The Ford School of Public Policy hosted a virtual event on birth equity, the shift from midwifery to hospital births and birth justice on Thursday as part of the Policy Talks @ the Ford School speaker series and the Harry A. and Margaret D. Towsley Foundation Lecture Series.

The event featured speaker Leseliey Welch, former deputy director of the Detroit Health Department and co-founder of Birth Detroit and Birth Center Equity. Dr. Abdul El-Sayed, the Towsley Foundation Policymaker in Residence also spoke at the event. 

The event began with Welch and El-Sayed, who both have public health experience, discussing the racial motivations behind the increase in medicalized hospital births, which they called the biggest turning point in childbirth care.

“There was a concerted effort to move birth out of the hands of midwives into the hands of white male obstetricians and into hospitals,” Welch said. “(Society did) that in a very racialized way — through policy, and 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 childbirth healthcare. Currently, Birth Detroit is a neighborhood-based clinic, but the center will soon start construction on Detroit’s first freestanding birth center, which will become one of seven in Michigan. Welch said birth centers provide women with more of an in-home experience when they are giving birth, which is intended to be more comfortable than a traditional hospital setting.

“A birth center is a free standing, home-like place where midwives are the leaders in care, providing prenatal care, birth care, postpartum care,” Welch said. “I would say to folks who haven’t been inside one: It’s like a (big) home, not a mini hospital.”

Welch said she wanted to reframe the idea of a Black maternal health crisis, which was brought to light by organizations like the Black Mamas Matter Alliance and the Black Maternal Health Caucus. In the U.S, the maternal mortality rate for Black women is 2.9 times as high as it is for their white counterparts, while the infant mortality rate for Black infants is 2.4 times higher than for white infants.

“The way that the issue is framed has problematized Black birthing bodies instead of really addressing or bringing a structural analysis to a system that is really not good to any birthing bodies,” Welch said. “It just is disproportionately bad for Black birthing bodies.”

Questions centered on the cost of giving birth in a birth center arose in the live chat. Birth Detroit operates as a nonprofit, which allows it to accept all patients; however, this is not the case for many birth centers. El-Sayed said these access disparities are a result of flaws with the Medicaid program, which reimburses providers for care they provide to low-income patients.

“Medicaid is one of those programs that is an incredible lifeline for folks who don’t otherwise have insurance,” El-Sayed said. “Yet (it) has been consistently undermined and made worse …  meaning harder to get on and stay on (and) get reimbursement for coverage (and care). There’s so much that we could do to make Medicaid, as it stands, better, that then will benefit organizations like Birth Detroit.”

In the live chat, students asked what policy changes would help fix the issue. Both speakers said the formal licensing of birth centers would allow them to receive reimbursement from Medicaid and other insurers. They also emphasized reproductive justice as an important policy issue. Welch said it is 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 voting around Proposal 3,” Welch said. “Specific to birth centers is birth center licensure. We need that. Any licensure that codifies our reimbursement and ensures our sustainability.”

LSA sophomore Eliza Shearing, communications co-chair of the University of Michigan Public Health Association, gave her thoughts in an interview after the event. She said maternal health inequity needs to be addressed through new governmental policy that addresses the root of the problem: institutionalized racism.

“I think in order to prevent maternal mortality inequities based on race, we really need to interrupt the systematic and structured aspects of our society that create those differential access and affordability to education and care,” Shearing said. “That starts with the government.”

Prior to the event, El-Sayed told The Michigan Daily he hoped attendees would leave the discussion with new knowledge about maternal health equity and support for existing organizations like Birth Detroit.

“The profound inequities in maternal and infant health in this country are unacceptable,” El-Sayed said. “In order to address them, and we must, we have to be invested in solutions that are tailor-made for the problem, and there are incredible people out there doing this work, and they deserve our support and our investment.”

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