News Maternity and Birthing

Uganda: Pregnancy and Childbirth Mean Playing Russian Roulette With Women’s Lives

Jessica Mack

Last March, a landmark maternal health petition was filed in Uganda, aimed at holding the government accountable for the deaths of two women in childbirth. It garnered global media attention at the time, yet five months into the process momentum has stalled. When will it be time to women to take the front seat?

Sylvia Nalubowa’s surviving twin is two-and-a-half; Jennifer Anguko’s baby turned one this past winter. Both of their mothers died giving birth to them – they are orphans of maternal mortality, an epidemic that continues to plague Uganda as it does the rest of the developing world. But these babies are also children of history.

Their mothers have become the face of a landmark case in Uganda that seeks, for the first time, to assign blame to the government for the deaths of women in childbirth. Last March, Ugandan human rights groups joined families of the deceased to file Constitutional Petition 16, alleging that the Ugandan Government failed to protect the women’s constitutional rights to life and health by allowing them to die in ill-equipped and poorly managed public hospitals, or failing to provide them with basic maternal care.

“We are seeking a declaration that maternal deaths happening due to avoidable causes is a violation of the right to health,” said Primah Kwagala, a lawyer for the Centre for Health, Human Rights and Development (CEHURD), a lead petitioner of the case. “The government should own up and increase funding towards maternal Health, and fulfill the Abuja Declaration to give at least 15% of the annual budget to the Health Sector.”

One of the key complaints in the petition is the Government spends just one-quarter on maternal health of what it pledged to spend, per capita.  

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Each woman died of negligence, essentially, as do 1 in 35 Ugandan women during pregnancy or childbirth. From ill-equipped health workers untrained for obstetric emergencies to inaccessible clinics, birth control stock-outs, and unsafe abortions gone very wrong, women in Uganda are forced to play Russian Roulette with a failing health system.  

The petition was filed in March and heard in October, garnering impressive and global attention from advocates and media around the world. It seemed a rare breakthrough in an endless news cycle that treats maternal deaths as sad, but inevitable.

“Maternal health has been overlooked, as people seem to look at it as the daily status quo. People do not know that they have a right to good health service provision; they think it is a privilege,” said Kwagala.

An objection was raised during the petitions hearing which derailed promising momentum, and which must first be ruled upon before the actual petition hearing can move forward. Since then, five months have elapsed  and the global media has long since packed up.

This petition was unique from other cases like it worldwide, which have sought retribution for the violation of women’s rights. Other cases before it have centered on unusually cruel and exceptional circumstances – for instance a 17-year old Peruvian woman denied the abortion of her anencephalic fetus, being forced to deliver and breastfeed until it died. Rather, this petition focuses on the mundanity of the status quo, seeking to “make it famous” as an acute abuse of human rights. Given the scale of maternal mortality in the country, the outcome of this petition could potentially put the government on the hook for crimes against humanity.

“Governments have an obligation to take action to prevent maternal deaths, which represent a gross violation of women’s basic human rights,” said Jill Sheffield, President of Women Deliver. “Where human rights have been violated, individuals and organizations must turn to the courts at the national, regional, and UN levels. Health systems that deliver for girls and women, deliver for everyone.”

Women Deliver and the Ugandan group Partners in Population and Development co-hosted a regional consultation on maternal health in the capital city late last month, drawing African maternal health experts from across the continent. The petition didn’t come up explicitly, but experts spouted the same important, but now redundant, points they have for years: women deserve more, and when they get more, we all win.

Maternal health seems to be a chronic back-seat issue, barring a few hopeful moments in history. One of those was 2010, when the Women Deliver conference drew 3,000 maternal health advocates to hear Melinda Gates announce $1.5 billion in new funds for the issue. Soon after, global maternal health data estimates confirmed that progress was underway; the G8 made maternal health its pet issue, and the UN Secretary-General launched a major initiative, the Global Strategy for Women’s and Children’s Health.

That was two years ago. It is too soon to comment on progress, but in many ways outward excitement for this issue has drained. In recent months, it isn’t maternal deaths, but rather the wanted ghost of war criminal Joseph Kony which has catapulted Uganda into the news once again. Love it or hate it, the KONY2012 campaign generated a magnetic force field of global attention toward Uganda. Deft Ugandan advocates parlayed that to leverage new commitments to Nodding Syndrome, a disease overlooked for years. The country’s rising HIV prevalence, has also garnered new focus. Surely this is an opportunity for maternal health advocates to claim their stake once and for all.

