The Ford School of Public Policy hosted a virtual event on birth equity, the transition from midwifery to hospital births and birth justice on Thursday as part of the Policy Conversations in the Ford School Speaker Series and the Harry A. and Margaret Foundation Lecture D. Towsley Series.
The event features speaker Leseliey Welch, former deputy director of the Detroit Department of Health and co-founder of Birth Detroit and Birth Center Equity. Dr. Abdul El-Sayed, Towsley Foundation Policy Maker in Residence, also spoke at the event.
The event began with Welch and El-Sayed, who both have backgrounds in public health, discussing the racial motivations behind the increase in medical hospital births, which they called the biggest turning point in birth care.
“There was a concerted effort to move birth out of the hands of midwives and into the hands of white male OB-GYNs and into hospitals,” Welch said. “(Society did) this in a very racial way – through politics, media and academic and literary articles about the midwife problem, about how unclean black midwives were.”
Welch then discussed birth centers like Birth Detroit, an alternative to the hospital birth model for birth health care. Birth Detroit is currently a neighborhood clinic, but the center will soon begin construction on Detroit’s first freestanding birth center, one of seven in Michigan. Welch said birthing centers give women more of a home experience when they give birth, which is meant to be more comfortable than a traditional hospital setting.
“The birth center is a freestanding, home-like place where midwives are the leaders of care, providing prenatal care, birth care, postpartum care,” Welch said. “I would say to people who haven’t been in one: It’s like a (big) home, not a mini-hospital.”
Welch said she wants to reframe the idea of the black maternal health crisis that has been brought to light by organizations like the Black Mamas Matter Alliance and the Black Maternal Health Caucus. In the US, the maternal mortality rate for black women is 2.9 times that of their white counterparts, while the infant mortality rate for black infants is 2.4 times that of white infants.
“The way the issue is framed is problematizing black maternity instead of really addressing or doing a structural analysis of a system that’s really not good for maternity,” Welch said. “It’s just disproportionately bad for black birthing bodies.”
In the live chat, questions arose related to the cost of giving birth at a birthing center. Birth Detroit operates as a non-profit organization, which allows it to accept all patients; however, this is not the case for many birthing centers. El-Sayed said these disparities in access are the result of flaws in the Medicaid program, which reimburses providers for the care they provide to low-income patients.
“Medicaid is one of those programs that is an incredible lifeline for people who otherwise don’t have insurance,” El-Sayed said. “Yet (it) has steadily eroded and deteriorated … meaning it’s harder to get on and stay (and) get reimbursed for coverage (and care). There are so many things we can do to make Medicaid as it is now better that will benefit organizations like Birth Detroit.”
In the live chat, students asked what policy changes would help fix the problem. Both spokespeople said formal licensing of birthing centers would allow them to receive reimbursement from Medicaid and other insurers. They also highlighted reproductive justice as an important political issue. Welch said it’s important to remember that reproductive justice includes both abortion and safe, accessible childbirth.
“The most imminent — and winnable — (proposal) in our state right now, I would say, would be reproductive justice and the vote around Proposition 3,” Welch said. “Specific to birthing centers is the licensing of birthing centers. We need that. Any license that codifies our recovery and ensures our sustainability.”
LSA sophomore Eliza Shearing, co-chair of communications for the University of Michigan Public Health Association, expressed her thoughts in an interview after the event. She said inequities in maternal health must be addressed through new government policy that tackles the root of the problem: institutionalized racism.
“I think that in order to prevent maternal mortality disparities based on race, we really need to break the systematic and structured aspects of our society that create this disparate access and accessibility to education and care,” Shearing said. “It starts with the government.”
Before the event, El-Sayed told The Michigan Daily that she hopes attendees leave the panel with new knowledge about maternal health equity and support for existing organizations like Birth Detroit.
“The profound disparities in maternal and infant health in this country are unacceptable,” El-Sayed said. “To deal with them, and we have to, we have to be invested in solutions that are tailored to the problem, and there are amazing people out there doing this work, and they deserve our support and our investment.”
Daily News Contributor Madi Hammond can be reached at [email protected]