Thursday, August 14, 2008

Born in the USA? Prove It.

Born in the USA? Prove It.

Summer tourists complaining of passport troubles can gain some perspective by reading a recent article in the Wall Street Journal on the legal challenges currently facing thousands of Texans. Because they were issued by midwives, these people's birth certificates have recently been rejected as proof of U.S. citizenship.

In the 1990s, a number of Texan midwives were convicted of selling up to 15,000 fraudulent birth certificates dating back as far as the 1960s. The State Department now doubts the validity of any birth certificate issued by a midwife in Texas, and lack of a recognized birth certificate makes it practically impossible to provide the proof of citizenship that is required of passport applicants. The more stringent legal requirements also make life harder for midwives still in practice and could harm the women and children that they treat. The Journal mentions the potential for racial discrimination in this case (low-income Hispanics make up the primary client base for midwives along the border) but fails to mention the health risk posed by threatening the continuation of border midwifery.

The presence of an experienced attendant at childbirth is the single most effective way to reduce maternal death, but unaffordable medical bills, lack of health insurance, and fears of deportation can deter soon-to-be moms from seeking professional care. Among rural and immigrant communities, midwives (some of whom have assisted thousands of births) have kept maternal, neonatal, and infant mortality down by providing an accessible care alternative. For many undocumented pregnant women, the choice in delivery method is not between midwifery and hospital aid but between midwifery and unattended birth.

A loss of midwives' perceived legitimacy could jeopardize the practice by providing more ammunition to midwifery's detractors. Despite debates about the safety of at-home vs. hospital births, few would argue that unattended births are safer than midwife-assisted deliveries, one of the reasons why such deliveries are still prevalent in southern Texas (in 2004, midwives delivered 6.6 percent of all Texas children). Fueling the "turf war" over prenatal care furthers efforts to criminalize midwifery and could pose a bigger threat than frustrations at the border if it places midwives' livelihood, and the lives of their future clients, at risk.