Month: June 2024

Categories
Anti-racism work Canada Health Care Maternal Mental Health Uncategorised

2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health

[vc_row][vc_column][vc_column_text title=”2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health” css=”.vc_custom_1718910346497{margin-bottom: 0px !important;}”]In the United States, publicly-funded healthcare is provided through Medicaid and CHIP (Children’s Health Insurance Program). These are joint programs of state and federal governments that provide health insurance to low-income people, children, people with disabilities, and pregnant people. These eligibility parameters mean that there are individuals who are eligible for coverage during their pregnancies and the postpartum period who are not eligible at other times. Medicaid finances 41% of births in the United States. Federal law requires states to provide coverage up to 60 days postpartum. A bill in 2021 gave states the option of participating in an extended coverage program offering coverage up to one year postpartum.

Medicaid Insurance card with thumb holding it

In May 2024, Centres for Medicaid and Medicare Services (CMS) released an infographic summarizing beneficiaries’ maternal health data. CMS collects demographic data on age, race and ethnicity, and geography. They collect outcome data on maternal mortality and severe maternal morbidity (SMM), underlying causes of maternal mortality, dental care access, postpartum contraceptive utilization, spacing between pregnancies, chronic conditions, timeliness of prenatal and postpartum care, smoking, behavioral health and substance use, neonatal abstinence syndrome, postpartum depression (PPD), preterm birth, and low-risk cesarean delivery. Additionally, they collect health system data on healthcare service provider distribution, state quality improvement activities, and state participation in an opt-in extended postpartum coverage program.

Key Take Aways

The data highlight key areas of disparity for Medicaid beneficiaries and provide an important road map for healthcare policymakers and system designers regarding where care could be enhanced. For example, the data show that Black birthers experience mortality 2.6 times more often than their white counterparts. This finding corroborates other research and supports advocacy efforts for publicly funded doula care as an intervention to reduce Black maternal mortality rates.  Another useful observation is that birthers under the age of 19 experience higher than average rates of PPD (22% compared to an average of 17%). This suggests that in addition to universal PPD screening, additional attention should be paid to this group during the postpartum period.

Black pregnant person with long braids and mustard coloured dress

This 9-page resource provides invaluable information to support US birthworker advocacy on expanded access to birth and postpartum doula care, freedom of provider choice and birth location, and mental healthcare. For birthworkers in Canada and other jurisdictions, it is an illuminating example of what can be learned from comprehensive demographic and outcome data collection practices.

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression Anti-racism work Canada decolonization

Emancipation is a collective State of Mind: Birthworkers need to talk about slavery

[vc_row][vc_column][vc_column_text css=”.vc_custom_1717529438169{margin-bottom: 0px !important;}”]As a child, I loved the “Heritage Minutes” on CBC. These memorable 60-second spots about Canadian history stand out more in my mind today than most of what I learned in Canadian history classes. One of the most notable stories was the Heritage Minute about the Underground Railroad which chronicled the moment when an escaped, enslaved African American family realizes they have successfully made it to freedom in Canada. “We’s free! We’s in Canada” exclaimed the family as they embraced each other tearfully.

Like many Canadians, I was unaware of Juneteenth until a few years ago when President Biden proclaimed it a national holiday. June 19th is a significant date in US history because it is when the last group of enslaved people were emancipated approaching the end of the Civil War. As a nation with a strong tendency to congratulate itself for being the nation that American slaves escaped to, it can be difficult to see what this emancipatory celebration has to do with Canadian history or society.

In fact, slavery was a normalized way of life in the colonized territories that eventually became known as Canada for over 2 centuries. In the early days of the colonial process, Indigenous peoples were enslaved, along with Black people brought to the Americas by the trans-Atlantic slave trade. It ended in Canada in 1807 when slavery was abolished throughout the British Empire. In contrast, Juneteenth commemorates June 19, 1865, fifty-eight years later.

So why is it important to talk about slavery today, and why is it relevant to birthworkers? To enslave people, you must first dehumanize them. The transatlantic slave trade codified beliefs about Black people that can’t be eradicated as easily as laws. These beliefs are alive and well, and responsible for much of the suffering experienced by Black people globally today. For example, on May 25, we commemorated the 4th anniversary of the brutal murder of George Floyd at the hands of a police officer. This is despite the many years the Black Lives Matter movement has raised awareness of similar incidents.

This is relevant to birth workers because this dehumanization is enacted in the health care system as well. We shared an article about “The Mothers of Gynecology” in February. The dehumanization that these enslaved women experienced as they were experimented on without anesthesia is the direct ancestor of the horror stories described by prominent Black figures such as Beyonce, Serena Williams, and Tatyana Ali. Their stories represent the stories of countless others who don’t have the same kind of platform, including many Canadian Black women and birthers.

As health researchers and policy-makers in the US struggle to combat the Black maternal and neonatal mortality crisis, growing evidence emerges that culturally competent doulas have a significant positive impact on Black maternal health outcomes. This evidence has led to an ever-increasing number of US jurisdictions providing public funding for doula care to ensure that this support makes it to families that need it most.

