You might wonder why a midwifery educationalist has chosen to blog about a subject that at face value appears to contradict the very purpose of midwifery – to help bring life into the world. My blog is about the control (or lack of it) American women have on their reproductive system. A university is the very place where we should be arguing and exploring philosophical viewpoints or as Newman (1852) eloquently describes it as a place in which ‘the intellect may safely range and speculate, sure to find its equal in some antagonistic activity, and its judge in the tribunal of truth’ .

In January, a seemingly innocuous picture went viral – it depicted a group of men witnessing President Trump sign a ban on funding for international groups on abortion (without one woman being present). Although this action does not directly affect women in USA, it could be argued that it represents a subtle misogyny which is starting to pervade the country.

In Oklahoma, women (or ‘hosts’ as described by the Committee) wishing to have a termination, will have to name the father and have his written consent if a bill is approved later this year.   More recently, the Texas Senate passed a law which ostensibly is designed to protect doctors from litigation if they fail to tell women about a fetal deformity – critics have argued that it gives pro-life doctors an opportunity to avoid providing the information if they feel that the woman might terminate the pregnancy.

So, why is this a problem? First and foremost, procreation affects women a lot more than men – their role (from a biological perspective) is completed within minutes, whereas the impact is a lot longer for women. In the USA, women are entitled to 12 weeks unpaid maternity leave (however, there are a number of limitations which means that a lot cannot even take advantage of this). American women are already poorer than their male counterparts: the gender pay gap currently stands at 20% (it is worse for certain ethnic groups and in some states), this means that women are further economically disadvantaged. One in ten Americans lack adequate health insurance, although this is a reduction since Obama’s Affordable Care Act (which is likely to be repealed under Trump) and there are very few options for pregnant women without health care insurance. Interestingly, it depends on the State whether the father is required to contribute to maternity fees. Unlike the rest of the world, the maternal mortality rate is rising (28 per 100,000 maternities) and this will be worse if women try to procure illicit abortions. The risks to women are not just death, pregnancy takes its toll on the body and a woman who is forced to ‘host’ a pregnancy that she does not want, could also have to contend with significant morbidity without access to health services. And as for the child? What are the implications for an unwanted baby born into a family in poverty?

This very brief foray into global health does affect midwives: the name means ‘with woman’ and part of this is understanding the impact of male dominated policies on female health. It is not a blog about pro-life or pro-choice but one about the ethics of self-determination. As an academic, I have a duty to challenge, to speculate and to antagonise and it is essential that all health students recognise political determinants of health to ensure that the UK does not fail women in the same way.

Traci Hudson, Senior Lecturer and Lead Midwife for Education Traci.Hudson@staffs.ac.uk