at least three days before being released on bond, just two days after giving birth, during which her child was in custody of Child Protective Services. Kylee Sunderlin of the National Advocates for Pregnant Women (NAPW), an organization that works closely with women charged under these types of laws, explained that when a baby is diagnosed with what’s called Neonatal Abstinence Syndrome—or, the constellation of symptoms that reflects substance exposure inutero—established treatments for it include skin to skin contact with the mother and breastfeeding. That treatment is next to impossible if the mother is incarcerated and her child is in state custody.

Read the full thing here.

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A new way to fight health disparities?

July 15, 2014

I have another article up at Colorlines today, this time about a new movement in medical education to address health disparities: structural competency training.

For the past few decades, issues of health disparities and race have been approached in medical education by way of cultural competency training. The idea behind cultural competency initially, says Hansen, was listening to the patient and learning about their world view. Instead, she recounted her own cultural competency training during medical school: “Chinese patients tend to like the color red so you might want to prescribe them red tablets. Mexican families like to be together so let them all come into the exam room.” In short, cultural competency training can actually serve to reinforce racial stereotyping by making providers believe they are the experts on a certain community. Instead of approaching someone from a race or culture different than their own with a desire to listen and learn about their world view, the provider might come with a set of predetermined ideas about what that person might need or want. Even if cultural competency training wasn’t reinforcing racial stereotypes, after decades of integration into medical school curricula, there is little evidence that it is effectively addressing the issues it was created to solve.

As an alternative, Hansen and Metzl are proposing that medical students train in structural competency instead. At its core, this training would be a crash course in the social determinants of health, an area that Hansen says has historically been seen as the domain of public health, not medicine. But she and Metzl are out to change that, and Hansen thinks the increased focus on holding providers (and insurance companies) responsible for the outcomes of their patients may help to push this effort along. In a Social Science & Medicine Journal article last year they argue: “clinical training must shift its gaze from an exclusive focus on the individual encounter to include the organization of institutions and policies, as well as of neighborhoods and cities, if clinicians are to impact stigma-related health inequalities.”

The Radical Doula Guide, although I didn’t know of the terminology yet (it was coined by Hansen and Metzl) is in many ways a structural competency primer for doulas. We can’t understand someone’s lived experience without first understanding the social and political systems that influence their lives and their health. The idea of cultural competency has always seemed a bit narrow to me, and I think an education in how racism, poverty, sexism, etc impacts health will be way more useful.

I’ve been obsessed with talking about the extreme disparities faced by women of color when it comes to pregnancy and birth, and I’m trying to spend my time looking at potential solutions to the problem, rather than simply the problem itself.

Here’s to hoping this kind of education becomes the norm for all types of providers–midwives, doctors–and doulas too.

Read the full article here.

Three reasons the Hobby Lobby decision is worse for women of color

July 2, 2014

I put together some analysis yesterday for Colorlines about the Hobby Lobby decision. It’s bad news all around, but the impacts are potentially worse for women of color. An excerpt:

While much proverbial ink has been spilled speculating about the impact this will have, few have talked about how women of color might fare under this ruling. On its face there is nothing about this ruling that singles out women of color. But because of our political and economic realities, women of color often bare the brunt of the negative impacts of restrictions on women’s health anyway.

Check out the full article here.

NYTimes: Abortion and Birth, Together

June 25, 2014

In case you missed this article from two weeks ago, I was interviewed by journalist Alissa Quart for an article about full spectrum reproductive justice work.

These doulas partner with clinics directly and accompany women to their operations, helping to alleviate pain through techniques like massage, acupressure and breathing. One of them is Ms. Pérez. When I met her in a Lower Manhattan cafe, she explained how she and others like her volunteered for years at hospitals and clinics, accompanying many women whom they met in waiting rooms for their abortions. Ms. Pérez speaks Spanish, and sometimes she would translate as well. “I want to push back against the idea that birth is over here in this corner and abortion is over there in that one,” she says.

