Replacing midwives with doctors? Not our brand of birth justice!

WHJI Statement on DHH/Medicaid Proposal on Birth Centers
January 29, 2015

Update: The comment period has been extended till end of day tomorrow, January 30, after which legislators will make a decision. So please continue to make your voice heard on this!  

Today, Louisiana legislators will review proposed regulations by the Department of Health and Hospitals (DHH) that could severely limit freestanding birth centers and the practice of midwifery in Louisiana.  As with most restrictions of holistic and women-centered health care, these limitations will disproportionately affect Black women, women of color, and poor women in our state.

The stated purpose of the DHH proposal is to extend Medicaid reimbursement to birth centers. While Medicaid reimbursement for birth centers is a measure we enthusiastically support, this legislation would also place severe restrictions on the types of birth centers covered and on who can practice within them. First, the proposal excludes Certified Professional Midwives (CPMs). If the measure passes as written, CPMs would not only be ineligible to receive Medicaid reimbursement for their work in birth centers, they would also be restricted from serving any Medicaid-eligible patients, even if the center or the patient were to cover the full cost. This restriction would exacerbate the barriers to access to birth services for Medicaid-eligible clients, in a context where access is already the worst in the country.  It would also place severe limitations on the practice of midwifery in our state by hampering professional access for CPMs, who are trained, certified practitioners with knowledge that is greatly of need to their communities.

Secondly, the proposal would require birth centers to hire physicians as medical directors. This is a highly detrimental measure for most free standing birth centers, as it is not considered medically necessary, physicians are reluctant to take on such a responsibility, and the cost often threatens the financial viability of the center.  In New Orleans, Birthmark Doula Collective has spent years intensively planning for the opening of New Orleans’ first freestanding birth center.  A number of community groups, birth organizations, and scores of families and community members have collaborated and put deep investment towards this effort.  The restrictions put forth in this proposal would now make it almost impossible for the birth center to open, further limiting access to respectful, woman-centered care.

Ultimately, the restrictions DHH is proposing would take an otherwise beneficial measure and turn it into something that will directly undermine the health and autonomy of low-income women of color in the state, in a multiplicity of ways. Most glaring, nearly 70% of births in Louisiana are Medicaid-eligible, meaning that the proposal would cut off access to CPMs for low-income women and families. Meanwhile, the need for the patient-centered type of holistic care that CPMs can provide is growing. We live in the state with the highest C-section rate in the country – six times higher than the rate determined as necessary by the World Health Organization. Much of this is related to the profit-orientation of the medical system we have today:  surgeries draw in cash, but also saddle women with longer recovery times, higher risks of infection, and a more challenging transition to motherhood.

As a state, we also suffer from some of the worst birth outcomes in the country. Louisiana ranks second in low birth weight and third in infant mortality. We also have a very high maternal mortality rate. Many of these statistics are far worse for Black women. African American women have a 2.5 times higher risk of delivering a baby that is low birth weight (or fewer than 32 weeks gestation). This is due to a combination of social factors reflecting historical and institutional racism and interpersonal racism in the medical context.  Recent research is even confirming what women of color have always felt – that growing up with a lifetime of racism actually has physiologic effects on our bodies, creating chronic levels of the stress hormone cortisol and impacting the fetal environment. Racism is embodied, and expressed in our health.

The autonomy and self-determination of Black women and other women of color in the birthing process is severely limited in the hospital setting, following a legacy of the policing of Black women’s reproductive choices and racist mistreatment by the medical establishment. Given this context, alternative birthing environments are all the more meaningful, representing one of the few options where women of color can expect they will be heard and their birthing choices respected.

Restricting the practice of midwifery would be another deep blow to our community.  Midwifery is a calling and a practice that has deep roots in the Southern United States; deep roots specifically among Black women. It involves knowledge of the most universal human act that has been cultivated and passed down from generation to generation, in many cases brought in the hearts, minds, and hands of African women who disseminated their knowledge while living under enslavement. For generations, community midwives guided mothers through the birthing process, when hospital care was actually off-limits to women of color. As the last century progressed, birth was increasingly medicalized and hospitals came to be seen as the optimal location for birthing, and for non-consensual medical education and training on the bodies of women of color. Midwifery, as a practice controlled not by white men or the scientific establishment, came to be seen as illegitimate and threatening. The practice has now undergone waves of restriction, policing, and criminalization by the medical establishment and by the US government – often in the name of public health.  The public health truth is, however, that midwives’ care results in better birth outcomes, more respectful care, and less unnecessary surgical intervention. This has even been shown repeatedly in published research.  But the idea of women – particularly Black women – retaining power over such a vital aspect of human life, and one that could potentially make more profit if controlled by the medical establishment, is simply too threatening for some.

The DHH measure, as proposed, will only serve to benefit birth centers that are already part of larger hospitals at the cost of real health and well-being for our communities.  We encourage all of our community to make your voice heard on this measure, demanding that birth centers receive Medicaid reimbursement but without these detrimental restrictions. Please spread the word, and check out the following actions you can take:

SUBMIT COMMENTS: Comments can be submitted via email to medicaidpolicy@la.gov or by mail to: J. Ruth Kennedy, DHH Bureau of Health Services Financing, PO Box 91030, Baton Rouge, LA 70821-9030.  Make your voice heard!

