There are no midwifery programs in the HCBUs – Quartz

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The profession of midwifery in the United States is on the rise.

After being relegated to the fringes of childbirth for many decades, midwives are increasingly recognized in the United States. This is in part thanks to an effort to tackle the over-medicalization of childbirth, to help cope with the maternal mortality crisis, as well as to provide a stronger workforce in areas where childbirth is poor. specialists are lacking.

The number of female students enrolled in midwifery programs at U.S. universities has climbed more than 20% since 2015, and the number of midwives has more than doubled since 2010. But a significant subset of the American higher education is lacking: historically black colleges and universities (HCBU).

The midwifery workforce in the United States is not only small, but very homogeneous. More than 90% of the 12,000 midwives in the United States today are white and fewer than 700 are black, says Michelle Drew, midwife and director of Ubuntu, a collective of health and community workers serving of black Delaware families.

This is of particular concern because black women have four times the risk of maternal mortality than white women in the United States, where the rate of pregnancy-related deaths is the highest of any wealthy country. Having more black midwives could encourage black women to seek their services, leading to safer deliveries. Additionally, research has shown that black healthcare providers are associated with better health outcomes for black patients.

The value of midwives

Midwives are health professionals, usually, but not always, nurses, trained to assist women during pregnancy and childbirth. They are not doctors, so they cannot perform emergency medical interventions, such as cesarean sections, but can otherwise replace an obstetrician during an uncomplicated delivery.

There are many valid reasons for promoting births with midwives. They can usually spend more time working with the mother before childbirth, and because they are trained differently from doctors, they are less likely to opt for unnecessary and sometimes risky medical interventions, such as medical induction of labor.

Research has shown that midwives are associated with safer births, and several policy programs and interventions, such as the recent bipartisan Midwifery for Moms Act, presented to Congress in May this year, have sought to develop and diversify the number of midwives.

Yet even with this progress, the United States lags behind peer countries in the number of midwives per capita. In the United States, only 8% of births are attended by a midwife. By comparison, in Europe, more than 75% are, with up to 80% in Germany, 90% in the Netherlands and 98% in France. For every 1,000 live births, countries like Australia and Sweden employ nearly 70 midwives; the United States employs four.

A legacy of discrimination

The story of how American midwives became so small and white begins 100 years ago, with the Sheppard-Towner Act of 1921, a law promoting maternal and child health. Among the provisions of the law was the regulation of midwives, who until then assisted about half of deliveries across the country. Overall, about 90% of black children were delivered by community midwives, says Drew, who has done extensive research on the history of midwifery in the black community.

Although the main culprit in infant mortality was syphilis (penicillin would not be introduced for two decades), the lack of formal training of midwives, who were usually black women, was named as the cause by the architects. of legislation.

When the law was passed, the medical profession was actively trying to discredit midwives. Since the turn of the 20th century, obstetricians and gynecologists have worked to establish their discipline in the United States by presenting pregnancy as a disease and presenting themselves as the doctors to cure it. Professional medical organizations have likened midwives to little more than witchcraft, encouraging women to resort to medical intervention for childbirth, with the aim of harnessing the commercial potential of childbirth.

To professionalize the profession of midwifery and make access more difficult, Sheppard-Towner introduced a requirement that midwives undergo nursing and public health training prior to formal midwifery training.

In less than a decade after the law was passed, the percentage of births attended by midwives fell by 15%, and it is mainly in the segregated South that community midwives have continued to deliver. of African-American babies, although without the current formal training. Required by law.

Obtaining midwifery training was also not easy for those who wanted it. Until the 1940s, only four institutions offered recognized training for nurses to become midwives: the Manhattan School of Midwifery, the Flint-Goodridge School of Nurse-Midwifery in Kentucky, the Catholic Maternity Institute in New Mexico and the Tuskegee School of Nurse-Midwifery. , Alabama.

With the exception of the latter, which was opened at Tuskegee University, an HBCU in 1941, all other programs were officially or de facto off limits to black students. (Prior to Tuskegee’s program, in 1932, Dillard University, an HBCU in Louisiana, opened a midwifery program that never went beyond the first year due to lack of funding.)

In the years that followed, the number of midwives continued to decline and the profession continued to be discredited by the obstetric establishment across the demographics. But black students’ limited access to midwifery training has all but erased their representation in an area that was once a mainstay of the community. And, with the absence of black midwives, black communities have become even less likely to avail themselves of midwifery services.

How to bring midwives to HBCUs

The Tuskegee School of Nurse-Midwifery finally closed in 1945, and although at least two programs have provided training for HCBUs over the years, the last one was discontinued in 2007.

No other HBCU has been able to set up midwifery training since, and the reasons for this struggle “are primarily financial. Midwifery programs are expensive to deliver because they must provide clinical training and the insurance coverage needed to work during childbirth is expensive.

HBCUs often have much smaller endowments than other institutions, and many have been chronically underfunded, causing them to lack the resources to establish an expensive midwifery program, even when they already have health departments. nursing or medicine, as do 39 of them.

Given that 60% of HBCU faculty and the majority of students are black, providing specific funding to set up midwifery programs there would have a dramatic effect on increasing representation in the profession. This in turn could help black communities become familiar with the role of midwifery and not see it as an extravagant novelty in childbirth for the white elite, Drew explains.

But HBCUs not only need the money to set up midwifery programs, they need the support of the institutions that already house them. Beyond the financial resources required, setting up midwifery diplomas is complex and takes time. “If you are considering starting a new program, it will usually take you between two and five years to go through all the administrative tracks of your own institution,” says Monica McLemore, professor of family health nursing at the University of California at San. Francisco.

Once the program is approved within the institution and a first batch of students has graduated, it can apply for the approval of the Accreditation Commission for Midwifery Education, so that its graduates can be admitted to licensing exams. It is a big risk to take, to set up a program and to have the students go through it before even obtaining accreditation.

Some help from non-HCBU friends

To accelerate this, McLemore offers a solution: partnerships. Facilities with established midwifery programs would work with HBCUs, providing support in the design and evaluation of their programs, so that once they are ready for review, accreditation would be faster.

But more fundamentally, McLemore believes existing programs should provide a bridge for HBCU students interested in pursuing midwifery while the programs are implemented in their own institutions. In practice, says McLemore, students at HBCUs would take courses according to the curriculum of another institution offering a midwifery program in the area, and then once the program is in place at their home university, they would resume there. their studies. As the new midwifery program would be implemented with support from the existing program, the transition would be essentially automatic and would not result in any loss of credit for students.

“I submitted [grant proposals] over the past five years of trying to forge links between historically black colleges and universities and universities like mine, ”says McLemore. “Why can’t we facilitate this process so that if we were in partnership, the students could start in our program and end in the new program? “

Unfortunately, obtaining financing remains difficult. Even well-funded universities do not have the resources to fund many new programs, so proposals in this area often compete with others that might be prioritized. Government funding for midwifery education must also cover many areas – and since none are specifically reserved for HBCUs, it tends to go to programs in areas that already have midwifery colleges.

But McLemore sees potential hope in private philanthropy. McKenzie Scott’s recent donations to HCBUs and Native American colleges, ranging from $ 20 million to $ 50 million, have drawn donor attention to the key role of these otherwise neglected institutions. This new focus, along with the actual resources made available through donations, could help, although without the partnership of established institutions the path might remain too difficult for an HBCU to risk substantial funding for it.

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