Equity Resource Guide

Midwifery in the United States has a complicated history of marginalization and division. Prior to the twentieth century, midwives served in their communities as the primary maternity care providers for childbearing people in the United States and attended the majority of births. The percentage of midwife-attended births declined steadily over time as chattel slavery ended, native and indigenous communities were decimated, and community midwives, foreign-trained midwives, and home birth were stigmatized through disinformation and anti-midwifery campaigns. These primarily physician-led campaigns were fueled by racism, classism, gender discrimination, and anti-immigrant fervor.

By 1975, the number of midwife-attended births reached its lowest point at less than 1% of births overall and 2.4% of non-white births. Many traditional midwives were being forcibly retired and the legacy of race, gender, and class injustice surrounding midwifery was deeply embedded in the dominant American cultural beliefs about birth and midwifery. For instance, in 1925 in the state of Georgia there were approximately 9,000 black, indigenous and immigrant midwives serving in their own communities. By 1944 that number had been reduced to 2,200. Today, there are approximately 600 midwives practicing in Georgia, and most of them are white (Georgia: “The Midwife Problem”).

The U.S. currently ranks 50th in maternal mortality and 38th in infant mortality, and the impact is not experienced equally. In our country, there are tragic disparities in health outcomes for childbearing people and infants of color due in large part to institutional racism. African American babies die at more than twice the rate of white babies, and maternal mortality is 4 times higher for black mothers than for whites, while American Indians and Alaska Natives have an infant mortality rate 60% higher than whites.

In light of these devastating statistics, this Equity Resource Guide is intended to begin to fill in social and historical knowledge gaps, to raise awareness within the CPM community about how racism and other forms of oppression are contributing to these deplorable outcomes for black and indigenous people and to stimulate dialogue and action. We believe midwives have a critical role to play in addressing these outcomes--but only if we each take individual responsibility for our part in bringing about change.

Of note: These Resources are meant to serve as an entry point from which we encourage our members to dive deeper, utilizing the many resources available to identify and implement concrete action steps. Setting an intention and developing awareness is not enough--it is only the beginning.

Equity is an ardent journey toward well-being as defined by the affected.
Equity demands sacrifice and a re-distribution of power and resources to break systems of oppression, heal continuing wounds, and realize justice.
To achieve equity and social justice in birth, we must root out and dismantle deeply entrenched systems of racism.
Equity promotes and builds agency, requires vigilance for unintended consequences of organizational policies and actions, and boldly aspires to be restorative.
Equity is disruptive and uncomfortable and not voluntary.
Equity is fundamental to the community we want to build.

Adapted from Seattle King County Best Starts for Kids

Organizations and Education Centers

Below is a list of midwifery, doula, and reproductive justice organizations led and staffed by people of color, LGBTQIA2S+, and indigenous people who are committed to using their expertise to serve their own communities and improve perinatal outcomes by ensuring access to safe, respectful, culturally relevant, and concordant care. Supporting these organizations can take many forms: NACPM members can consider providing annual financial support as a demonstration of their ongoing commitment to equity; they can amplify the extraordinary work that these organizations are doing by sharing articles and posts on social media; and they can cultivate opportunities for partnership and collaboration, using their connections and privilege to help direct attention and needed resources to these programs. This is a partial list--please click here to let us know about other organizations that should be added.

Books

Articles and Blogposts

Podcasts / Videos / Webinars / Documentaries

Commitments

Websites

People