Nicolle Gonzales in a video for The Changing Woman Initiative Fundraiser
Over at Colorlines, I wrote about an exciting new initiative led by two Native midwives, Nicolle Gonzales and Brittany Simplicio, to open a Native-run birth center for Native women in the New Mexico region.
Nicolle Gonzales is a 35-year-old certified nurse midwife (CNM) with three kids ages 9 to 14. She’s Navajo (or Diné, as Navajo people refer to themselves), from Waterflow, New Mexico, and has embarked on a journey to create the nation’s first Native American birth center. “I’d like to see a nice building with pictures of our grandmothers, cedar welcoming you into the door, and moccasins for babies instead of blankets,” says Gonzales. “I want a place where women and families feel welcome.”
Gonzales is among only 14 other Native American CNMs in the United States. She and Brittany Simplicio, another midwife who is Navajo/Zuni, began raising money for a nonprofit that will run the center, Changing Woman Initiative (CWI), last year.
Indigenous women face incredible health disparities and barriers to supportive and humanizing care during pregnancy and birth. I was really surprised to learn that 70% of births at Indian Health Services (the agency run by the federal government that provides most care to Native people in the US) are attended by CNMs. But very few of those midwives are Native themselves. Gonzales says she’s one of 14 Native American CNMs in the entire US.
It’s one major issue with the midwifery and birth center movement–just bringing the midwifery model of care isn’t enough. You also need to bring culturally appropriate care along with it, and sometimes the best way to do that is with midwives who are from the community they are serving.
I think it’s really important for doulas, and activists, and birth workers to understand the social and political context of pregnancy and birth in the US. Clearly, I think it’s so important that I wrote a book about it.
A big piece of this history is understanding how the fertility of women of color, and low-income women, and immigrants, and those who are mentally-ill or incarcerated has been manipulated by government institutions, including hospitals.
I recently interviewed the director of a new documentary about one of these instances, where Latina immigrant women in a teaching hospital in Los Angeles were sterilized after c-sections without their full and proper consent. It’s a really heart-wrenching story, but also one of resilience and successful pushback–laws mandating informed consent for tubal ligations arose as a direct result of this situation.
Ever since I joined the doula movement there has been a strong anecdotal sense that the doula community is very white. While I haven’t seen any official data on this (I could imagine it’d be difficult to access a community that is pretty small, but also not congregated in any one organization), it’s the sense I’ve gotten from all of my time and work in this field.
In recent years there has been more attention to race and racism in the doula community, and way more doulas (and midwives, other birth activists) of color speaking up about race and representation.
I think there are many ways the doula community needs to engage with the reality of racism, how it impacts the maternal health of women of color, especially Black women, but increasing the number of doulas of color in our movement is one really important step.
I often get asked by white doulas–what can I do about racism and maternal health disparities? I talked a lot about this question in my speech from SQUATfest two years ago, but I didn’t explicitly answer it.
Well, now you have a major opportunity to step up. A group in the Bay Area is fundraising to bring more doulas of color (and low-income doulas, and formerly incarcerated doulas) into the work.
Infographic via East Bay Community Birth Support Project
It’s a problem we all know about, and one that just keeps getting worse. A new shadow report, written for the United Nations International Convention on the Elimination of Racial Discrimination, examines the ongoing crisis of maternal mortality for African-American women, which I wrote about in my latest article for Colorlines.
“Over the last 40 years, the rate of black women dying in childbirth has been three to four times the rate of their white counterparts. For example, in Fulton County, Georgia, which includes Atlanta, there are 94 maternal deaths per 100,000 live births for black women—three times the national average. The white maternal mortality rate in the same county is essentially zero—too insignificant to report. In Chicksaw County, Mississippi, the maternal mortality rate is higher than those in countries of Sub-Saharan Africa, including Kenya and Rwanda.”
