Birth Options Essential to Reproductive Justice

Erin Wilkins

The same oppressive cultural mechanisms that restrict women's abilities to make decisions about when to have children also affect their decisions regarding where, how, and with whom to birth those children.

Working part-time as a pregnancy options counselor at a busy abortion clinic and also as an apprentice midwife in an out-of-hospital birth practice, I see firsthand the obvious parallels between birth and abortion every day. Given that clear connection, I am continually disappointed by the lack of attention the mainstream reproductive rights agenda has shown to birth options.

For those of us who work in abortion care or are advocates for reproductive freedom for all, we know that sex and pregnancy are more than just biological events. They are social and political events as well and can carry very different meanings among individuals. The ability to access abortion services, as well as birth control and comprehensive sex education, are dependent on cultural and geographical factors. It has been widely acknowledged that the mainstream reproductive rights movement has historically fallen short because of its compulsory and singular focus on access to safe and legal abortion specifically for economically privileged white women. What many of us have missed in our critique of these shortcomings is that the same oppressive cultural mechanisms that restrict women's abilities to make fully informed decisions about when to have children also affect their decisions regarding where, how, and with whom to birth those children. It is clear that the current reproductive rights agenda has overlooked the broader reproductive experiences of women and families, including those who choose out-of-hospital births attended by midwives. This absence is to the detriment of pregnant women, children, and families.

Birth Options

Part of our responsibility as advocates for women's health and reproductive freedom is to educate ourselves on the full range of birth options in order to help facilitate well-informed birth options and also to support and protect the practitioners who provide out-of-hospital birth, prenatal and postpartum services. Midwives in the U.S. have attended births at home for hundreds of years and have a strong history of offering professionally trained, highly skilled, woman-centered care during the childbearing year and beyond. Current research reflects what many consumers of midwifery care have known for years – that planned home births for low risk women attended by Certified Professional Midwives are safer and ultimately involve much less intervention than births attended by doctors in hospitals. Of course, giving birth at home or in a birth center is not appropriate for high-risk pregnancies or women with severe health problems, as well as those women who do not desire to birth out of the hospital. But for women and families who do desire out-of-hospital birth, it is a valuable and necessary option that must be protected.

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There are many reasons that women choose to give birth out-of-hospital, and this includes the fact that hospital birth can be an unpleasant, and even traumatic, experience for some people. The current state of mainstream obstetrics in the U.S. reflects steeply rising cesarean rates and increasingly "actively managed" births using technological and medical interventions to alter the course of labor, birth and the postpartum. Currently in the U.S., more than 1 million cesarean sections are performed each year, amounting to more that 29 percent of all births. However, the World Health Organization has calculated that the optimal c-section rate is between 10 and 15 percent. Despite the increased documented risks of undergoing cesarean section rather than giving birth vaginally, the numbers continue to rise. While access to cesarean in the case of true obstetrical emergency is essential to the health of women and babies, it does bring up many ethical questions when it becomes an overused and even non-medically indicated option. Some pregnant women have found that the best way to avoid these risks altogether is to choose the care of midwives. As more women and their partners question the practices and protocols of obstetricians, midwifery care has become a common alternative.

Midwifery and Medicine: An Uneasy Alliance

The relationship between midwifery and medicine is complex on many levels and the two models have struggled in conflict with one another since childbirth started to become medicalized during industrialization. The medical opposition to midwives and the transition of childbirth away from the home and into the hospital has been well documented by historians. This history of intense scrutiny that midwives have undergone in the U.S. is directly related to the current marginalization, and even criminalization, of contemporary midwives.

Many aspects of reproductive freedom are affected by the conflict of theory and practice between midwives and doctors, and it is an issue that the reproductive justice movement must take on. The fact that abortion care is so enmeshed within the medical model presents trouble on many levels for a potentially inclusive movement. It is particularly problematic that the mainstream reproductive rights agenda has historically focused almost exclusively on abortion rights, especially for economically privileged white women, in that it inherently bonds the movement solely to the medical model, and thus prevents true alliance with the midwifery model at times when it is appropriate. In simpler terms, birth and abortion are separated within our culture as entirely different events, having nothing to do with one another, while in fact both are defining elements of the reproductive experiences and choices of women. While it may seem subtle, this separative dynamic serves to block coalition building and mutual support among a full scope of health care providers.