“The Government of Uganda talks a good game about its commitment to maternal and reproductive health, but it needs to do more than talk,” says Elisa Slattery, Africa Regional Director for the Center for Reproductive Rights. “It must put money and resources behind efforts that save the lives and health of women.”

What exactly should those efforts look like? That should be up to Ugandan health professional and advocates. Kwagala easily rattles off a list: “recruit more midwives, increase the pay of health workers to motivate them. Amend the constitution to include the right to health. Provide redress measures to patients whose rights have been violated & respect citizen’s rights.” There are other crucial issues to address, like ensuring access to birth control and considering expansions to the country’s abortion law. A recent government estimate suggests it is the cause of 26 percent of maternal deaths in the country.

An even more pragmatic first step might be addressing electricity cuts. “How honestly do you expect a health worker to perform C – Sections on a mother who is suffering obstructed labour if there is no electricity to sterilize instruments, or even light to see if it is in the night,” asks Kwagala. Last week, CEHURD filed a complaint against a major power company, alleging indiscriminate load shedding (rolling blackouts to save money) at hospitals undermined patients right to health.

It’s not for lack of ideas to save them, whether creative or practical, that Ugandan women are dying,  but for lack of action. And when it comes to maternal mortality, Uganda is in a unique position: it has neither the best nor the worst death rates in the continent. It was commended by the UN in 2010 for “making progress,” having reduced deaths by 36 percent from 1990 to 2008. Maternal mortality remains a problem of considerable magnitude, but there are potentially enough resources to actually address it.

Last week, CEHURD and their co-petitioners got a break. After constant follow-up and months of waiting, they received a letter from Deputy Chief Justice Alice Mpagi Bahigeine:

“The delay in delivering the ruling is very much regretted. However, it has been brought to the attention of the Hon. Justice responsible and everything possible to ensure speedy disposal of the matter.”

This acknowledgement signals that the government knows the world is watching, and perhaps really is committed to prioritizing this issue. The outcome is still in question, so it is too early to say that the paradigm has shifted but instead we should recognize that it is, indeed, shifting, and we can still do our part to catalyze that.  

Analysis Maternity and Birthing

Pregnant Women Are Being Shackled in Massachusetts—Even Though It’s Been Illegal for Years

Victoria Law

According to a new report, not a single jail or prison facility in the state has written policies that are fully compliant with the law against restraining pregnant women behind bars.

Korianne Gamble was six months pregnant in November 2014 when she arrived at the Bristol County Sheriff’s Office Women’s Center, a jail in North Dartmouth, Massachusetts. Six months prior, the state had passed “An Act to Prevent Shackling and Promote Safe Pregnancies for Female Inmates.”

According to the new law, the jail should have been prohibited from using any type of restraint on Gamble during labor, and using of leg and waist restraints on her during and immediately after her pregnancy. It also guaranteed her minimum standards of pregnancy care and required—as with everyone incarcerated while in their second or third trimesters—that she be transported in the jail’s vehicles with seat belts whenever she was taken to court, medical appointments, or anywhere outside the jail.

But that wasn’t the case for Gamble. Instead, she says, when it came time for her to give birth, she was left to labor in a cell for eight hours before finally being handcuffed, placed in the back of a police cruiser without a seatbelt, and driven to a hospital, where she was shackled to the bed with a leg iron after delivering.

According to a new report, Gamble isn’t alone. Advocates have been monitoring pregnancy-related care since the law’s passage. After obtaining and analyzing the policies of the state’s prison and jail system, they found that no facility has policies that are fully compliant with the 2014 law. They issued their findings in a new report, Breaking Promises: Violations of the Massachusetts Pregnancy Standards and Anti-Shackling Lawco-authored by Marianne Bullock of the Prison Birth Project, Lauren Petit of Prisoners’ Legal Services of Massachusetts, and Rachel Roth, a reproductive-justice expert.

In addition to analyzing policies, they spoke with women who were pregnant while in custody and learned that women continue to be handcuffed during labor, restrained to the bed postpartum, and placed in full restraints—including leg irons and waist chains—after giving birth.

“The promise to respect the human rights of pregnant women in prison and jail has been broken,” the report’s authors concluded.