It’s so upsetting to see this crisis worsen, and wonder whether there is any political will to really address it. The report also includes anecdotal evidence from two focus groups conducted in Mississippi and Georgia by Sistersong, where black women shared their experiences with health care. Unsurprisingly, there were many accounts of racism, miseducation and disrespect experienced.
One woman from Jackson, Mississippi, shared that her doctor had assumed she wouldn’t be able to use birth control effectively: “After I had the baby, and I went back for my checkup…[the doctor] told me, ‘I’ll see you in six weeks.’ I said, ‘Why?’ He said I’d be pregnant again.” Others described prenatal and labor experiences where they didn’t feel their providers adequately informed them of their options. Another woman from Jackson had this to say: “We really don’t have a lot of good experiences when it comes to having childbirth, especially because we’re poor…Why are all these women having caesareans? Was it really necessary for me?…You have more black women having caesareans. Now I’m questioning.”
I didn’t include this in the article, but Monica Raye Simpson, Executive Director of Sistersong, told me that doulas and midwives were brought up in both focus groups. While we may not be able to solve maternal mortality on our own, we may be able to improve individual women’s health care experiences by providing support and resources.
The report also addressed lack of access to health care because of immigration status for Latina women living in South Texas.
My only hope is that the more we raise the alarm about this problem, the more likely we are to see steps taken to address it.
Read the full article here, and the full report here.
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.
In early August I had the honor of speaking at the SQUATfest conference. It was a first of its kind gathering that brought together doulas, midwives and other birth activists interested in radical politics. It didn’t have a central theme, but I knew that it was going to be a unique space.
I gave the talk below to the attendees on the morning of the second day. I have a lot more to say about the gathering, and the topics I addressed below, which I’ll do in follow up posts. Makeda Kamara gave an absolutely earth-shattering and life-altering keynote address the following day. I don’t believe that it was recorded, but if you ever have a chance to read Makeda’s writing or see her speak, you have to do it. She has incredible wisdom about midwifery, as well as racial justice movements in the US and abroad.
The gathering was inspiring, but it was also another reminder that there is much work left to do, even within the “radical” parts of our movement, particularly around questions of racial justice and dealing with white privilege.
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The reason I started my blog, Radical Doula, in 2007, was because I couldn’t imagine a room like this one existing. I had been a doula for a few years, and as my own identity and politics developed, I looked around me and felt alone.
I felt alone as a queer and genderqueer person. I felt alone as a Cuban-American, a Latina, a child of immigrants. I felt alone as a reproductive justice activist and someone who supported access to abortion as well as access to homebirth and midwives. I felt alone as someone who approached my work as a doula as social justice activism.
I remember one of the first, possibly the very first, conversation I had with another doula who felt similarly. Christy Hall, who is here today, and I met at a reproductive justice conference, and the memory of crouching in the corner with her, infant in arms, talking about being doulas with radical politics is seared in my brain.
So very much has changed since that first conversation all those years ago. The fact that this gathering is happening at all is a major testament to that change.
Needless to say, I no longer feel alone. Instead I’m in awe of the incredible growth in the doula movement, and particularly in the movement of doulas who see their work as part of a broader social justice vision. For so many of us, this work isn’t just about improving a few select people’s experiences with pregnancy and birth–it’s about changing the systems altogether.
This is no easy task. And while the growth and expansion of the doula movement is really good news in many ways, it also presents its own unique challenges.
What I wanted to talk about today is how I see our work as birth activists as part of the broader reproductive justice movement.
For those of you who aren’t familiar, reproductive justice is a movement that was established by women of color in the reproductive rights movement who wanted a framework through which to see their organizing that better mirrored the lives of the people in their communities. It’s an intersectional framework that acknowledges the complexity of people’s lives and the many issues that affects them.
One way I describe it is building a world where everyone has what they need to create the family that they want to create.
While abortion still tends to most of the attention in this work, I think birth workers, are also perfectly suited to be part of this movement and to utilize the framework to support our own efforts.
So what does it really mean to understand our work as doulas, or midwives, or birth activists, as part of the movement for reproductive justice?
