How accessible is home birth without a home? Is home birth accessible to Indigenous and Black people if housing isn't?
Housing is a human right, and a determinant of health. Lack of safe, affordable housing has a ripple effect on the health and well-being of individuals, families, and communities.
Racism is deeply embedded into the structures that influence housing. I remember my Dad telling me that he chose his bank because it was the only one that would approve a mortgage for him to build a house on-reserve. That was in the early 1990’s, but, it was December 2019 that an Indigenous man and his granddaughter were handcuffed at a Vancouver BMO branch while trying to open an account, because the employee suspected fraud and called 911, so yeah, banks
are still racist.
During the late 1800's through 1900's, under the Indian Act, First Nations were forced onto reserves (a fraction of the land-base of traditional lands) with poor quality, overcrowded housing and lack of infrastructure (like safe drinking water - as of February 2020 there are still 61 long-term drinking water advisories in effect for First Nations), while traditional midwives were outlawed and it became Canadian policy that all births must be attended by a doctor or nurse/nurse midwife. Due to unsafe housing conditions (and racism), federally employed doctors and nurses refused to attend births on-reserve and Indigenous persons were forced to give birth away from home. Rather than invest in improving housing conditions, and reclaiming traditional midwifery, the government has stayed committed to the evacuation policy that persists today (Learn more here and here).
Today, more than half of Indigenous folks live off-reserve, and finding safe, affordable housing in urban settings is a challenge too. Vancouver is the second most expensive city to live in across Canada. Indigenous people represent 2.2% of the city's population based on 2016 Census data, yet of the 2,223 Vancouver residents who identified as homeless in the 2019 count, 495 of those, or 39%, identified as Indigenous.
Vancouver is also home to BC Women's Hospital and BC Children's Hospital, which are tertiary hospitals that offers specialized services for high-risk pregnancies and neonatal intensive care to people from across BC. Indigenous folks who are evacuated from their home communities at 36 - 38 weeks gestation may come to Vancouver to birth at BC Women's Hospital. This typically involves residing in a motel or other temporary accommodation while waiting to birth, with limited funding available to bring only one companion for support.
In the US, Black people have been denied housing through racist policy and practice (the linked article is the reading for Day 10 of Rachel Cargle‘s 30 Day #DoTheWork course, which I highly recommend for all birth workers), and like in Canada, traditional midwives, or Granny midwives, were marginalized and outlawed through state regulation of midwifery. Black women are three to four times more likely to die due to a pregnancy-related cause than white women. These outcomes are a result of systems of oppression and racism, not biology or genes, or lifestyle choices as suggested by Ina May Gaskin. The unacceptable rates of morbidity and mortality among Black birthing people is not really surprising when you consider the history of obstetrics and racism within medicine.
The new context of birthing during a pandemic has added yet another layer of uncertainty and fear, and more Black birthing people are seeking access to home birth.
If we support a person’s right to choose home birth, and are willing to advocate for it, we should also support a person’s right to a home, and be willing to advocate for it.
And if we recognize that not everyone can birth at home, because they don't want to, or they risk out of a planned home birth, or they don’t have a home, or their home isn’t a safe place to birth, or they are incarcerated, or they are receiving in-patient care; then we should be willing to advocate to make hospitals a safer place for all birthing people, and to advocate for all families to have access to affordable, safe housing to return to.
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