Why are natural childbirth advocates vilifying a black obstetrician who wants to reduce racial disparities in maternal mortality?


Privilege can be very ugly.

Witness the specter of a black obstetrician being upbraided primarily by white people for a speech about reducing racial disparities in maternal mortality.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Vilifying Dr. Brown for stating an incontrovertible medical fact — contraception saves women’s lives — reflects the privilege of well off, white women who have easy access to birth control and the money to pay for it.[/pullquote]

Dr. Brown made an incontrovertible claim: the single most effective way to prevent maternal mortality is birth control and now he’s being pilloried for it.

Comments, predominantly from white women, make three main accusations;

  • Claiming that Dr. Brown wants women at risk of maternal death to stop reproducing.
  • Implying that maternal death is due to an overuse of technology.
  • Insisting that midwives could reduce the maternal death rate.

These commenters are blinded by pregnancy privilege.

As I wrote in a recent post, pregnancy privilege is a set of assets a woman can count in on cashing in, and to which she is by and large oblivious. By far and away the most important asset in pregnancy privilege is this: The pregnancy is planned and wanted.

That’s not the case for many women. While it is difficult to imagine anything more tragic than a woman dying to give birth to a baby she wanted, dying as a result of an unintended pregnancy is possibly worse. Since 45% of US pregnancies are unintended — and possibly an even higher percentage of pregnancies of women of low socio-economic status — that means that easy access to birth control, including insurance that covers the cost, is a simple, effective, relatively inexpensive way to prevent maternal deaths.

That was Dr. Brown’s point and it is hardly a trivial point in the current political atmosphere where reproductive rights are under sustained assault and “pro-life” means pro-fetus, not pro-mother. If all women had access to the means to control their fertility, maternal deaths would likely fall precipitously.

But apparently privileged women can’t grasp this basic point and are accusing Dr. Brown of blaming the victim. That’s the last thing he has in mind. Reproductive rights — specifically the right to avoid unplanned pregnancy — is the sine qua non of women’s health, both physical and economic.That disparities in access to contraception exacerbate disparities in maternal mortality is a preventable tragedy.

Pregnancy privilege blinds women to other realities about maternal death. The leading causes of maternal death are cardiac disease, chronic pre-existing health conditions and complications of pregnancy like pre-eclampsia. Many women die of these problems because they lack access to the high tech care that saves privileged women. They aren’t healthy to begin with; they don’t have health insurance; they receive care from clinics; they must deliver at hospitals with poor safety records.

Invoking the rhetoric of natural childbirth: that obstetricians don’t follow scientific evidence (false), that unmedicated vaginal birth is safest (false), that interventions cause more health problems than they prevent (false) is worse than useless. In nature, childbirth is inherently dangerous with a “natural” maternal mortality rate of 1000 per 100,000. That nearly 50X HIGHER than our current maternal mortality rate, which is unacceptably high. It is ludicrous to imagine that a return to nature — a beloved affectation of privileged white women — is going to save the lives of chronically ill black women when nature itself is deadly.

The same thing applies to calls for more midwifery care. How is a midwife going to save a woman dying during pregnancy or postpartum of cardiomyopathy or congenital heart disease or kidney disease or eclamptic seizures? She isn’t, but the privileged women who recommend midwifery care are thinking of themselves and what they want instead of poor women of color and what they need.

The ugly truth is that vilifying Dr. Brown for stating an incontrovertible medical fact — contraception saves women’s lives — is a reflection of the privilege of women who have easy access to birth control and the money to pay for it. Recommending natural childbirth and midwifery care to reduce racial disparities in maternal mortality is the obstetric equivalent of “let them eat cake”: repugnant, clueless and entirely ignorant of the reality of life for anyone other than the privileged.