Pregnancy, Birth, and the Need for Global Harm Reduction

CW: Mention of pregnancy loss, state violence, miscarriage, death

Image for post
Image for post
Unsplash

When I think back to the fear, embarrassment, and pain I felt during my labor and delivery nearly two years ago, I let memories involving my incredibly loving and supportive birth team wash over me, the closest thing to Lethe to drown out the scars of the trauma.

While I’ve come to accept that the painful memories might always remain with me, the immense privilege of being taken care of and surrounded by love for over twenty hours of my thirty hour labor isn’t lost on me. I’m a vocal advocate for reproductive justice, whose work as a doula and researcher ties into that advocacy, and am aware of the horrifying and alarming data regarding issues related to pregnancy and childbirth around the world. I’ve written extensively on the topic for many publications and the harsh realities that I, and countless other writers, investigate highlight the need for immediate changes in policy and legislation related to reproductive justice.

In the United States, pregnant people in nationwide jails are suffering pregnancy loss and experiencing birth trauma, during labor and delivery, due to negligence at the hands of staff. The number of miscarriages in ICE concentration camps has increased in the last few years. Multiple pregnant people — like Renee Davis, Charleena Lyles, Alteria Woods who were shot by police or Korryn Gaines who, before her death at the hands of police, suffered a miscarriage during a violent arrest — and are killed or suffer pregnancy loss while in police custody each year. It is important to note, though, that data related to pregnant people and incarceration is often unreliable due to the fact that record-keeping systems that focus on prenatal care in the prison system aren’t fine-tuned. Globally.

Image for post
Image for post
Unsplash

The different institutions that make up the prison system fail to carefully and accurately record information related to pregnant people for a number of reasons. For sake of scope, I won’t expand on those reasons here but I plan to, and already have, elsewhere. What’s most important to keep in mind, however, is that negligence, carelessness, and complete disrespect for pregnant people who are incarcerated are common features of carceral spaces, unsurprisingly.

Tragic cases involving the most cruel and unusual types of punishment for pregnant people, including people in active labor, in police custody are shockingly common. All it takes is a google search to read about the horror. While the harms suffered by pregnant people behind bars are a public health concern that must immediately be addressed, they are just one piece of the biopolitically violent puzzle.

Maternal mortality is another public health issue in need of immediate attention. Alarming rates of, sometimes preventable, death are impacting communities all over the world. Countless families and communities are forced to cope with unthinkable loss and trauma while policy and legislation change at a glacial pace. Multiple cities invest in programs aimed at improving outcomes, and groups of doulas committed to addressing the maternal health crisis are doing important work, but birthing people continue to die and pregnant people continue to lack access to medically necessary care and treatment.

Image for post
Image for post
Unsplash

In the midst of all of this, lack of access to culturally-competent, quality mental health services remains another public health issue in need of immediate attention. So, when families suffer loss, coping and healing themselves become yet another obstacle. Then, when you factor in how things like race, class, and disability impact how people navigate life generally the weight of these issues is even heavier.

Enter COVID-19.

When I first saw the news that some hospitals were restricting visitors from accompanying birthing people I panicked. My heart sank so deeply that I could feel each ounce of chamber blood circling the pit of my stomach. No matter where a birthing person is they should have complete autonomy and the right to be joined by anyone they choose to have with them.

I was reminded by multiple people in the doula community that some birthing people choose to birth alone. Further, in other places around the world, birthing alone is the norm whether or not the birthing person chooses to. So the panic surrounding these policy changes in hospitals was, to some people, unwarranted. Especially considering the circumstances. We’re living through a pandemic that’s having such an extreme impact on global society that borders are closing and cities around the world are scrambling to transport rapidly growing amount of corpses to their final resting places.

