On the back of the Obama administration’s decision to drop its attempts to block sales of Plan B without age restrictions, I’ve been thinking about the greater spectrum of women’s reproductive health. Women’s rights advocates, social justice advocates, and feminists (including myself) sometimes suffer from a tunnel vision of sorts when it comes to reproductive justice and focus most of our attention on a woman’s right to choose whether or not to continue a pregnancy, access to birth control and emergency contraception. But what about the women who choose to continue their pregnancy?
Reproductive justice needs to be re-framed to include the entire spectrum of choices surrounding every stage of women’s reproductive health. The United States is currently in a maternal health care crisis and no one seems too concerned.
According to Amnesty International, more than two women die every day in the U.S. from complications of pregnancy and childbirth. The United States spends more than any other country on health care, yet women in the U.S. have a higher risk of dying of pregnancy-related complications than those in 49 other countries.
Adequate prenatal care is essential for improving maternal health. But one of the most significant barriers to getting either is cost. Currently the way the United States health care system is organized and funded fails to ensure that ALL women have access to affordable, timely and adequate maternal health care.
For many women, health care costs are beyond reach. It is not uncommon for private insurance policies to exclude maternal care and most insurance companies will not provide coverage for a pregnant woman unless she had insurance before she became pregnant. In an essay for the book Get Out of My Crotch, Martha Bayne writes, “Babies, it turns out, are not cost-effective for the insurance industry. Because, guess what? When women purchase maternity coverage, it’s a pretty good bet they plan to use it.”
While 42% of births are covered by Medicaid, complicated bureaucratic requirements result in significant delays to prenatal care. Jennie Joseph, a certified professional midwife from Florida says, “If you go to apply to the Medicaid system, you need a ‘proof’ of pregnancy’ letter, with the due date, the date of your last period, and the gestational age of the baby. Where do you get that kind of letter? – A doctor. If you have no Medicaid, how are you going to get to the doctor to get that letter?”
Maternal health can be greatly improved if the structures of maternal health care are made affordable and easily accessed by all women. Maternal health is a human right. Preventable maternal mortality is a violation of multiple human rights including the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. The world of reproductive justice needs to do a better job at helping ensure the rights of women who choose to go through with their pregnancy, not just the women who don’t. While we’re fighting for affordable access to birth control, let's fight for affordable maternal health care.
The documentary, The Business of Being Born, (available on Netflix) looks at the American maternity care system, hospital delivers, and at-home childbirths. They argue that the increased medicalization of childbirth has resulted in a booming business where medical decisions are made based on monetary and legal reasons rather than what is good for the mother and baby. Hospitals are convincing women that their bodies are not designed for natural childbirth, and therefore are interfering when it is unnecessary and greatly exacerbating complications that wouldn’t necessarily have been there before.
For example did you know that the lithotomy position (lying on your back with your legs up) is essentially the worst position to give birth in? It closes the pelvic area by about 30% and puts the mother at greater risk of intervention, including episiotomy, vacuum extraction, and C-section. But because it is the best position for the doctor most women give birth in a position that goes against gravity.
Hospitals have attempted to get court orders to force women to have C-sections against their will. Cesarean sections are extremely doctor friendly. C-sections now account for nearly 30% of all deliveries. The risk of death following cesareans is more than three times greater than for vaginal births.
How do we fix the (over) medicalization of childbirth? Education and awareness about women’s rights and options in childbirth. While we’re fighting for comprehensive sexual education for children and teenagers, let’s continue to educate women and their partners about the choices and rights in maternal health.
Reproductive health rights means more than those women who choose not to continue their pregnancy. Let’s widen our vision of reproductive justice to be more inclusive of all the choices women have in their reproductive health. Women who choose to continue their pregnancies aren’t the enemy. Looking at them like they are has only allowed for the crisis in maternal health care to continue to exist. Maternal health care is a part of reproductive justice that we can no longer afford to overlook.
Let me know your thoughts on the issue on Twitter: @genia_castro