A Birth Plan Does Not a Mom-zilla Make

Rounding out this week’s theme of Empowered Birth Awareness, I’d like to invite you to look at my most recent Christianity Today blog post.

In part, it is a response to several blog posts by the bloggers collectively known as Femina, who happen to be the wife, daughters, and daughter-in-law of the controversial Moscow, ID pastor Douglas Wilson, who criticized women who used birth as an occasion to become “self-absorbed fusser[s]”–

The Femina bloggers are not the first to claim that women who, like me, advocate for “normal” or “physiologic” childbirth tend toward inordinate self-focus (or even that we are “selfish and reckless,” as one UK writer put it). It’s true that some modern women seem to forget the fact that birth is about more than her own experience of becoming a mother. However, there are reasons for choosing physiological birth that go beyond simple consumer preference.

There is no question that medical advances over the past 100 years have vastly improved maternal health outcomes. There is no question that c-sections save women’s and babies’ lives (5 to 15 percent of women will always need them—and they should have them!). There is no question that North American women have much to be grateful for in this area.

But none of these developments mean that women are best served by sitting back and simply being grateful. Maternal death rates in the United States have nearly doubled in recent decades as rates of c-section and induction continue to climb. The World Health Organization has long held that no developed nation is justified in having a c-section rate above 15 percent; above that point, sections are more likely to be performed unnecessarily, which is not without risk. What if these “advances” have advanced so far as to take a step in the wrong direction?

The post goes on to state what I firmly believe: that safe birth is a human right, and that the state of maternity care in this country may well be infringing upon a woman’s right to informed consent and self-determination. (Check out this book if you doubt the extent of the problem.)

Rachel Jankovic wrote a response suggesting that our real point of disagreement is over the question of gratitude:

“It is important to note that all the commands in Scripture, such as ‘In all things giving thanks’ are not tethered with a contingency plan about whether or not you think unnecessary c-sections are on the rise.”

{a comment from Rachel Jankovic’s post this morning–}

apparently Jenn thinks that  Rachel Held Evans and I have all but ruined the name Rachel.

This is a point that warrants further consideration, but for now I will simply say (again) that as important as gratitude is, it is not the key that opens all locks. It is not the only possible posture for a Christian to take toward the happenings of life. Giving thanks in all things doesn’t mean giving thanks for all things, and I think Scripture gives us enough examples of lament–of arguing with God–(see Psalm 89) to show that bemoaning rising maternal death rates is not out of place.

(See my friend Ellen’s post “Do I Hate My Life? No, But I Do Hate My Disability.”)

Jesus was not grateful for the moneychangers, nor even for the fact that he had to go to the cross. He asked for that cup to pass. Job was not grateful for his afflictions. Daniel was not grateful for the exile, nor was Jeremiah, nor the author of Lamentations. St. Paul was not “grateful” for those who were proclaiming a different gospel.

And neither am I prepared to be grateful for what amounts to injustice.

God is good when circumstances are not. I am thankful for each breath of my life, but I will not be thankful for the fact that women all over the world lose theirs needlessly, nor for the fact that my own country, which has the resources to do better, allows profits to come before people.

Where’s the Controversy in Saving Lives?

I have to admire Melinda Gates’ chutzpah. In her recent TED talk and on her blog, Impatient Optimist, she insists that “contraception is not controversial”–when, in the last year, it has been explosively controversial, with many Christians (not just Catholic Christians) seeing the “contraceptive mandate” as a real threat to religious freedom. Yesterday, the law took effect, meaning that most employers must now provide free birth control coverage in their health insurance policies. Whether it constitutes a threat to religious liberty remains to be seen: faith-based groups with religious objections to the law have a “safe harbor” until Aug. 1, 2013. Whether HHS will create an extension of this harbor remains to be seen.

Regular readers of this blog know where I stand on health insurance. As to the contraceptive mandate specifically, I’d prefer not to wade in those particular waters–David Gibson at Religion News Service has a good piece if you’re interested in the question of whether the mandate kills religious freedom. However, I do want to consider two small points about contraception that leans me toward the (self-identified Catholic!) Melinda Gates point of view:

Point 1: contraception doesn’t take life

Point 2: women want contraception

Frequently, discussions of birth control come back to the question of eugenics and attempt to suggest that Margaret Sanger and other early birth control advocates wanted to keep poor people and immigrants from having babies. While it’s always dangerous to speak in general terms, it seems to me that Sanger (and others) were attempting, in good faith, to answer a need, a call for help–not to impose their will on less-educated, less-wealthy women. Here is the tri-lingual (English, Yiddish, Italian) poster from the early days of the movement:

Despite these efforts, the very unfortunate discrimination in Sanger’s (and others in the early birth control movement) thinking seems to taint contemporary discussions of birth control, perhaps understandably so.

But even that history doesn’t change this: just meeting current demand for contraception could cut maternal deaths by 1/3. Which means maybe 100,000 lives per year–or more–just by meeting the unmet, self-identified needs of women.

Where my family and I are headed–Malawi–the contraceptive prevalence rate is just 40%; recently, Malawi’s Vice President pledged to try and raise the rate to 60% by 2012, partly by raising the legal age of marriage and partly by enacting policies which–with help from organizations like the Gates Foundation–will increase access to contraception.

This is not the wealthy, white, West forcing the Pill–much less sterilizations or abortion–on Africans, Indians, or anyone else. We are talking about working in partnership to help women meet their self-identified needs. It’s not about rejecting God’s gift of fertility. It’s about stewarding it well in a complicated world.

I just don’t see the controversy–religious or otherwise–in that.

“when women die in childbirth it is a violation of their rights.”

I’ve been inspired in the last week by reading about the women who are petitioning Uganda’s highest court to declare that “when women die in childbirth it is a violation of their rights.”

So far, their bids in the lower courts have been unsuccessful, but they’re pressing on.

$60 million. That’s what it would take to hire enough medical workers to meet Uganda’s needs–specifically, to staff village health clinics that lack people and supplies to the degree that an estimated 16 pregnant women die needlessly each day.

It’s not that the money is not available, say analysts–Uganda spent more than ten times that amount on Russian-built fighter planes last year, though they were not and are not at war–it’s that the Ugandan government isn’t making maternal health a priority.

A woman in Uganda has a 1 in 35 lifetime chance of dying in childbirth; just 42% of births are attended by skilled practitioners.

By contrast, a US woman’s lifetime risk of dying in childbirth is just 1 in 2100; virtually 100% of births are attended by skilled practitioners.

“The point here is not the money,” said Samuel Lyomoki, a lawyer who has joined in the call for action– “the problem here,” he said, “is a lack of commitment.”

But for the women pursuing an official declaration of their right to birth safely, commitment doesn’t appear to be flagging. Their willingness to speak up and insist that the government calls maternal death by its right name–a violation–may be what it takes to provoke the will to end preventable maternal death in Uganda as well as the rest of Sub-Saharan Africa.

Because a more peaceful world is delivered by more midwives, not more munitions.

{Adapted from my recent post at Sojourners’ God’s Politics blog–original post here.}

“Ekizibu” –A Short Film About Midwives in Uganda