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The Midwives’ Resistance: How Native Women Are Reclaiming Birth on Their Terms

Posted: January 17, 2018

Aboriginal or indigenous midwifery is seeing a resurgence as conventional health-care policies in hospital and clinics perpetuate an environment in which most contemporary pregnant Native women are considered pathologically unhealthy.

“The mainstream medical narratives surrounding Native women depict moms who don’t breastfeed and don’t have partners. According to this portrayal, Native women don’t exercise, eat poorly, and have diabetes. We are seen as hopeless,” said Marinah Farrell, an indigenous Chicana certified professional midwife based in Phoenix.

“When I worked in the hospital, I saw so many Native mothers who would hemorrhage and have terrible outcomes during their births. It seemed so abusive; they were treated like they were sick already when they entered the hospital doors,” said Rebekah Dunlap, a member of the Fond du Lac Band of Ojibwe who works as a doula and is a registered nurse, bachelor of science nurse, and public health nurse in Minnesota.

What began quietly as the efforts of a few dedicated women has in recent years grown in size, scope, and agility. Today, Native women across the United States and Canada are putting their skills to work in challenging the status quo of mainstream medicine.

Birth has become dangerously medicalized for them. Cut off from traditional diets, support networks, and community midwives due to colonization and assimilation, many Native women have chronic health conditions that mean giving birth is a high-risk activity—and one that requires travel to well-equipped hospitals.

Aboriginal or indigenous women, especially those in the United States, are overwhelmingly classified as high-risk. In Canada, according to Statistics Canada, birth outcomes among indigenous peoples are consistently less favorable than among the non-indigenous population. Native American and Alaska Native women have higher rates of maternal morbidity or injury compared to the general population, according to the Centers for Disease Control and Prevention (CDC). The risk of maternal death for Native women is twice that of white women in the United States. The infant mortality rate for Native American and Alaska Native babies is .83 percent, second only to rates for non-Hispanic Black American babies of 1.13 percent.

The practice of forcing Native women to travel to hospitals because their traditional ways of caring for pregnant people were outlawed contributes to an endless cycle of poor outcomes. Despite the public health industry’s best attempts at addressing Native women’s high-risk status, this cycle can’t be addressed by the same Western-style institutions that are complicit in perpetuating the problems in the first place, according to indigenous midwives including Katsi Cook of the Mohawk Nation.

Reclaiming Tradition

The efforts of indigenous midwives in Canada and the United States run a wide spectrum of styles and practices. However, according to Nicolle Gonzales, Navajo nurse-midwife, “Indigenous peoples share a worldview of connection to the land. We view birth and motherhood as ceremony,” she said.

“Traditional midwives took time to sit and talk with the mothers about their lives, families and challenges,” Dunlap noted. “Our women were given time and support to have their babies; there was no agenda dictating the various stages of labor,” she said, drawing a clear distinction between birthing experiences at hospitals versus in Ojibwe communities. 

Among indigenous peoples, as birthing women moved through the stages of labor, they were fed certain foods to provide physical, emotional, and spiritual strength. When the baby was born, its feet touched the earth even before it was given to the mother. “All of these ways had important meanings that are not yet completely lost,” she said.

“Woman is the first environment,” Cook said, echoing Dunlap’s sentiments. “With our bodies we nourish, sustain, and create connected relationships and interdependence. In this way the Earth is our mother, our ancestors said. In this way, we as women are earth.”

Cook has influenced and inspired generations of midwives to embrace their traditional Native ways. “I have a long tail in championing indigenous midwifery extending back to when I was first pregnant in 1973,” Cook said.

Cook has worked as an indigenous women’s health and midwifery advocate for many years. In 1983, she helped create a “Birthing Crew” of local elders and midwives on her home reservation of Akwesasne in New York and Canada. The crew provided midwifery services and health education to tribal members. In 1985, after the nearby St. Lawrence River was polluted by polychlorinated biphenyls (PCBs) from General Motors, Cook established the Mother’s Milk Project. A study found PCB contamination of breast milk of Mohawk women who ate fish from the St. Lawrence River.

Today, Cook’s many devotees and students continue taking up the challenge to revitalize indigenous midwifery.

Gonzales is working within U.S. medical laws and regulations to create what will be what she describes as the first Native culturally focused birth center on tribal lands. Founder and executive director of the New Mexico-based Changing Woman Initiative, Gonzales received her bachelor’s of science in nursing and master’s degree in nurse-midwifery from the University of New Mexico and is a member of the American College of Nurse-Midwives and certified with the American Midwifery Certification Board. Although eligible to practice in a conventional hospital, Gonzales envisions creating a birthing environment that is friendly and welcoming and where Native women can have ceremony, eat traditional foods surrounded by family, and reclaim their traditional ways of birthing and healing.

