Edited to add:
After publishing this, I learned another terrific lesson on critical importance of language and saying what we really mean. Dr. Monica McLemore appropriately reminded me that phrases like “racial disparities in birth outcomes,” or “race is an independent risk factor in birth outcomes” imply there could be something inherent about black (or indigenous) skin that affects parents and babies at birth. And, to Dr. McLemore’s point, in the past few weeks I have seen a number of birthworkers trying to work out the biologic relationship between melanin and birth. (There is none). So I want to be very clear about what we know: it is the exposure to racism that negatively affects the health and wellbeing of Black and Indigenous birthing families. Indeed, the exposure to racism has biologic implications (such as increases in the stress hormone system), that affect health and birth. But it is the experience of racism that changes birth outcomes. The experience of racism is intergenerational and daily – navigating systemic racism in every part of life changes a person’s biology. These data are very clear - there is no doubt in this scientific conclusion. So, in fact, it is more appropriate to say that the exposure to racism is an independent risk factor for birth outcomes. This post has been edited to reflect this new understanding.
It has been a few weeks since the conference in Texas where Ina May Gaskin’s answer to a question initiated a conversation that exploded on social media. It created an intense flurry with the usual divisiveness and defensiveness. The entire situation caused harm to many.
And yet, I believe Ina May has handed us a terrific opportunity to examine a number of specific examples of systemic racism and white supremacy at work. Further, given that Ina May is a white woman and hero to (mostly) white women in the US, a critical interrogation of the interchange and the resulting response may bring us – us white women - one step closer to understanding our own participation in white supremacy. Which, I hope, will bring us one step closer to how to disrupt systemic racism more effectively.
Before I begin, I want to be clear about who I am and what I hope to offer. I am a birthworker and a white woman attempting to navigate what it looks like to disrupt white culture in practice– and I think Ina May provided a moment to learn from. I offer these thoughts outside of the traditional judgement, guilt and shame that keep us from being bold – but with an attitude of curiosity, empathy and compassion. I want us all to move with intention beyond an intellectual analysis into a place of action.
I want to get this one right out there. I understand that Ina May is 80-something years old. That has no bearing on how I feel about this or evaluate the situation. If she is competent to continue to use a stage as a platform, I feel I must hold her accountable for all the things she says if she is 15, 45 or 80.
She didn’t know better
From what I understand, Ina May absolutely knew better as there have been concerted efforts to make sure she understands the impact of the exposure to racism on birth outcomes and reports that she has previously spoken to racial disparities in birth outcomes. Regardless of her personal history with this information, it is not new news: we have known that exposure to racism is an independent risk factor for maternal and neonatal mortality for 10-15 years. It has been in the public eye for a decade now (see PBS’s 2008 video here). As a birth advocate, Ina May should have known. In my view, every birthworker in the US should understand the current reality and historic context of Black and Indigenous families. I feel very strongly about this.
When I shared this history/perspective with several white women – they replied that they hadn’t known that Ina May had been told before and, knowing that she had previous access to the information increased Ina May’s responsibility. White women!! We must stop this! We must stop excusing our elders for centering whiteness once again. We must expect, from our leaders and ourselves, that disrupting white supremacy will take all of us stepping up every single time we can.
I don’t want to spend much time on this, because the apology was not to, for or about me. I suppose publishing an apology was better than silence, though in my view the apology sounded canned and inauthentic. It is unclear to me if the apology itself caused harm, but it may have. I also believe that apologies are best when they take place in the same venue as the harm, so I would have preferred to see a video apology. Enough said.
The “shero” element
I am quite sensitive to public shaming. I have witnessed it and lived it. My goal in this conversation is not to knock a hero off her pedestal. However, I am also extraordinarily sensitive to the ways in which we are not talking about the role of racism in maternal and family health in this country right now. Particularly in midwifery.
I feel frustrated and angry that this particular hero is credited with being the matriarch of “modern out of hospital midwifery” in the US. She deserves lots of credit for highlighting a wealth of knowledge of midwifery and her persistent courage in speaking about her experiences at the Farm.
But midwifery in the US has a much longer history than that. We rarely if ever talk about the countless black women, the grand midwives, who attended out of hospital births for much less glamorous reasons. They attended births when no hospital was available to communities of color, keeping traditions of midwifery alive when white folks were benefiting from the gynecologic/obstetric advances perfected on the bodies of black female slaves without their consent and with inhumane treatment (thank you Anarcha, Betsy and Lucy). Why didn’t I see pictures of grand midwives repeatedly during Women’s History Month in my FB feed? I saw Ina May as the matriarch of midwifery over and over. I worry part of the reason for this is that white birthworkers do not know the history of the Grand Midwives. If that describes you - please educate yourself now.
