Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice


by

Dobbs after Roe

As the Dobbs regime succeeds Roe, the flames creep closer to everyone.

width="1100"

The end of an era

With this year’s decision in Dobbs v. Jackson Women’s Health Organization, SCOTUS has ended an era that began with Roe v. Wade in 1973. The action to which the decision has spurred outraged Americans is a silver lining, especially as activist energy extends to other legal regimes deserving of attention. Voting rights? Immigration law? Responses to climate change? One can hope. Without undervaluing the importance of abortion rights, however, we can also admit that Roe, as well as its subsequent line of cases, was not without problems.

Roe‘s problems

The decision’s grounding in the right to privacy, as pulled from the Bill of Rights – or thin air, as per opponents – did not offer the soundest protection. (For other theories of abortion rights, see here. For an examination of privacy and poverty, see this book by the brilliant Khiara Bridges.) Roe also contained language that placed at least some decision-making capacity In the hands of the physician rather than the pregnant person, and used a trimester measurement that reflected only a chronological marker rather than a substantive reason for restricting abortion. It took no notice of the existing uneven access to abortion, similar to access to other health care services. In 1992, Casey v. Planned Parenthood replaced the trimester measurement with “viability,” a moving target due to ever-improving medical developments to treat the neonate. Casey introduced a new legal standard: states were not permitted to restrict abortion for pre-viability pregnancies in ways that presented an “undue burden.” However, subsequent cases failed to rule out most restrictions as undue burdens. Pregnant people apparently suffered no undue burden by being forced to travel long distances with a forced overnight stay so that they might be read a state-mandated script on the alleged risks of abortion and then wait 24 hours to let it sink in before their procedure might begin. In many states, access to abortion under Roe and then Casey was no cakewalk.

Roe‘s OTHER problems

Equally onerous, but much less remarked by the pro-choice movement, was Roe’s misapplication to pregnant people who wanted to continue their pregnancies. How did that work? Roe granted states an increasing “interest in the fetus” over time: states were granted the ability to restrict abortion the farther a pregnancy advanced. Unfortunately, various segments of law enforcement and the judiciary misinterpreted abortion law to mean that states also had an interest – that is, a right to interfere – in pregnancies carried to term. The result has been any number of state interventions, from railroading pregnant people into cesarean surgery, threatening them with child abuse and neglect investigations for failing to fall in line with medical recommendations, all the way to the criminalization of pregnancy, in which Black and Brown people especially are prosecuted if they are found to have used drugs and/or their pregnancies do not result in a perfectly healthy child, even lacking any evidential causal relationship between the two circumstances.

Roe’s demise, far from removing this misapplication, shifts it earlier in the pregnancy. Who can say now when the state’s interest in the prenate begins? When, in fact, does the prenate’s life begin? (That question is examined in this post.) And how early in the life of a person with even the appearance of a future capacity for pregnancy might the state step in? What might the state do now to maintain control over reproduction while continuing to feed the racist prison-industrial complex?

Lace up those boxing gloves!

The moral of this story: Pregnant people possess a common interest, whether they intend to terminate their pregancies or carry them to term. It is in the interest of anyone with a desire to protect reproductive rights, whether that be the right to have children, the right not to have children, and the right to raise children in safety and with dignity, to fight like hell against legal regimes that allow the state to impose restrictions for which pregnant people will bear the consequences.

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

 


by

A new world

A heartfelt reaction to a performance of the opera, Octavia E. Butler’s Parable of the Sower.

220125 audit mi

Click image to open larger version in new window.

Further reading

Octavia E. Butler’s Parable of the Sower is an opera written by Toshi Reagon and Bernice Johnson Reagon. If you are lucky enough to have a performance available to you, grab a ticket right away! Read more about the opera here and be sure to read both the novel and the graphic novel, and to listen to the podcast hosted by Toshi Reagon and adrienne maree brown.

A word about the images that make up the Love Letter: A photo of Sweet Honey in the Rock was placed behind the photo of Toshi Reagon, even though the group was not involved in the opera. However, Bernice Johnson Reagon, the leader of Sweet Honey in the Rock, is the co-author of the opera; the photo was used as a tribute to her, and to the style of music that the opera grew from. 

