“Some things are so easy to spring clean — glass can be restored to sparkle, tiles to a warm smooth glow, cobwebs banished at the dusters touch and wood reveals its perfect grain once more. The world itself gazed clean and rendered spotless. We can start afresh.”

A sincere welcome back to Call the Midwife—I have missed the show. I was so excited to see familiar faces and we have a new midwife (Sister Veronica) who has joined the ranks of Nonnatus House!! Season 12, Episode 1 dealt with issues that, unfortunately, still echo today—racism with criticism of immigration. At the beginning of the show they had a reference to Enoch Powell’s infamous speech criticizing immigration and in a borough of Poplar the Dockers were going to march in support of Enoch. I had never heard of Enoch Powell but as a modern day midwife I felt saddened to see the same threads of anger and fear which are still heard and felt years later! 

Enoch Powell served as a Conservative Member of Parliament and was Minister of Health then Ulster Unionist Party MP. Powell’s speech became known as the “Rivers of Blood” speech. In 1968 Britain was debating the Race Relations Act, which made it illegal to deny a person employment, housing or public services based on race or national origin. In his speech he strongly criticized mass immigration, especially Commonwealth immigration to the United Kingdom. Immigrants had been granted British citizenship and were helping to rebuild the nation since the end of World War II. The Race Relations Act had been meant to protect immigrants.

To put in some historical timeline the United States had signed the International Convention on the Elimination of All Forms of Racial Discrimination (“ICERD” or “Convention”) in 1966 (The United States did not ratify the Convention until 1994). Martin Luther King Jr. was assassinated by a white nationalist on April 4th, 1968. Enoch gave his speech at a Conservative Party event at the Midlands Hotel in Birmingham England on April 20th, 1968. The speech came to define him and to divide the country. The speech was labelled as an "evil speech" by The Times in London and he was dismissed from the Conservative Party leadership. However, polls showed many Britons supported Powell and there were racial slurs, swastikas, graffiti and much unrest.

It can feel overwhelming when we think of our progress, or lack of progress, from the late 1960s. I was reading an article by Human Rights Watch and they wrote that compliance remains elusive regarding the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) with numerous key areas including reparative justice; discrimination in the US criminal legal system; use of force by law enforcement officials; discrimination in the regulation and enforcement of migration control; and stark disparities in the areas of economic opportunity and health care. As well, we see that structural racism and xenophobia persist strongly in American society.

In the last few weeks we have read again of the dismal statistics in the United States regarding maternal and infant health. The United States spends the most on health care and yet has the highest infant and maternal mortality of any other high-income country. The US reported the highest infant mortality rate at 5.4 deaths per 1000 live births (year 2020) while Norway, which has the lowest mortality rate, reported 1.6 deaths per 1000 live births. US maternal mortality (in 2020) was over 3 times the rate in most of the other high-income countries, with almost 24 (23.8) maternal deaths for every 100,000 live births. From 2000 to 2020, the global maternal mortality ratio (MMR) declined by 34 percent—while it increased in the United States. In 2021, there were about 33 maternal deaths per 100,000 live births – a 38% increase from the prior year according to the report released from the National Center for Health Statistics at the Centers for Disease Control and Prevention. Maternal death rates among all racial groups saw statistically significant increases; however, Black women again saw the highest rates at almost 70 deaths per 100,000 births, up from about 55 in 2020. 

There are many drivers for these outcomes and some of the factors at play included the pandemic but also include chronic conditions during pregnancy, access to quality care during and after pregnancy, and structural racism and implicit bias. No one discusses the style of maternal healthcare; however, most women are attended by providers that approach pregnancy and birth in a very highly medicalized framework. Health care systems need to prioritize equity and implement evidence-based practices along with expanding access to midwifery care. There are maternity deserts with many rural women not having adequate access or availability of any obstetrical providers—this is a true issue and problem.

As a modern day midwife—I am proud to be educating nurse-midwives at Frontier Nursing University (FNU) where our mission is to provide accessible nurse-midwifery and nurse practitioner education to prepare competent, entrepreneurial, ethical, and compassionate leaders in primary care to serve all individuals with an emphasis on women and families in diverse, rural, and underserved populations. One of our strategic goals is to create an environment that promotes diversity, equity and inclusion, and promotes the success of all community members. The last two weeks I have been in Versailles, Kentucky, at our campus where we are welcoming our new students that will embark on their educational path. We have much work ahead—but I felt hopeful as I looked out at the diverse and excited faces of our new students as they are eager to answer the call.

“Not every new beginning is a good thing. There are things we cannot clean away. We invest in the water and the light; we can choose to listen and speak; we are more enmeshed in others’ lives than we imagine. We are all somebody’s memory, someone’s joy or their regret. We are the weavers of each other’s cloth -- the keepers of our fellow travelers in time. Change is not a threat — it is a chance and if we embrace it we can begin again.”