Birth Justice, Like Reproductive Justice: Reclaiming Our Time

This essay is published in Funding Equity: Birth Justice and Human Rights in Maternal and Infant Health

by Indra Lusero

Birth Justice is a concept that has grown alongside Reproductive Justice. However, since childbirth and the perinatal period have continued to be ignored or inadequately addressed it is helpful to articulate Birth Justice on its own. Like Reproductive Justice, Birth Justice is a call for intersectional change rooted in communities of color and queer and transgender communities.

Following Forward Together[i], it can be helpful to understand the need for a Birth Justice framework by looking at three ways of addressing the problems in birth and the perinatal period: Perinatal[ii] Health Care, Perinatal Rights, and Birth Justice. Each of these three avenues have distinct theories of change, which I outline below.

Perinatal Health Care

Looking at the issue from a Perinatal Health Care perspective approaches the problem as one of service delivery. The idea is that if the service delivery system were improved it would lead to better birth outcomes. This approach is based on research and direct-service models that follow research findings. The focus of this approach is on reducing medical interventions, increasing evidence-based services that support physiologic birth, and increasing access to the midwifery model of care. The root of the problem is seen as inadequate or absent information about optimum care on the part of practitioners and consumers alike. Thus, if everyone was better informed, practitioners would provide optimum care and consumers would choose that care.[iii]

Perinatal Rights

The central theme of perinatal care as a legal and advocacy issue is that pregnant people and those who provide care to them should have certain rights, and that the protection of those rights is essential to inidivduals’ health during the perinatal period and to the wellbeing of society at large. These rights are secured through legal and legislative advocacy. Therefore, the focus is on liberty as expressed through informed consent/refusal, bodily autonomy, the right to privacy, the rights of parents to make healthcare decisions for their children, and the right to choose among health care approaches, procedures, and providers. From this perspective, the problem is seen as a lack of protection for basic rights during the perinatal period. The idea is that if these rights were better protected, people could assert their rights against threatening providers, facilities, regulators, and legislators. At the very least, individuals would have a legal recourse when their rights are violated[iv] and this would improve the system overall.

Birth Justice

Birth justice sees the issue as one of structural inequality. Ideas about pregnant bodies, infancy, motherhood, family, reproduction, and life reinforce historical power dynamics that are based on bias and economic inequality. The perinatal health care system creates ideas and effectively stratifies using laws and policies that were built to advance the racial identity, gender position, and economic position of white men. The problem is therefore seen as existing in both social institutions and individual consciousness.

Perinatal health care is a space where these inequities are reinforced or broken down, especially because it is a natural point of transformation. As a result, the strategy for change is multidimensional; it involves ensuring access to service delivery, and guaranteeing rights, but it also involves developing leadership and building social, political, and economic power. In order to break down inequities, the focus is on bringing those who have been historically marginalized to the center. When childbirth is more just, we will also give birth to more justice, and more justice will promote the health and wellbeing of people through the perinatal period.[v]

The Need for All Three

There is incredible need for all of the work being done in Perinatal Health Care, Perinatal Rights and Birth Justice, and there is need for more of all three approaches. So far, the majority of the funded work in this area has focused on Perinatal Health Care, which is important. But very little funding has supported work related to Perinatal Rights or Birth Justice.

Birth Justice asserts that without a multidimensional strategy for change that focuses on expanding access to power and leadership beyond the current actors, and dismantling oppressive structures within the system, gains in service delivery and legal rights will be inadequate or may even reinforce existing inequities. This is why the Birth Justice approach should be the at the center. Perinatal Health Care and/or Perinatal Rights work can be optimized by implementing it in collaboration with a multidimensional Birth Justice strategy.

Birth Justice at Work: The How and the What

At Elephant Circle we prioritize the Birth Justice approach. When we think about Birth Justice we picture the HOW and the WHAT. How we achieve birth justice is just as important as what we achieve. How do we get there? By tackling power and oppression through strategies for change and resilience. What do we need to get there? Expertise in the health care system, the legal system, and the sociobiology of the perinatal period.