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Medical experts, including the American Congress of Obstetricians and Gynecologists, the American Medical Association and the American College of Nurse-Midwives, have all agreed that shackling during pregnancy is unnecessary, inhumane, and dangerous. Shackling increases the risk of falling and injury to both mother and fetus while also preventing medical staff from assessing and assisting during labor and delivery. In 2014, both the Massachusetts legislature and then-Gov. Deval Patrick (D) agreed, passing the law against it.

“The Massachusetts law is part of a national trend and is one of the most comprehensive in protecting pregnant and postpartum women from the risks of restraints,” said Roth in an interview with Rewire. “However, like most other states, the Massachusetts law doesn’t have any oversight built in. This report clearly shows the need for staff training and enforcement so that women who are incarcerated will be treated the way the legislature intended.”

Gamble learned all of this firsthand. In the month before her arrest, Gamble had undergone a cervical cerclage, in which a doctor temporarily stitches up the cervix to prevent premature labor. She had weekly visits to a gynecologist to monitor the development of her fetus. The cerclage was scheduled to be removed at 37 weeks. But then she was arrested and sent to jail.

Gamble told jail medical staff that hers was a high-risk pregnancy, that she had had a cerclage, and that her first child had been born six weeks prematurely. Still, she says she waited two months before seeing an obstetrician.

As her due date drew closer, the doctor, concerned about the lack of amniotic fluid, scheduled Gamble for an induction on Feb. 19, 2015. But, she says, jail staff cancelled her induction without telling her why.

That same evening, around 5 p.m., Gamble went into labor. Jail staff took her to the medical unit. There, according to Gamble, the jail’s nurses took her blood pressure and did a quick exam, but did not send her to the hospital. “They [the nurses] thought I was ‘acting up’ because my induction was canceled,” she told Rewire.

She was placed in a see-through cell where, as the hours progressed, her labor pains grew worse. “I kept calling to get the [correctional officers] to get the nurse,” Gamble recalled. By the time a nurse came, Gamble was bleeding. “The nurse made me pull down my pants to show her the blood—in front of a male [correctional officer]!” Gamble stated. Still, she says, no one called for an ambulance or made arrangements to drive her to the hospital.

At 1:45 in the morning, over eight hours after she first went into labor, the jail’s captain learned that Gamble was in labor. “[He] must have heard all the commotion, and he called to find out what was going on,” she said. He ordered his staff to call an ambulance and bring her to the hospital.

But instead of calling an ambulance, Gamble says jail staff handcuffed her, placed her in the back of a police cruiser without a seatbelt—in violation of the law—and drove her to Charlton Memorial Hospital. “My body was already starting to push the baby out,” she said. She recalled that the officers driving the car worried that they would have to pull over and she would give birth by the side of the road.

Gamble made it to the hospital, but just barely. Nine minutes after arriving, she gave birth: “I didn’t even make it to Labor and Delivery,” she remembered.

But her ordeal wasn’t over. Gamble’s mother, who had contacted Prisoners’ Legal Services and Prison Birth Project weeks earlier, knew that the law prohibited postpartum restraints. So did Gamble, who had received a packet in jail outlining the law and her rights from Prisoners’ Legal Services. When an officer approached her bed with a leg iron and chain, she told him that, by law, she should not be restrained and asked him to call the jail to confirm. He called, then told her that she was indeed supposed to be shackled. Gamble says she spent the night with her left leg shackled to the bed.

When the female officer working the morning shift arrived, she was outraged. “Why is she shackled to the bed?” Gamble recalled the officer demanding. “Every day in roll call they go over the fact that a pregnant woman is not to be shackled to anything after having a baby.” The officer removed the restraint, allowing Gamble to move around.

According to advocates, it’s not unusual for staff at the same jail to have different understandings of the law. For Gamble, that meant that when the shift changed, so did her ability to move. When the morning shift was over, she says, the next officer once again shackled Gamble’s leg to the bed. “I was so tired, I just went along with it,” Gamble recounted.

Two days after she had given birth, it was time for Gamble to return to the jail. Despite Massachusetts’ prohibition on leg and waist restraints for women postpartum, Gamble says she was fully shackled. That meant handcuffs around her wrists, leg irons around her ankles, a chain around her waist,g and a black box that pulled her handcuffs tightly to the waist chain. That was how she endured the 20-minute drive back to the jail.

