Midwives Alliance of North America (MANA) supports the implementation of a universal healthcare system that addresses the health needs of all people, based on the understanding that all human beings have the same human rights, as defined by the 1994 International Conference on Population Development and reaffirmed the next year at the Beijing (Fourth) World Conference on Women:

Reproductive health is a state of complete physical, mental, and social well-being in all matters relating to the reproductive system and to its functions and processes. It implies that people have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this is the right of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice… Reproductive health care also includes sexual health, the purpose of which is the enhancement of life and personal relations.

More specifically, MANA supports reproductive justice as defined by SisterSong:

Reproductive Justice is the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.

MANA recognizes the role of the midwife as a provider of client centered care for women and families throughout the childbearing year and beyond. Basic to this role is individualized care and education that takes into account the unique physiologic, psychological, and social needs and realities of each client. We acknowledge the lack of respectful, compassionate, and adequate care, and the effect of those deficiencies on trans and non-binary people, along with people of color, people with disabilities, incarcerated people, women, girls, and all underserved groups.

We assert that we can honor the power of all women, while at the same time extending this reverence to all people who are pregnant and giving birth, and that to do so is in full alignment with the heart of midwifery. For that reason, MANA is committed to a policy of inclusive language and the use of both gender neutral and female gendered terms.

Midwives Alliance asserts the following:

• The ethical principle and fundamental right to individual autonomy and bodily integrity, in accordance with the Universal Declaration of Human Rights (UDHR)
  • through care that includes
    • shared decision making between provider and client
    • informed consent and refusal without coercion or abandonment
  • and lives free from
    • sexual coercion and trafficking
    • arranged childhood marriages
    • systemic and domestic violence and abuse

• The right of all people to receive humanized and inclusive midwifery care without discrimination in regard to sex, gender identity, race, color, marital status, ethnic origin, socioeconomic status, religion, age, sexual orientation, size, or disability, which requires:
  • the identification and recognition of inequities in the provision of healthcare services and the resultant disparities in outcomes
  • support for improved, non-biased, culturally safe research involving childbearing people
  • access to community based, culturally congruent, autonomous midwives

• The right to respectful and dignified sexual and reproductive healthcare services for women, girls, and all people, that incorporates:
  • improved and expanded preventative services
  • comprehensive sexual education
  • family planning education and care inclusive of all methods
  • midwifery services that are both geographically and financially accessible

• The right of sexually active people regardless of age or income level to both parent and control their fertility which includes:
  • the full range of contraceptive options
  • access to fertility counseling and treatment
  • access to legal and safe abortion
  • respect for the rights of parents within all family configurations

• The worsening reproductive morbidities and mortality in the US, particularly for people of color, must be acknowledged and addressed:
  • by reducing the systemic racism that causes disproportionate maternal and infant mortality rates, and overall health inequities
  • through the identification of risk factors for maternal mortality
  • by recognizing the role of routine medical interventions as a contributing factor in increasingly poor outcomes

• The right to pregnancy and childbirth safe from preventable injury and death, which necessitates:
  • access to safe and effective midwifery services
  • freedom from obstetric violence
  • treatment for addiction as a disease during pregnancy, without fear of prosecution or incarceration
  • structural support for families during the postpartum period
  • a standard of living allowing for health and well-being in accordance with the UDHR
  • access to affordable healthy food and clean water

MANA is committed to enabling transformative research, promoting an evidence-based midwifery model of care, addressing health disparities, and achieving optimal outcomes through normal physiological birth and healthcare across the lifespan. MANA envisions a world where every person, in the setting of their choice, has access to high quality midwifery care provided by culturally safe, autonomous, community-based midwives.

References:

International Confederation of Midwives. Midwives’ Provision of Abortion-Related Services. https://tinyrul.com/y9qcl96g

Kotaska, A. Informed consent and refusal in obstetrics: A practical ethical guide. Birth. 2017;44:195–199. https://doi.org/10.1111/birt.12281

MEAC List of Essential Competencies. https://tinyurlcom/y9j3qn2h

Sadler, M. et al., Moving beyond disrespect and abuse: Addressing the structural dimensions of obstetric violence. https://www.tandfonline.com/doi/full/10.1016/j.rhm.2016.04.002

SisterSong. What is Reproductive Justice. http://sistersong.net/reproductive-justice/

United Nations Educational, Scientific and Cultural Organization. Universal Declaration of Human Rights. Records of the 33rd session of the General Conference, Paris Oct 2005. 33 C/Resolution 15; Articles 5 & 6.
 
United Nations. International conference on population and development, Cairo 5–13 September, 1994. Programme of action, United Nations, Dept. for Economic and Social Information and Policy Analysis, New York (1995)
 
United Nations. Sustainable Development Goals. http://www.un.org/sustainabledevelopment/health

Vedam, S. Mapping integration of midwives across the United States: Impact on access, equity and outcomes. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192523

World Health Organization. Maternal Mortality. http://www.who.int/mediacentre/factsheets/fs348/en