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.


by

The crushing weight of Audit MI

Michiganders must crush this attempt to sell our elections to the highest partisan bidder.

Do not sign the petition!

220125 audit mi

Click image to open larger version in new window.

Further reading

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

 

 


by

Securing ourselves out of a vote, #4

This is the fourth and final installment in a series of cartoons warning voters not to sign the Secure MI Vote petition.

The so-called “Secure MI Vote” petition currently being circulated puts barriers in the way of Michigan voters, particularly voters already vulnerable to disenfranchisement.

If you have ever locked yourself out of your house or your car, consider that this is exactly the kind of “security” this petition stands for.

Do not sign the petition!

C

Click image to open larger version in new window.

Further reading

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

  • The “Stop the Steal” protestor is from a photo by Elvert Barnes. The figure was isolated from other protestors and background images.
  • The photo of parent and child is from pxfuel.com.

Securing ourselves out of a vote, #3
Part 3 of the series


by

Securing ourselves out of a vote, #3

This is the third in a series of cartoons warning voters not to sign the Secure MI Vote petition.

The so-called “Secure MI Vote” petition currently being circulated puts barriers in the way of Michigan voters, particularly voters already vulnerable to disenfranchisement.

If you have ever locked yourself out of your house or your car, consider that this is exactly the kind of “security” this petition stands for.

Do not sign the petition!

C

Click image to open larger version in new window.

Further reading

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

Securing ourselves out of a vote, #2
Part 2 of the series

Securing ourselves out of a vote, #4
Part 4 of the series


by

Securing ourselves out of a vote, #2

This is second in a series of cartoons warning voters not to sign the Secure MI Vote petition.

The so-called “Secure MI Vote” petition currently being circulated puts barriers in the way of Michigan voters, particularly voters already vulnerable to disenfranchisement.

If you have ever locked yourself out of your house or your car, consider that this is exactly the kind of “security” this petition stands for.

Do not sign the petition!

C

Click image to open larger version in new window.

Further reading

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

Securing ourselves out of a vote, #1
Part 1 of the series
Securing ourselves out of a vote, #3
Part 3 of the series


by

Securing ourselves out of a vote, #1

This is first in a series of cartoons warning voters not to sign the Secure MI Vote petition.

The so-called “Secure MI Vote” petition currently being circulated puts barriers in the way of Michigan voters, particularly voters already vulnerable to disenfranchisement.

If you have ever locked yourself out of your house or your car, consider that this is exactly the kind of “security” this petition stands for.

Do not sign the petition!
CClick image to open larger version in new window.

Further reading

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

Securing ourselves out of a vote, #2
Part 2 of the series


by

All the controversies at once!

What this cartoon is not about

  • Abortion, and whether it’s good or bad to have one.
  • Vaccines, and whether it’s good or bad to have one.

People will and do differ on these questions. This cartoon assumes that you want to do the good thing, whatever that is, and that a bad thing is mistreatment or exploitation of people of Color based on racism, whether intentional or not. Are we clear?

What this cartoon is about

C"Click image to open larger version in new window.

<a href="https://mamasgotaplan.files.wordpress.com/2021/06/210609-one-moral-concern.jpg&quot; alt="C" width="1018" ><img="" class="wp-image-2081 size-full aligncenter" style="margin-bottom: 0;" title="CLICK TO ENLARGE!"

<a href="https://mamasgotaplan.files.wordpress.com/2021/06/210609-one-moral-concern.jpg&quot; alt="C" width="1018" ><img="" class="wp-image-2081 size-full aligncenter" style="margin-bottom: 0;" title="CLICK TO ENLARGE!" Some people with concerns about the safety or efficacy of vaccines object to the presence of “aborted fetal cells” in vaccines. However easy (and gruesome!) it is to picture a dismembered hand pushing up through a syringe’s liquid, that is not the reality. As the blue-jacketed person in Frame 3 tries to point out, what is in question are cell lines. How are cell lines formed? Scientists use cells taken from an organism, e.g. kidney cells taken from a dead human embryo, and create a replicating cell line. The original kidney cells eventually die off, just as cells in the body do, and are replaced by genetically identical cells created by standard biological cell division. These cells are then combined with viruses and used to create a vaccine. (For fascinating photos of human embryonic stem cells, see here.)

