This guest post was written by Wendy Gordon, CPM, LM, MPH. The thoughts expressed are her own and may not be representative of all members of Anti-Racism and Anti-Oppression Work in Midwifery, nor of the other organizations with which she is affiliated.
The events over the last few days are causing quite a buzz in the midwifery community, as Midwife International – a U.S.-based training program that focuses solely on the use of clinical sites in low-resource countries as a vehicle for student midwives to gain experience – has been called out for reports of unethical behavior.
Full disclosure: I am a midwife who participated in a short-term clinical rotation in a low-resource country to “get my numbers” some years ago. I regret that I did not have much of an ethical or anti-racism lens at the time. I didn’t think twice (or even once) about the power dynamics of being white, relatively wealthy, and American in a country where most of the people were brown, impoverished, and had been colonized by American military in WWII.
I didn’t think much about these power dynamics, because I convinced myself that the gentle, woman-centered type of care I was trained to provide would benefit all mothers and babies, even across international boundaries and language barriers. Because the hospital maternity ward I trained at didn’t have enough staff as it was, the only logical assumption was that my presence there would be beneficial to the local midwives. My American dollars were being spent in that community. It was so obvious that this was a win-win.
My training helped me to justify that the type of care these mothers were getting from me, even as a student, was better than what they would have had without me there. Furthermore, my whole life experience as a working, middle-class white person led me to believe that it was perfectly OK for me to elevate my needs and desires over the concerns of people who were poor, lacking formal education, or had brown or black skin. I could enter that community without knowing their history, their language, their cultural norms, their concerns or their needs, and just assume that whatever I had to offer was better than what they had. My primary interests were to “get my numbers”. My training in a white-dominant society demonstrated on a daily basis that there would be no adverse consequences to me for believing and behaving in that way; in fact, it was “normal.”
I had no knowledge of the centuries of white, wealthy, European-Americans practicing on the brown and black bodies of low-income, enslaved and/or colonized communities – not for the benefit of those communities, but for the purpose of advancing medical knowledge for the ultimate benefit of the white folks who were accessing it. It was rationalized just like I did; it was decided (by the white folks who were doing the practicing and experimenting) that the people of color in these communities were getting better care than they would have otherwise (although they weren’t really asked). Some call this “medical apartheid.” I didn’t have to know or care about this; there was no penalty to me as a white person for not knowing it, no adverse impact on my life for not having educated myself about these atrocities, no one in my family was involved or impacted, and besides, that stuff happened in the past, right?
So it is without surprise that I recognize the same cultural training in the formal response of Midwife International’s CEO and President, Sarah Kraft, to the testimonials from people who are speaking out against her actions in their communities. In an open letter to the members of the Alliance for Ethical Midwifery Training (and also copied to the members of Midwife International’s (former) advisory board and the leadership of NARM, MANA and ICM “to ensure transparency”), Sarah writes:
The statements recently circulated about Midwife International on ethicalmidwifery.org are not based in truth and we have a strong body of evidence to disprove and discredit the accusations that have been made against our organization.
Midwife International is committed to holding high standards of quality midwifery care and midwifery education in the international context. Because the individuals who have spread these statements do not meet our credentialing requirements and have not proven to be accountable financially or otherwise, we stand by our decision to dissociate from these individuals, their organizations and their affiliates.
With gratitude for the voices that help us grow and evolve our pioneering model, we always welcome constructive feedback. However, we consider it unethical and a breech of privacy to engage in public discourse about any of our past and current site directors, students, preceptors, or other affiliates. We therefore request that “Alliance for Ethical Midwifery Training” website be removed until it contains accurate and valid information that has been verified by credible sources.
For anyone who is currently endorsing this campaign we ask that you educate yourself about all sides of the issue and do homework before jumping in and taking sides. By supporting a negative campaign without knowing the full story, you can harm the very causes you support. Midwife International stands firmly for ethical behavior, inclusiveness, integrity, and truth and invites the larger midwifery community to stand there with us.
We intend to remain focused and move forward with the development of our programs, and to deliver a curriculum that demonstrates evidence-based midwifery and optimal MotherBaby maternity services (IMBCI.org). We will remain accountable to all of our current students and partners and will continue to forge a path for improving international midwifery educational standards, while honoring our true clinical partners and the mothers and babies with whom we work.