First it means we put at the center of our work those who face the most challenges.
It’s been tough to say much of anything online, or otherwise, since the verdict came down on Saturday evening in which George Zimmerman was acquitted of all charges for the murder of Trayvon Martin.
The murder has stirred up intense conversations about race, necessary, painful conversations about race. Because George Zimmerman is a mixed-race Latino, (his mother is Peruvian, his father white) his race has been called into question in many ways throughout this process. Some people of color, and Latinos, have tried to minimize his Latino-ness. The right wing has tried to play it up, claiming that his mixed heritage means that race could not possible be a factor in the murder. Some have labeled him a “white Latino or hispanic.”
I felt personally very pulled by these conversations because I too could be put in a category with George Zimmerman. I am a light-skinned Latina. My parents are both immigrants from Cuba, but my mother’s parents immigrated to the island from Eastern Europe as Jews fleeing anti-semitism and persecution. My father’s side had been in Cuba for multiple generations.
Race is a complicated socially-constructed and politically-shaped reality. For Latinos in the US, this reality is very different than the reality we might experience in our family’s country of origin. People who would be seen as White in Latin America may be seen as people of color in the US. These categories are fluid, ever changing and also extremely important in shaping our lived realities.
I am not Trayvon Martin, and as someone who could be George Zimmerman, I have a unique responsibility to work against racism within communities of color, including Latino communities. It’s a responsibility that weighs heavily on me. It’s also one that I see as distinct from the responsibility of white people to fight racism.
My understanding of my own identity has been heavily shaped by my knowledge of the political history of race and racial justice organizing in the US. The term woman of color originated as a term meant to build solidarity between Latinos, Blacks, Asians and Native Americans in the US. Loretta Ross has a great clip I originally found at Racialicious that I often refer to:
You can read the transcript at Racialicious, but this is the part that is most important to me:
And they didn’t see it as a biological designation—you’re born Asian, you’re born Black, you’re born African American, whatever—but it is a solidarity definition, a commitment to work in collaboration with other oppressed women of color who have been “minoritized.”
Now, what’s happened in the 30 years since then is that people see it as biology now.
Race is not a biological reality, it’s a social and political one. And that social and political reality differs widely depending on how you are read, how the world interacts with you. Because I am light-skinned, because I speak English without an accent, I walk through the world with relative privilege when it comes to race. But I also have a clearly marked Latino name. I may not even know how that has shaped interactions that happen virtually, or where my name is the first thing someone sees. There are many ways in which one can be racialized in this country, and that is why the term woman of color, or person of color, was employed—to build solidarity across groups, not ignore differences or presume we all have the same experience.
There is a great post at Black Girl Dangerous, by Asam Ahmad, further extrapolating on this in reference to Trayvon:
We are NOT all Trayvon Martin. People of color keep getting hella mad for being called out on white passing privilege, for being asked to hold themselves accountable to the ways they are not like Trayvon and more like Zimmerman. So many folks seem to be having a hard time acknowledging that this murderer was a Latino who had light-skinned privilege and played into the rules of White supremacy to get away with murder. The fact that so many white folks are identifying with him should tell you something: it is a marker of how some people of color gain access to the toxic privilege of passing for White, of choosing not to identify themselves as poc but coopting into the system of White supremacy instead. Sometimes we do this for our own safety but sometimes, obviously, we do it for other reasons altogether. These are all realities of this case, and they are realities of a hierarchy that accords privilege and oppression on the basis of the amount of melanin in our bodies.
Why do these facts make you mad? Why is it so hard to acknowledge that you have access to forms of privilege that Black folks simply never have? As poc we are so often taught to think of ourselves as oppressed and as nothing else. But oppression is not a static entity and it does not remain constant for all POC. How can this not be obvious to anyone paying the slightest amount of attention right now?