Given this significant distance in both time and nature between embryo and vaccine, what are the moral and practical grounds for boycotting the vaccine because of this association? Those who wish to discourage abortion will not do so by refusing vaccines; the abortions that created the cell lines involved took place decades ago. Should a scientist decide to create a new cell line from embryonic material, current U.S. ethical rules1 forbid the solicitation of pregnant people to terminate pregnancies for the purpose of supplying material for scientific research. People will no doubt continue to terminate pregnancies and the products of conception might subsequently be donated to science, but disrupting that relationship will not prevent abortions. 

Do boycotts ever work?

1979 divestment protest, University of Michigan

Boycotts have been effective in other circumstances. Starting in the 1970s, a divestment movement demanded that global institutions isolate South Africa from external trade and investment as a way of pressuring the regime to break down its racial Apartheid system. It worked! South African carried out reforms, a civil war was averted, a Truth and Reconciliation commission took place, and eventually Nelson Mandela became president. By the mid-1990s, Apartheid was no more. In South Africa’s case, the objectionable behavior – the subjugation of a majority of the citizenry – was ongoing. The intense financial pressure applied in the boycott served as an incentive for the government to change its behavior.

Harm that can be redressed – but how?

Other wrongs, however, remain to be righted: consider the case of Henrietta Lacks. The HeLa cell line was developed from cells taken from the cervical tumor that killed Lacks in 1951. The line has been successfully used for far-reaching discoveries in cancer drugs, space research, and immunology, including in the study of COVID-19 in search for a vaccine. The moral issue arises from the fact that while great good came of the establishment of the line, none of that good was directed specifically toward the Lacks family.

The cell line was created from cells taken from Henrietta Lacks, all without the knowledge or permission of the the Lacks family. This practice was and is perfectly legal, as validated by a 1990 California case: the court found that patients do not own any blood or tissue samples taken from their bodies, nor do they possess a right to share in profits from research activities that made use of those samples. However, in HeLa’s case it is difficult for us to ignore the vast gulf between the sums generated by the cell line and the reality of the lives of the Lacks family, who were African-American tobacco farmers in Virginia at a time of blatant racial discrimination. Because such inequalities continue and magnify down through the generations, this injury can be considered an ongoing one.

Should we refuse COVID vaccines because of what was done to the family of Henrietta Lacks? The last panel of the cartoon shows the absurdity of such a proposal: even if it were possible to discard the findings of the space program (!), how would such an action help the Lacks family? 

Restorative justice

Let’s try that again.

The concept and practice of Restorative Justice provides a way to compensate victims of injustice, while simultaneously working to prevent future similar injustices. Once used primarily as an alternative within the criminal justice system to address individual instances of property crime, Restorative Justice is now beginning to be deployed more broadly to tackle systemic injustice and inequity.2 The Restorative Justice framework would dictate compensation for the Lacks family and a strategy to reform medical research so that research subjects, particularly those whose bodies were historically used for others’ profit, would be assured of enjoying the benefits of the research. 

Following the publication of Rebecca Skloot’s 2010 book on Henrietta Lacks, her descendants established a foundation to “preserve her legacy by educating future generations on the impact of her phenomenal HeLa cells while promoting health equity and social justice.” In fact, August 1, 2020 marked the beginning of a year’s “Cellebration” of the 100th anniversary of Henriette Lacks’s birth. Today, February 14, 2021, the day of this blog post, the foundation suggests a donation of $14 as a “V-Day gift.” It is also worth noting that the foundation actually advocates for receiving the COVID-19 vaccine as a way to honor the legacy of Henrietta Lacks.