These strides forward are connected to a broader trend in US culture of acknowledging its racist past and that racism is still a part of the fabric of its nationhood.

Frankly, my observation as a Black woman who has lived in Canada for over 40 years is that as a nation, we are still stuck in denialist whitewashing. For example, while I had long since debunked the mythology of the underground railroad heritage minute, I had no idea that Indigenous people had been enslaved in Canada until I started researching this article.

We know that reconciliation cannot exist without truth. The path to collecting the same level of data that has made publicly funded doula care possible in the US begins with acknowledging that racism is as baked into our history and as prevalent in today’s social fabric as it is in the US.

Canadians observing Juneteenth can use today to learn about the history of Black and Indigenous enslavement in Canada and reflect on how it impacts the modern day. I highly recommend looking at the work of Black Canadian scholar and historian Dr. Afua Cooper. In particular, her book “The Hanging of Angelique: The Untold Story of Canadian Slavery and the Burning of Old Montreal” is a great read.  It chronicles the tragic tale of an enslaved Black woman in Lower Canada (now Quebec) who was scapegoated and tortured into confessing to the great fire of 1734 in Montreal. Cooper’s prodigious research captures the nightmare of Canadian slavery and the early colonial period. Drawn largely from copious trial records, Angelique’s words are considered the earliest known first-person account of slavery in the New World.

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
LGBTQ2S+ pride

Pride is Being There for Each Other

[vc_row][vc_column][vc_column_text title=”Pride is Being There for Each Other” css=”.vc_custom_1717529719709{margin-bottom: 0px !important;}”]Nowadays, the word “Pride” is almost immediately associated with “Parade” in many people’s minds. But in the LGBT2SQ+ community we know that at its inception “Pride” went with “Protest”.

Most people think of the Stonewall Riots as the start of the gay liberation movement in North America. Here in Toronto, we had a similar watershed moment that acted as a catalyst for the emergence of the June Pride Festival. On February 5, 1981, Metropolitan Toronto Police initiated Operation Soap. Four Toronto bathhouses were raided and over 300 men were arrested. This was the largest mass arrest in Canadian history at the time. The arrests caused careers and families to be destroyed. The event sparked nation-wide protests and was an important turning point for Queer and Trans liberation in Canada.

These protests and rallies denouncing Operation Soap evolved into the Toronto Pride Festival, one of the largest pride festivals in the world.

In the four and a half decades since Operation Soap, there have been many reasons for our community to celebrate. We’ve made important strides forward like marriage equality and easier access to family-building. And by celebrating our identities, we resist the pressure to hide, assimilate, and deny our truth.

However, Pride still needs to be a protest. Backlash is here and it’s a real threat. Unfortunately, children seem to be the primary targets of this backlash. There is a movement aiming to make it hard for kids with queer parents to talk openly about their families and be affirmed at school while making it difficult for kids with cis, straight parents to learn that queers exist and humanize them. This movement also aims to force educators to disclose confidential information about the gender identity of their students, which would inevitably expose some of these children to abuse. A federal ban on conversion therapy in 2022 has simply driven the practice more underground, and no charges have been laid under the new legislation. Kids can’t show up to listen to drag queens read stories without having to walk past a phalanx of angry anti-trans protestors.

We can drown out this hateful backlash with a flood of compassion. It starts by declaring proudly and unequivocally that you affirm queer and trans people in your birth work practice. Then, you bring the skills to the table.

Here’s a guide to resources that can support you in growing a queer and trans-competent birthwork practice.

The Queer Doula Toolkit

This free download developed by Wellness Within and Nova Scotia Public Interest Research Group (NPIRG) is a must-have resource for birth workers supporting queer and trans clients. It is choc full of educational resources and fillable exercises. Some of these are on topics that are relevant to the 2SLGBTQ communities, like pronouns, queer families, and queer terminology. Others go over the usual perinatal health topic in a queer-trans-inclusive way. The toolkit is illustrated with vividly realized characters encompassing humans of all shapes, sizes, colours, gender presentations, abilities, and family structures.

The fillable exercises include a queer-affirming and trauma-informed birth plan. The birth plan is supported by trauma-informed reflections that ask the client to reflect on their triggers and potential coping strategies. The strategies can be documented in the plan, including how their doula can help.

 

Books & TV

Why Did No One Tell Me This? The doulas’ honest guide for expectant parents.

This book is a great resource for parents and birth workers. It’s not specifically queer, but it is written from an intersectional standpoint and uses inclusive language and imagery throughout. It’s a great option for parents looking to supplement their prenatal class or work with a doula and affirms a wide range of birthing people.

 

What Makes a Baby?

If the older sibling of a gayby (child of same-sex parents) wants to know where their new sibling came from, this is the book for them. Appropriate for early-years children, it answers the question “Where do babies come from?” in a way that is scientific and inclusive of the various ways in which queer and trans people family-build.