Abortion Remains Elusive in Midwifery Community

Doctors are not the only ones responsible for this ideological division. Within the midwifery community, abortion remains a somewhat elusive topic. Regardless of its relevance and importance to women's reproductive health, abortion is missing from much of the midwifery literature, education curriculum, and community conversations. In her article Mi Companera, Rewire contributor Miriam Perez writes about this controversial issue as it relates to the new phenomenon of abortion doulas. Clearly, abortion is an issue that midwives are likely to come across in their careers. According to the Alan Guttmacher Institute, over 60% of abortions are among women who have had one or more children. It seems logical then, not only from a clinical perspective, but also emotionally and culturally, that abortion would be a valid and important matter of discussion among midwives.

Despite this, the topic remains distinctly unspoken. The only midwifery organization to speak out about reproductive choices is the American College of Nurse Midwives, although they don't at any point in their literature specifically use the word "abortion." For many pro-choice midwives, doulas, and other birth professionals, this avoidance of the topic of abortion can be alienating and often seems unfounded. Some members of the community maintain that birth activism and pro-choice activism go hand in hand. On a personal level many of these midwives, doulas and birth advocates are communicating with each other about the place of birth options in the reproductive justice movement, and also the role of abortion within midwifery. To these birth advocates, it is apparent that strong bridges must be built between the midwifery model of care and the reproductive justice movement and that coalition building among us is essential.

But abortion is clearly a divisive issue. Some midwives do not consider abortion to be a valid reproductive option and do not want to align themselves with any pro-choice movement. And conversely, many pro-choice medical providers do not want to align themselves with direct entry midwives or out-of-hospital birth communities. This dynamic is at the crux of our cultural struggles for control over reproduction and the female body.

Personal and political action is needed to help us to achieve the ultimate goal of providing a full range of birth options to all women and families. This includes fully integrating midwifery care into the health care system of each state, including pushing our state medical programs and private insurance companies to cover midwifery care. Currently, many families who choose to give birth out of hospital with the help of licensed midwives are forced to pay out of pocket, even if they are insured.

Birth options advocates in several states are hard at work fighting for insurance coverage, and in New Hampshire this month the House voted to require insurance coverage of home births. Nationally, activists have launched "The Big Push for Midwives" campaign, advocating for regulation and licensure of midwives in every state. The media too, not just politics, has begun addressing these important issues. The new documentary from Ricki Lake and Abby Epstein, "The Business of Being Born," examines and questions childbirth in the U.S. and advocates for wider acceptance of midwifery care.

And in addition, we need to fight cohesively and effectively to legalize the practice of midwifery nationwide and to ensure the availability of state licensure.

Pregnancy, reproduction and birth practices are significant social and cultural issues that greatly effect women and their families. For midwives and reproductive rights activists alike, the inclusion of birth options into the conversation will offer an essential connection within this movement. Comprehensive birth options have an appropriate, and even necessary, role within this movement. We can help further this role by demanding a new framework for understanding "choice," as well as creating a more comprehensive philosophy that includes and honors the varied reproductive experiences of all women. I encourage those of us who are involved in any way with reproductive health and the movement for reproductive justice to expand our conversation past merely protecting the decision of when to give birth, but also advocating for a full range of options of how, where, and with whom to give birth.

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Commentary Politics

Democrats’ Latest Platform Silent on Discriminatory Welfare System

Lauren Rankin

The current draft of the 2016 Democratic Party platform contains some of the most progressive positions that the party has taken in decades. But there is a critical issue—one that affects millions in the United States—that is missing entirely from the draft: fixing our broken and discriminatory welfare system.

While the Republican Party has adopted one of the most regressive, punitive, and bigoted platforms in recent memory, the Democratic Party seems to be moving decisively in the opposite direction. The current draft of the 2016 Democratic Party platform contains some of the most progressive positions that the party has taken in decades. It calls for a federal minimum wage of $15; a full repeal of the Hyde Amendment, which prohibits the use of federal Medicaid funding for abortion care; and a federal nondiscrimination policy to protect the rights of LGBTQ people.

