Midwives for Reproductive Justice

This post originates on the Nursing Students for Choice (NSFC) blog. The American College of Nurse-Midwives (ACNM) recently celebrated its 60th Anniversary with a gathering of over 2,000 members in Washington, DC. Prior to this meeting, a caucus within the college, Midwives in Support of Reproductive Health and Abortion (MSRHA), initiated a discussion of a how to publicly represent its membership in a way that would align with other public symbols of identifiable groups at the meeting. A tradition at ACNM, as with many conferences, is to announce involvement in College groups by wearing colorful ribbons on the conference badge, examples of which include "Preceptor," "Future Midwife," and "Speaker," among many others. MSRHA asked, and received, a ribbon for distribution: "Midwife for Reproductive Justice." Reproductive justice is the phrase that is used to represent the complexity of the needs of women seeking sexual and reproductive health care. The SisterSong Collective describes the reproductive justice movement as follows:“The reproductive justice framework – the right to have children, not have children, and to parent the children we have in safe and healthy environments -- is based on the human right to make personal decisions about one’s life, and the obligation of government and society to ensure that the conditions are suitable for implementing one’s decisions.Reproductive justice addresses the social reality of inequality, specifically, the inequality of opportunities that we have to control our reproductive destiny. Our options for making choices have to be safe, affordable and accessible, three minimal cornerstones of government support for all individual life decisions.”“Choice” is well-recognized as not all-encompassing of the complexities of abortion access, economy, education, community, employment, sexuality, gender expression, religion, etc. One word just doesn’t cut it anymore: a broad movement is more nuanced and inclusive, as well as representative of the work to be done. Importantly, this linguistic and community work toward intersectionality was initiated and continues forward with force by indigenous women and women of color, a history not to be lost or co-opted as the movement gains momentum. Similarly, but not in mutual exclusion, many identify midwifery as a broad movement: toward physiologic birth, holistic care, informed consent, reproductive rights, and better integrated healthcare teams. The reproductive justice framework provides us with a unifying approach to ensure that we are addressing women in the complexity of their lives, and in respect for their human rights. As midwives, we are all encouraged to support and advance women’s comprehensive reproductive health and wellbeing, as outlined in the ACNM statement on “Reproductive Choices”:“The American College of Nurse-Midwives (ACNM) affirms the following:

• Every woman has the right to make reproductive health choices that meet her individual needs;
• Every woman has the right to access factual, evidence based, unbiased information about available reproductive health choices, in order to make an informed decision;
• Women with limited means should have available financial resources to support access to services to meet their reproductive health care needs."

This is also consistent with the ICM Position Statement on “Midwives’ Provision of Abortion-Related Services”:“ICM affirms that a woman who seeks or requires abortion-related services is entitled to be provided with such services by midwives… The education of midwives should prepare them for their role in providing abortion-related services that ensure safety and wellbeing for the woman.”Neither the midwifery nor the reproductive justice movement efforts exist in a vacuum. The individuals we serve are part of our daily passion and motivation toward justice, respect, humanity, and medically accurate education and healthcare provision. Midwives and Nurse Practitioners well know that there is never just one component to an exam, nor a history, nor a personal story: it is a beautiful and ornate web of life and experience and subjectivity and objectivity and truth and pain and progress and history. For a glimpse in time and an example of intersectionality… While ACNM gathered and discussed latest research, built community, challenged ideas, strategically planned for the future, and celebrated leaders in our community, many events pertinent to the reproductive justice movement dominated the headlines.

• SCOTUS rulings on gay marriage and the Affordable Care Act
• Bree Newsome removing the Confederate Flag
• Donald Trump's racist comments about immigrants
• Black Churches being burned in the South
• Wisconsin passes 20 week abortion ban
• SCOTUS debates abortion access

There is no way to separate these issues from discussions of intended pregnancy, access to accurate information, finances, education, safety, racism, equality, healthcare, family, or community. There. Is. No. Way. Political leaders and young activists are doing great work to normalize abortion. Physicians are opening birth centers that also provide abortion care. Feminists of color are breaking down historically white walls. Writers title articles “Free Abortion On Demand Without Apology.” Radical birth workers are publishing and motivating community. The movement is forceful and passionate and led by some amazing people.Within ACNM, a major effort toward furthering midwifery’s involvement in reproductive justice is through a task force entitled "Diversification and Inclusion.” Conversations about diversity can be complicated on both sides, but that in no way diminishes their importance. If anything, honesty and boldness are even more important in the growth process as injustices are identified and work that has been done by midwives of color is adequately recognized and white midwives and leadership begin the work to make change within themselves, as we jointly work within the organization as a whole. As midwifery fully recognizes its history (ACNM was founded on the premise that black midwives in the south be included equally in the organization's founding) and eliminating a white revision of midwifery's origins in this country (black midwives in the south traversing difficult rural terrain to provider birth care well before and during the Mary Breckinridge era, Guatemalan midwives teaching Ina May Gaskin the maneuver that now bears the latter's name), only then can we move forward in understanding how midwifery needs to, must, and can align with the reproductive justice movement in proceeding forward in our collective intentions. Find your own path within reproductive justice. Wear ribbons and buttons and tattoos and your words out loud. Challenge your organizations to do more. Speak the words "abortion" and "midwifery" and “nursing” in the same sentence. Spread the history and the movement of reproductive justice at every turn. Elevate the voices of those who are powerful but unseen or unheard. Do more, everyday, every moment, with everything you have: we each deserve it, the individuals and families we serve deserve it, and the future we create together deserves it. Learn more about the history of the reproductive justice movement by following SisterSong and Forward Together.Learn more about ACNM’s Diversification and Inclusion Task Force and the 2015-2020 Strategic Plan. If you are a midwife, join ACNM here and become a part of this conversation. As a member you are able to join caucuses and listservs such as Midwives in Support of Reproductive Health and Abortion. For more information about MSRHA, contact our Chair Amy Levi, CNM, PhD at amylevi@salud.unm.edu.Many thanks to Amy Levi for her contributions to this post. The views expressed in this blog are not intended to represent the official positions of ACNM.Stephanie Tillman is a midwife in Chicago, IL, where she works at a Federally Qualified Health Center serving a predominantly Spanish-speaking community and attending birth at inner city hospitals. She has served as a Board Member of Nursing Students for Choice (NSFC) since October 2014, and joined the ACNM Board of Directors in July 2015. Stephanie founded Feminist Midwife in 2012, and through the blog and social media she continues to write about feminist and human rights issues in medicine and midwifery, engaging in and promoting work of the reproductive justice movement, and elevating conversations around women, health, and care. Follow her: facebook.com/FeministMidwife, @FeministMidwife on Twitter and Instagram.