Similarly, those who wish to decrease the number of abortions might also consider a Restorative Justice approach. All birthing people, but especially people of Color, who are disproportionately represented among people terminating pregnancies, should be guaranteed sufficient health care access and financial support so that those who wish to do so can carry their prenates to term and parent all their children in safety and with dignity. Data from the Guttmacher Institute, as reported by CBS News, suggest that the inability to afford a baby is a reason for 73% of women who obtain abortions. Obviously, the fate of prenates who were not carried to term cannot be changed. But the fate of birthing people can. It would make sense for everyone, whatever their position on abortion, to support organizations that fight to improve circumstances for birthing people and their children, like Mothering Justice, Black Mamas Matter Alliance, and others. 

One moral concern?

Finally, regardless of the utility of boycotts and the application of a restorative justice lens to problems of fairness and equality, is there ever a world in which one moral concern can override all others? You might believe, for example, that your cause in life is to save elephant species from extinction. They are beautiful, intelligent animals, and you are sure they have souls. You might feel moved to decline a vaccine because it was created using, say, cells from elephant ivory,3 which poachers obtain by killing the animals. But to ignore all other issues – climate change, political unrest, or a world pandemic, perhaps? – not only means  that an opportunity to save the elephants might elude you, but also suggests a lack of connectedness to the larger world. Friends, the world needs many things. We our connected to our natural world and to one another. Please, let us consider multiple viewpoints and multiple approaches for our mutual aid.

Updated June 9, 2021: graphic replaced and small stylistic changes made

1The Common Rule (45 CFR part 46), the Federal Policy for the Protection of Human Subjects, was established in 1991. It is enforced by research institutions through Institutional Research Boards. Note that the Common Rule applies only to medical research, not medical practice.

2“Restorative justice began as an effort to deal with burglary and other property crimes that are usually viewed (often incorrectly) as relatively minor offenses. Today, however, restorative approaches are available in some communities for the most severe forms of criminal violence: death from drunken driving, assault, rape, even murder. Building upon the experience of the Truth and Reconciliation Commission in South Africa, efforts are also being made to apply a restorative justice framework to situations of mass violence. These approaches and practices are also spreading beyond the criminal justice system to schools, to the workplace and religious institutions. Some advocate the use of restorative approaches such as circles as a way to work through, resolve and transform conflicts in general.” Zehr, Howard. The Little Book of Restorative Justice: Revised and Updated. New York: Skyhorse Publishing Company, Incorporated, 2015. See also “Restorative Justice as a Social Movement,” in Mark Umbreit and Marilyn Peterson Armour, Restorative Justice Dialogue: An Essential Guide for Research and Practice, 2010.

3Completely fabricated, in order to make a point.

Further reading

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.


by

Separation anxiety

C

Click the image to open a larger version in a new window.

You wouldn’t cut the rope of someone rappelling down a mountain, would you? The umbilical cord fulfills a similar lifeline function for a newborn: it delivers oxygenated blood to the baby until Junior’s lungs expand and begin to function. With her usual wisdom, Nature has provided this backup because she knows that newborns do not always breathe immediately. So why the widespread and persistent belief that the cord must be cut, or at least clamped, immediately after birth?

The medical record

A 2012 article1 describes the origin of early cord cutting:

The first records of cutting before placental delivery hail from the 17th century. It has been suggested that changes in third stage management accompanied the emergence of male midwives; it became normal practice to deliver women in bed, thereby decreasing the likelihood of spontaneous delivery of the placenta …

In other words, the prone position demanded by new-fangled male birth attendants caused a slower or problematic delivery of the placenta, which then dispensed with the need to wait for the placenta to cut the cord. It makes as much sense as anything else. Providers also believed there to be little benefit in preserving the umbilical cord because the blood flow was so brief:

The contribution of the umbilical arteries was considered to be minimal as it was thought that arterial flow stopped within 25–45 s[econds]. However, no explanation for this cessation of flow was provided …2