Part of what I have heard from women of color is that Ina May was never their matriarch precisely because she has never been speaking to their reality. White women must understand this. One of the problems with the idea that Ina May is a Hero is that Ina May was actually a hero for white women. Some of what I heard from black women is that their speaking out did not knock Ina May off her hero status because she was never a hero for their communities. In my view, part of the reckoning with this situation is that we need to understand that white heroes for white people may not be heroes for all people. We must stop making that assumption.
I also want to speak to the impact of white supremacy on our white heroes. They grow into leaders, in part, because of their ability to navigate white culture. In that navigation, they swim ever more deeply in white culture and it gets harder and harder to remind themselves what is outside white culture. As a result, unlike leaders of color who must navigate race every day, my experience with white leaders is that they are not as prepared to speak to race and racism as their colleagues of color because that ability has not been honed by their every life experience. In fact, white leaders succeeding at white culture are invested in not seeing their complicity in white supremacy, which keeps them from seeing, which makes them more complicit - and the cycle continues. Our white heroes are bound to disappoint us when they demonstrate white supremacy. And we need to understand the system was built and maintained that way.
How we deflect talking about race specifically (and why this a benefit of being white).
The issue of whether Ina May said “racist” things or not doesn’t feel like the central issue to me. Rather, it is the way Ina May dealt (or did not deal) with a very direct question about race and mortality that is problematic for me. And in my opinion, it is a lesson all of us white women in birth should examine closely. It is a pattern that I experience us repeating over and over and I want us to learn something from Ina May’s response. I want to make different choices myself if presented with a stage and a question like that.
What I saw in the video reflected something I see over and over in the birth world. Ina May refuses to talk directly to the role of racism on birth outcomes for African Americans and Indigenous communities. Tasha Portley, the person asking the initial question asks it once – relating it to her own experience in her own community – and Ina May replied with statements about nutrition and poverty and overcoming these risk factors. Tasha Portley asks the question more directly the second time – uses the word race in fact – and still Ina May refuses to use the moment to highlight what we all need to know: EXPOSURE TO RACISM changes birth outcomes for parents and babies. I am not going to break this down in this post (for more information look here) – but we know for certain that the stress of racism is passed down through generations and affects pregnancy and birth dramatically. These stressors transcend class and education and are not related directly to poverty. They are directly related to white supremacy increasing the stress of black and brown bodies their entire lives, including in the womb.
Instead of using her platform to talk about something we white birthworkers all need to be talking more about, Ina May talked about poverty and the Amish and that more prayer might go a long way towards improving birth outcomes. I agree that community and centered spirituality is a terrific way to improve outcomes and experiences, but it completely missed the mark of the question. Even worse, it redirected the conversation away from the essential topic: RACISM. Increasingly I try to stand in a perspective that if I am not actively disrupting white supremacy and white culture, I am complicit with it and upholding structural inequities. Ina May’s silence was a failure to disrupt. In that moment, she upheld white supremacy rather than actively dismantle it.
I am not judging Ina May except that I am disappointed she missed an opportunity to talk about all the data we have on the topic of racism and birth outcomes. I always hope my heroes use their platform to raise awareness about the topics that scare us.
White folks, we can go our whole lives and not talk about our race. This is one of the benefits of whiteness. So when a situation like the one in Texas gets as much coverage as it does – we need to be very careful to recognize that just because we are new to the conversation does not mean it is a new conversation. I encourage us to move quickly past our discomfort with the conversation and all its implications, aware that it is our white privilege to expect comfort at any given time. We are used to being racially comfortable nearly all the time - another benefit of whiteness - and this can make us quite resistant to the hearing about the pain racism causes to other communities. I hope that we can stand back and listen to and acknowledge the hurt. We should not need evidence of the harm, instead, let’s listen to and learn from the experiences of those who have been harmed by our failure to talk about whiteness and racism.
I challenge us all to raise our voices and talk loudly and regularly about the effects of racism (yes racism, not race itself) on birth outcomes. There is plenty to talk about – intergenerational stress, healthcare inequities, bias at every step of the way – so we need to start talking. And we need to start acting to disrupt these systems that perpetuate these outcomes. As white women in birthwork, we need to be actively working to change these outcomes by supporting leaders in communities of color who have the knowledge and skills to drive real change. For me, to learn from Ina May’s silence is to commit to speaking out about racism and birth outcomes every chance I get with everyone I know. And to donate my time and resources raising voices of folks of color whose work aligns with the change I hope to see.
Will you join me?