Gamble’s jail records do not discuss restraints. According to Petit, who reviewed the records, that’s not unusual. “Because correctional officers don’t see it as out of the ordinary to [shackle], they do not record it,” she explained. “It’s not so much a misapplication of the extraordinary circumstances requirement as failure to apply it at all, whether because they don’t know or they intentionally ignore it.”

While Bristol County Sheriff’s Office Women’s Center’s policies ban shackling during labor, they currently do not prohibit restraints during postpartum recovery in the hospital or on the drive back to the jail. They also do not ban leg and waist restraints during pregnancy. Jonathan Darling, the public information officer for the Bristol County Sheriff’s Office, told Rewire that the jail is currently reviewing and updating policies to reflect the 2014 law. Meanwhile, administrators provide updates and new information about policy and law changes at its daily roll call. For staff not present during roll call, the jail makes these updates, including hospital details, available on its east post. (Roll call announcements are not available to the public.)

“Part of the problem is the difference in interpretation between us and the jurisdictions, particularly in postpartum coverage,” explained Petit to Rewire. Massachusetts has 14 county jails, but only four (and the state prison at Framingham) hold women awaiting trial. As Breaking Promises noted: “Whether or not counties incarcerate women in their jails, every county sheriff is, at minimum, responsible for driving women who were arrested in their county to court and medical appointments. Because of this responsibility, they are all required to have a written policy that spells out how employees should comply with the 2014 law’s restrictions on the use of restraints.”

Four jurisdictions, including the state Department of Correction, have policies that expressly prohibit leg and waist restraints during the postpartum period, but limit that postpartum period to the time before a woman is taken from the hospital back to the jail or prison, rather than the medical standard of six weeks following birth. Jails in 11 other counties, however, have written policies that violate the prohibition on leg and waist shackles during pregnancy, and the postpartum prohibition on restraints when being driven back to the jail or prison.

Even institutions with policies that correctly reflected the law in this regard sometimes failed to follow them: Advocates found that in some counties, women reported being restrained to the bed after giving birth in conflict with the jail’s own policies.

“When the nurse left, the officer stood up and said that since I was not confirmed to be in ‘active labor,’ she would need to restrain me and that she was sorry, but those were the rules,” one woman reported, even though the law prohibits restraining women in any stage of labor.

But shackling pregnant women during and after labor is only one part of the law that falls short. The law requires that pregnant women be provided with regular prenatal and postpartum medical care, including periodic monitoring and evaluation; a diet with the nutrients necessary to maintain a healthy pregnancy; written information about prenatal nutrition; appropriate clothing; and a postpartum screening for depression. Long waits before transporting women in labor to the hospital are another recurring complaint. So are routinely being given meals without fruits and vegetables, not receiving a postpartum obstetrician visit, and waiting long stretches for postpartum care.

That was also the case with Gamble. It was the middle of the night one week after her son’s birth when Gamble felt as if a rock was coming through her brain. That was all she remembered. One hour later, she woke to find herself back at the hospital, this time in the Critical Care Unit, where staff told her she had suffered a seizure. She later learned that her cellmate, a certified nursing assistant, immediately got help when Gamble’s seizure began. (The cell doors at the jail are not locked.)

Hospital staff told her that she had preeclampsia, a pregnancy complication characterized by high blood pressure. Postpartum preeclampsia is rare, but can occur when a woman has high blood pressure and excess protein in her urine soon after childbirth. She was prescribed medications for preeclampsia; she never had another seizure, but continued to suffer multiple headaches each day.

Dr. Carolyn Sufrin is an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. She has also provided pregnancy-related care for women at the San Francisco County Jail. “Preeclampsia is a leading cause of maternal mortality,” she told Rewire. Delayed preeclampsia, or postpartum preeclampsia, which develops within one to two weeks after labor and delivery, is a very rare condition. The patient suffering seizures as a result of the postpartum preeclampsia is even more rare.

Postpartum preeclampsia not only needs to be treated immediately, Sufrin said, but follow-up care within a week at most is urgent. If no follow-up is provided, the patient risks having uncontrolled high blood pressure, stroke, and heart failure. Another risk, though much rarer, is the development of abnormal kidney functions.