One reason that practitioners might have believed blood flow to stop within 45 seconds after birth is that by clamping and cutting the cord immediately after delivery of the newborn, they caused it to stop! Other scientific rationales for early cord cutting included:
  • The desire to prevent analgesic or anesthetic medications administered to the mother from reaching the infant. Of course, these medications would already have crossed the placenta to the prenate* in utero, but it’s hard to argue with a harm reduction approach.
  • As early as 1938, placental and umbilical cord blood began to be used in transfusions.1 The value of this particular blood was recognized again in the 1990s after the function of stem cells became better known. Costly services offering “cord blood banking” cropped up; they persuaded anxious new parents to collect this blood and store it against the possibility of their newborn developing diseases years in the future for which stem cells might be the cure.
  • Newborn resuscitation in contemporary medicine is facilitated by very specialized tools. The baby is typically removed to a surface on or near a crash cart; an intact umbilicus is a hindrance to this removal. 
  • The outdated belief that blood from an uncut cord will flow backwards, out of the newborn, continues to find traction among medical professionals.
  • One also cannot discount the effect of institutional inertia, the perceived need to preserve hospital routines that promote speed and consistency (which then frees up expensive and in-demand physician time), and an inclination on the part of some medical professionals to invest the results of their early medical education with a carved-in-stone quality.
Whatever the rationale, premature clamping and cutting of the cord causes one very distinctive harm: It deprives the newborn of approximately one-third of its total blood volume. This puts the infant at risk for iron deficiency, which in turn may have neurological consequences.3 With many young children in the United States already at risk for iron deficiency from other causes, such as premature birth or lead poisoning, the need to transfuse as much blood as possible into the newborn seems particularly important. That’s the roundup on premature cord cutting from the medical community. But really …

We blame Hollywood

Fictional representation of birth on the silver screen and TV always features:
  • labor beginning with water breaking (8% in reality!) and sudden, immense pain
  • birthing person screaming in pain
  • the phrase (directed at male partner) “You did this to me”
  • whether in or out of hospital, birthing person lying on her back
  • someone telling birthing person to PUSH (or occasionally “don’t push!”)
  • and, of course, immediate clamping and cutting of the umbilical cord following birth of baby
The photo below, that shows an elevator birth in a 2004 episode of Joan of Arcadia, is typical of precipitous birth depicted onscreen. For whatever reason, people seem to fixate on the shoelace. Even Embezzler Home Birth Dad, who surely should know better, feels the need for one. With such depictions so ubiquitous, it’s hardly surprising that parents, first responders, and even medical providers believe that immediate clamping and cutting of the cord is an urgent necessity. Fortunately, care of the cord following a precipitous birth is remarkably simple: Do nothing.  Want to know more? The 2016 article How to Deliver a Baby (If You Absolutely Have To) provides an excellent set of instructions for supporting a birthing person through a birth in an unplanned location at an unplanned time. We take issue with the headline “You birthed a baby!” since it seems to attribute that accomplishment to the person assisting, rather than to the one who has just produced a new person, but in the face of so much otherwise sound information, we’ll forgive the article’s editors that small oversight.
*Prenate. We use this term, coined by Rebecca Todd Peters4 as a neutral descriptor of the being in utero.

Bibliography

  1. Candice L Downey and Susan Bewley, “Historical Perspectives on Umbilical Cord Clamping and Neonatal Transition,” Journal of the Royal Society of Medicine 105, no. 8 (August 2012): 325–29, https://doi.org/10.1258/jrsm.2012.110316.
  2. I Boere et al., “Umbilical Blood Flow Patterns Directly after Birth before Delayed Cord Clamping,” Archives of Disease in Childhood – Fetal and Neonatal Edition 100, no. 2 (March 2015): F121–25, https://doi.org/10.1136/archdischild-2014-307144.
  3. Judith S. Mercer et al., “Effects of Delayed Cord Clamping on 4-Month Ferritin Levels, Brain Myelin Content, and Neurodevelopment: A Randomized Controlled Trial,” The Journal of Pediatrics 203 (December 2018): 266-272.e2, https://doi.org/10.1016/j.jpeds.2018.06.006.
  4. Rebecca Todd Peters, Trust Women : A Progressive Christian Argument for Reproductive Justice (Boston, Massachusetts: Beacon Press, 2018).
  5. Judith S. Mercer and Debra A. Erickson-Owens, “Rethinking Placental Transfusion and Cord Clamping Issues:,” The Journal of Perinatal & Neonatal Nursing 26, no. 3 (2012): 202–17, https://doi.org/10.1097/JPN.0b013e31825d2d9a.

Image credits 

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.