According to the CDC, in 2015, 98.5 percent of births in the United States occur in hospitals. Out-of-hospital deliveries represented 1.5 percent of births in 2015. Of the more than 61,000 out-of-hospital births, 63 percent occurred at a home and 31 percent at free standing birthing centers. However, most insurance companies don’t cover home births and may only offer limited coverage at birthing centers.

Gonzales hopes she can establish Medicaid certification for the birthing center they are building and establish other ongoing funding in order to offer services for women who may lack other health insurance.

She and her supporters and co-workers at Changing Woman Initiative equate Native women’s rights to birth in their own ways as inherent and inalienable rights affirmed by the United Nations Declaration on the Rights of Indigenous Peoples. They hope to complete the birthing center, on the Pojoaque Pueblo, north of Albuquerque, this year.

Providing Truly Culturally Sensitive Care

Gonzales and her colleagues argue that although the Indian Health Service is tasked with providing health care to Native Americans, it is unable to effectively meet its mission. IHS is the federal agency within the federal Department of Health and Human Services that is charged with meeting treaty agreements between federally recognized tribes and the U.S. government, which promises to provide tribal members with health care. These promises have their base in Article I, Section 8 of the U.S. Constitution governing duties and powers of the Congress.

Criticism of the type of health care offered by IHS, however, could be lodged against other conventional health-care facilities in the United States that are also subject to the same limitations and laws regarding types of services that can be offered.

A statement provided by the Phoenix Indian Medical Center indicated that it employs ten certified nurse-midwives who provide culturally sensitive and relationship-based services. According to the statement, the health center provides pregnant people with therapeutic massage, hydrotherapy, and lactation support. Gonzales, however, argues that although IHS insists it offers culturally sensitive birthing practices, most of the midwives are non-Native and the facilities are still governed by the same strict hospital-style protocols as its mainstream counterparts. So no matter where a Native pregnant person might reside, their access to culturally sensitive care will be limited, if nonexistent. Birthing mothers are restricted regarding food consumption and the use of open fires, and ceremonial food preparation is restricted.

Aboriginal midwifery in Canada, however, has long been recognized by mainstream organizations such as the College of Midwives of Ontario. The college, responsible for registering midwives in the province, declared in a 2001 vision statement that midwifery care in Ontario, including aboriginal midwives, was defined by ongoing support for community-based midwives working in partnership with childbearing women. Aboriginal midwifery is seen as a valuable way not only to improve patient and infant health outcomes, but also as a means to help reverse overall health disparities among Native peoples.

“Indigenous midwifery and healing practices are keystones in addressing reproductive health and longstanding problems in communities such as addiction, disease, shame and trauma,” said Cook, who helped create the 1994 exemption of the Regulated Health Professions Act in Canada.

Preliminary data and evaluations indicate that birth outcomes have improved since the exemption was added. For instance, Inuulitsivik Health Centre’s Midwifery Service in Nunavut territory has provided care by traditional Inuit midwives to clients since 1986. According to research funded by Health Canada and published in Birth Issues in Perinatal Care, findings indicated low rates of intervention for births despite the high-risk designation of many Inuit mothers. Ninety-seven percent of births were documented as spontaneous vaginal deliveries; Inuit midwives attended 85 percent.

Read more on Rewire.

How to Build a Healthy City

Posted: January 16, 2018

“People are part of many different communities,” Dr. Clay Johnston says. “Not just their physical community, but also the communities in which they work, and in which they share religion and other cultural commonalities.”

The notion that individual well-being can be a citywide concern is changing how civic leaders approach the subject of community health and how community members support each other.

Dell Medical School director Dr. Clay Johnston and Hogg Foundation executive director Dr. Octavio Martinez discuss the utility and viability of community health care. Their combined experience as educators, practitioners and civic leaders makes for an illuminating exchange of ideas.

Mental Health in the Lived Environment

When it comes to addressing mental health issues at the community level, Dr. Martinez and Dr. Johnston agree on the necessity of situating clinical spaces in a broader context of care.

“At the Hogg Foundation, when we look at a community, we do concentrate a lot on what’s outside the medical setting,” Dr. Martinez says. “Where everyone lives, learns, plays and prays.”

Public health care paradigms that account for the social determinants of mental health don’t just expand the size and capacity of a community’s support networks. They also lengthen the time window for potential stewardship and aid, creating more opportunities for interventions that are preventative in nature, rather than prescriptive.

Unfortunately, as Dr. Johnston points out, prevention efforts are presently far more underfunded and underutilized than in-hospital care. “We’re waiting for things to get really bad,” he says. “We’re not actually upstream about how to get people out of that system.”

Constraining the boundaries of mental health treatment to medical settings, however, ultimately excludes facets of community life that can be equally vital to an individual’s well-being, and even recovery.

