Midwifery's Diversity Problem Hits Spotlight

Black midwives have a rightful seat at any leadership table in their field, without having to prove themselves to white-dominated establishments.
Members of the International Center for Traditional Childbearing.
Members of the International Center for Traditional Childbearing.

(WOMENSENEWS)-The United States Midwifery Education, Regulation and Association (US MERA) is facing allegations of racial exclusion for giving an intentional cold shoulder to the only autonomous organization that represents the interests of midwives of color.

The claims concern the International Center for Traditional Childbearing (ICTC), a nonprofit, professional midwifery and doula association for women of color established in 1991 in Portland, Ore. ICTC and its founder and president, Shafia Monroe, have a respected track record of supporting and promoting midwives and doulas of color.

Nonetheless, not a single person from ICTC was invited to join the steering committee of US MERA, a collaborative working group of seven organizations representing the midwifery industry.

Midwifery associations and advocates are also charging US MERA with creating new barriers for ICTC‘s inclusion in a nearly year-long brouhaha that has already led to the high-profile resignation of the only woman of color on the committee.

US MERA steering committee members and its funder, The Transforming Birth Fund, have acknowledged that not including ICTC was an oversight. But instead of quickly correcting the matter, US MERA created new rules and guidelines for ICTC‘s application and admission, a process that has already taken nearly a year, and counting.

Earlier this month, the Midwives Association of Washington State sent a letter to US MERA calling for the immediate inclusion of ICTC "to begin to remedy the wrong done by initial omission and the ongoing wrongs constructed to justify the first." The letter also urged US MERA members to commit to facilitated, anti-racism work.

"We did not exclude them intentionally," says Mary Lawlor, the executive director of National Association of Certified Professional Midwives, and the only steering committee member of US MERA who agreed to be interviewed for this article. "We were thinking specifically to the responsibility to credentials."

"That was probably an oversight," says Betsy McNamara, consultant to The Transforming Birth Fund, a donor-advised fund of the New Hampshire Charitable Foundation, based in Concord.

Still Waiting

Oversights happen. Any organization can have a "blind spot" about the critical role of diverse voices in making decisions that affect the future of maternity care options and untold numbers of women and babies.

But why-after nearly 10 months of having the oversight flagged and after ICTC has submitted all of the newly required forms-isn't the situation resolved?

No other member organization of the steering committee was subjected to such rigor. Or should I say rubbish.

ICTC is still waiting for its rightful seat at the table of the white-female dominated group. For many of us, the creation of inexplicable entry barriers for the one group representing women of color does not sit well.

For several months the Midwives Alliance of North America, or MANA, did what it could to ease the insult by inviting Monroe to use one of its seats on the US MERA steering committee. But when MANA prodded US MERA committee members to vote on granting ICTC a real seat, the vote was No.

Marinah Farrell, a Phoenix-based certified professional midwife, is MANA‘s president. After US MERA rejected ICTC‘s request to join the steering committee, Farrell shot a strongly worded letter of resignation to US MERA, saying she would no longer represent MANA on the committee. "As a woman of color-if they don't want the independent voices of people of color, then they don't have mine either," she said in a phone interview.

When US MERA formed in 2012 it had the notable goal of ending decades of unnecessary fragmentation in the midwifery sector. For years the midwifery industry has set boundaries and levels of professional "respect" based on how you became a midwife and where you practice. Certified nurse midwives who practice in and out of hospitals have their own organization. Certified professional midwives who practice outside that setting have another. Other distinctions, gradations and pay scales have created a dizzying alphabet soup.

US MERA was created with the grand idea that perhaps all these organizations, who serve mothers and babies could put their differences aside and reach some basic collaborative conclusions on accreditation and education, as a starting point for further consolidation.

Troubled Historical Relationship

However, when this leadership deliberately excludes voices of color it reeks of systemic racism, building more barriers when none should exist. This latest debacle is another sad story in the thickening chronicle of the troubled historical relationship between black midwives and white midwives in this country.

Despite a long history of midwifery in the black community, black women currently represent less than 2 percent of the nation's reported 15,000 midwives.

In a powerful and thorough doctorate dissertation entitled explores "how a very racist and classist denigration of black midwives in the early 20th century is still manifesting itself in their experiences and perceptions of predominantly white midwifery education programs and professional organizations."

For years, midwives, who were mostly black, were a central part of birthing in this country. In the early 20th century, as birth became more medicalized, the obstetrics-gynecology specialty sought to advance and secure professional boundaries.

"Physicians began labeling the primarily immigrant and midwives of color (the majority of whom were black women) attending approximately 50 percent of the nation's births at the time as dirty, ignorant, evil and the like which had a profound effect in nearly eradicating midwifery. Despite a revival of midwifery during the 1960s and 1970s, 1 percent of today's United States births are attended by midwives, of which black midwives and black mothers are but a fraction of that 1 percent," Goode writes.

Worse Outcomes

Given that one of US MERA‘s stated goals is to create "a positive impact on U.S. maternity care that will improve the health of women and infants," it should be sure to prioritize representation from those who are suffering the most under the current system. Black women and infants continue to have the worst birth outcomes of any racial-ethnic cohort in the United States. Black women have the highest rate of preterm birth and low birth weight babies. Black women lose their babies at a rate that is almost 2.3 times greater than white women. Meanwhile, the black maternal mortality rate is 34 percent or three times that of white women. However, show that midwives have been proven to have a positive impact on birth outcomes and improved breastfeeding rates.

Given these two key dynamics-at a time when midwifery and non-medicalized birth options are moving more into the mainstream of U.S. birthing culture-it is important for the midwifery industry to better represent the interests of black women and infants.

"As a British-trained midwife and a staunch supporter and believer in standards and regulation I couldn't be more thrilled to see the development of national and uniform American midwifery standards and education," says Jennie Joseph, a certified professional midwife and executive director of Common Sense Childbirth, a birth center and midwifery school in Winter Garden, Fla., in a phone interview. "But without embracing all stakeholders in the formation of such essential changes, I wonder if we might end up back where we started - without positively impacting maternity care in the USA at all?"

That would be the largest travesty.

African Americans have positively participated in birth work and contributed to infant health outcomes for centuries. When no one would touch our babies, black midwives did. When white women deemed themselves too posh to breastfeed their children, black women did; often to the detriment of our own babies. Black midwives have a rightful seat to represent the interests of black women and infants at any leadership table in the industry, without having to prove themselves to white-dominated establishments.

US MERA I implore you to do better. And faster.

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