An Open Letter from Vicki Penwell

Reflections on racism and oppression in midwifery

An Open Letter: Mercy In Action’s commitment to stand against

oppression and racism within midwifery in developing countries

By Vicki Penwell, LM, CPM, Masters in Midwifery, Masters in Inter-Cultural Studies

Mercy In Action, the non-government organization (NGO) providing maternity care in the Philippines that I founded, has sought to be a leader in the provision of ethical, respectful, and evidence-based maternity care.  Open access services are provided to all who come to our door. We seek to provide up-to-date care specific to the developing country we are in, according to World Health Organization (WHO) protocols and the International MotherBaby Childbirth Initiative (IMBCI) standards, while actively removing barriers to care.  These barriers include addressing cost by having no user fees, addressing distance by building maternity waiting homes, and addressing race and culture by opening our hearts fully to be deliberate about seeking to be culturally competent and relevant in all we do.

Like so many, I am outraged at the unethical practices that go on in birthing sites around the world, including the recent charges against Midwife International, but I am not apologetic for the work of Mercy In Action in the Philippines.  And I cannot feel bad because the color of my own skin does not match the color of the skin of the women our birth center serves; because that is something I cannot change. The skin of our staff does match the color of the women having babies… which of course may be important to the individual woman giving birth, but I believe the heart matters, too. My own grandmother felt very fortunate to have a wonderful midwife assist her home birth in the Ozark Mountains in the 1920’s… a Black midwife helping a White woman.

As the founder and director of Mercy In Action, I give full disclosure that I am a White midwife working and living full time in the Philippines, with a staff and advisors that are multi-national–Asian, African-American/Asian, Hispanic, and White. My family came to the Philippines in 1991 because we were invited by Filipinos to help be a solution to the high maternal and infant mortality rate in this country. We went to the poorest (people living in graveyards, slums, garbage dumps and resettlement camps) and have served among them for the past 22 years. We have not always done everything right, but we are deliberate in our attempts to be evidence-based and culturally appropriate, and the mortality rate for newborns within the walls of Mercy In Action’s clinics has been 4 times lower than the country we are in, the maternal mortality rate is 8 times lower. According to a survey we conducted asking why they come, they say because we are kind.

In Mercy In Action, we work as a team, each with strengths and abilities and cultural understandings complimentary to each other and helpful to women in crisis. We have been able to create a safe, well-stocked and beautiful first class birth center where women feel privileged to give birth.  We train and give scholarships to local indigenous women in midwifery, and update skills for local health professionals. Foreign visitors only assist the indigenous midwives; foreigners never give primary care. How we conduct ourselves is all explained on our website.

Because of the responsibility we felt after being chosen for a chapter in Robbie Davis-Floyd’s book Birth Models That Work, we have tried to be generous with our advice to those who have asked over the years. So when Sarah Kraft of Midwife International wrote to me earlier this year, asking me to be an advisor for a new organization that was going to work in developing countries, I said yes.

I apologize for inadvertently being a part of anything that wounded another human being. I admit it was unwise to allow my name to be put on any organization’s website when I knew nothing at all about them. Nor did I ever at any time have any power at all as far as decision-making or policy. In fact, I have never met Sarah Kraft, and I never attended any advisory board meetings before resigning (Sarah tried to get me into a proposed board meeting on conference call, but only one other person came on the call.)

I wrote one long letter of advice to Midwife International, which they did not take, asking them to use the International MotherBaby Childbirth Initiative as a guide to keep them respectful and medically safe, and then I got busy and did not pay any attention to this organization… until September 2nd when a friend wrote me about the campaign against Midwife International, and asked if I knew my name was associated.

I have wished a thousand times in the last few days that when asked to give advice to Midwife International, I had said yes to giving advice but no to being put on their advisory board. You see, I cannot apologize for offering to give them advice, because I have so often complained loudly about unethical practices I see happening surrounding birth, so I feel it is only right to be generous and share my hard-earned experience when asked. But as I was way too busy to research or find out anything about them, I should have never said yes to being an advisor on an actual advisory board, a role I indeed never even served in.

Here is what I am doing now:

1. I have already contacted Sarah Kraft in private emails asking her to refund all students who ask, and pay the sites what is owed. She has not answered. I have written to the other former advisory board members to ask them to contact her also.

2. If Midwife International refuses to refund Shauntée Henry, I will personally donate to a fund to help her recoup her losses, and gladly offer her an alternate intern position free of tuition fees at our birth center, if she should so desire.

3. I will also offer to mail a box of medical supplies to any clinics affected by loss because of the actions of Midwife International. I have supplies to share from our clinic here because God has been so generous to us and just this week we received a large box of gloves and syringes and baby hats.

Finally, I want to acknowledge and thank the brave and wise Women of Colors who have been my mentors and counselors these past few years as I found my way to a place where I realized I could work to affect change in the shameful disparities in American birth outcomes, even as I lived and worked as an expatriate in Asia, namely Michele Peixinho, Claudia Booker, and Jennie Joseph. Thank you for being my friends and speaking truth to me. You have all helped me have endless “aha” moments and encouraged me greatly as we launched the Mercy In Action scholarships and the Scholarship Solution and Grand Challenge.


Vicki Penwell

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