To End Stigma and Discrimination and Empower Birthing People Globally, We Need More Doula Love!
The month of March begins with Zero Discrimination Day (March 1st), and March 8th is International Women’s Day. In honour of these days, we thought it worthwhile to look at some of the various realities in which birthing happens across the world, and some of the challenges still faced by many.
There are 140 million people who give birth every year. Unfortunately, approximately 830 birthing folks die each day from preventable causes related to pregnancy and childbirth. Almost all maternal deaths (99%) occur in developing countries, with more than half of these deaths occurring in sub-Saharan Africa. Inequity in access to and quality of health care, whether in high-income countries like Canada or low- and middle-income countries in sub-Saharan Africa, drives many of the preventable complications, injuries, and deaths related to pregnancy and birth. We know that skilled care before, during, and after childbirth can save the lives of newborns and those who birth. This has led to a push for more hospital or facility-based birthing, though there is still much work to do to address the abuse, stigma, and disrespect birthing folks experience during facility-based childbirth across the world, as well as ensuring access to good care for those who do not have access to or do not want to use a birthing facility.
What we also know, and what is gaining traction worldwide, is that having continuous support in labour and birth from a companion, such as a doula, has an immensely positive impact on maternal and newborn health outcomes, as well as improving the experience of childbirth overall. Dr. Princess Nothemba Simelela, the World Health Organisation’s (WHO) Assistant Director-General for Family, Women, Children and Adolescents is committed to placing women and all birthing people at the centre of their care. “High quality care for all pregnant women and their newborns, throughout pregnancy, childbirth and the postnatal periods, is essential to ensure that mothers and children both survive and thrive,” she says. The World Health Organization, she adds, believes that “high-quality care” should include not just service delivery, but also the birthing person’s experience.
Excitingly, in 2018 the WHO released a new guideline on care for a positive childbirth experience. What’s included in the 56 evidence-based recommendations detailing the clinical and non-clinical care that is needed throughout labour and immediately afterwards? Yup, you guessed it! Continuous labour and birth support, including that of a doula. And while the guidelines do cite a lack of evidence around “companionship interventions” (such as doulas) in low- and middle-income countries, it does acknowledge the value of doula care in high income countries, and in particular increasing access to doula care to low-income folks as a way to increase equity. Good thing the Doula Support Foundation is on that mission!
In terms of stigma and discrimination, we have come a long way globally, and there is much to celebrate. Unfortunately, there is still much work to do. Abortion is illegal in many countries, and even in the U.S. the Trump administration has just made it incredibly difficult for many folks, particularly low-income folks, to access safe abortion services and contraception. Many may not also realize that, regardless of how you feel about abortion, one of the negative consequences of making abortion illegal is that the equipment, medication, and counselling skills necessary for pregnancy loss, miscarriage, and stillbirth can also be negatively impacted by such policies. Those who are living with HIV also often face stigma and discrimination around their desire to have children, despite a growing body of evidence on safer conception strategies and the ability to prevent HIV transmission between couples and to their children. In many countries, it is also still illegal to love someone of the same sex/gender, which makes becoming pregnant, accessing pregnancy care, having a safe birth, being cared for postpartum, and even having legal access to your own child additionally challenging. And while the vast majority of countries that still make homosexuality a crime are in the developing world, it also behooves us to remember that colonialism is largely to blame for importing such punitive treatment against homosexuality (and remembering that homosexuality and a broad spectrum of sexualities have existed, in all parts of the world, since time immemorial).
So, as we look to the (possible) first signs of winter abating, let’s also remember to take care of each other, to have gratitude for what we have, and to continue to work towards equity and health for all. For us at the Doula Support Foundation, that includes working hard to make doula care accessible to everyone who would like such support but could not otherwise afford it.
About the author: Dr. Laura Pascoe is a certified birth doula providing doula services privately and through the Doula Support Foundation. She also runs her own consulting business working with nonprofit organisations and universities both locally and internationally in the areas of sexual and reproductive health and rights, masculinities, gender justice, and gender-based violence prevention and response. Laura loves her two cats, her human family, and being upside down. To learn more about her work or book a doula consult, click here: http://withyouinbirth.com/