The Farm

Summertown, Tennessee, USA

Editorial Comment by Ina May Gaskin

Interviewer: I've really come to believe in the jury system because if you talk to the jury in North America and you really explain to them what midwifery is all about, what midwifery is all about in other parts of the world, the jury you see identifies with the midwife, not with the doctors. And the midwives have a far, far better chance of winning with a jury. And so, it is also extremely important that it be public. And if it's a trial in public, and the journalists are there, and it gets in the newspapers and so forth, that is extremely important because the doctors do not know how to deal with the media and the public because they have always done everything behind closed doors and they do not know how to cope with scientific evidence presented in a public newspaper. They fall apart. So, the midwives who end up being the victims of this witch hunt have to do everything they can to see to it that they have a jury trial, or if it's some type of medical board or nursing board, or whatever it is, see to it that it gets open to the public because that makes the difference.

Ina May: It's been ten years since you invited me to take part in that consensus group down in Ethelon, and I believe I remember you saying "we'll never get those obstetricians to change willingly." But I'm curious now from what you've seen in ten years. Are you pessimistic, optimistic, don't know which to be? How does it look to you now that we're ten years since that consensus group? I'm just interested in how you think it's going here?

(Unable to hear beginning of answer, tape blurring) The obstetrical profession is changing or leading the way to change. On the other hand, I am optimistic about the maternity care system in the future of midwifery. Ten years ago was sort of a pinnacle of the marginalization of midwifery. I'm not talking about the United States, I'm talking about the rest of the world. The pendulum is swinging the other way. The midwives are getting empowered and they're getting stronger and they're raising hell and the change is happening. They now have an incredible progressive rapport out of the British Parliament that strongly endorses midwives being right in the center of having that role in homebirth. In Scandinavia, the midwives are getting stronger and stronger. The Netherlands provide us with a wonderful barometer. The percent of homebirths in the Netherlands which went down, down, down, down until 1980, when it hit bottom at 32%. They had managed to get homebirth down to 1/3. But since 1982, every single year it goes up, up, up, slowly, slowly, slowly. In a funny way, that's a kind of barometer of the whole maternity care evolution taking place in the industrialized West where the midwives are slowly, slowly, slowly getting stronger, and that's true also in the United States. Of course, what happened in Canada is dramatic, and exciting and wonderful and we can all be extremely proud of our brethren in the North. In the United States every year there are more midwives. Every year, I think I see less in-fighting among the various groups of midwives. I mean it's not gone. Your still spending some of your energy fighting each other and not all of your energy in fighting the oppressor. But it's getting less as far as I can tell. There are now midwife organizations and MANA meeting together. Even on the local level you see more of this. Ina May, I saw you and Jan trying to collaborate in a very warm and friendly way in deciding whose journals are going to get what. To me that was sort of symbolic of the whole change that is taking place in this country. At this conference I saw the nurse midwives and the direct entry midwives and the lay midwives and you name it, the Christians and non-Christians, and all the rest, and they were all in the same room and they were all making a honest effort to work together. Not perfectly, but they are making an honest effort. So I am in general, optimistic about midwifery, the future of midwifery in North America and in the rest of the world. And I am optimistic that the maternity care system will likewise, improve.

Question: We have another struggle in the United States as I am sure you are aware, that we have 41 million uninsured now, it's grown 2 million in the two years of the Clinton presidency. So, I want to ask you about something we hear pretty frequently in the United States. We hear this phase "socialized medicine" and we hear this particularly from our speaker of the House Newt Gingrich who says all the countries of western Europe are socialist countries. I wondered if you would comment on that.

