Friday, September 28, 2007

Homebirth, race, class and privilege

Sagefemme wrote a recent post about race and birth issues. Several other midwife bloggers picked up the post to encourage more answers. Now several are puzzling over the fact that virtually no one responded. I'm not surprised. The questions and, particularly, the way they were framed, are self referential and condescending. The incident gives us additional insight into the fact that homebirth advocacy is not some sort of universal truth, but rather a small social subgroup of white, Western, well educated and relatively well off women.

Sagefemme asks:
In my midwifery school, it was VERY rare to see a woman of color. In my experiences in the birth activism/lactivism world, again, not only is it nearly all white women but the class issue plays a big piece, too.

A woman of color once said to me, "Midwifery is a rich, white girl's hobby"...

I guess what hits me most is that if black women make up for some of the worst outcomes in birth, is the inaccessibility to midwifery schools (especially homebirth) to blame? Or is there a lack of awareness re: options in birth? Are we, as white women, keeping the role of midwife in our own privileged community and not taking it further ...
Let's look at some of the assumptions behind these questions.

Assumption #1: Birth activism/lactivism is some sort of standard to which women of color and poor women should aspire.

Assumption #2: Birth activism/lactivism would reduce the incidence of poor birth outcomes among black women.

Assumption #3: If only women of color and poor women knew about what homebirth advocates (well off white women) do, they would want to do it, too.

Assumption #4: Homebirth advocates (well off white women) must examine their own actions, to be sure that they are not inadvertently preventing women of color and poor women sharing in the brilliant insights and important opinions of homebirth advocates (well off white women).

I'm not surprised that there have been very few answers. The topic is irrelevant to women who are not Western, white, well educated and relatively well off. Moreover, the way that the questions are framed is self absorbed, self referential and self congratulatory. The questioner never even thinks to ask: What are the needs, desires and goals of pregnant women of color or pregnant women who are poor. How can those needs be met?

Women of color and poor women have cultural legacies the they find meaningful and helpful. They do not require lessons from homebirth advocates on how they should integrate birth issues within their own lives. The poor outcomes for black women reflect multiple medical, economic and social causes. There is no evidence and no reason to believe that homebirth would address any of the root causes, or have any impact on outcomes (except, possibly, to make them worse).

Chris Bobel, author of The Paradox of Natural Mothering addresses some of these issues in an interview with MamaZine:
... Of course, one of the features of privilege is not knowing you have it—that's how it works. So, I can understand how many natural mothers don't readily see how their class, race, and sexuality privileges protect them when they make alternative choices... After all, you need resources to buy organic or pay out of pocket for holistic healthcare. You need to have time off from work long enough to establish breastfeeding, or not go back to work at all, etc...
On the chapter titled, "Natural Mothering: Social Change or a Narcissistic Retreat?":
...There were a few mothers who were quite critical of natural mothering, and I admired their willingness to take a careful look at what they were doing and what it meant. These moms did notice how white and middle class the natural mothers were, and they wondered if a movement that depended on privilege could initiate broad change...
It is not a coincidence that homebirth advocacy is a movement of privileged women. Homebirth, as it is understood by its advocates, is nothing more than a social construct. It has nothing to do with nature, and very little to do with birth. As a social construct, it depends absolutely on the assumptions, beliefs, needs and prejudices of its advocates.

At its most basic level, homebirth is about achieving self-actualization and self-actualization is a luxury that very few people can afford. Self-actualization also presupposes a culture that values individuation and autonomy, and scorns subsuming individual needs within the collective good.

Homebirth advocacy depends absolutely on living in a wealthy society. Advocates never have to worry about where their next meal is coming from, how to obtain or afford the basic necessities of life, how to stay safe in a dangerous world of gang violence, or tribal warfare, or war.

Homebirth advocacy presupposes a world with easy access to birth control and abortion. Every child is a wanted child, and every birth a celebration.

Homebirth advocacy depends absolutely on the assumption that high quality medical care is only a short drive away (and everybody has a car to get there). It can only take root in a society with low perinatal mortality, because only people living in those societies can pretend that perinatal mortality is intrinsically low and that childbirth is inherently safe. Anybody who is has contact with the reality of childbirth in nature would never indulge in the ridiculous fantasies of homebirth advocates.

There is nothing wrong with the values and beliefs underlying homebirth advocacy. There is something wrong, though, with the assumption that it represents some sort of universal truth, and that women of color and poor women just need to be "educated" (or have barriers to understanding removed) in order to see how the superior Western, white, well educated women give birth and learn to copy them.

Simply put: why are almost all homebirth advocates white and well off? Because homebirth is "rich, white girls' hobby."

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