Those of us who are not Black need to be very explicitly clear about this: Trayvon was not murdered because he was a person of color. This verdict was not delivered because he was a person of color. Trayvon was murdered because he was Black. This verdict was delivered because he was Black. Given the amount of intense anti-Black racism that continues to circulate in non-Black poc communities, given the number of ways we continue to benefit from anti-Black racism, it is paramount that we do not forget this. To appropriate the specificity of this injustice, to attempt to universalize this travesty as one faced by all people of color is to perpetuate another form of violence. To not acknowledge the role and specificity of anti-Black racism in this whole charade is another form of violence. This murder and this verdict are very specifically about anti-black racism – about the power of White supremacy and about what it means to have a black body in a White supremacist society.
And our inability to acknowledge these facts are hurting Black folks and African descended folks right now. This is not solidarity. This is not what solidarity can ever look like. It shouldn’t be that fucking hard to sit back and listen to the grieving voices of black people in this moment. It shouldn’t be this hard to not get defensive and keep your mouth shut and just listen.
I’ve been heartened by this and other efforts, like the tumblr We Are Not All Trayvon Martin, have taken on to try and explain the difference between solidarity and appropriation, between allyship and silencing.
Personally, I’ve grown and changed in countless ways over the years in my identity and understanding of my role within the broader community of color. From refusing to write an accent on my last name as a kid and the inclination to be silent about my identity and how I see myself, to instead insisting on spelling out clearly where my privilege lies and what I see as my role, it’s ever evolving. I have big thanks to give to many mixed-race and light-skinned people of color for walking the journey with me.
I’ve realized in the many years that I’ve written this blog, I’ve often assumed my audience was predominantly white. That’s because the doula community is predominantly white, and the full-spectrum doula community I’ve met and interacted with is also predominantly white. I know I’ve been able to feel comfortable, or be welcomed into some of these spaces because of my passing privilege, and it’s something that I think about constantly.
I also know that for doula work to be truly radical, truly transformational, we have to center race as a key factor that shapes the experiences of pregnancy and parenting in this country. We have to talk about it politically, personally, in every aspect of our work. So I’ll start with my vulnerable place, my story, my experience.
This article in The Modesto Bee, authored by Corey G. Johnson of the Center for Investigative Reporting, shows what many of us have assumed: coercive sterilization is not a historical practice—it’s a present reality. While fights rage on across the nation to maintain our access to safe and legal abortion procedures, for some folks, the fight to maintain the ability to become pregnant, and parent those kids, continues.
These fights, primarily because they impact low-income folks of color, don’t get the kind of attention and resources that other battles do. There is racism and classism in this divide, and we have to do all we can to raise hell and attention for the ways population control efforts continue today in this country.
Doctors under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates from 2006 to 2010 without required state approvals, the Center for Investigative Reporting has found.
Former inmates and prisoner advocates maintain that prison medical staff coerced the women, targeting those deemed likely to return to prison in the future.
The article explains that the reason these procedures required state approval is precisely because of the history of coercive sterilization for incarcerated women. Court cases in the 1970s based on the discovery that Latina women in California public hospitals were being sterilized without proper consent led to a set of rules regarding how and when you can properly consent to a sterilization procedure (like a tubal ligation).
In order to obtain consent, you have to provide consent information and documents in the patient’s native language (Latina women were found to have signed papers in English consenting to the procedure, despite not speaking English) and you also can’t obtain consent during labor or delivery.
In addition, this article explains that federal funds could not be used to provide sterilization procedures to incarcerated folks because of fear of coercion.
From this reporting, which relied on the work of Justice Now, an organization working with folks on the inside to eradicate prisons, coercion is exactly what took place in many of these sterilizations.
One interesting thread throughout the article, which is distinct from the historical incidences of coercive sterilization, is the use of repeat c-sections as a medical rationale by the doctors quoted for these procedures. With repeat c-sections, they say, there is a risk of uterine rupture upon subsequent pregnancies.