Answer: I have been living for over 20 years in Denmark. Denmark has a capitalist economy. It has a free market economy. It has industry out there that is private. Everything is as private as anything in the United States. And it is a capitalist country which has a well developed system of human services, including health services and social services, educational services and so forth. It is not a socialist country. I mean it is not a socialist economy. It is a capitalist economy. You know, you have to be careful, are you talking about the economy, are you talking about the form of government? Listen. Denmark is a democracy just like the United States. It has national elections, it has political parties. You know, and it has a Parliament. It has the same form of government with minor details. It has one house instead of two. It has more than two political parties but it's the same form of government, it's the same form of economy. The only difference is they have a more highly developed form of human services for the people. In the case of health care, it has a national health service. Now, listen. You really do understand I hope, that the United States is the only country in the entire world that does not guarantee a minimum health care to every single citizen. Let's call a spade a spade. The United States is all alone here. And all of them. Well okay. The United States and South Africa. Big changes in South Africa though. The Americans have to understand that they stand all by themselves in not guaranteeing every single citizen certain inalienable rights, like for example, a basic level of health care. This has nothing to do with socialism or communism. That's a smoke screen. We're talking smoke screens here. It's got to do with a commitment of the public regardless of what form of government we have, because all of those other countries out there, we're talking about over 100 countries out there who are giving this to their people and some of them are dictatorships for heaven sakes, some of them are democracies, some of them are communist countries. It has nothing to do with that. It has to do with a commitment of providing a basic health care and seeing it as an inalienable right for every citizen of our country.

Question: Can you explain to those, when the argument came up? We had a good number of people that said, "we need a single payer health care system, we need a national health care system like the other ones," and the argument came up that we already had that, which is Medicare and Medicaid. Or that's the (BA?) and that doesn't work. We see the price going up. Can you explain that and why that's a false argument?

Answer: In the United States, you put people into categories. Your a little poor, or your a lot poor. And you provide services only for certain categories of people. While in all of the countries of western Europe for starters, and I'm not talking about eastern Europe and those ex-communist countries. I'm talking about democracy with capitalist economies. Their approach is, "we will do this for all of our citizens, regardless of how rich or poor or whatever, we don't put people into those types of categories and have what are called categorical programs. Categorical programs are basically flawed because you are forever falling between categories, and that means you are going to end up with lots of people getting no service. Do you see? In the case of health care, I don't understand what socialized medicine means. In Denmark I choose my own doctor, I have absolute free choice in choosing my doctor. I have absolute free choice to go to any hospital in that entire country that I choose to go to. I have absolute control of which tests I will or will not get and which treatment I will or will not get. All of this freedom and the only difference is that it is paid for. And that is the only difference. And I have to tell you something else. I hear again and again in this country that we have the best health care in the whole world and we need to be very careful that we don't destroy it. That is the most arrogant, narrow minded position I have ever heard. Let me tell you a big secret. Health care in the United States is no better than health care in Germany, in France, in Denmark, in England, and so forth. It is no worse but it is no better. If I get sick, if I get desperately ill, or I need medical, the best high tech medical care I can possibly want, I don't need to come to the United States. I'll get it in downtown Copenhagen. There is by the way an exception to that. Recently I was interviewed for a newspaper in Denmark and I was talking about health care in Denmark. I said what I had just said which is that health care in Denmark is generally very good. And then the last little paragraph in the interview said, however, if I were a woman and I found myself pregnant, I would get on the next plane to Amsterdam, because although maternity care in Denmark, if you want to know the truth, is infinitely superior than maternity care in the United States. I'm sorry, but it is and that is because of midwifery. But the place in the world where you can get the most choice with the most options in maternity care is in the Netherlands. And that is the reality. Although I have lived in Denmark for 20 years, I'm perfectly prepared to say that when it comes to maternity care, Denmark is not number one. Somebody else is. So the Americans have to get over this hang-up that they need to be number one here. Because the system of health care that is provided in these countries that have a single payer, national health service, the quality of medical care in those countries is absolutely as good as it is in the United States. And in certain instances, for example maternity care, it is better. And that is not an anti-American thing to say. That's a pro-American thing to say. Because if you love America, then what you want is to make America even better. So don't put your head in the sand. Learn from others. Americans tend to be incredibly parochial. If you think your number one, your doing a terrible disservice to yourself because then your saying we don't need to learn from anybody else because we know best. Well, everybody knows if a child thinks they know best, they'll never learn anything. Every school teacher knows that. But Americans think, because they think they have to believe they're best, they just think they can't learn from anybody else. Americans have a lot to teach other countries in terms of, for example, health service research. Being able to research and critique health care systems. This is something Americans do incredibly well. The irony is, they don't turn around and use their results on their own system because there is no system of health care in the United States. It's a non-system. Europeans can't do that analysis nearly as well. But the irony is they have a health care system that takes care of everybody. One of the things we hear over and over again is there is a tremendous distrust of government. I think that probably stems to a lot of things. The Vietnam war is a very large factor there. Now given that, we have a tremendous obstacle in the way to government administering health care. Any suggestions about how we might go about getting over that obstacle. First of all, there are other alternatives which can work. I give you Germany. Germany has a system of health insurance programs so that everybody ends up being covered by one of these programs. And the government just has a situation where they will only step in if somebody, for some strange reason, ends up being uncovered. The government will then cover that person. But these are private, capitalist, for profit insurance companies, just like Aetna, Prudential, you name it. These are private, for profit. This is where Americans were never told this. This is private, for profit health insurance companies recruiting citizens to join their health insurance program. Everybody in Germany is in one of these. The government will help you get into it. So, there is a system where you don't have 31 million people or 41 million people uncovered, you have zero people uncovered and you have a capitalist insurance system doing the job. So, that's okay too. That's far less efficient and far more costly solution, but it is a solution that may be feasible in the America and quicker than the other solution.