While Sufrin has never had to treat postpartum preeclampsia in a jail setting, she stated that “the protocol if someone needs obstetrical follow-up, is to give them that follow-up. Follow through. Have continuity with the hospital. Follow their instructions.”

But that didn’t happen for Gamble, who was scheduled for a two-week follow-up visit. She says she was not brought to that appointment. It was only two months later that she finally saw a doctor, shortly before she was paroled.

As they gathered stories like Gamble’s and information for their report, advocates with the Prison Birth Project and Prisoners’ Legal Services of Massachusetts met with Rep. Kay Khan (D-Newton), to bring her attention to the lack of compliance by both county jails and the state prison system. In June 2015, Khan introduced An Act to Ensure Compliance With the Anti-Shackling Law for Pregnant Incarcerated Women (Bill H 3679) to address the concerns raised by both organizations.

The act defines the postpartum period in which a woman cannot be restrained as six weeks. It also requires annual staff trainings about the law and that, if restraints are used, that the jail or prison administration report it to the Secretary of Public Safety and Security within 48 hours. To monitor compliance, the act also includes the requirement that an annual report about all use of restraints be made to the legislature; the report will be public record. Like other statutes and bills across the country, the act does not have specific penalties for noncompliance.

In December 2015, Gamble’s son was 9 months old and Gamble had been out of jail for several months. Nonetheless, both Gamble and her mother drove to Boston to testify at a Public Safety Committee hearing, urging them to pass the bill. “I am angered, appalled, and saddened that they shackled her,” Gamble’s mother told legislators. “What my daughter faced is cruel and unusual punishment. It endangered my daughter’s life, as well as her baby.”

Since then, both the Public Safety Committee and Health Care Financing Committee approved the bill. It is now before the House Committee for Bills in the Third Reading, which means it is now at the stage where it can be taken up by the House for a vote.

Though she has left the jail behind, Gamble wants to ensure that the law is followed. “Because of the pain I went through, I don’t ever want anyone to go through what I did,” she explained to Rewire. “Even though you’re in jail and you’re being punished, you still have rights. You’re a human being.”

Culture & Conversation Maternity and Birthing

Exploring Birth Justice: A Conversation With Julia Chinyere Oparah and Alicia Bonaparte

Kanya D’Almeida

Rewire delves into the emerging birth justice movement and some of the historic and contemporary examples of how Black women and women of color, as well as trans and gender nonconforming people, have fought to preserve pregnancy and childbirth as a safe and sacred experience.

The numbers surrounding maternal and child health are bleak: Black women are three times as likely to die giving birth as their white counterparts; infant mortality rates for Black children are three times higher than those of white kids; and despite a widely held belief that vaginal deliveries are the safest route for both mother and child, women of color represent the highest cesarean rates of any other demographic in the United States.

Behind these statistics, however, are powerful stories of grassroots childbirth activists and traditional birth workers of color, including midwives and doulas, coalescing for “birth justice.” Building on a long history in which Black women and women of color have resisted birth oppression through the centuries, the term birth justice was coined in an effort to foreground activism and justice for birthing parents in movements around reproductive justice and Black lives.

A newly released anthology titled Birthing Justice: Black Women, Pregnancy and Childbirth explores some of the key issues within the nascent movement, including efforts to end the criminalization of pregnant women of color and trans or gender-nonconforming people, advocacy that aims to expand access to traditional and indigenous birth workers, and struggles to resist medical violence. The anthology is a project of Black Women Birthing Justice, a collective dedicated to transforming birthing experiences for Black women.

Foregrounding the stories in this collection are historical analyses of medical violence and “medical apartheid,” which shaped the fields of obstetrics and gynecology in the United States, as well as a close look at the ways in which “a patriarchal medical establishment seeks to control women’s bodies.”

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In an interview with the book’s co-editors, Julia Chinyere Oparah, co-chair of ethnic studies and director of the Research Justice at the Intersections Scholars Program at Mills College, and Alicia Bonaparte, associate professor of sociology at Pitzer College, Rewire delved into some of the intersections between the emerging birth justice movement and the broader reproductive justice movement, and explored some of the historic and contemporary examples of how birthing parents have fought to preserve pregnancy and childbirth as a safe and sacred experience.

Rewire: Walk us through the current landscape of the birth justice movement.

