"Midwives: Making a difference through supporting women's and girls’ rights.”

Statement by Kate Gilmore, Deputy High Commissioner for Human Rights

31st International Confederation of Midwives Triennial Congress

The significance of midwives as generators of female empowerment in health and human rights contexts

21 June 2017

Thank you

Excellencies, trouble makers, subversives, scientists, inspirators, energizers, vision holders – thank you.

Thank you – you dignifyers of women and you guardians of us at our smallest and most fragile;

Thank you, you who are spirit guides – guides of our spirit – as life emerges, in all its shapes, sizes, colors and contours, bringing with it intense joy but perhaps too, unimaginable sorrow - bountiful beginnings and soul crushing completions.

Thank you – those who uphold these highest standards for the most intimate of compassions; the providers of solidarity even when life-saving commodities stock out; when essential services fail or are simply absent; when health systems crumble and betray.

Thank you – those of you who from Syria to Vanuatu, from Yemen to Colombia, from Eritrea to the Ukraine, who - understanding that birth waits for no man - are crises’ first responders when conflict or contagion, climate instability or catastrophe, bring their caustic shocks to communities, large and small.

Thank you for your death-defying acts: when bombs fall on hospital grounds; as bullets spray the clinic’s walls; when surgical theatres collapse under deliberate and targeted attack; when labour wards are swept away by flood or terror; when you are pushed onto a front-line that places your own health at risk too. Thank you to those who gave up their own lives in pursuit of life’s protection.

Thank you for your resilience, even though your stories are rarely fully told; when your courage is never fully seen as just this bold.

“Thank you for the times that your tears joined hers, after she told you that she had been raped; for the times you have known her sorrow, as in her arms, you placed not a healthy mewing newborn but a languid and silent corpse; thank you for comprehending why she asked you if her miscarriage was her god’s way of punishing her for sins, imagined or real.

Thank you for the times you heard the desperation that broke her voice when she told you that she simply could not care for this child that she was carrying; thank you for seeing through the feeling of shame that she could not conceal when she asked you if, wanting to have sex made her a whore like her mother said; thank you for taking in all those fears that colonized her face after you told her that her test results, her mammogram, her pap smear, her ultrasound, her surgery, did not go as expected.¹”

In these processes, you accompany us – across a life cycle of life choices from life exploring to life making, life carrying and life delivering – the processes by which we are brought into human being-ness. Enabling effective family planning, preventing malaria in pregnancy, guarding against mother to child transmission of HIV; essential if we are to eradicate obstetric fistula; you are the primary means by which culturally sensitive care can be offered; deaths from unsafe abortions prevented; by which gender based violence can be responded to and the child who is bearing a child can be supported and perhaps even protected at last.

For this, we thank you and all who went before you - for contributions stretching back over centuries – contributions of solidarity, compassion and affinity – contributions unbroken in time – unbent in intent – older than the world’s oldest profession … I mean, no one knows what came first - the chicken or the egg – but let’s just be clear that there always was a hen.

Thank you for being “la sage femme” – for being wise women and for being wise about women - for being “mid wyf” – or in other words, with women.

We all are here only because you were there.

In your unique and persistent roles in conception, pregnancy, labour, birth and early infancy, early motherhood and onward, you accompany - not only heal; you bear witness, are not merely observer; you stand for dignity – not merely with science.

By this accompaniment, you are numbered too among the earliest of humanists and among the first, albeit, more often unseen, defenders of our most fundamental rights as human beings.

Working for accompaniment and against abandonment at the times of our greatest vulnerability, for information and against misunderstanding, for reassurance and against fear - deploying knowledge, skill and craft to guide and enable the exercise of a woman’s rights to be supported, not impeded, in what should be the free and unfettered exercise of her rights to sexual and reproductive dignity – whomsoever she be, wheresoever she may be.

The exorbitant price of abandonment – being the antithesis of accompaniment – has been paid throughout human history. The worst horrors of WWII were a product of feckless abandonment that is the very antithesis of mid-wifery …. As Martin Niemöller famously described “First they came for the Socialists, and I did not speak out... Then they came for the Trade Unionists, and I did not speak out. Then they came for the Jews, and I did not speak out. Then they came for me—and there was no one left to speak for me.”

Friends, it is striking that over the centuries, in every culture and tradition, that in all era – there you will find, by contrast with the worst of WWII, the accompaniers - mid-wfy – those skilled at “being with women” – midwives on the front lines of defense of women’s human rights including of the most intimate of rights to dignity in reproductive and sexual health and wellbeing.