Question: Is there any move to change that in Germany because it is less efficient?

Answer: Not that I know of but I'm not up to date on every political movement in Germany. But please understand that there is not a single country in the world, outside of the United States, who is giving any serious consideration to doing away universal coverage. Not a one. And there is no country outside of the United States who would consider this for one second. Sweden recently went through a major political shift to the right with a conservative government and with privatization of the some of human services. Never for one second, was there any discussion to do away with universal health coverage for every Swede. They were making adjustments in the systems.

Question: (Cannot hear full question). You never know if the information your getting here is a lie.

Answer: It is being discussed in the UK but no one in the UK seriously thinks that, first of all, they are not discussing doing away with universal coverage. They're discussing privatization similar to Germany. So they are not discussing doing away with universal coverage. They're just discussing whether to have it done by the government or whether to have it done by private insurance companies. They're only talking about privatization which is a totally different notion. Nearly every country has a one payer national health service of some kind or another. There is a not a feeling that Big Brother is not giving me a chance for the kind of health care I want. Obviously, every country makes adjustments in their system, tries to find better ways to do it. I know the country I live in, Denmark, they are making all kinds of adjustments. This lack of confidence in government is uniquely American. It really is. I think I would have to agree with you that it is probably related to things like the Vietnam war, but it's amazing to me to live in a country like Denmark where your policeman is your friend, not your enemy. And if you go to the biggest department store in downtown Copenhagen, what you see around the entrance are a bunch of baby buggies parked with the babies in the buggies and the mother is in the store someplace. And the mothers would never worry about kidnapping because it has never happened. Secondly, they don't have to worry about the baby because as the baby begins to fuss, the first person coming by is going to take care of that baby. And then I come to America and what do I see? I see milk cartons with pictures of missing children. It's scary. There is a belief in "we all take care of each of other" which goes back hundreds of years in these countries. And the government is simply a representative of that general confidence in society. That doesn't exit in America and that is an enormous tragedy. The one for all and all for one doesn't exist in America but truly does exist in these other countries. And so you believe that the government is full of a lot of stupid bureaucrats and you think that in Denmark. And you think that sometimes people are falling between the chairs and all the rest. And it happens. But beyond that there is a belief that at the end of the day, we are all trying to help each other here. This just does not exist in America. I don't know if that is partly because America is such a young country, only 200 years old. I live in an apartment in downtown Copenhagen that is 400 years old. It's like America is a teenager that has suddenly grown up and it has all the power, and it has a big strong body, and it feels real vigorous and real strong, but just does not have the maturity that comes with the centuries. One thousand years ago Denmark went out and licked the whole world. They're called Vikings. They went out and beat up on everybody. Then for the next 600 or 700 years, everybody gradually took them on and cut then down until about 200 years ago and they ended up this tiny little country like they are now. Then they said, "well we went out and licked the world and what did it get us? It got us a kick in the butt. Thank you very much. So we're going to stop trying to lick the world and see if we can take care of our own people." And in the year 1776, which is an interesting year for Americans, they passed a law in Denmark that said if a woman had a baby and was not married. She had a choice on whether or not she wanted to name the father. It didn't matter if she named the father or not because she would get a benefit to help her rear that child. And that benefit wasn't given in the form of food coupons or other evidence of not trusting you. It was given in the form of cash. And if she named the father, the government then went to this man and said "listen, this is apparently your baby over here, and we think it would be nice if you would contribute to the upbringing of that child." And the government and that man had to hassle about whether or not the man was going to pay anything. But that between the government and the man, and the woman and baby never got in the middle of that hassle. You don't have that in the United States. That has been effect since 1776. And you still don't have it in this country. So way back then they started to take care of each other. And that's what this is all about. This is about taking care of each other which is really interesting because if you think about maternity care and you think about health care in general, the bottom line is taking care of each other. You can have all the hospitals, all the machines and all the doctors you want but the most important thing in health and healing is taking care of each other. And where does at least 90% of health care take place? It takes place at home. The mother does for the babies, and the husband does for the wife, and the wife does for the husband, that where the vast majority of health care takes place. And that is true for pregnancy and all the rest. And whether you have your baby at home or in the hospital or wherever, it doesn't matter. It matters, but what I mean is, you can still take care of each other.