SIGN THE PETITION: https://www.change.org/p/la-dhh-bureau-of-health-services-financing-amend-proposed-la-medicaid-rules-for-freestanding-birth-centers

Bad Home Training: An Open Letter to Melissa Flournoy of Planned Parenthood Gulf Coast


A little back story:

Last night, August 13th, there was a screening of We Always Resist: Trust Black Women. The documentary touches on the ways that the pro choice framework abandons black women. It talks about solution oriented community activism and the ways that black women are left in the lurch when the conversation about reproductive rights focuses only on the single issue of abortion.  After the film, local activists Deon Haywood of Women With A Vision and Paris Hatcher of SPARK and Race Forward got together to do a panel discussion about their work and the film.

Melissa Flournoy, Louisiana Director of Planned Parenthood Gulf Coast, was the first person to speak. She proceeded to rudely derail the entire conversation. 

This is my response as a member of the Women’s Health and Justice Initiative, a queer black femme woman, a New Orleans native, and a daughter of a mother who taught me not to think about my body on anybody else’s terms but my own.

-Kris Ford, WHJI

WHJI logo

To Melissa Flournoy, PhD

Louisiana State Director of Planned Parenthood Gulf Coast:

Before you say that I don’t know where you’re coming from, I feel like I do. You spent a lot of last night interrupting me and other women to talk about yourself and your views and motives. You felt that last night’s discussions should have centered on how organizations like Women With A Vision, the communities they serve, and women of color as a whole could “show up” for Planned Parenthood’s pro-choice fight.

Since I’m fairly certain that you didn’t spend a lot of the meeting taking in what by the women around you said, let me sum it up:

  • Black women know the needs of our communities, our families, and our bodies. We trust ourselves to have our best interest at heart.
  • The pro-choice/pro-life framework that Planned Parenthood supports and fuels largely leaves marginalized women behind. We gain nothing from joining your parade or lending our faces or our children’s faces to your billboards.
  • You, Melissa Flournoy, are a perfect example of the schism in work around reproductive rights. Your refusal to listen, your insistence on centering the conversation on your personal wants, and your flippant disregard for the work that organizations led by women of color have done. Worse, the huge organization that supports you is guilty of the same.

Part of why I’m wary of Planned Parenthood is that I lead an intersectional life by default. All black women do. We are not only black, only women, only disabled, only lesbians, only trans, only genderqueer, only poor, only southern, only indigenous, or only anything. We actively resist spaces where we are the only ones. In those spaces, we are profiled. We are shamed and abused. You push us to the front of one charge after another so that you can wave your diversity banners. We fall first and are left bleeding every time.

Last night, I got together with a bunch of members of my community. There were women, men, colored people, white people, babies, various genders and disabilities and personal convictions. We got together to view Trust Black Women and eat some pizza. The film was short, but powerful. We watched person after person talk about the ways that the reproductive rights dichotomy leaves behind black women. It’s produced by Sister Song, the same organization whose member Monica Simpson wrote an open letter to Planned Parenthood on August 5th. Monica’s letter details the ways that Planned Parenthood consistently omits the intersectional work of grassroots organizations on reproductive issues.

The recent exclusion of the long-term work of scores of reproductive justice organizations, activists, and researchers that have challenged the “pro-choice” label for 20 years, seen recently in New York Times and Huffington Post articles, is not only disheartening but, intentionally or not, continues the co-optation and erasure of the tremendously hard work done by Indigenous women and women of color for decades.” – Monica Simpson

Monica published her letter barely two weeks ago, and yet here I am publishing this one today because of your appalling behavior last night.

After we watched We Always Resist: Trust Black Women, Deon Haywood and Paris Hatcher took the floor for a discussion about their reproductive justice activism. Deon detailed some of her work with Women With A Vision. She spoke about working within the community on a person to person level to actively reorganize the power dynamics in black women’s lives. She talked about experiences with research organizations that ask WWAV to give access to “them.” The “them” these organizations want includes black women, sex workers, trans women, homeless women, and many other marginalized folks. She spoke about how important it is for women of color to be not just partners but leaders in  defining what reproductive rights mean to us. Paris spoke about her reproductive justice work as the cofounder of SPARK Reproductive Justice NOW. She talked at length about the importance of viewing reproductive rights outside of the Pro Choice vs. Pro Life framework.