Alicia Bonaparte: I consider this a movement that is designed to respect the rights of all individuals who aspire to become birthing parents and have a child in a supportive environment: one in which the birthing parent has autonomy over their body and the ability to choose the ways in which their birthing process flows, from the prenatal to the postpartum process.

Julia Chinyere Oparah: This is a movement led by Black women and women of color, so the focus is on dismantling inequalities around race, class, citizenship, sexual orientation, and all of the intersecting oppressions that lead to negative birth outcomes, particularly for women of color, trans folks, low-income communities, and immigrant women. We are working toward reclaiming a midwifery tradition that originates within communities of Black women and women of color, and making sure these communities have access to these alternative birthing practices, including doula services. We are trying to raise awareness and build grassroots power, so we focus on ways in which communities can come together, talk about the violence, coercion, and neglect that’s happening in medical contexts, and work together to improve birth inequalities. We look at disproportionate maternal and infant mortality as the very visible tip of the iceberg, but we also go further to examine issues that might not necessarily cause mortality but that lead to pain and lasting trauma.

Rewire: What are some of the synergies between the reproductive justice (RJ) movement and the birth justice (BJ) movement? Are there distinctions between the two?

JCO: The BJ movement is part of the broader movement to dismantle reproductive oppression. Both the RJ and BJ movements aim to decolonize our bodies, and both advocate for the right of every person to choose whether or not to carry a pregnancy to term. Many of us in the BJ movement are birth activists who come from the RJ movement, so there isn’t a huge difference in terms of our frameworks, which are really intersectional. The only real difference is that we try to center issues that sometimes get sidelined in the larger RJ movement, such as fighting the stereotyping of women who choose home births as selfish and irresponsible, or highlighting the disproportionate impact of VBAC (vaginal birth after c-section) bans on women of color. We foreground the right to choose when, where, how, and with whom to birth, and try to lift up experiences that have been somewhat invisible in reproductive justice organizing, such as the right to access traditional and indigenous birth workers.

AB: Another synergy is that both the RJ and the BJ movements aim to lift the voices of women of color and resist a narrative that is dominated by white middle- and upper-class women. Both movements also aim to push beyond the narrow boundaries of “choice” and instead use a lens of economic and racial justice. But the movements diverge slightly when it comes to policy. Birth activists are trying to raise legal and policy issues that would, for instance, force insurance companies to pay for midwife-assisted births. Nationally, midwifery services covering everything from prenatal to postpartum care run between $6,000 and $8,000. In comparison, hospital births can cost upwards of $15,000, depending on what interventions are deemed “necessary” for the birthing parent. So midwifery-assisted birth is actually cheaper than a hospital birth assisted by an OB-GYN, and yet policy fails to address this—so this is something the birth justice movement is fighting for.

Rewire: The book talks a lot about medical violence and medical apartheid. Can you explain these terms, in both historical and contemporary contexts?

JCO: Both terms refer to the ways in which the bodies of Black people, both alive and dead, have been made into sites of medical examination, to achieve medical advances that improve the health of white communities. It’s important to foreground Black women’s stories here: such as the story of Anarcha, an enslaved Black woman who was forced to endure a series of horrendously painful medical experiments at the hands of J. Marion Sims, a white physician who is often held up as the so-called father of modern gynecology for “pioneering” a technique to repair vaginal fistulas (a condition caused by traumatic or obstructed labor resulting in an opening between the birth canal and the bladder or rectum) by experimenting on Black women with fistulas. Scholars like Harriet Washington have documented the legacy of American obstetrics, in which the bodies of enslaved Black women have been used to further birth options for white women. She documents the work of Louisiana surgeon Francois Marie Prevost, who “introduced” the cesarean section in the 1820s. At the time, opening up a woman’s abdomen was considered a death sentence, yet this was exactly what was done to Black women in the name of advancing medical techniques.

AB: An example of contemporary medical apartheid might include the ways in which, for example, Black and Hispanic women receive disproportionately fewer screenings for potential birth complications like preeclampsia. The medical establishment is grounded in racism, classism, and inherent sexism, and so unfortunately these axes of oppression come to the fore in doctor-patient relationships. Involuntary c-sections are another example of medical violence in the way we see women of color experience far higher rates of c-sections than white women. In particular, women of color are coerced by OB-GYNs and nurses [who convince them] that they are acting in the best interest of the child, despite the fact that many of these c-sections are unnecessary and unwarranted. We see hospital workers like nurses resort to fear-mongering to create the narrative that you are not a good mother if you don’t subject yourself to the unnecessary interventions and processes that the medical establishment has chosen for you, and this also hits Black women and women of color hardest.