This is by no means the first article I’ve been interviewed for over the years, and not even the first that was maybe going to be in the NYTimes. That kind of media coverage comes with the territory of being easily found by googling “abortion doula”–mostly a product of how long this blog has been around (7.5 years!). Also in the interest of full disclosure on how the media world works, Alissa and I have a mutual friend who also suggested she talk to me.

But it’s clear that the work of full spectrum doulas is gaining some momentum, and some media recognition. This NYT article is a big one, simply because of the level of visibility that such a publication has. And I won’t lie, there was a thrill in picking up an actual physical newspaper and seeing my name, and quote, in print.

Just a few days after the NYT article went live, another article about abortion doulas, this one featuring the work of Lauren Mitchell, a co-founder of the NYC Doula Project, was published.

And there are more to come (I’ve already gotten another interview request from a journalist wanting to write about the topic). I always offer additional suggestions of people in this work to talk to, usually suggesting other doulas of color, and I’ll continue to do that. This movement has been fueled by the labor (pun intended) of many, and it’s important to me that my blog, and writing, don’t overshadow the many people who’ve contributed and led this work.

It’s exciting to see the fruits of so many years of work from so many of you turning it to legitimate attention. I do think the connections between abortion and birth highlighted in the NYT article are radical and affirming and have the potential to counter a really damaging political environment that tries to drive a wedge between experiences that are part of our lives.

I got one question from a midwife after the article was published, in reference to this quote:

“Midwives didn’t talk about abortion, really,” says Miriam Zoila Pérez, a doula and author of “The Radical Doula Guide.” And, she said, “some people in the midwife community are anti-choice.”

She wrote to ask if I was misquoted, and talked about the many midwives (herself included) who are indeed pro-choice. I know, and am really happy to know, that there are many in the midwifery community who are supportive of all reproductive choices, including abortion. Midwives are abortion providers in many places of the world, including in California now that legislation allowing midwives to provide some abortions passed last year.

What the first half of my quote was referencing was my experience in the birth activist community, particularly in 2005-2009, where I never heard abortion referenced overtly, particularly in birth activist writings or at the MANA conference I attended in 2005 or 2006. While the political orientation of midwives when it comes to abortion varies widely, there has been a history of silence on the topic, I assume in an effort to avoid conflict and focus on common ground between politically disparate groups. There is a contingency of midwives and doulas with strong religious views that are anti-choice. I in no means want to minimize the amazing work of pro-choice and full-spectrum midwives, but much of what lead me to start this blog was that silence on issues like abortion (as well as race, sexuality, immigration, gender and more).

I’m excited to see these topics being addressed in a more overt fashion across the birth activist world, and hope we’re moving closer to providing truly comprehensive and non-judgmental support to folks throughout their reproductive lives.


Radical Doula Profiles: Amy Haaf

June 4, 2014

This is a series highlighting folks who identify as Radical Doulas. Are you interested in being part of the series? Go here to provide your responses to the profile questions and I’ll include you!

About Amy: Hi. My name is Amy. I’m a newly trained postpartum doula. I have three children ages 4, 16 and 18 years old. Besides being a busy mom and wife with children with a vastly varying age span. I am also passionate about many things such as breastfeeding and a positive birth experience for all women. I practice attachment parenting and believe in Waldorf and other natural teaching styles. I hold many hats as an elimination communication mentor through Diaper free Baby, a Certified Lactation Counselor and a WIC peer counselor. I practiced self weaning and baby led solids with all my children. I can be reached via email @ amysppdoula@aol.com. I am listed through Birth Columbia and also have an individual website. I also have a Facebook page called Amy’s Postpartum and Lactation Services. I offer a bevy of services to women through pregnancy as well as postpartum. Areas served: Columbia County, NY and Western MA.

What inspired you to become a doula?
I have always felt drawn to birth and motherhood. I enjoy being able to empower women through helping them before and after their babies are born. Working with families is what I have always liked doing. I had positive birth experiences and help after my first son was born. I feel that I would have benefited greatly from a postpartum doula after my second and third children were born.