“It’s not just that interaction with your doctor, or the medication, or other non-pharmacological interventions,” Dr. Martinez says. “It’s also our lived environment.”

Building a Healthy City Means Building Connections

According to Dr. Martinez, improving the quality and availability of public services within a lived environment is one way to promote the well-being of its inhabitants. In a city like Austin, civic projects in this vein might aim to optimize transportation systems or incorporate more greenspace into urban areas.

Development executed from the top down, however, can falter if the base perceives itself as far-removed from potential impacts. Simple human-to-human connection thereby has a key role in making communities more livable, and thus, healthier.

“Engagement is very, very important to health, including—and especially—mental health,” Dr. Martinez says. “We’re human beings. We’re emotional beings.”

In order to achieve that baseline of humanity and connectivity, no population should be expected to conform to a lesser standard of care than another. “If we want to make Austin a model healthy city, the easiest and most appropriate way to do that is to focus on where we have inequities,” Dr. Johnston says.

“When you don’t examine how things impact the entire community,” Dr. Johnston continues, “you lose sight of what needs to get done.”

Learn more and listen to the podcast on the Hogg Foundation website.

MLK Day: A Reminder to Reflect, Understand, and Continually Pursue Equity

Posted: January 15, 2018

The following is a post from Tirzah Enumah, Vice President of Diversity, Equity and Inclusion for the New Teacher Center.

We are in the education sector because we want to serve kids. However, despite the efforts of millions of adults in schools, districts, and education support organizations, we still have a system that perpetuates inequity and oppresses children of color. If we really want to serve kids, we need to do better— and fortunately, we can do better.

What does it mean to “do better?” In the education sector, one thing each of us can do is to bring a racial equity lens to our work (and lives). Equity is ensuring that everyone has what they need to be successful. Equity is also acknowledging, understanding, and working to dismantle the systemic, intentional, and institutional discrimination, often based on race, language, class, and learning variabilities, that have created today’s inequities.

Understanding Ourselves to Understand Each Child.

To give each child what he or she needs, we must know what each child needs. And in order to know what each child needs, we must get past our assumptions, unconscious biases, and overly simplified narratives about communities each child belongs to. We have to look in the mirror and examine ourselves: how do our own racial identities inform our beliefs about the world? What biases have we held about kids? How do our personal privileges blind us in how we understand the experiences of others?

When I was teaching for a nonprofit in Washington, D.C., it took a student asking me why our class spent so much time writing about rap lyrics and basketball players for me to realize that bias and assumptions were informing my work. Even as a black woman, I had internalized racist messages that our culture tells us about black and Latino kids: that they only cared about rap and basketball and that they definitely weren’t interested in academic learning. My biases were holding my students back.

Understanding Equity.

Every adult who serves kids can engage in the self-reflection necessary to disrupt inequitable systems. At New Teacher Center, we are fully committed to this journey. Since the fall, our whole organization has been collectively learning about the history of racism and inequity in the U.S., to reflect on our racial experiences and assumptions, and to have honest and uncomfortable conversations together about race. We know we have a steep learning curve ahead of us. We know it will be mentally, psychologically, and emotionally challenging— it already has been. And we know that if our goal is to support teachers, school leaders, mentors, and coaches in bringing an equity lens to their work, we first have to practice bringing an equity lens to our own day-to-day work.

Dr. King believed in the power of love, compassion, and service to bring about justice and equity. These are foundations for dismantling inequity, but we need to do more. We can want to serve, but just wanting to serve is not enough. We can be loving people and simultaneously hold racial bias. We can be compassionate people and still unwittingly perpetuate systemic and institutional racism. We have to reflect on our identities, examine our beliefs, and challenge ourselves and one another to replace any damaging assumptions we might hold about students of color with belief in their potential for greatness. Once we do that, we’ll get closer to the mountaintop that Dr. King envisioned for us all.


Supportive Environments are Vital to Reducing LGBTQ Youth Suicide Risk

Posted: January 12, 2018

LGBQ teens are more vulnerable to planning or attempting suicide, according to a research letter published Tuesday in the journal JAMA.

Looking at answers in the 2015 National Youth Risk Behavior Survey in the US, researchers found that 40% of high school students who are considered sexual minorities -- who identify as gay, lesbian or bisexual or questioning, meaning they are unsure of their orientation -- were seriously considering suicide.

Transgender teens were not included in the US government's survey, but research has shown that transgender youth may face a similarly high, if not higher, suicide risk.

The survey, conducted by the Centers for Disease Control and Prevention, looked at a nationally representative sample of 15,624 students across the country in that were in grades 9 through 12 (typically 14 to 18 years old).

