This article is part of a Mama’s Day series by Strong Families, published in partnership with RH Reality Check in our Mother's Day 2011 series. Follow Strong Families on Facebook and Twitter. See all articles in this series here.
Childbirth can be a deadly matter in the U.S., especially if you are middle or working class. But it was when looking at race and income together that one civil rights organization decided it needed a new lens.
Women in the U.S. living in lowest-income areas are twice as likely to die during pregnancy and childbirth, according to a groundbreaking report released today by Amnesty International. In Amnesty’s one year update to their Deadly Delivery report on maternal health, they showed that the U.S. is one of the most dangerous countries to go give birth in the west, especially if you are poor.
But thanks to a pioneering report by the Urban League of Portland, Oregonians know that pregnancy is dangerous to both mother and child, and that race plays as much of a factor as income in who lives and dies. It turns out that the intersections of race, gender and class are, literally, a killer.
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In 2009, the Urban League released their State of Black Oregon Report, which highlighted many shocking disparities, the most disturbing being that Black babies mortality rates in Oregon were closer to Botswana or Sri Lanka than to the US average; Black babies are twice as likely as whites to be born with low birth weight or to die before their first year. Birth disparities exist even for upper class Black mothers.
“The State of Black Oregon really highlighted the inequities in health care and maternal care access, and how it is a life and death issue - literally,” says Midge Purcell, Organizing and Advocacy director for the League.
That’s when the Portland chapter of this 100-year-old civil rights organization, which runs numerous programs including an assisted living facility and an employment program, decided it was time to start doing some reproductive justice work.
As part of regional nonprofit Western States Center’s reproductive justice project, the Urban League embarked on a six-month research project to highlight national programs that effectively reduced infant mortality and low birth weight in the Black community. Many of the most successful programs incorporated the use of doulas. A doula is someone who accompanies and attends a woman before, during and after pregnancy. One specific program named in the study is the International Center for Traditional Childbearing, based in Portland. ICTC focuses on training Black doulas and midwives, and improving birth outcomes for all women, and they run a camp for girls of color to learn more about community health care.
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Out of this research Urban League found that there was no one silver bullet in reducing birth disparities in the Black community. Instead, they needed a lens that allowed them to see the intersections of poverty, race, gender, education, housing and health care access–and they found that lens in reproductive justice.
“Reproductive justice is about building strong families,” says Kalpana Krishnamurthy, Program Director for Western States Center.
“It’s about making sure that families and communities who have the least amount of resources and who are most under attack, are given the opportunities and resources needed to thrive, and that their voices are heard and supported when it comes to making bigger level decisions, about their bodies, their families and their communities.”
Purcell says succinctly, “An investment in maternal health is an investment in our community’s health.”
The League found the most effective ways of reducing birth disparities were using principles from the reproductive justice model: addressing racism, both institutional and individual; building stronger and broader social support for Black women; enhancing culturally proficient prenatal care; and community mobilization and empowerment to address their own issues.
Out of this research and analysis, the Urban League of Portland crafted policy recommendations for the state, county and city governments, and presented them to a packed room of decision makers and community members last September.
Multnomah County government (the county Portland is a part of) was so impressed, they expressed strong interest in implementing the League’s county level recommendations, which included: funding a doula program led by a community organization such as ICTC; including community members in decision making; increasing access to data and information the county records; and create stronger competency requirements for county staff around working with low income urban Black women.
The League is in conversation with Multnomah County Health Department about developing a strategy to implement and monitor the recommendations. “We want to make this an inclusive process,” Purcell explains. “We want to be accountable to the community, and want this process to be rooted in the community.”
To other traditional civil rights organizations who may be wary of taking up reproductive justice as a way of looking at their work, Purcell says:
“I would say to other organizations that if you are interested in developing strong communities, strong families, that reproductive justice is a key part of that, because employment, education, criminal justice issues, they are all intricately tied up with reproductive justice. It’s a natural connection.”
In addition to its legislative work to create racial impacts statements and administering a community garden, The Urban League of Portland is working to create a statewide community health worker program, where Black community members will be trained to support Black pregnant women, in the tradition of a doula.
Because, as Purcell says so clearly, “I believe reproductive justice is part and parcel of civil rights and social justice.”