Why do you identify with the term radical doula?
I feel that even with my first child I was drawn to very natural approaches despite what my peers believed in. Even at twenty two as a mom I believed in natural parenting, breastfeeding, no pacifiers, no bottles, baby wearing, co sleeping, baby led solids, elimination communication and much more.

What is your doula philosophy and how does it fit into your broader political beliefs?
I believe in all woman having a positive birth experience and have been particularly following the prison birth project and the different states that are passing anti shackling laws. I am a very caring and non judgemental person, much like my political beliefs.

What is your favorite thing about being a doula?
I enjoy helping whole families adapt and well one new babies into their families.

If you could change one thing about the experience of pregnancy and birth, what would it be?
I think that women need to always remember that it is their birth and their baby. Practicing skin to skin after baby’s birth and to let baby’s natural instincts and bonds help her with breastfeeding and closeness. I would say that the moments and hours after birth need to be handled with the utmost respect with as little medical intervention ( unless faced with an emergency situation) as possible to let the fourth trimester unfold naturally to ensure mom, baby and family are savoring these precious moments as baby is introduced to the world outside mom’s womb.

Radical Doula Profiles: Kaity Molé

May 28, 2014

This is a series highlighting folks who identify as Radical Doulas. Are you interested in being part of the series? Go here to provide your responses to the profile questions and I’ll include you!

Kaity wearing red shirt sitting in front of carAbout Kaity: Kaity sees herself today as a product of the struggle to accept and love despite the obstacles of conflict and despair. Kaity grew up as a military kid and moved around every 3 years, she doesn’t have roots and isn’t sure she wants them. She came face to face with numerous violent and abusive encounters throughout her life and has struggled deeply with depression, dissociation and the long path of healing from trauma. She speaks French and loves apples, safe spaces and her kooky queer community. She’s currently a nursing student at Hopkins in Baltimore, MD. She hopes to continue on to work in public health, nurse-midwifery and sexual assault/violence research. She’s learning to let the light in and to give back and pass onward all the good that comes her way.

What inspired you to become a doula?
I’ve always been interested in birth work, but probably in my late teens, as I was discovering feminism and intersectionality/race and class conflict in America and heard about being a doula, it seemed like such an important concept. Child-bearing people in America have a long history of being silenced and controlled. For there to be an advocate present, someone who can care for you and support you and help cultivate the space and experience you want for your birth…it sounds great! Haha. I wish I had a doula for everyday life….
I see it vitally important that all people feel safe, validated and cared for in their health experiences and like THEY are in control. I think that one of the biggest obstacles to good health and positive birth experiences is the wall that’s there between the medical institution and minority groups, whether it’s people of color, the poor, the queer or trans community etc.

Why do you identify with the term radical doula?
I identify with the term radical doula because I see being a doula/birth and repro work as an inherently political thing. The ideas and practice surrounding birth work (and other care) in hospitals needs a massive overhaul and a healthy dose of patient empowerment. I believe in giving doula care with all intersections of people’s lives taken into account, particularly trauma history, race/experiences of racism, gender experiences, sexuality, orientation, ableism, self-concept etc. Everyone who gives birth is going to have a different experience that they’re bringing to the table, not everyone even identifies as a “woman”. These are really important things for doulas to be aware of and to nurture! As a queer birth worker with a long trauma history, I want to be a safe space for child-bearing people and to help empower them and amplify their voice in their experience.

What is your doula philosophy and how does it fit into your broader political beliefs?
My doula philosophy definitely is grounded in empowerment. I kind of went into this above, but particularly with birth and the creation of another life: people should do whatever they want to do.  I’m pursuing nurse-midwifery licensure mainly for reasons of insurance/Medicaid covering CNMs and the populations that I want to be accessible to, but for larger issues of birth work/midwife licensure and legal restrictions put on childbearing people, I think it’s bullshit. People should give birth/not give birth/do whatever they want with their bodies! Medical control of all people and particularly marginalized bodies needs to STOP.

