Homebirth midwives exploit poor women of color in developing countries

Got ethics ?

The good news is that homebirth midwives are beginning to recognize that being an “expert in normal birth” is meaningless. Any taxi driver can preside over an uncomplicated birth. Women hire birth attendants to prevent, diagnose and manage complications and homebirth midwives have zero experience with that.

The bad news is that homebirth midwives are trying to get that experience by exploiting poor women of color in the developing world.

That’s the explosive charge leveled at Midwife International by The Alliance for Ethical Midwifery Training.

What is Midwife International?

According to its website:

More than 58 countries lack enough qualified midwives to provide timely access to skilled healthcare for mothers and infants. Our solution is to train midwives who are equipped to work in resource-constrained regions where maternal and child mortality is high and the need for professional midwives is greatest.

Not exactly. Midwife International is a midwifery school, charging exorbitant tuition, using poor women of color as a source of complicated cases, and providing nothing in return.

For this privilege, American students are charged $19,000/yr, PLUS books, supplies, travel, insurance, accommodations, and living expenses.

Midwife International managed to corral a who’s who of American homebirth midwifery into supporting this scheme. Board members included Aviva Romm, MD, Jan Tritten, the editor of Midwifery Today, and Robbie Davis-Floyd, among others.

But, according to The Alliance for Ethical Midwifery Training:

The communities MI claimed to be serving were exploited for the benefit of the MI students and the considerable profit of MI, furthermore, host sites and local midwives were taken advantage of and at times blackmailed into compliance.


… MI is alleged to have:

  • Used bribery to undermine the host site Directors and their programs and to de-stabilize the local programs and clinics:
  • Taken back much need supplies and equipment if the host site Director would not comply with MI’s demands;
  • Negotiated secret agreements with host site midwives to give priority to MI students (many of whom are in the first steps of early midwifery training and whose skill level, in some cases, could best be described as elementary) over their own indigenous midwives who are being trained to meet the ICM Millennium skill goals; and
  • Not compensated host sites at the rate initially negotiated, nor reimbursed host sites for modifications made to their programs and sites in order to accommodate the MI program. In addition, the demands made by MI for accommodations and life style issue for the students and preceptors were unreasonable given the realities of the countries in which the MI students and preceptor would be living.

The website contains testimonials from the women who run the clinics for the underserved and they make for very disturbing reading.

The Alliance identifies the key problem with first world laypeople learning midwifery on third world women:

There is a structural violence that occurs when a person from the west attempts to learn on those who have less power and privilege than they do. There is a long history of exploitation of Black and Brown bodies for the purpose of western power and gain. There is also a long history, even within midwifery, of silencing those who speak out about these issues. What has happened here is that an institution has been built based on each of these acts of violence. We refuse to be silenced. We stand together to share the stories of what has occurred…

The behavior of Midwife International, if true, is starkly reminiscent of the behavior of Big Pharma. The rules and regulations for testing new medications on people from industrialized countries are onerous and expensive because the governments of those countries want to protect their citizens from exploitation. The same protections do not exist in many countries of the developing world, so pharmaceutical companies often test their products there.

Similarly, the rules and regulations for midwifery training in first world countries are appropriately onerous for a profession responsible for the lives of babies and mothers. Hence, the certified professional midwife credential (CPM) is considered inadequate by ALL first world countries, and CPM trainees are not allowed in hospitals where to gain clinical experience. The same protections do not exist in many countries of the developing world. How much easier, then, to foist uneducated, untrained laypeople on those countries.

In light of these allegations, several board members, including Aviva Romm, MD, have resigned, but one must question their judgment for signing on in the first place (and ask if financial compensation was paid to them for their board positions).

The fundamental ethical question remains, however. Is it ethical for homebirth midwives, who cannot meet the standards for education and training of any industrialized country, to “practice” on poor women of color in developing countries? It could possibly be ethical if proper safeguards were put in place, but it is not clear if homebirth midwives would be allowed to care for poor women of color in developing countries if proper safeguards were put in place.

The bottom line, as always, is that the CPM credential should be abolished. There is no need for a second, inferior class of midwife in the US, and there is certainly no need, or benefit, to a second, inferior class of midwife who learns about pregnancy complications by preying on underserved poor women of color in developing countries.