 

 

Flamingo Rampant

This independent children’s press has a beautiful and ever-growing selection of children’s books that celebrate the diversity of families and identities. Operating from an intersectional social justice lens, this publisher prioritizes stories about gender and sexually diverse children, youth, adults and families doing things that are bold, cool, adventurous and fun without making identity the focus of the story. Each book radiates a message of joy, acceptance, community, and love.

 

 

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Categories
Anti-Oppression Anti-racism work Canada collaboration community decolonization Equity indigenous doula intersectionality national indigenous peoples day

Land Back, Bodies Back

Indigenous standing on the dock of a lake and greenary

[vc_row][vc_column][vc_column_text title=”Land Back, Bodies Back” css=”.vc_custom_1717529147132{margin-bottom: 0px !important;}”]Many settlers (i.e. all non-Indigenous residents on Indigenous land) are resistant to the Land Back Movement. Misinterpreting “Land Back” as a call for all settlers to “go back where they came from”, they often get scared, then angry.

I am a Black settler on Turtle Island and I support the Land Back Movement. I certainly have no intention of “going back where I came from”. Aside from the fact that this would split up my interracial family, my ancestors hail from a Caribbean island wherein there are more of us in the diaspora than there are living on the island. If all of us who are now settlers elsewhere suddenly “returned” this would lead to social chaos and economic collapse.

Land Back isn’t symbolic either. It is about restoring the stewardship of this land and its resources back to Indigenous people, ensuring they have self-determination. It’s about changing the narrative such that Indigenous ways of knowing and doing become the status quo.

I am ride or die for a Turtle Island stewarded by Indigenous leaders. Climate change is heating up quite literally, with “wildfire season” starting earlier with bigger outbreaks each year. There is growing talk of returning to Indigenous “controlled burning” practices to mitigate the devastation. Indigenous communities were forced to abandon the practice because their colonizers thought controlled burns were “barbaric”. It’s one of countless examples of traditional resource stewardship practices that were abolished to the detriment of all.

The Canadian state has a long history of interpreting its treaties with Indigenous nations in bad faith. Settler-colonists spuriously interpreted the land as meaning nothing more than the ground we are standing on. Where treaties have designated the land to specific nations, the state and its agents have still felt entitled to help themselves to the resources on that land, including plants, water, minerals, and animals.

Indigenous nations have a more holistic understanding of the land. Everything the land produces is part of the land and the Indigenous elders representing their people signed the treaties with that pragmatic worldview. Seen in this way, our bodies and families are also part of the land. As such, reproductive and perinatal health and services are significant arenas for the Land Back movement.

Indigenous midwives and doulas are at the forefront of actions to decolonize and reclaim birth. Here are a few examples of their initiatives that are bringing Indigenous birth back to the land:

 

  • Konwati’shatstenhsherawi’s means “Women are Giving Each Other Power” in the Mohawk language (Kanien’kéha). This collective trains Indigenous birth helpers to support birthing people using ancestral worldviews and practices. Since the grassroots program’s inception in 2017 demand has been high and the 4-person training team is busy teaching new cohorts all the time.

 

  • Call Auntie is an Indigenous-led sexual and reproductive healthcare clinic operating weekly at Toronto Birth Centre, and as a pop-up at other locations around the city. They offer a holistic suite of services rooted in traditional Indigenous knowledge, including mental health, primary care, and social support programs. Their service model emphasizes problem-solving, removing barriers, and community-led care.

 

  • Pauktuutit Inuit Women of Canada is making important strides forward in expanding access to traditional midwifery in remote northern communities. Their position is that this access is a health and cultural right for Inuit people. They recently published a report finding that governments do not provide adequate financial support to culturally safe sexual and reproductive health care. They advocate for an end to forced birth evacuation and a return to traditional birthing practices on the land.

 

  • Mālama Nā Pua o Haumea is a collective of Hawaiian traditional midwives who are working to reduce maternal mortality rates which are higher in Hawaii than in the continental US. Recently, legislation governing midwifery care has changed and they are now required to become certified nurse midwives (CNM) or certified professional midwives (CPM). Pale keiki (traditional Indigenous Hawaiian birth attendants) experience multiple institutional barriers to completing this certification, including cost and relocating to an urban centre. In contrast to these 4-year certification programs, pale keiki train with a mentor versed in intergenerational knowledge for over a decade. Some pale keiki are continuing to provide culturally safe care in Pidgin, despite these legislative changes. (US)

 

  • Kehewin Cree Nation has launched a program to train traditional midwives and has received federal funding to open a birth center on its territory. The nation aims to see more Cree babies born on their land and to honour sacred traditions such as placental ceremonies. Trainees in the program learn the knowledge of their midwife ancestors alongside Western medical knowledge. Four women are in the inaugural cohort and the program will take up to 4 years to complete. Kehewin Cree Nation anticipates these 4 trainees will be the first of many.

 

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]