The phrase “intersectionality” has become part of the public discussion regarding many powerful social justice movements from the Women's Movement, Black Lives Matter, #MeToo, LGBTQ Rights, and Climate Change. It is defined as “the complex, cumulative manner in which the effects of different forms of discrimination combine, overlap or intersect.” Essentially, it means that discrimination is not linear, falling under just one category, but rather various types of prejudice are amplified in different ways when combined. It is a critical concept in understanding our world today. This article will show how intersectionality is also prevalent when discussing postpartum, the roughly six to eight-week period after a pregnancy.
Cross-culturally women have helped each other have babies and recover from having babies since ancient times. China’s postpartum, zuo yuezi or “sitting the month”, Japan’s ansei or “peace and quiet with pampering” and India’s Ayurvedic postpartum of 42 Days for 42 Years to Jamaica, the Dominican Republic and Mexico observation of 40 days of la cuarentena or “quarantine”, – postpartum is a sacred and practiced ritual throughout the world. Mothers are given family support up to three months after birth in the Congo as well as in several other African nations. In colonial America it was common for women to have a “lying period” of four weeks following a birth to allow mom to regain her strength and connect with her child while other female attendants ran her house.1 Many of these traditions have stood the test of time and are still practiced and honored today around the world. In Korea, old ajummas have been known to chase down modern moms who take the newborns out for fresh air.
Although specific traditional postpartum rituals vary from culture to culture most have six universal commonalities. The first is organized support. Family members and/or friends of the mother’s inner circle or tribe offer practical, social and emotional support to the postpartum woman. Second is a rest period with restricted activities. Although this period of time varies, it usually falls within a four to eight-week time period. The main objective is to allow the mother’s body to rest and refresh after labor and childbirth. The third includes a diet rich in warming foods and herbs that nourish and replenish mother’s muscles, body and tissues while promoting lactation for breastfeeding. The fourth cultural commonality involves the hygiene of the mother – limiting showers and baths that might chill mother and make her vulnerable to sickness – and instead offering warm herbal oil applications, sponge baths as well as steams and saunas to purify mother’s mind, body and spirit. The fifth similarity includes infant care. Women in mother’s circle come to care for the newborn by holding, cleaning and playing with baby, allowing the mother to rest when she feels the need. Finally, specific postpartum rituals related to cultural tradition such as burial of placenta, belly binding of the abdomen or disposal of lochia are practiced.
The common goal of all six of these postpartum applications are to nourish, replenish and nurture mom and baby back to optimal health. By accomplishing this, mother is less likely to have worry, fear and compulsion in the postpartum period. This also decreases instances of postpartum depression, anxiety and other imbalances. All of these cultures believe that if mother does not care for herself in the postpartum period then her mind, body and spirit will suffer greatly.
In the United States there are no laws requiring mothers to practice specific postpartum rituals or traditions. All families are free to practice whatever cultural postpartum healing traditions they chose. Yet most do not. Many women do not have the luxury of allowing their postpartum bodies to heal. The United States is the only developed country that does not have a national paid maternity or parental leave program, leaving many pregnant women and their families without job protection, health insurance benefits, or wages at a vulnerable time. In the United States it is common for mothers and pregnant women to work outside the home. Most women (73%) return to work within 6 months after giving birth. Only 14% of US civilian workers have access to paid medical leave.3 In order for mothers to benefit from a healthy postpartum period, they must be in a financial position to do so. That is, they must be able to generate enough income to pay for food, diapers, mortgages, car payments, utility bills, etc., while no longer working outside the home during their postpartum recovery. Therefore, economic status greatly influences a mother’s postpartum care.
In November of 2017, the U.S. Census commissioned a report, The Parental Gender Earnings Gap in the United States, to examine the earnings gap between parents before and after the birth of a child.4 They found the corporate environment (in the U.S. at least) pays women less than men, mothers less than fathers, and mothers less than women who don’t bear children. A second study explored another circumstance that compounds the mother’s inability to become financially stable called, “skill deterioration theory.” This argues that women with a break in employment (ie during postpartum and beyond) aren’t as valuable as others who were continuously employed because those absent for a period weren’t actively utilizing their skills which have deteriorated or become obsolete from lack of use. The single income salaried mother is less likely to be financially able to afford the unpaid postpartum period. Gender greatly influences financial income which subsequently determines a woman’s ability to receive care during postpartum. Therefore, the status of motherhood limits financial income and prevents equality in postpartum care in the United States.
According to the Massachusetts Institute of Technology Living Wage Calculator, in order for a single adult to make a living wage in the state of Texas she would have to earn $11.03/hour. Texas minimum wage is $7.25/hour. Single income mothers working minimum wage jobs have almost no chance to receive the benefits of healthy postpartum care. It is equally unlikely a woman working two or more minimum wage jobs will have the ability to leave work during her postpartum period. Therefore, economic disparity prevents equality in postpartum care in the United States. Women of color are more likely to be exposed to racial discrimination and to experience psychological distress during pregnancy and postpartum compared with white women. In the state of Texas, maternal mortality is at its highest in the country. Many low income non-Hispanic black women do not have access to healthcare. Even if they have access, one study found that African American new moms 1) had difficulty understanding and communicating with their providers; and 2) felt instructions did not translate to their community setting. Although nurses provide education to all women who give birth, common potential problems may not be presented in a usable way.
The Children’s Bureau, a division of the Federal Security Agency, published this in 1947: “The death rate for white mothers is 18.9 per every 10K live births while the death rate for African American mothers is 50.6. Although obstetric care has undergone a revolution in this generation, African American women has not benefited.” This historical trend clearly is not getting better and reveals a vulnerable population — and, it is not singularly about poverty.
Recently, a globally known tennis player — a black woman — nearly died from complications surrounding childbirth. Her life hung in precarious balance and by media reports she was hours away from becoming another statistic. When an athlete of such renown — with access to state-of-the-art facilities, impeccable providers and prompt care nearly dies — what scant rays of hope light a path for rural or teen moms who can’t even find transportation to get to a clinic. Or if they do wrangle an appointment, perhaps they find themselves awash in micro-aggressive, condescending treatment from the front desk to the exam room. Therefore, women of color, in this example, African American mothers are less likely to receive quality care during pregnancy, childbirth and postpartum. Many more women of color do not survive the postpartum period than white women, thus, revealing yet another inequality during the postpartum period in the United States.
Although this article has only touched lightly on socio-economic, gender and ethnic issues, so many more relevant factors – such as, sexuality, religion, political influence – come into play when discussing the inequality of accessible postpartum care. It is glaringly undeniable that low income women, women with children and women of color face a near impossible battle to receive postpartum care that nearly every culture around the world considers a vital part of a woman’s childbearing life. Each of these unjust and prejudicial factors alone inhibit a woman’s ability to receive healthy postpartum care in the United States. However, if these factors combine or intersect in a single individual, her chances of receiving quality healthcare decreases exponentially or becomes non-existent.
In the big picture the importance of passing legislation, specifically, a Universal Healthcare plan that includes paid leave for families is just the start to a solution. Equal pay for equal work and a hard look at racial inequality and micro aggressive behavior in clinics and physician’s offices are also major problems to be addressed. Individually, we must build, grow, nurture and value our individual community networks. We must have both in order for women to have the care they require after pregnancy: women supporting each other on the government level through legislation and regulations to help women financially in the postpartum period and the individual friend or family member who organizes support during the postpartum period.
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