Our bodies, Our lives, Our right to decide! Why birthing is critical to reproductive justice for all women

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On 17 June 2020, Prime Minister Scott Morrison was asked in Parliament if he thought it acceptable that women, about to give birth, had to travel more than an hour from home in Yass, New South Wales to a hospital in Goulburn or Canberra. Yass hasn’t had specialist maternity services since 2004. Some women, unable to make the distance, have given birth on the side of the Barton Highway. 

The PM answered with a spiel about the government’s plan for the highway’s $150 million upgrade. It would reduce the travel! 

Jasmin Jones is one of the women forced to birth at the roadside in the dead of night. Nine years later, she and other mothers are still fighting for birthing facilities at the Yass District Hospital. 

The experiences of Jones and women across the country are part of a national trend called Born Before Arrival (BBA), which are linked to the closures of maternity units. According to an Australian College of Midwives study published in 2015, BBAs throughout Australia increased 47%, and 206% in Queensland, between 1992 and 2011. In this period, maternity units decreased nationally by 41%, and 28% in Queensland.

Rural regions bear most of the cuts. Once closed, these units rarely reopen, and the impact on women is severe. For example, Jones points out the high percentage of caesarean sections (major abdominal surgery) in Canberra hospitals, which are above the national average and highest among women living around Yass — at 35%. She suspects caesareans are hospitals’ way of managing the problem of women having to make the long trek multiple times. 

The closures also put babies’ lives at risk. Two years ago, Queensland media reported that closures of 40 rural and regional obstetric units were linked to 23.1 babies in 1,000 dying, compared to 6.1 per 1,000 in rural areas with services.

It’s called sexism. There once was a time when women were looked to as society’s sustainers and leaders. Reproduction was a public domain, and women had full control — from birth control and maternal care to giving birth and raising the children. Birthing was done in the supportive company of women, including a midwife (literally meaning “with the woman”). 

But communal property became privatised, class division emerged and the state, which enables one class to rule over all others, was designed to maintain the new order. To preserve this complete overhaul of society, women had to be reined in. They became chattel of men, and their sexuality and fertility have been micromanaged ever since. They were consigned to the home to breed labourers and raise, feed, clothe and care for them — all of this at no cost to the economy. Monogamy was invented, but only for women, to establish man’s ownership over his family and the bloodline. The profit system that later evolved is patriarchal to its core.

Motherhood on a pedestal. As with any capitalist hard sell, the glorification of being a mother requires a glossy surface to cover over cracks. Morrison, for example, lauds motherhood, and his government wants women to have more kids — with or without maternity services. And, without free, 24-hour childcare or steady work with equal pay, this means staying home. 

The abuse of women by maternity systems globally is so pervasive, brutal and harmful that it has a name: Obstetric Violence. To be shouted at or threatened with legal sanctions, such as placing the newborn into state “protection,” for asserting herself; to be slapped and bullied; or to have requests for help ignored or ridiculed are examples of what some women endure while in labour. Others are unnecessary interventions, such as caesarean section, which disrupt the natural rhythm and timing of birth. Or the insertion of contraceptive devices, without consent, after birth. Overall, the abuse, in whatever form, is a complete violation of a woman’s autonomy and her right to have her decisions respected and supported. 

Midwives have immense knowledge but have long been demonised.

Making homebirthing taboo. Obstetric violence is a reason some women choose to birth at home, supported by a midwife. Home births and midwives go together, and for millennia this is how babies have been brought into the world. Anyone who has watched Call the Midwife, the popular television series set in London’s working class East End in the 1950s and ‘60s, would have enjoyed this glimpse of a recent past. But it’s in danger of extinction by a system intent on wiping out all remaining traces of women communally in control. 

The global onslaught on home birthing appears relatively recent, but it’s part of a centuries-old war. The European witch-hunts, from the 1400s to the 1700s, saw peasants, estimated in the millions and overwhelmingly women, burned at the stake. Many were healers and midwives, who had been developing and carrying on the traditions of natural medicine. As social organisers and scientists, these peasant women were (rightly) considered a threat to the authority of the Church and nobility, which were consolidating their hold on property and power. The mass slaughter opened the way for professional physicians — protégés of the nobility and rising capitalists.

A tense co-existence between this medical élite and midwives lasted for some time. In the United States, for example, the majority of births in the early 1900s were delivered at home, many attended by midwives. However, the American Medical Association lobbied for stricter regulation of their competitors and carried out a campaign vilifying them. By the 1950s, more than 95% of all births were in hospitals, performed by doctors.

In Australia, the Australian Medical Association has played a similar role, alongside the Royal Australian and New Zealand College of Obstetrics and Gynaecology and the Australian Health Practitioner Regulation Agency (AHPRA). In the past 20 years, restrictive insurance requirements, legislation and regulations, were sewn together by these bodies and governments into a straightjacket for midwives who independently attend home births. These midwives can no longer get indemnity insurance, which prevents them from registering and legally practising. 