Image for post
Image for post
A photo of a pop-up morgue outside of Bellevue Hospital in NYC taken on March 25 taken by Bryan R. Smith/AFP via Getty Images

If birthing people everywhere always had access to quality healthcare and hospitals more than fully-equipped to safely, respectfully, and holistically treat and care for them then countless reproductive injustice issues wouldn’t exist. Unfortunately, maternal mortality rates, statistics on pregnancy outcomes, and data related to prenatal care around the world paint a bleak picture. Before COVID-19, medical services for pregnant and birthing people were rarely about health and even less about care. Reproductive injustice is, and has always been, a public health issue impacting the lives of billions of people, many of whom are Black, Brown, or Indigenous and most of whom are chronically disenfranchised a.k.a. poor.

Now that COVID-19 has exposed us all to the truth about the systems we navigate on a daily basis, and more people are more aware of the endless failings of neoliberal capitalism as evidenced by the inherent violence of those systems, every policy change that impacts how we navigate those systems can be a death sentence. Especially considering the circumstances. We’re living through a pandemic that’s having such an extreme impact on global society that borders are closing and cities around the world are scrambling to transport rapidly growing amounts of corpses to their final resting places.

Moving forward, the goal of educators, legislators, and policy makers should be to work toward one goal: eliminating the conditions of possibility for harm. For the intents and purposes of the present inquiry I’m specifically referring to harms suffered by pregnant and birthing people but harm reduction and, ultimately, elimination is a goal that we should all strive toward. With respect to pregnant and birthing people, though, harm reduction should be the first priority of educators, legislators, and policy makers in the field of reproductive justice.

Image for post
Image for post
Unsplash

But this call for action comes in media res. The response to the pandemic has differed greatly from country to country, state to state, even city to city, leading to difficulty in determining when curfews will be lifted and quarantine orders will be withdrawn. Businesses and institutions are struggling to keep up constant changes and many people are struggling to cope with sudden realization that their government has deemed them disposable. People who have lived in that liminal space between human and other for most, if not all, of their lives are struggling to cope, too, but the pain is less fresh.

So while the world struggles to adjust to rapid change, new policies and laws are impacting multiple aspects of our lives. From changes in public transportation operating schedules to methods of educational instruction, the institutions we navigate on a regular basis are figuring out how to respond to a crisis. Sometimes, it seems like they’re playing it by ear but were handed an instrument they’d never played before after refusing to listen to the notes. Even in the case of institutions staffed by hardworking, care-focused, passionate people who are committed to ensuring that they do their jobs to the best of their ability for the sake of the people inside, and outside, their scope of care, lack of funding for necessary materials and lack of access to life-saving resources create problems.

So when a hospital suddenly changes their policies regarding labor and delivery, especially in the midst of a pandemic, harm reduction becomes a complicated and difficult goal to reach. A necessary first step, however, is to quickly fund programs aimed at ensuring that all birthing people have access — and I specify access because, as I mentioned previously, some birthing people choose to birth alone and that choice should be respected — to some form of emotional, psychological, physical, and educational support during labor and delivery. By “all birthing people” I mean that wherever a birthing person is they should have access to a support system, preferably one comprised of members of their choosing and preferably one that is physical.

After the threat of COVID-19 is gone, however, the focus should switch from harm reduction to harm elimination in the birthing world. There is no more time for reform, revolution is needed to transform the profit-driven, neglectful, sexist, violent world of the biomedical birthing industry into a person-centric movement for reproductive care. Trauma-free births should be the norm instead of the exception. Always.

Until then, pregnant and birthing people all over the world need our support and it’s up to policy makers and legislators to ensure that the conditions of possibility for them to receive that support is a top priority. The people meant to care for and support birthing people are in need of care and support, too.

COVID-19 isn’t the first global health crisis to change the world as we know it to this degree and it won’t be the last. Initiatives and programs for harm reduction and elimination in the birthing world need funding now. Birthing people need support now. As hospitals continue to change their policies, a framework of care must drive the changes. Therefore, policy makers and legislators must work as if lives depend on it. Because they do.

NYC-based philosophy graduate student whose work covers Genocide Studies, Repro + Enviro Justice, and Critical Race Theory. @moontwerk

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store