What is your favorite thing about being a doula?
Oh man. I still get tripped out when I see that little baby head come out and I still get all the endorphins, which is pretty great. I generally love everything about birth work. But probably the relationship that I create with the people/families I work with, it’s really something special. To be involved in such an intimate event, you become spiritual family. When I leave I’m just so honored and thankful that I got to witness such amazing badassery.

If you could change one thing about the experience of pregnancy and birth, what would it be?
Definitely the limits and restrictions that are put on childbearing people. I would also really love to just annihilate all the crap that poor women, women of color and incarcerated women get for reproducing and how their motherhood and pregnant experience is shamed or devalued.

Radical Doula Profiles: Kayla Q Frawley

May 14, 2014

Kayla smiling, lying on a bed with two other people

This is a series highlighting folks who identify as Radical Doulas. Are you interested in being part of the series? Go here to provide your responses to the profile questions and I’ll include you!

About Kayla: Currently living in Austin Texas, Kayla is from South Minneapolis, and has attended births in Flores, Guatemala, El Paso, Texas, and Austin Texas. She is a yoga instructor, dancer, slam poet, and a student Midwife. She was raised by a social worker and a community developer in a progressive and segregated city. She spent her earlier years working with poor People’s Economic Human Rights Campaign, collaborating with Philsbury House in Minneapolis as well as Kensington Welfare Rights Union in Kensington PA. After having had the opportunity to work with different communities in arenas of women’s health such as resource management, domestic abuse, sexual abuse, and sex work she realized she wanted to be able to have more of an affect on women’s reproductive health. After doing her midwifery training in El Paso at Maternidad la Luz in 2012-2013 and attending dozens of clients she moved to Austin for a position at Austin Area Birth Center. She had the opportunity to co-facilitate the Cultural Competency class to the students of MLL Fall 2013. Behind her midwifery training and passion resides her devotion to addressing whiteness/white privilege/racism/oppressive practices in the medical and midwifery world. She is developing herself as an ally and desires to see more white women sharing dialogue about such issues.

What inspired you to become a doula?
Health Disparities.

Why do you identify with the term radical doula?
I identify with the term radical doula because sometimes in the midst of midwives and doulas I feel like my language and passion need to be walking on egg shells. I identify with the term radical doula cause I am a white woman learning what is means to be a white midwife who wanted to become a midwife because of health disparities and the complexities of that identification. I consider myself a radical doula because I am always intersecting race/class/sexual orientation with birth experience because we can not be separated from our political bodies. I consider myself a radical doula because I see blatant racism practiced in all birthing environments I have worked in, in all institutions I have studied midwifery under and among preceptors, students, and myself throughout my pathway to midwifery-which in itself maybe isn’t radical-but realizing anti-racism work is just as important as contributing to decreasing health disparities and advoca ting for safe just birth. I also identify with being a radical doula in that I offer full-spectrum services with a main focus to meet individuals where they are in their reproductive health and offer the support they need with their individual care.

What is your doula philosophy and how does it fit into your broader political beliefs?
My doula/midwifery philosophy is looking at an individual wholely including her life experience, her political, sexual and spiritual identity as well as their desires, and needs so that they are met with the right support to give them the most control they can have over their pregnancy, birth, postpartum, miscarriage, abortion, and reproductive care. My doula/midwifery philosophy are not separate from my broader political beliefs.

What is your favorite thing about being a doula?
To be apart of individuals gaining more control or awareness of their bodies, minds and spirits, practicing anti-oppression work in the reproductive health arena and knowing that along everyone’s lineage there was always a midwife.

If you could change one thing about the experience of pregnancy and birth, what would it be?
Free quality care for all women that need it in the full spectrum arena, and to enforce on-going white privilege conferences specific to midwifery and reproductive health to all white individuals who desire to go into reproductive health.


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