(Editor’s note: This piece was edited October 24, 2013 to clarify that “abortion doulas” do not perform medical abortion procedures.)
I write a lot about specifically female public policy – IVF, pay discrimination, etc. I do this not because I think specifically male policies – like, let’s say, Viagra subsidies or abysmal suicide rates following custody battles – aren’t worthy of notice. They are, and other people are writing about them with great vigor. I focus on the female policy side because I think it’s important for libertarians and conservatives to be having these conversations, as opposed to only liberals. Policy illnesses that receive a blanket treatment (i.e. regulation, taxation and government intervention) are not receiving the full benefit of our democratic system.
A microcosm of this conflict might be policies towards doulas versus midwives. Both professions are viable alternatives to obstetricians and hospital births for families, but they are subject to very different treatment by the government.
Doulas are not medically certified – in the United States, a doula is certified by Childbirth International or D.O.N.A. (Doulas of North America). The certification process to become a birth doula (as opposed to a post-partum doula) is holistic and undemanding compared to other birth-professions, though still surprisingly expensive. She is an emotional and physical assistant to a pregnant woman and can provide pre-partum or post-partum support entirely separate from the actual birth. The average cost of a doula is $250 to $2000 per visit, dependent on area and cost-of-living. While many, including Nicole Kidman and other celebrities, have quoted doula-use as extremely helpful to them during their pregnancies, there are also an increasing number of complaints coming from mothers and doctors alike, in what some refer to as political and professional “turf wars.”
Midwives, on the other hand, are health care professionals subject to varied state licensures and medical training. Certification is available from the North American Registry of Midwives and the American College of Nurse Midwives, and the categories of certification include a certified nurse midwife (CNM), certified professional midwife (CPM), direct-entry midwife (DEM), registered midwife (RM) and licensed midwife (LM), depending on the state’s licensing options. According to a 1999 Stanford study, midwives can offer care at a lower cost than an obstetrician and with lower mortality and morbidity as the result of fewer medical interventions on low-risk pregnancies (60-80 percent of births). They are also popular on Catholic mommy blogs for the general perception that they are pro-life.
Why does this matter? First off, because a known component of doula culture in the United States is their specialized training to support women choosing abortions, such as through the national, NYC-based The Doula Project, whereas midwives have to fight for the prerogative to perform abortions as health care professionals if they want it – and many don’t. Secondly, and significantly, there is an increasing number of city and federal programs that subsidize specifically doula care for low-income women.
Because conservatives and libertarians don’t want to talk about female policy, they haven’t even noticed that they are losing this women-centric battle.
Should doulas be more regulated? Not necessarily. And conservatives may object to the difference in treatment because of the pro-life component, while libertarians may object due to the disparity in regulations and subsidies. But by comparing the policies towards midwives with policies toward doulas, we can see how politics informs the policy-making process when you’re not looking.
It’s very important that conservative and libertarian voices contribute to these issues – everyone in the room is smarter where there is discord.