All three of these are in direct response to the work of grassroots activists and coalitions that have been shifting the conversation and pushing the party to the left.

But there is a critical issue—one that affects millions in the United States—that is missing entirely from the party platform draft: fixing our broken and discriminatory welfare system.

It’s been 20 years since President Bill Clinton proudly declared that “we are ending welfare as we know it” when he signed into law a sweeping overhaul of the U.S. welfare system. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 implemented dramatic changes to welfare payments and eligibility, putting in place the Temporary Assistance for Needy Families (TANF) program. In the two decades since its enactment, TANF has not only proved to be blatantly discriminatory, but it has done lasting damage.

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In one fell swoop, TANF ended the federal guarantee of support to low-income single mothers that existed under the now-defunct Aid to Families with Dependent Children (AFDC) program. AFDC had become markedly unpopular and an easy target by the time President Clinton signed welfare reform legislation into law, with the racist, mythic trope of the “welfare queen” becoming pervasive in the years leading up to AFDC’s demise.

Ronald Reagan popularized this phrase while running for president in 1976 and it caught fire, churning up public resentment against AFDC and welfare recipients, particularly Black women, who were painted as lazy and mooching off the government. This trope underwrote much of conservative opposition to AFDC; among other things, House Republican’s 1994 “Contract with America,” co-authored by Newt Gingrich, demanded an end to AFDC and vilified teen mothers and low-income mothers with multiple children.

TANF radically restructured qualifications for welfare assistance, required that recipients sustain a job in order to receive benefits, and ultimately eliminated the role of the federal state in assisting poor citizens. The promise of AFDC and welfare assistance more broadly, including SNAP (the Supplemental Nutrition Assistance Program, commonly known as food stamps) benefits, is that the federal government has an inherent role of caring for and providing for its most vulnerable citizens. With the implementation of TANF, that promise was deliberately broken.

At the time of its passage, Republicans and many Democrats, including President Bill Clinton, touted TANF as a means of motivating those receiving assistance to lift themselves up by their proverbial bootstraps, meaning they would now have to work while receiving benefits. But the idea that those in poverty can escape poverty simply by working harder and longer evades the fact that poverty is cyclical and systemic. Yet, that is what TANF did: It put the onus for ending poverty on the individual, rather than dealing with the structural issues that perpetuate the state of being in poverty.

TANF also eliminated any federal standard of assistance, leaving it up to individual states to determine not only the amount of financial aid that they provide, but what further restrictions state lawmakers wish to place on recipients. Not only that, but the federal TANF program instituted a strict, lifetime limit of five years for families to receive aid and a two-year consecutive limit, which only allows an individual to receive two years of consecutive aid at a time. If after five total years they still require assistance to care for their family and themself, no matter their circumstances, they are simply out of luck.

That alone is an egregious violation of our inalienable constitutional rights to life, liberty, and the pursuit of happiness. Still, TANF went a step further: It also allowed states to institute more pernicious, discriminatory policies. In order to receive public assistance benefits through TANF, low-income single mothers are subjected to intense personal scrutiny, sexual and reproductive policing, and punitive retribution that does not exist for public assistance recipients in programs like Social Security and Supplemental Security Income disability programs, programs that Democrats not only continue to support, but use as a rallying cry. And yet, few if any Democrats are crying out for a more just welfare system.

There are so many aspects of TANF that should motivate progressives, but perhaps none more than the family cap and forced paternity identification policies.

Welfare benefits through the TANF program are most usually determined by individual states based on household size, and family caps allow a state to deny welfare recipients’ additional financial assistance after the birth of another child. At least 19 states currently have family cap laws on the books, which in some cases allow the state to deny additional assistance to recipients who give birth to another child. 

Ultimately, this means that if a woman on welfare becomes pregnant, she is essentially left with deciding between terminating her pregnancy or potentially losing her welfare benefits, depending on which state she lives in. This is not a free and valid choice, but is a forced state intervention into the private reproductive practices of the women on welfare that should appall and enrage progressive Democrats.