Question: A lot of Americans don't think about all this advertising. They just think their health care cost will go up. That is one of the odd things about for profit, capitalist medicine is it costs more because you have the billboards, you have the TV, all of this stuff costs money. That's just a comment. I was curious about how much, because Hillary Clinton is trying to do something about the amount of sex that is in the advertising because we have this huge teenage pregnancy epidemic, along with the sexually transmitted diseases, including HIV. And then to try to get people to buy things, the young people are manipulated by their sexuality. Does that happen in Europe very much? Is sex a big part of the advertising industry?

Answer: The amount of it is uniquely American. There may be a little bit of it in basically, for example, in England and Great Britain, but much, much less on the continent in western Europe. A little bit. The approach human sexuality in the United States is very, very special and very different from anywhere in Europe, except for the United Kingdom. It goes back to the Puritan roots. Generally speaking in continental Europe, there was no real strong Puritan movement. There was absolute Protestantism and Christianity everywhere in Europe, and Catholic Christianity. But we're talking about now about the Puritan roots of the way the human sexuality is viewed in America which is very special. For example, I think the problem of unwanted adolescent pregnancy in the United States is a function of mainly two things. One, a society which offers a certain group of adolescent girls so little that they turn to motherhood as the only source of any kind of any satisfaction in life. That's one driving factor. The other driving factor is that there has been little or no education in human sexuality and education of family planning in the United States. The United States has the highest unwanted teenage pregnancy rate in the entire world. It's double what anybody has. But the Netherlands has the lowest. The rate in the United States is about ten times that of the Netherlands. And Denmark is very close to being the lowest, as with the Netherlands. Now, I think about Denmark because I know the data there. In Denmark which has a very low rate of unwanted teenage pregnancy, they have a very high rate of teenage sex. And we have shown this with research. So it is not that they are saying no. They're doing it but they are doing it responsibly. They have had sex education from kindergarten on. They practice sexuality in a responsible way and they have no need to grab motherhood as a way out of a very bad life situation. So the problem in the United States is, let's face it, sex is everywhere and everybody is doing it. And that's the reality. And saying no is ridiculous in the extreme. Your not going to succeed. What you need in America is to learn responsible sexuality. That is really the key. You can't teach responsible sexuality if your not teaching sexuality. You are going to have to work and it's going to be long and hard but you have to work to come to understand human sexuality as normal, healthy, life enhancing part of life. And that it isn't something that you use to fill horrible gaps in what's wrong with life.

Copyright © 1994 Ina May Gaskin

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