Access to women’s reproductive and sexual health care services in the U.S. is spotty at best and woefully poor at worst. Our country has a history of enacting barriers to women’s health care when it comes to services related to reproduction and sexuality. Interestingly, and maybe not surprisingly, whether we’re addressing abortion or childbirth our laws have spiraled every which way. Even more tellingly, the spirals began as concentric circles. 

In this country, it was the midwife who performed (legal) abortion until the early nineteenth century when states began to enact restrictions on abortion provision. By 1880, abortion was illegal in all states, except to save the life of the mother. Much of this legislative control, according to Our Bodies, Ourselves, arose parallel to women’s journey towards bodily and societal autonomy. When women began the fight for voting rights and birth control, specifically, both legislators and medical professionals fought back through the enactment of anti-choice laws. The American Medical Association (AMA) was primarily responsible for ensuring the illegality of abortion, in large part because of their opposition to midwives – health care providers who did not fall under the domain of the AMA or fit the male medical establishment’s definition of what a medical provider should be.

Margaret Sanger, founder of Planned Parenthood and heroine of modern women’s health care exemplifies these concentric circles of women’s health care – a midwife whose determination ensured that the pregnant and parenting mothers she cared for had the means to control their reproductive lives. Sanger’s drive to create and improve access to birth control for women in this country changed women’s lives forever but also can be seen as yet another reason why midwifery has been so stigmatized in this country.

I provide this quick backgrounder because, under President Obama – a leader who calls for both an exploration of common ground in the abortion debate and is spearheading the fight for health care reform – we have an opportunity to re-examine the gamut of women’s reproductive and sexual health care in order to improve access to all care.

One group is working hard at this moment in time to ensure that health care reform remember midwifery.  The MAMA campaign (Midwives and Mothers In Action) is a collaborative
effort between a host of advocacy and consumer organizations. MAMA is ramping up its energy now in order to do all it can to influence
the current health care reform measures making their way through
Congress. The campaign’s overall agenda focuses on gaining "federal
recognition of Certified Professional Midwives so that women and
families will have increased access to quality, affordable maternity
care in the settings of their choice." Right now they are zoning in on ensuring Medicaid coverage for Certified Professional Midwives is included in any health care reform. Why, you ask, is this necessary? 

It’s simple. Can we say that until all women in the U.S. have access to the full range of reproductive and sexual health care services – regardless of economics, race, class, ethnicity, language barriers, or sexual or gender identity – we have true choice? That is, do we include choice in childbirth options (where and with what kind of health care professional we birth) and medicaid coverage for certified professional midwives to be equally as important as abortion and contraception access for all women? Can we agree that ensuring these necessary options for women are included in health care reform is critical not only to bringing down health care costs for all but for improving women’s health? In 25 states in this country it is illegal to choose the care provider
or setting for your birth because Certified Professional Midwives are
outlawed as birth facilitators. The rise in cesarean sections and unnecesary medical interventions both contribute to poorer health outcomes for women and newborns. Is it just as important for a low-income woman to have access to the kind of birth she believes is best for her and her baby as it is for her to have access to safe, legal abortion or contraception? Currently, there is no federal regulation of certified professional midwives and so medicaid coverage for out of hospital birth varies from state to state leaving many women without any options at all.

The truth is, as The Big Push for Midwives puts it, "We can no longer afford a system that produces inferior results at premium costs." As we work towards immense health care reform, the question for all reproductive health advocates should be: How much longer will we tolerate a system in which women’s and babies’ health and lives are compromised, costs to the consumer are rising, access to childbirth care remains inequitable and Certified Professional Midwives must fight for their livelihood? Access to abortion care, contraception and childbirth care should be seen as concentric circles – they are all connected and all part of the continuum of womens’ reproductive and sexual health care with which reproductive heatlh and rights advocates should be concerned.