TANF’s “paternafare,” or forced paternity identification policy, is just as egregious. Single mothers receiving TANF benefits are forced to identify the father of their children so that the state may contact and demand financial payment from them. This differs from nonwelfare child support payments, in which the father provides assistance directly to the single mother of his child; this policy forces the fathers of low-income single women on welfare to give their money directly to the state rather than the mother of their child. For instance, Indiana requires TANF recipients to cooperate with their local county prosecutor’s child support program to establish paternity. Some states, like Utah, lack an exemption for survivors of domestic violence as well as children born of rape and incest, as Anna Marie Smith notes in her seminal work Welfare Reform and Sexual Regulation. This means that survivors of domestic violence may be forced to identify and maintain a relationship with their abusers, simply because they are enrolled in TANF.

The reproductive and sexual policing of women enrolled in TANF is a deeply discriminatory and unconstitutional intrusion. And what’s also disconcerting is that the program has failed those enrolled in it.

TANF was created to keep single mothers from remaining on welfare rolls for an indeterminate amount of time, but also with the express goal of ensuring that these young women end up in the labor force. It was touted by President Bill Clinton and congressional Republicans as a realistic, work-based solution that could lift single mothers up out of poverty and provide opportunities for prosperity. In reality, it’s been a failure, with anywhere from 42 to 74 percent of those who exited the program remaining poor.

As Jordan Weissmann detailed over at Slate, while the number of women on welfare decreased significantly since 1996, TANF left in its wake a new reality: “As the rolls shrank, a new generation of so-called disconnected mothers emerged: single parents who weren’t working, in school, or receiving welfare to support themselves or their children. According to [the Urban Institute’s Pamela] Loprest, the number of these women rose from 800,000 in 1996 to 1.2 million in 2008.” Weissmann also noted that researchers have found an uptick in “deep or extreme poverty” since TANF went into effect.

Instead of a system that enables low-income single mothers a chance to escape the cycle of poverty, what we have is a racist system that denies aid to those who need it most, many of whom are people of color who have been and remain systemically impoverished.

The Democratic Party platform draft has an entire plank focused on how to “Raise Incomes and Restore Economic Security for the Middle Class,” but what about those in poverty? What about the discriminatory and broken welfare system we have in place that ensures not only that low-income single mothers feel stigmatized and demoralized, but that they lack the supportive structure to even get to the middle class at all? While the Democratic Party is developing strategies and potential policies to support the middle class, it is neglecting those who are in need the most, and who are suffering the most as a result of President Bill Clinton’s signature legislation.

While the national party has not budged on welfare reform since President Bill Clinton signed the landmark legislation in 1996, there has been some state-based movement. Just this month, New Jersey lawmakers, led by Democrats, passed a repeal of the state’s family cap law, which was ultimately vetoed by Republican Gov. Chris Christie. California was more successful, though: The state recently repealed its Maximum Family Grant rule, which barred individuals on welfare from receiving additional aid when they had more children.

It’s time for the national Democratic Party to do the same. For starters, the 2016 platform should include a specific provision calling for an end to family cap laws and forced paternity identification. If the Democratic Party is going to be the party of reproductive freedom—demonstrated by its call to repeal both the federal Hyde and Helms amendments—that must include women who receive welfare assistance. But the Democrats should go even further: They must embrace and advance a comprehensive overhaul of our welfare system, reinstating the federal guarantee of financial support. The state-based patchwork welfare system must be replaced with a federal welfare assistance program, one that provides educational incentives as well as a base living wage.

Even President Bill Clinton and presumptive Democratic presidential nominee Hillary Clinton both acknowledge that the original welfare reform bill had serious issues. Today, this bill and its discriminatory legacy remain a progressive thorn in the side of the Democratic Party—but it doesn’t have to be. It’s time for the party to admit that welfare reform was a failure, and a discriminatory one at that. It’s time to move from punishment and stigma to support and dignity for low-income single mothers and for all people living in poverty. It’s time to end TANF.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (D-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

CORRECTION: A previous version of this article included a typo that misidentified Sen. Tim Kaine as a Republican. We regret this error.