Saturday, March 21, 2009

Racial and Class Aspects of Homebirth

Via Feministing, I found this thought-provoking article by Miriam Pérez (who blogs at RH Reality Check, Feministing and Radical Doula) about additional barriers to safe, midwife/doula-assisted homebirth poor women and women of color face.

Some of those barriers are:

Lack of insurance coverage
"I work in a (very) low-income Medicaid clinic in Sacramento [California], and the women all have Medicaid or Family Pact as insurance," [Certified Professional Midwife JayVon] Muhammad explains. "Medicaid doesn't cover homebirth, so even if women choose to have homebirth, they are not covered, leaving no choice at all. As a result, when women show an interest, and very few do, they don't have a choice. They are forced (due to lack of money, and insurance) to deliver in the hospital."
Documentation worries
In recent years, particularly since 9/11, obtaining passports and other citizenship documentation has become increasingly difficult. The crackdown has focused on people born to midwives at home. Immigration authorities have begun questioning the validity of documents from these midwives and holding these individuals to a much higher burden of proof. This has had a disproportionate impact on Latinos and other immigrants, requiring them to go to great lengths to obtain passports and other documentation. [Washington, D.C. doula] Claudia Booker thinks this fear of citizenship being questioned may keep low-income people from leaving the hospital to give birth.
Lack of awareness
Doulas and midwives who work in low-income communities of color see the barriers as being social in addition to financial.
"My clients don't know a thing about homebirth, nor do they understand why they would even consider such a thing," explains Muhammad. "They are not educated about the benefits of birthing out of the hospital or birthing without interventions."

Experience of homebirth as something done because there was no other choice
Claudia Booker ... explains that women in low-income communities of color stopped giving birth outside of hospitals at least three generations ago. There is also a sense, she noted, that giving birth at home is "what poor people do and [that homebirth] was something we did because we had no option." This history reflects a larger transition among US women giving birth at home to hospital birth, which happened in the 1920s. Low-income communities, and particularly African-American ones, took longer to make this transition because of poverty, racism and lack of access to hospitals.
While for well-off white women, giving birth at home might sound like a way to take control over one's own pregnancy and delivery, and secure more choices, to poor women of color it could just as easily look like a loss of those choices they have only recently gained.

As one of the commenters points out, this reflects a "two-tiered system of giving birth in America." Of course, our entire health-care system is multi-tiered, with only the top tier providing anywhere near the level of care people need.

Read the whole thing!


Anonymous said...

Actually, in many states, Medicaid does pay for home birth. Medicaid is a joint federal/ state program. Nurse-midwives, some of whom do home births, are mandated Medicaid providers at the federal level. That means that every state MUST pay for any service that is within the legal scope of practice for nurse-midwives within that state. Nurse-midwives may legally provide home birth services in nearly every state. Certified professional midwives and other licensed midwives who are not CNMs, have not yet attempted to achieve inclusion in the federal Medicaid law but have been obtaining Medicaid provider status on a state-by-state basis. At the present time, the states of New Mexico, Oregon, Washington, Alaska, South Carolina, and 4 or 5 other states will pay for home births attended by a licensed midwife. As the Obama adminstration begins the process of reforming the health care system, it is vital that consumers and midwives speak up and let their national and state government officials know that the entire health care system, including Medicaid, MUST cover all birth options, including home birth, birth centers, and all categories of midwives. Go to the White House website and register your demand that midwives, birth centers, and home birth must be covered services under Medicaid and in a reformed health care system.

thinkingdifference said...

not related to this post at all, but read this article today and thought you'd be interested in it:

it got me curious: is autism a geographically specific condition? does it correlate statistically with particular groups (i'm quite suspicious of stats, but maybe you have some ideas).

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