And on the front lines of defense too, stand the accompaniers for the rights of the new born. The right too to be born equal in dignity and rights. After all, is there a baby who at birth is less than simply human? Made the lesser by the pigment of her skin? Whose first cries are any less miraculous just because some of his/her cells have XX chromosomes while others have XY; or because he has an extra copy of chromosome 21?

Are we born carrying within ourselves at birth, any justification for contempt of another or for receipt of the other’s hatred in turn. Really? Are we born with an instinct that if white, I am superior?; if masculine, I am tougher?; if my limbs are intact and my spine sturdy, then I am more worthy?

Yes, most certainly we are born into toxic milieu – into communities and societies in which the bigotries of racism, sexism, homophobia, xenophobia are manufactured but born with these callous toxic ideas pret a manger? Absolutely not. In the words of the incomparable Nelson Mandela “No one is born hating another because of the color of his skin, or her background, or their religion. People learn to hate, and if they can learn to hate, they can be taught to love….”

And so we must ask – because of what you witness as human life emerges, if hate is not present nor justified at our very commencement, whenever is it in our life course - by which dystopian schedule - should hate’s intrusion become somehow acceptable?

Don’t be fooled. Midwifery too has fallen casualty to the snares and snarls of bigotry. The ebbs and flows of midwifery’s history are inextricably linked with these toxicities. Midwifery – accompaniment – after all is a deeply political practice because it is concerned with the dynamics of power and resistant to the systems of thought by which some of us come to be abandoned. The Latin word for mid-wife is actually “obstetrix”– from “obstare” or to stand before. But by the 19th century, “obstetrix” had been co-opted – coopted by medical schools, that women were not allowed to attend, which, with the rise of the man-midwife, rebranded curricula for his comfort from “midwifery” to “obstetrics” – and thus appropriating women’s status, power, traditions.

Yet still, even as slaves and during the violent transition into freedom – the “grand midwives” of the United States’ deep South, accompanied both white and African descendant women, acting too as resisters of repression and fighters for freedom - even when physicians sought to reduce the role and number of midwives by publishing in health bulletins of the time stories falsely discrediting midwifery care.

Under South Africa’s infamous internal passport system designed to help segregate the country’s population, midwives were victimized as they sought to accompany, enduring abuse, violence and imprisonment. But they emerged also as leaders in the fight against apartheid and played major roles in political resistance to its evil.

In the middle ages, the same fear of the power of accompaniment, meant midwives were tortured by burning and hanging as heretics or witches.

Agnodice of ancient (pre-modern history) Athens grew up appalled by the rates of preventable infant and maternal mortality but as a woman was prohibited, on pain of death, from studying medicine. What was a girl to do?

Cutting her hair and donning male attire, our trans-gendered hero attended classes, gaining such a reputation for her/his subsequent skill that jealous (male) peers had her/him dragged before a court under accusation that seduction was the basis for her thriving practice. She/he refuted her/his accusers claims by simply stripping off in front of the court to reveal that indeed she was biologically a woman.

Friends, she had not entirely thought that through! Because, although exonerated it seems of seduction, she was nonetheless immediately sentenced to death for her masquerade. Things were not looking good. That is, until her patients realized what had happened. A massive group of Athenian women (including a few very highborn wives of the men who wanted Agnodice dead) stormed the assembly, demanding her release. Faced with the wrath of their wives, the men relented and—amazingly—changed the law. Thanks to Agnodice, freeborn women in ancient Greece could legally study and practice medicine, as long as they treated only female patients².

I tell these stories of courage and conviction so that we understand that yours is a brave and insistent tradition the courage of which legacy of we need just as much today and tomorrow as we benefited from it yesterday.

For in today’s world, the need is great for the humanity that you represent - for accompaniment where others would abandon - and for its struggle and inevitable activism, for its defiance and subversion, so that indeed we too do not turn our backs nor walk away.

Look, for example, to the seemingly intractable conflicts that today are destroying lives, families, homes. Wrecking communities’ infrastructures of justice, health, education, culture, memory and future. Millions upon millions of people forcibly displaced – torn from their homes, their livelihoods, their communities by violence and fear. Hundreds of thousands scrambling across and out of their countries of origin - over desert and ocean – at great personal risk - in flight from further violence, worse persecution, deeper poverty. Today, more people are on the move within and across borders than ever before. We must accompany them.

Traditional livelihoods eroded and depleted, for the first time in history – more people are living in the city than in rural communities – millions of women and children as slum dwellers eek out their lives absent basic dignities. We must accompany them.