Of the sexual minorities in the study, 34.9% were planning suicide and 24.9% had attempted suicide in the previous year. Compared with heterosexual teens, those numbers are exceptionally high: Of the straight teens in the study, 14.8% had seriously considered suicide, 11.9% had been planning suicide, and 6.3% had made an attempt in the past year. The children who were bisexual faced the greatest suicide risk; 46% had considered suicide in the past year. Bisexual girls were the most vulnerable, with nearly 48% saying they had considered taking their own lives. Girls who identify as lesbian also had higher rates. More than 40% said they seriously considered suicide in the past year; in comparison, 19.6% of girls who considered themselves heterosexual said they had seriously considered suicide in the past year. Of boys who identify as gay, 25.5% had.

Past research has noted the higher suicide risks for these groups, but much of that work comes from regional surveys, or teens who were surveyed were not from a general sample of the population.

This research is one of the first nationally available estimates representing the general population, and it documents how LGBQ teens' experience with suicide is different from that of other youth.

"We want this to be a wake-up call and a call to action, so that this will become a part of the national agenda to address this very real public health crisis," said research co-author John W. Ayers, a computational epidemiologist who works as an adjunct associate professor at San Diego State University. He hopes the numbers will prompt a "comprehensive reaction" from policy-makers, clinicians and parents and teachers. "While this may be a small subset of our teens, this burden is tremendous."

Jason Cianciotto, executive director of the Tyler Clementi Foundation, agreed. "The question is, how many times are we going to reveal the same horrific information about young people in the US before we do something about this?" asked Cianciotto, who was not involved in the new study.

When Cianciotto was co-authoring the book "LGBT Youth in America's Schools," he came across similar startling suicide statistics that go back as far as the late 1980s. What's driving them, he said, is that not all teens live in a supportive culture, even with the advances in same-sex marriage, inclusive anti-bullying programs and non-discrimination protection.

"There are still too many LGBTQ young people growing up in harmful environments where they are rejected at home or at church or school; they face pervasive bullying; they lack access to safe or supportive spaces and don't have supportive physical or mental health care, and all those comorbidities pile up and increase the suicide risk," Cianciotto said.

Research has shown that lesbian, gay and bisexual students had fewer suicidal thoughts and attempts when schools had gay-straight alliances and had long-term policies prohibiting expression of homophobia. Yet not all schools have these programs, although national groups like the Trevor Project offer 24/7 crisis lines to help young LGBTQ people.

In a separate study on suicide issues concerning LGBTQ teens, researchers saw a heightened risk for suicide and found that these teens were more likely than their straight peers to have experienced some form of adverse childhood experience such as abuse. The authors of this study also say there is evidence that suicide rates are going up for this age group.

"Too little is changing, and for too long, our society has put Band-Aids on this problem," Cianciotto said. "While Band-Aids are good, we need to help by better addressing the root causes of these problems."

Learn more on

Boosting HIV Prevention Drug (PrEP) Awareness Among Minorities in Midwestern Cities

Posted: January 11, 2018

Compared with people living along the coasts in the United States, those who are at risk for HIV and living in Midwestern cities are not as aware of the HIV prevention regimen called PrEP (pre-exposure prophylaxis). A $3.4 million research grant aims to figure out how to change that.

As Shepherd Express reports, a five-year grant from the National Institutes of Health was awarded to Jeffrey A. Kelly, PhD, and Yuri A. Amirkhanian, PhD, two professors of psychiatry and behavioral medicine at the Medical College of Wisconsin’s Center for AIDS Intervention Research (CAIR).

Currently, the only PrEP regimen approved by the Food and Drug Administration is the daily pill Truvada. When taken as directed, it reduces the risk of contracting HIV by 99 percent or more among men who have sex with men (MSM) and 90 percent or more among women. (The risk reduction for women may very well be greater than 90 percent, but there isn’t sufficient research available to refine the estimate.)

The CAIR research will focus on raising awareness of PrEP in Midwestern cities, notably among Black men who have sex with men (MSM), a population at particular risk for HIV.

The research will focus on Milwaukee and Cleveland and take place in two phases. The first phase entails talking to Black MSM and discerning their knowledge and attitudes about PrEP.

“We need to spend a long time listening to learn why PrEP uptake is pretty low,” Kelly told Shepherd Express. “Some people are not very aware of what it is. Others are aware but have concerns that it’s nothing they need because they’re not that sexually active. Others ask, Why would I take a pill when I’m healthy? There’s also a legacy of medical mistrust in minority communities. Why are they trying to get me to take pills? It goes back to the Tuskegee days. [Begun in the 1930s , the Tuskegee experiment was a government study in Alabama in which Black men with syphilis were allowed to go untreated while thinking they were getting health care]. We’re not trying to convince everyone but hoping to give them the ability to make informed choices.”

During the second phase, researchers will build the intervention and test it among the targeted populations.


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