There was a feeling of reverence for the heaviness of the topics we’d discussed. Out of the three seconds of silence, your hand went up and the whole meeting went off the tracks. You started by introducing yourself as the Louisiana State director of Planned Parenthood Gulf Coast. After that, you proceeded to ask Deon what she could “do about Katrina.” Though you didn’t pause to give context, you were talking about Katrina Jackson, the state representative out of Monroe, Louisiana who penned HB388. The bill effectively shuts down some of the abortion providers here in Louisiana. You complained about the representative’s unwillingness to hear your pleas, and jokingly said that you wanted to “put (Deon) into a ring and let you kick her ass!” Didn’t we JUST get done talking about how hurtful it is for black women to constantly be profiled as dangerous? Violent? Subhuman? How is this helpful? Deon had told us about the police reports she sees where police officers describe black women as primarily “big,” “black,” and “angry.” YOU TURNED AROUND AND DID THE SAME THING. Deon stated that she’s not going to go fight any other black women. She’s not doing this work to go be the black person who can tame other black people for you. None of us are. It was clear that you weren’t getting the answers or feedback that you wanted. I’m sure you were aware of the people expressing their dismay in the background as you charged on to talk at length about how what we REALLY need to just focus on less race stuff and more political stuff. According to you, the solution lies in pressuring elected officials and voting the bad eggs out of office. You asked question after question, made statement after statement, and barely paused for Deon or anyone else to answer. When she was able to sneak a word in edgewise, you cut her off again! This went round and around. You interrupted most of the people who spoke last night, including me. I explained that I rejected the Pro Choice vs. Pro Life framework because it leaves behind many of the communities represented in that room. I stated that while I was glad you came, I didn’t want this entire conversation to become us simply focused on and responding to you. I also said that when you ask questions of people like Deon, like Paris, like the many activists and organizers in that room who have exactly the kind of analysis that your organization sorely lacks, you need to shut up and listen. You didn’t. In fact, you cut me off before I could finish talking. Here’s more of what I want to say:

How dare you, Melissa? How dare you show up to an event by and for women of color, then go ahead to tell us that we’re not focusing on YOUR organization enough? That we aren’t showing up for YOU enough? We afforded you every opportunity last night to get a feel for where women of color are coming from on this issue. The answers to why we aren’t as common as we could be among the Planned Parenthood ranks was staring you in the face, and you turned away every time. You heard it from black women, you heard it from black men, you heard it from faith leaders and scholars and activists and average folks walking down the street. You even heard it from Laura McTighe, a white ally who was so upset by your behavior that she stepped forward to name that you had effectively derailed the entire conversation and wrapped it around yourself, and that it was inappropriate of you to ask women of color why they weren’t doing more for YOU. Did you listen to her? Did you listen when she said that she felt the more appropriate question to ask was how you, your organization, and white people in general could show up and be better allies for US?

I don’t think you did. What you did was talk over people, take up too much space emotionally and physically in the room. I knew you weren’t really engaged with us because people were standing uncomfortably in the back of the room while you sprawled across two chairs of your own. How can you show up to a screening of We Always Resist: Trust Black Women when you clearly don’t even trust black women enough to pay attention when we decide on what strategies are most effective for our communities?

After last night’s distasteful experience, I’m left with three very real truths:

  • If the Louisiana State director of Planned Parenthood Gulf Coast can listen to the lived experiences of women of color and then try to mock us and disrupt our meetings, then what hope is there for Planned Parenthood to work in an anti-racist framework? Why should I bother with trusting or investing in any of your political ventures if you can’t see the merit in my community based activism?
  • Black women’s bodies are the scapegoat here. No matter how you turn it, when we view ourselves on your terms, the jokes fly about how we should go fight people for you. We are damned for having children, damned for having abortions, damned for refusing to navigate our bodies within your framework, and then chastised for not showing up for you.
  • I trust black women. I trust us to know what is best for ourselves, our communities, our families, and our wellbeing. I do NOT trust YOU.

After being in a room with black women while we talked about concrete solutions to the issues that affect us most, you still took it upon yourself to push our thoughts and feelings and very humanity aside to talk about how we could better serve your agenda. Rather than listen to the way that you could have been more constructive, you told me not to make assumptions about you. Rather than listen to the young people in the room, you reminded us that you’re 53. Rather than resist the urge to stack oppressions like a playground contest, you tossed out you’re a lesbian from Shreveport and that I shouldn’t judge a book by its cover. I think I judged you appropriately. I think I had you figured out when I reluctantly had to lump you in with the rest of the big money non-profits that just want to hijack our stories for convenient marketing. I think I had you right when I assumed that you wouldn’t be able to simply be a member of the community that night. I think I was correct in assuming that you and the organization that you represent have a long way to go. If you commonly behave this way professionally, expect to alienate more and more people.

Want to attract younger folks? Look how you behaved. Want to attract women of color? Look how you behaved. Want to attract more women of New Orleans? Look how you behaved.

To sum it up, you cannot cry foul when black women and our community based organizations are not always interested in working with you. You cannot wonder why backs were turned and feelings ran high in that room last night. The kind of disregard for us, our bodies, and our spaces that you displayed last night showed us that we knew already. You don’t. We are the right people to decide what happens to our bodies. We know what is right for our communities. You don’t. We love our families and our friends and our neighbors. You don’t.

I thought our meeting would go to hell as soon as you spoke up about who you were, and I was right.

Do better.

A Reproductive Justice Blog