And with data, speech and information traveling at lightning speed around the globe, there are alive today on this more interconnected planet - the largest generation of adolescents in all of human history – concentrated however in places of greatest poverty, least opportunity with fewest prospects for prosperity. Accompany them.

Yes, over the course of the past decade and more, we have turned the HIV/AIDS crisis around; we halved maternal and infant mortality. But at the same time? We deepened too inequality, as never before. Accompany those who bear inequality’s harshest burdens - Aboriginal and Dalit women, sole parent households, transgender people, people with albinism, people with disabilities.

And in the face of criminal terror, we have witnessed a rising and toxic tide of hate for the “other” – xenophobia’s sour soup stirred up by reckless would-be political profiteers - peddlers of fear, pimps of prejudice, the pushers of the narcotics of bigotry. And their casualties? -- the rejected, the reviled, the excluded and the marginalised – accompany them.

For, in this world of ours, let there be no doubt that walls, borders and fences do not erode our obligations to each other. Walls within this human family, on a small, distressed planet in a globalized world, home to the largest population of the youngest people in all of human history? Walls are untruths.

At this time, in this interconnected world, on this climate-stressed planet, no country or people can rightfully abandon others, isolate themselves, stand apart, or bury their heads in the sand of myopic self-interest or absent itself from the global table of rights-filled solutions.

There is no wall so high nor border so patrolled; no special identity nor privilege made so rarefied; no surveillance system so comprehensive nor unmanned drone so swift; no enmity so heartfelt nor friendship so rare that, on this domicile planet, there can be placed between you and me such a distance that your rights do not count with me; that my rights do not matter to you; that their rights do not register with us.

No such distance exists upon this village planet, except, that is, in the fabrications of fantasist, sinister, popularist ideologies whose destructive force feeds off a mendacious manufacture of desperation, despair and disillusion. A fabrication of a fictional criminalization of the “other”, woven out of massive demographic changes and the muck of deepening inequalities.

So, accompany those who would be locked out, left out, kept out – the migrant, the refugee. Accompany those whom false walls seek to deny or deprive or exclude.

In our mid-wifery of this troubled and turbulent world, let us not forget after all that each and every country joined the United Nations by signing on to universal human rights values freely, and without coercion. Basic justice-loving principles – enshrined in UN Charter, elaborated in the Universal Declaration of Human Rights and detailed through a range of international covenants, conventions, treaties and declarations.

Human rights are not primarily about law, judges and courtrooms – human rights are our shared definitions of the person and the nature of being human.

The science of human anatomy is a codification – a typology – bringing order and system to the physicality of the human being. Grey’s anatomy is its core compendium.

Human rights likewise – is but a textual codification who focus is not our skeletal structure or musculature but our human-ess. Its core compendium - the UDHR – sets outs the characteristics/elements of this human-ness, that if absent or when eroded or defied also enables us to recognize and understand that we are “de-humanised”.

This “textual” account – defining the essential grounds/preconditions for human dignity – are hard won understandings, forged in the worst of times and reflecting common patterns across diverse traditions, culture and philosophies. Human rights - principles that do not prevent our diversity – they protect it. Principles that do not limit our diverse expression – they ensure it. Principles that do not restrict our access to culture or belief or opinion – they guarantee them and set out, what’s more, the terms and conditions under which we may exercise these rights without cost to the exercise of any other person’s rights.

And, the opposite of human rights upheld? Selfishness, bullying, bigotry, injustice, tyranny and oppression – toxic stepping stones – a perverse paving of pathways to privation, suffering, conflict and, ultimately, atrocity. Contempt for the “other”; hatred of the foreigner; distrust of those who look or love or worship differently … aided and abetted by clampdowns on freedom of the press; stepped-up surveillance in cyber space; encroachment on public movement; closure of national borders to people fleeing persecution; gagging of activists and the deprivation even of life saving services such as those essential for sexual and reproductive health: The pounding of these malicious fists may grow louder and louder on the doors of our dignity, of our privacy, of our freedom but still they must be resisted.

After all, humanity has travelled down this path before and we know only too well where it leads … to a dead end – to death-ridden ends. Small, mundane acts of every day contempt, flourishing into common garden-variety intimidation, inflating into brutalizing discrimination against the “other”, fueling popular persecution under whose caustic clouds we then so casually descend into conflict's callous catastrophe.

Perhaps today, these matters appear primarily to be the product of party politics. And for sure, certain parties’ politicians pedal pernicious policies in a pugnacious pursuit of power. But, in reality, it is not about one political party versus another.

