MANA's Access and Equity Committee

The Access and Equity Committee is a new MANA initiative to address systemic issues impacting midwifery and those seeking midwifery care. "Access" and "equity" are both words that capture the essence of this work: access = the right or opportunity to use or benefit from something; equity = the quality of being fair and impartial. As a midwife, you know that the right or opportunity to use or benefit from midwifery has not been fair or impartial. This is true for many, layered reasons:

• state laws criminalize some forms of midwifery;
• state scope of practice laws make it hard to practice the midwifery model of care;
• insurance companies don’t include midwives as covered providers;
• insurance commissions interpret "adequate networks" without considering midwives or place of birth;
• state agencies regulate midwives using an obstetric model not made for midwifery;
• federal grants and loans for education aren’t available for all midwifery educational paths.

The list could certainly go on, and each of these issues is compounded by how the right or opportunity to use or benefit from a wide range of things has not been fair or impartial when it comes to race, class, gender, sexual orientation, national origin, gender expression, region, language, and more. This is the intersection where the Division of Access and Equity works.

One strategy we will use in this effort is to increase the capacity of midwives to connect with their clients about these issues. To this end MANA has established a strategic partnership with Elephant Circle with the goal of charting a course for a stronger and more diverse political base for physiologic birth and access to the midwifery model. This partnership deliberately combines a professional association (MANA) with a grassroots, consumer-based, non-profit (Elephant Circle).

Elephant Circle has found, in organizing and legislative work for maternity care, that consumers are most effectively mobilized by their midwives. Consumers often feel a strong loyalty and commitment to their midwives, and when that passion is channeled into advocacy efforts it can be very effective. Connecting consumers and midwives in coalition as policy-collaborators is a deliberate strategy to increase political power. Midwives don’t hold as much political power as medical providers in existing health systems for a variety of reasons, not the least of which is sheer numbers (less midwives, less consumers of midwifery care).

The dominant model of political advocacy among healthcare providers is professional associations, and it is essential that midwives have healthy professional associations as a result. However, as minority providers, that advocacy model (professional associations) reinforces the power imbalance, keeping the "voice" for midwifery and physiologic birth small. Building an alliance between midwives and consumers adds sheer numbers, increases political strength, and moves the forum from a place where medical providers have an advantage (professional associations) to one where midwives have an advantage (consumer loyalty and passion).

Make sure to connect with the Access and Equity Committee this fall in New Mexico to learn more and get involved. Look for more articles and updates including the infographic on Physiologic Birth for African American Women, and the "Executive Summary of Existing Research on Racial Disparities in Birth Outcomes" created by ICTC, ICAN, MANA and Elephant Circle coming out soon. Share your resources with us at equity@mana.org, and we will share resources with you! Here are a few:

1. Take a short test at Project Implicit.
2. Watch a video at BeyondWhiteness.
3. Learn more about health care licensing boards in this Tool Kit from the Citizen Advocacy Center.
4. Learn about The Speaking Race to Power Fellowship, which will connect and support leaders who want to develop generative ways of breaking through the current bottlenecks of race and power in the reproductive health, rights, and justice movement.

About the author

Indra Lusero, Esq., works as an organizer, trainer, and lawyer practicing family formation and regulatory law in Colorado. Indra’s publications include “Challenging Hospital VBAC Bans Through Tort Liability” and “Making the Midwife Impossible: How the Structure of Maternity Care Harms the Practice of Home Birth Midwifery.” Indra went to law school after attending a MANA conference in 2005 where folks lamented not having a “hot shot team of lawyers” who could help defend midwives. Indra has endeavored to develop just such a team.