How Birth Equity Became Law in Colorado
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This week, we await Supreme Court decisions on abortion access and gun control measures. Depending on the rulings, some people may be allowed to carry concealed guns wherever they would like, and some folks will be forced to carry to term pregnancies they do not want.
I’m not one to give into despair, but I don’t have a lot of hope for reasonable decision-making happening at the national level, especially as it concerns families and children.
So at a time when so much appears to be going wrong, it’s worth looking around for what’s going right. Seeking out examples of what’s working is a way of holding powerful people to account. If it can happen in one place, what can we do to make it happen somewhere else?
And in Colorado, something appears to be going right, at least when it comes to the experience of birthing people.
In April 2022, Colorado passed the Reproductive Health Equity Act, which has no restrictions on the gestational limit for abortion access. (The 19th’s guide to state-by-state level guide is an invaluable resource for checking the status of abortion access across the U.S.)
And just about a year ago, in July 2021, Colorado passed a trio of birth equity bills that allows for all people - including people experiencing incarceration or detention - to have the support of a doula or another companion, in addition to their partner or spouse, while in the process of giving birth.
The birth equity package also prioritizes newborn bonding with their families and requires medical settings to prioritize natural birth over medical interventions during the birthing process. The bills expanded postpartum Medicaid coverage and required more health reporting to collect data that would help address health outcomes.
One of the forces behind their successful adoption was a Denver-based birth justice group called Elephant Circle. The organization takes its name from the way elephants give birth in the wild, surrounded in a circle of support.
Heather Thompson is the co-deputy director of Elephant Circle. Thompson is a molecular and cellular biologist, a clinical researcher, and – like many of the folks who work with Elephant Circle – a doula and a parent.
“Most of us are doulas in some way, shape or form. And so we've been there, at the bedside,” she said.
Thompson, who uses she/they pronouns, started thinking about birth and pregnancy when she was teaching at the college level. Then she moved to Colorado, and got pregnant.
“I walked into a hospital and was like, ‘Uh, this does not match what I know mammals do.’ And I'm a queer person, and I just didn't think it was going to be a good fit for me. So I had both my kids out of the hospital, one in my home and one in a birth center.”
Indra Lusero, Elephant Circle’s founder, often says that Elephant Circle shows up where nobody else does. That principle has led their work for a long time. They were founded in 2009, and started thinking about birth and people experiencing incarceration by 2010. “We’ve always been rooted in the LGBTQ community. We’ve always been led by the BIPOC community,” Thompson said.
“We very much believe that community folks are the experts. That's where it starts, that's where it is in the middle, and that's where it goes in the long run.”
Elephant Circle believes that the communities most affected by potential legislation should be asking the questions, and should be the first ones saying, “This is what we need.”
“We sat down and Indra took about half an hour and wrote up the birth equity bills, more or less in the shape that they ended up being,” Thompson said.
They were able to do that because everything that was in the bills “was at the tip of our tongue from having spent years helping people in the community organize around their own issues.”
When it came to pushing the bills forward, Elephant Circle made sure that testimony was community-led, and that there were Black and brown people testifying, Thompson told me.
“COVID made that easier. People could give remote testimony, and that changed the game entirely for us,” Thompson said. People who weren’t able to take a day off in the middle of the week were able to participate in a new way, they said.
Elephant Circle also practices “trauma-informed” community engagement: Their approach takes into account the fact that telling your story of experiencing racism while pregnant and through childbirth, talking to legislators or policymakers, can have a negative impact on you.
“A Black woman just said to me, ‘I'm so tired of being a Black woman talking about Black women dying all the time,’” Thompson told me. “That's a super-real part of reproductive justice with Black and indigenous and brown folks: It does take a toll.”
“We use doula as a verb in everything we do. We have doula-ed people through testifying,” Thompson continued.
“When a Black woman says, ‘I'm afraid for my daughters to have babies because I might lose one or both of them.’ And a legislator responds with, ‘I think this bill is a solution in search of a problem, because racism doesn't exist,’ you’ve got to create space for people to debrief about that.”
Thompson was in charge of organizing testimony around the birth equity bills, and made sure anyone offering testimony could discuss their experience with her, or had a professional to talk to.
Elephant Circle also supports people who work with them with what they call “wellness stipends”: $100 to $200 to do whatever people want with in order to improve their wellness.
Another strategy: Stay nimble. Elephant Circle keeps trying new approaches and exploring new issues as they become relevant to the communities they serve. “We're really big into open-source information, which is why we have so much of our legislative work on the website. We want it to be available to people so that they can really use it.”
“We have always wanted to be nimble enough to lean in,” Thompson said. “Our next year's legislative priorities are coming directly from a form that we had on the website where anybody could write in what they thought we should do next.”
I asked Thompson whether the work of Elephant Circle could change the system that we currently have for people who are having babies in the U.S.
Changing the system isn’t always the focus of Elephant Circle’s work, she told me. “Right now we're looking to provide access to the things that we hear our communities are wanting, and provide integration and sustainability for community providers, whether they’re midwives, or birth workers, or doulas.”
“In the systems where that's not an option, we continue to talk about human rights,” she said.
Thompson said that the impacts of the birth equity bills are already being felt.
The Department of Corrections has “actually taken the implementation of these bills incredibly seriously,” Thompson said. “They have a mom-baby unit now, where they would love to try to have overnights with babies. The newborn bonding – they've really latched on to it as maybe a transformative idea.”
Thompson said Elephant Circle would like to see no pregnant or parenting people incarcerated. They anticipate that, as part of future legislative efforts, they will focus on legislation to have a deferral program for people who are pregnant, so they don't experience incarceration.
In short, Elephant Circle’s strategy is to intervene in the systems that their communities are closest to.
“Black and Indigenous people know that they are taking their life in their hands when they walk into a hospital to give birth,” Thompson said. “They know that it could potentially be a legal situation; that intersection is really clear to them every time. “
“That makes what we've been doing feel even more relevant, because they themselves are choosing to give birth closer to their community.
To not just take a doula in and hope it goes better. But to make a different choice.”