Perhaps, it appears as if it is about a particular leader’s qualities or approach as compared to another’s. And for sure, there are leaders - across all walks of life I might add - lavishing themselves with illegitimate license for a lecherous looting of power's spoils. But really, it is not about one leader versus another.

Some do think it is all about economic systems - the capricious, callous, cash-coveting, cruelty of unaccountable capitalism or of …. wait a minute … of communist systems too. But it is not just a question of one economic system versus another.

More fundamentally and more far reaching than one election, one government, one president, one prime minister, one referendum, there is today underway, and arguable as far as the eye can see, a deep struggle underway to protect and uphold that hard won reciprocated recognition – and its committed accompaniment - that we all are born equal in dignity and rights. In this struggle, there is no north or south, no right or left, neither east nor west. There is only the humane and the inhumane. Our rights to not be subjected to hate, or violence or discrimination. Our rights to not be coerced, deprived of liberty, or to be denied voice. Rights from the court room to the board room to examination room to the school room to the bedroom. Accompany this struggle.

Earlier this year US President Donald Trump’s reinstated the Global Gag Rule which bans providers in receipt of US funds from giving information and referrals for abortion or providing abortion care, even with their own non-U.S. funds. Unless substitute resources are found elsewhere, the Global Gag Rule will force closure of women’s health services the world over contributing to more unintended pregnancies, more unsafe abortions, more illness and more deaths.

To affirm the rights of girls and women to decide freely and for themselves about their sexual and reproductive lives, including whether, when, with whom and how many children they have, the Dutch Minister of Foreign Trade and International Development, Lilianne Ploumen, mid-wived into being a global movement for SheDecides so that women whose rights are imperiled by Global Gag Rule are accompanied at this time. Hash tag She decides.

Friends, you don’t have to be like me to respect my rights. I don’t have to be like you to uphold your rights. We do not have to agree with each other to defend each other’s rights. Rights are not a beauty parade or a reward system. They are not some kind of nepotistic prize for good behavior as defined by arbitrary standards.

Rights are not some kindly dispensation by the powerful to the powerless. Rights are that which cannot be taken from us. Rights are for the best and the worst of us; for each and every one of us; to the exclusion of none of us, in the interests of all of us. And against attack they must be defended.

Stand up for rights! Use our rights to defend their rights.

• Be midwives who provide dignified access to care, regardless of a patient’s identity or social status;
• Be scientists who pursue knowledge without fear or favour, but deploy its fruits for the betterment of a planet under strain; a climate undergoing hurtling change and a people undergoing inconceivable suffering;
• Be authors who love the truth; who prize evidence, protect fact and diversify voice.
• Be innovators and creators – so that more rapidly and comprehensively we replace unfairness and exclusion with something more equal, inclusive and more sustainable.
• Be dissidents who speak truth to power, and not for our own elevation but rather for the elevation of that in which we believe, that which we know to be true.

We can be – we must be:

• Artists who disturb, provoke, illuminate and enchant.
• Philosophers who seek to understand and thus erode our ancient practices of cruelty against each other;
• Workers for rights, rather than consumers of entitlements.

(hash tag) Stand-up for some’s rights today!

Rights activist and artist Billy Holliday stood up for rights when, with a poet’s voice, she sang out against the lynching of black Americans in the US’ southern states:

“Southern trees bear strange fruit / Blood on the leaves and blood at the root / Black bodies swinging in the southern breeze / Strange fruit hanging from the poplar trees”.

Today, in this world that so casually betrays hard won principles, that flourishes so readily xenophobia, seeds so easily the toxic harvest of hatred and bigotry, there is strange fruit again budding on populist trees: – assassinations of human rights defenders; imprisonment of journalists; arbitrary detention of political dissidents; removal of activists’ passports; rejection at our borders of the refugee in flight; indiscriminate rounding up of people wrongly denied access to citizen rights; bullying of children for their gender identity; sexual violence against women just because he can; the rape of little girls covered up through marriage; defunding of essential services; deprivation of choices over our own bodies!

Should such daily, banal manufactured cruelties pass us by unremarked? Are basic qualities of equalities to be eroded without resistance? Are we to abandon their victims rather than accompany?

NO! Stand up we must and stand up we will. Every day, in any way we can, where ever we are – we must stand up. Stand up so that we do not abandon; stand out for those we must accompany; stand for that which is most precious – the fact, the reality, that you and I are born equal in dignity and rights.

Notes:

1. This section is based on reflections of Camila S. Espinoza, Certified Chilean Midwife as published at https://www.quora.com/What-is-the-surprising-part-of-your-job-as-a-midwife

2. https://en.wikipedia.org/wiki/Agnodice