President/CEO, Midwife International
Vice President & Treasurer, Midwife International Foundation
It is Sarah’s white culture training that says the white person’s story — even when it remains untold — is always more believable than the person of color: “we have a strong body of evidence to disprove and discredit…”
It is Sarah’s white culture training that helps her to believe that people of color need white folks more than we need them: “we stand by our decision to dissociate from these individuals…”
It is Sarah’s white culture training that says that the tone used by those people of color is offensive, so we can dismiss what they’ve said: “we always welcome constructive feedback…”
It is Sarah’s white culture training that says that her beliefs about what is unethical trump those of people of color: “we consider it unethical and a breech of privacy to engage in public discourse about…” (while the ethical concerns of the people being harmed are not addressed at all)
It is Sarah’s white culture training that says that white folks get to decide what and who is to be believed: “we request that … website be removed until it contains accurate and valid information that has been verified by credible sources.”
It is Sarah’s white culture training that makes her believe that her truth is The REAL Truth: “educate yourself about all sides of the issue and do homework before jumping in and taking sides.” (while not offering any information at all)
It is Sarah’s white culture training that permits her to think that she gets to determine when REAL harm is done: “By supporting a campaign without knowing the full story, you can harm the very causes you support.”
It is Sarah’s white culture training that tells her that there will be no consequences to sweeping aside the voices of people of color who express that harm is being done to them, so go on and forge ahead: “We intend to remain focused and move forward with the development of our programs…”
It is Sarah’s white culture training that allows her to decide who, if anyone, she will be accountable to, which generally in a white dominant culture does not include the communities and people of color who receive the impact of our actions: “We will remain accountable to all of our current students and partners…”
It is white privilege that permits Midwife International employees to silence dissent by deleting curious questions from their Facebook page; to remove their own names and information about their foundation from their website; to keep recruiting and pretend as if there is “nothing to see here” while sending out a fun-filled newsletter that makes no mention of the issue at hand. After all, it is the winner who gets to write the history of what really happened.
It is white privilege that refuses to examine the possibility of another version of the truth other than our own; that will actually lash out at those who dare to speak up about injustice and turn the tables back on them, making ourselves out to be the real victims. It is white privilege that says that the real damage done here is to the good reputations of the midwives on Midwife International’s (former) advisory board, and that this concern for the reputation of white midwives supersedes the harms being done in communities where Midwife International operates.
The concerns that have been raised (and that keep coming in) about the ways in which Midwife International has been operating describes extremely unethical behavior. It is one example of how midwifery training – like medical training in other professions – can be medical apartheid. This is a problem for all of us, and it is an extremely complex one. The criticisms leveled at our field yesterday by “Dr. Amy” on her hateful blog are not, as some have suggested, the fault of those who have called for changes at Midwife International. The ethical problems of medical apartheid have existed in our profession for decades, and we as a community have an opportunity right now to begin to address it.
White culture training assures us that there will be no adverse impact to white midwives if we just walk away from this piping hot mess. The folks at Midwife International could just continue to wave their hands, avoid the conversation with the community, and hope that this blows over quickly so that we can all just get back to getting our numbers. It is certainly uncomfortable to have to think about the complexity of this and the deeper training issues that need to be addressed within midwifery and all healthcare professions.
And when we exercise that ability to turn our backs and walk away without consequence, to go back to our daily struggles that are already hard enough, and we leave this mess for someone else to sort out, then we have opted to once again leave people of color to bear the brunt of our profession’s problems. When Midwife International is not only allowed to be completely unaccountable to the communities that they purport to serve, but are openly bullying them in front of our professional leadership for speaking about being harmed, they highlight a major, major problem for the entire midwifery community.
What can you do?
- If you are a student midwife, start to learn about medical apartheid, the complexities of midwifery tourism, and the long history of ethical injustices in learning and practicing on the bodies of people who have less power and privilege than you. Will you be getting any training at all on these issues, cultural competency, power & privilege, and/or the history, challenges and strengths of the community that you would be practicing in/on? Demand it of your program, and seek it if you are educating yourself.
- If you are a midwifery educator in a program that offers international training for your students, what are you doing to adequately prepare your students to learn and practice ethically? What are best practices for true service learning, and how might you implement these in your program? Should we be doing this at all? What conversations are you having about this, and how can we broaden these conversations within the midwifery education community? How can we reach out and be accountable to educators in international sites who are hosting U.S. students? How can we help Midwife International to be more accountable and transparent?
- If you are a leader in the U.S. midwifery profession, please don’t walk away from the issue for fear of getting your hands dirty. In what ways might you reach out to Midwife International to learn more about how they are preparing their students and preceptors, how they are working with host sites, and how they are being accountable to the communities they hope to serve? How might you lead our profession into the work that needs to be done around this issue, so that we might once again act as an example to other healthcare professions for best practices?
Consider the ways in which you personally can add your voice and your actions to the immediate and longer-term hard work ahead of us around this issue. Now is the time.