Rewire: Who are “birth revolutionaries,” and how are they reclaiming natural birthing traditions?

JCO: Two sections in the book, “Changing Lives, One Birth at a Time” and “Taking Back Our Power: Organizing for Birth Justice” really lift up the stories of birth workers and birth activists working to change the systems, policies, and spaces surrounding pregnancy and childbirth. The word “revolutionary” suggests that the movement is not only about reform and tinkering around the edges, so to speak. We are not looking to simply reduce disproportionate mortality rates; we are seeking a fundamental transformation of the conditions under which we become pregnant and give birth so these inequalities no longer exist. One example I can point to is Tina Reynolds and the Women on the Rise Telling HerStory initiative, an advocacy organization comprised of current and formerly incarcerated women resisting the brutality of the prison system, such as the shackling of women during labor.

AB: I co-authored a chapter in the book with a Black birth revolutionary named Jennie Joseph who works to change deleterious birth outcomes for women. She has worked specifically in the three counties in Florida that have the worst maternal and infant health outcomes for women of color and has created a program called the JJ Way, which unites volunteer community health workers with birthing parents in underrepresented and underserved neighborhoods to improve overall health outcomes. Such efforts amplify birth advocacy and activism for the benefit of the entire community, and I would argue that this is revolutionary.

Rewire: The book discusses the “commercialization” and “co-optation” of traditional birthing practices. Can you tell us what this means?

AB: If you have a global perspective on childbirth, you will notice that midwife-assisted births are the most common form of delivery worldwide. Here in the United States, however, midwifery has long been denigrated by the white medical establishment, and associated with superstition and other “non-scientific” practices. Birth workers have fought against this quality versus quantity approach, which frames hospital births and all their attendant interventions as being the better option. This is largely the result of living in a highly consumer-driven society.

JCO: The other side of the coin is that natural birth and midwifery activists have achieved greater acceptance of these practices, but this has not opened the door to women of color because the system is premised on the ability to pay. A typical response within a highly commercialized and consumerized society is that the establishment will recognize certain demands, but only for those who are able or willing to pay. Coming at this from an economic justice lens, we see this as exclusionary, since many Black women and women of color do not have the means to “purchase” their preferred birthing process. This is where we return to what civil rights activist Ella Baker called “legalism”—the idea that laws alone will not build participatory democracy. She believed that change would not come only from individuals speaking to power in the language that power understands, and advocated for the mass mobilization of collective power. In the same way we see arguments for the legalization of midwifery, which stops short of calling for it to be accessible.

Rewire: What would you say are some of the most important messages in the book?

JCO: One of the messages I’d like to lift up is that this is an urgent movement about saving our lives. I consider birth justice part of the broader Black Lives Matter movement, especially the SayHerName campaign, which has really worked to center women’s voices and stories. In the same way, this book highlights how Black women are reclaiming birth as a powerful and beautiful experience, despite all the forces of birth oppression. Many stories in the anthology uphold moments of what I would call “autonomy,” where Black women and women of color have created completely separate spaces and moments of full empowerment. This is a message of hope in the now—we are not only struggling for a future birth experience but celebrating the birth revolutionaries who are decolonizing the birth experience in the present moment too.

AB: One thing I think the book highlights that is missing in conversations about reproductive justice is the shame associated with miscarriage. I think there has been a lot of internalization of the idea that women are machines who exist solely for the purpose of producing children—and when we are unable to do so it means we are defective in some way. It’s extremely important to interrupt this narrative with one that centers the autonomy of women and birthing parents, and fights the notion of miscarriage as something shameful. We have a chapter in the book by Viviane Saleh-Hanna, a professor at University of Massachusetts Dartmouth, “On Natural Birth and Miscarriage,” which really speaks to this important message.

And finally, one of the things that I find incredibly powerful about the anthology is that we historicize the cultural traditions of Granny Midwives, older Black women who have functioned within Black communities not only as birth caretakers but also health workers for the entire community. So we start there, and end the book by looking at ways in which activists are reclaiming these traditions, and reclaiming the birth space as something sacred, which I see as a really hopeful message.

This interview has been lightly edited for clarity.