Transcript: Ana Delgado, CNM, MS

I did not come to midwifery through a love of birth. I was training as an advocate, having studied government and done several stints in policy-related roles. As an undergrad I wrote about the rise of Latinos in the US labor movement, and the criminalization and incarceration of communities of color in the name of immigration enforcement or anti-gang initiatives. I understood that oppression was not about individuals, but structures.  As a young feminist I consistently centered women, mothers, matriarchs in my work, sensing on a visceral level that there was a connection between my understanding of justice and the role of women and girls.

But early on, I realized my body craves motion and doing and I began to look for more tactile and concrete ways to contribute to the well-being of the communities I cared about. As an immigrant, bilingual and bicultural person I found myself quite by accident (or divine providence!) working as an interpreter at a prenatal clinic run by midwives that catered to central American refugees in the 1990s in Washington DC. Through this work, I realized that the connection I had always sensed between justice and people capable of reproduction was real: through birth we have direct access to a power bigger than ourselves, to the very concept of humanness and our rights to control what happens to our bodies.

I immediately saw my future as a midwife, accompanying people as they entered into these sacred spaces of birth, abortion, sexuality, and even death. The attraction was not just to those spaces themselves but to the capacity of those spaces to power movement towards liberation for individuals and communities.

Fast forward a decade into my practice, serving the low-income community of San Francisco. I was filling in the gaps left by a traditional health professions curriculum, struggling to continue in alignment with my original purpose. And through the generous mentorship of Black women, I was introduced to the framework of reproductive justice, and my original purpose felt in complete alignment. The thread that connected the sacred spaces I was witnessing is the fundamental human right to thrive, to decide if, when and how to give birth, and the right to live life to one’s fullest potential with joy.

Around the same time, one of my patients, we will call her Ashley, disclosed to me that her three year old was in foster care due to “neglect” and her history of substance use disorder. During her pregnancy, I worked with her and her public health nurse, writing letters and going to family court to advocate for her getting her daughter back. Despite only expressing the righteous anger that any mother would, Ashley was labeled as the “angry Black woman,” and an impassioned moment in family court lost her the custody of her daughter. Forever. This caused Ashley to relapse, but I was damned if I was going to see her lose another child. The harder I worked, the more I realized I was going up against a system hell-bent on surveillance, policing, and control of families from its very roots in chattel slavery and the punishment and control of the poor. Through a network of like-minded providers, Ashley was able to avoid another CPS case, and she went home with her baby.  Preventing this from happening to other patients would require systems and policy change. It could not sustainably rely on good intentions .

Despite always being critical of mandated reporting and urine toxicology testing of pregnant patients, I had never really taken a hard look at the systematic and pervasive nature of this aspect of policing in healthcare, and even more disheartening, my role in it. I was overwhelmed.

And yet the universe provides! Because as soon as I started to see this system as policing, it opened up a world of strategies and tactics, and introduced me to a community of comrades in abolition. Even before DPH Must Divest was formed, we had already started to meet in pockets of love and rage, pushing for the end to law enforcement in all aspects of our small but mighty piece of the healthcare system. I became a voracious student of abolition, realizing that policing and state violence is at the root and upholds the structure of every racist and oppressive system in our world. And that the antidote of abolition: community care, accountability, love, and liberation for ALL OF US was just the framework I needed to continue the journey. Fannie Lou Hamer, the famed civil rights activist, reminds us that, “Nobody’s free until we are all free.” This is the essence of abolition, and I believe this to my core.  Guided by both abolition and reproductive justice we started to research, write, develop tools, advocate for resources, amplify the community voice, and demand changes in the way we contribute to (or don’t!) to the surveillance of the families we serve. One key win was the complete de-coupling of the use of urine toxicology testing to determine fitness to parent, replacing it with a strengths-based care plan focused on how we can safely keep families together.

Years later I ran into Ashley. This is one of the great privileges of working in the same community for more than two decades. She and her daughter were still together! She introduced me to her daughter as “your midwife” which generated the most giant of eye rolls. I have come to love this predictable and endearing response from the young people I accompanied on their fetal journey! Out of earshot of her daughter, Ashley confided that she lives in constant fear of losing her. We cried. No person should have to live this way. And yet for many people, particularly Black, Latinx and indigenous people, this is a daily reality. And this does not even speak to the issue of policing in communities (which often leads to violence), immigration raids, and other ways that people living in poverty are criminalized.

Abolitionist futures asks us to envision a new type of community care, where we are accountable to and love one another. Dr. Jamila Perritt, a reproductive justice leader and OBGYN physician, was speaking to a small group of healthcare providers, inspiring us to stay true to our values. She said: “Don’t just remember who you are, remember whose you are.”  When I think about whose I am I think about my own lineage and ancestors, and I think about Ashley. And Karla. And Maria. And Luz. As a midwife, you learn that you have not really earned that title until you are claimed by the families you serve, until you belong to them. Until you know “whose you are.” That deep knowledge and belonging keeps me hopeful and working towards freedom, for all of us.