The question there, of course, is why so many c-sections to begin with? I don’t buy it, and assume it’s just a medical attempt to cover up what is really a procedure pushed because of judgement about who should parent, and how many children someone should have, particularly someone who is incarcerated.
I increasingly get more and more infuriated about how little attention in the reproductive rights arena goes to the struggles of low-income, people of color trying to maintain their right to pregnancy, parenting and bodily autonomy. If you are truly doing reproductive justice work, than this issue should get as much attention as any abortion rights fight.
My latest column at RH Reality Check discusses the fact that last week was the tenth anniversary of National Latino AIDS Awareness Day, and delves a bit into the causes of race-based health disparities.
I was inspired to write about this topic after hearing scholar and Professor Dorothy Roberts speak at Barnard College. She’s the author of two incredible books about race and health, Killing the Black Body–an absolute must read for anyone interested in reproductive rights, and Fatal Invention, her most recent book (which I reviewed here last year).
Fatal Invention takes on the question of race and genetics, and addresses the growing movement which tries to connect race-based health disparities to genetic difference, despite very little evidence to support these claims.
Latinos do not experience higher rates of HIV and AIDS because of any unique genetic propensity or susceptibility toward the disease, but instead because of the social and economic reality faced by Latinos that lead to higher rates of HIV infections and AIDS-related illnesses. Things like lack of access to health care, homophobia, lower rates of condom use, and language barriers among other causes.
To some it may seem absurd to think that anyone would argue that race-based health disparities are a result of genetic or biological differences among racial groups, but the fact is this argument is on the rise, and it isn’t new. Studies with these kinds of claims grace the front page of the New York Times science section on a regular basis. Rather than acknowledge disparities, some want to highlight the concept of difference—meaning that racial groups have biological differences that account for these statistics, rather than blaming the conditions of racism that shape our lives and our health.
This distinction feels as important to highlight as the problem of race-based health disparities themselves, particularly in an era where the FDA can approve a race-specific drug (BiDil, a drug for congestive heart failure) with little scientific evidence backing the claim that it successfully targets African Americans over other groups.
Our work to address health disparities needs to be based outside of the laboratory or pharmaceutical industry, and instead placed in the broader social context that is likely to blame for these disparities in the first place.
Precisely because I talk so much about these race-based health disparities, I think I, and all of us, need to do a better job of explaining the likely cause. Because if not, in our silence, the assumption can be made that the statistics are simply a matter of differences. This obscures the real and horrific injustice of poverty, racism and all of the other social factors at play.
I mentioned a bit about the news that a key group of midwives of color, who were previously involved with the Inner Council at the Midwives Alliance of North America, resigned early this week.
More has been released regarding their resignation, so I wanted to post additional information here.
I realized shortly after posting that I in fact do know quite a few of the midwives who resigned–I just hadn’t been in contact with them lately, and did not know they were so active in MANA. Jessica Roach sent me their letter of resignation, which is also posted on this blog.
The first part is a letter from MANA, seemingly in response to the resignation of the midwives of color. What follows is the resignation letter.
Again, because I am not involved in MANA, I don’t want to comment on the situation specifically, except perhaps to say that I feel much solidarity with the women who have resigned. Claudia Booker, Jennie Joseph and Michelle Peixinho I know to be really incredible midwives and passionate leaders–I trust their opinions and experiences.
Again, for me, the bottom line is this: we can no longer ignore the disproportionately high negative maternal and infant health outcomes faced by communities of color.
And it’s going to be damn hard to address those disparities if we can’t even address racism in our own organizations–especially if that racism means that providers of color choose to leave or are pushed out.
The needs of communities of color in maternity care can no longer be the topic of an interest group, or a caucus, or a breakout session. It has to be THE FOCUS. And my guess is that if we address the needs of communities of color, we’ll probably change maternity care in ways that benefit everyone.
Jessica Roach also wrote a follow-up letter about the resignation that Claudia posted on her facebook page–I’ll share it at the Radical Doula facebook page.
Radical Doula 