How: Tackling Power and Oppression

Tackling power and oppression as part of a Birth Justice approach means that at every level, in every project, every decision is geared both toward advancing the stated goal and toward dismantling oppressive systems. So, for example, at Elephant Circle when we run legislative or regulatory campaigns we are trying to persuade policymakers of our platform, but we are also trying to disrupt white supremacy. It’s a squirmy thing, white supremacy. It wears many guises. Sometimes it’s saying “that’s too queer” and other times it’s saying “she’s just too aggressive,” it takes a full-time commitment and ongoing practice to tackle.

One of the biggest symptoms of white supremacy that we deal with when it comes to perinatal and newborn health is the absences of birthworkers of color where one hundred years ago there were black midwives in the South, indigenous midwives of all tribes, Latino midwives of every hue, and every immigrant community had midwives who spoke their language and knew their culture. White supremacy shows up in our field when we accept the status quo as some sort of natural state of affairs or just the way things are. To achieve Birth Justice we must actively work against acceptance of the status quo as a natural state of affairs.

How: Strategies for Change and Resilience

Tackling power and oppression alone is interminable and ultimately insufficient because Birth Justice requires not just the disruption or elimination of oppression, but the ability to envision and create something new. This is why we also need strategies for change and resilience. Having strategies for change and resilience means that we support our humanity as we do the work. We honor seasons of growth, cultivate joy and wonder, and listen deeply. We draw from art, psychology, spirituality, leadership development, meditation, trauma-informed care, and innovation. This work is key to how we advance Birth Justice.

What: Expertise in the Health Care System, Legal System, and the Sociobiology of the Perinatal Period

Our current perinatal health care system is rife with inequties, subpar outcomes, expensive and ineffective interventions, human rights violations, and preventable deaths and complications. For this reason, the WHAT of Birth Justice requires expertise in Perinatal Health Care systems—their clinical, organizational, and legal aspects—and in Perinatal Rights.

In both policy and clinical work, risk is a common thread. Racial, and other biases, are implicit in notions about risk. Risk is a subject that illustrates the importance of a Birth Justice approach. It is important to understand risk from a clinical, health care system, legal, and sociobiological perspetive and to be able to identify bias in the way risk is defined or managed or mitigated.

Centering Birth Justice

The Birth Justice approach helps us not only understand and address risk but to dismantle oppressive systems and protect our humanity while doing so. Perinatal Health Care and/or Perinatal Rights work can be optimized in collaboration with a multidimensional Birth Justice strategy.

More resources are needed across the board to tackle these interconnected challenges. Birth Justice organizations, like Reproductive Justice organizations, need to be centered and scaled up to ensure that as resources in this field expand, they are used to truly transform the conditions that led here, and to point the way to more just and humane solutions.

[i] A New Vision for Advancing Our Movement for Reproductive Health, Reproductive Rights, and Reproductive Justice, Asian Communities for Reproductive Justice, (2005). Available at:  https://forwardtogether.org/tools/a-new-vision/

[ii] I use the term perinatal health in place of maternal health in order to better identify care related to the time before and after childbirth, and as a more gender neutral term for that care.

[iii] This publication is a good example of the Perinatal Health Care approach: Peter B. Angood, et. al. The Transforming Maternity Care Symposium Steering Committee, Blueprint for Action: Steps Toward a High Quality, High-Value Maternity Care System, Womens Health Issues 2010 Jan-Feb;20(1 Suppl):S18-49. doi: 10.1016/j.whi.2009.11.007

[iv] The Birth Rights Bar Association was founded to address these issues. This document is a good example of the Perinatal Rights approach: Birth Rights Bar Association, “Know Your Rights,” available at: https://birthrightsbar.org/resources/Documents/brba-know-your-rights.pdf

[v] The work of Black Mamas Matter Alliance is a good example of this multidimensional understanding of the problem and similarly multidimensional approach to the solution, see https://blackmamasmatter.org/