Hannah Dahlen, Professor of Midwifery at the University of Western Sydney, said in 2017 that nationally the number of these midwives had more than halved over the previous five years. At the same time, about half of them had been reported to AHPRA — not by the women they assisted but by health professionals. The witch-hunting hasn’t stopped. As Dahlen says, “it doesn’t involve fire, but involves an incredible amount of trauma.” 

Two Melbourne midwives are on trial for manslaughter, resulting from a tragic home birth death nearly a decade ago. In Australia between 2009 and 2018, 6.7 per 100,000 women died while giving birth. Yet those happening in hospitals haven’t resulted in criminal prosecutions, nor are they reported in the media. 

In 2019, another midwife was tried for manslaughter after the deaths of two newborns. She was found not guilty. We don’t see doctors on trial for birth-related deaths — for example in the series of infant deaths, in which negligence was found, at Victoria’s Bacchus Marsh Hospital between 1990 and 2015. 

These trials are a warning to midwives to stay away from home birthing. A conviction potentially could lead to the outright criminalisation of the practice. 

Already, women are in a near-impossible position. The few publicly funded homebirth centres in existence accept only “low-risk” women. Risk includes pregnancies with twins, breech babies, vaginal birth after a caesarean section and gestations beyond 41 weeks. 

Natalie’s situation is not unusual. Her first birth, in a hospital, was traumatic. For her second, she wanted to birth at home with a midwife. When rejected by her local birth centre as a high risk, Natalie felt she had no choice but to freebirth — at home, unattended. In Australia and across the world, freebirthing is on the rise. 

Motherhood only for some. Worldwide, the forced sterilisation of women who are indigenous, of colour, refugees, disabled and poor has been well documented — including Australia’s use of the contraceptive Depo Provera on Aboriginal women and women with disabilities.

For those who have children, their birthing rights are savagely violated. In the U.S., for example, women prisoners are shackled during their labour. Refugee women in the cages of the U.S. Southwest and the hellholes of Australian detention endure treatment no less inhumane.  

First Nations women bear the brunt of genocidal practices, from sterilisation to the incarceration and deaths in custody of women and their people. In Australia, Aboriginal women are 34% of the female prison population; 80% are mothers. The rising number of children removed from their families under “care and protection orders” is the continuation of the Stolen Generations. 

Birthing on country is vital. Jilipia Nappaljari Jones, Walmadjari traditional owner of the Pilbara region of Western Australia, explains,“being born on our land allowed us to be regarded as traditional owners of that land.” She attributes the scarcity of maternity resources in rural and remote areas to doctors winning their power struggle with midwives. The increased medical intervention and sidelining of trained traditional midwives has taken a toll on Aboriginal mothers and their connection to country. Removing women to regional hospitals has caused not only delayed labour, resulting in greater intervention and extreme anxiety for women stuck in an alien environment, it means that Aboriginal babies are not born on their land.

On Djab Wurrung country in western Victoria, the state government is chopping down sacred birthing trees to make way for a freeway extension. These trees, hundreds of years old, have hosted the delivery of approximately 10,000 babies. Women giving birth took the placenta to a tree to mix with the tree seeds, and the tree became the child’s direction tree. In 1994, Ngarrinjeri women fought to protect secret women’s business from destruction by developers at Hindmarsh Island in South Australia. The birthing traditions of First Nations women are the nexus of Aboriginal culture and sovereignty. These assaults are deliberate, meant to sever this connection and destroy it. It’s a clear act of genocide.

Radical Women fights for women’s choice and control at a birthing rights rally in 2013. Photo from RW archives.

Front and centre in reproductive justice. Birthing rights are up there with abortion rights, childcare, freedom of sexuality and gender or non-gender expression, economic independence and everything else women need to make genuine choices about having kids or not, how many to have, where and when. They are survival for the world’s First Peoples.

Reclaiming these rights requires a movement that integrates these struggles. These are some demands we can unify around: 

  • Restore, expand and fully resource free, public maternity care in rural, remote and urban communities, controlled by women and the workers;
  • Fund a well-resourced and expansive network of birthing centres and home birthing services, women-centred and controlled by women and midwives;
  • Recognise the right of every woman to decide where, how and with whom she will give birth, with the resources and support to make this real;
  • Unconditionally recognise the sovereignty of First Nations and respect cultural traditions.
  • End obstetric violence! Make perpetrators accountable to bodies elected by women who use maternity services with the powers to investigate and act. 

Linked into demands for full reproductive justice, they would launch a powerful offensive against a ruthless system that is unfit for humanity. It’s time to take it down. 

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