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Does the State know best?

By Bill Britt
Alabama Political Reporter

In a complex world where the government continues to play an increasingly larger role in the lives of its citizens, it is often necessary to step back and ask: when is it appropriate for the government to limit individual liberty?

The latest fight over decriminalizing midwifery is an example of how governments rules and regulations have permeated every aspect of our lives. Home birth was commonplace in Alabama until the passage of  which made 2006 Alabama Code Section 34-19-3 makes midwifery a crime. The code reads, “It shall be unlawful for any person other than a licensed professional nurse who has received a license from the State Board of Nursing and the Board of Medical Examiners to practice nurse-midwifery in this State. Any person violating this subsection shall be guilty of a misdemeanor.”

Opinions differ on whether a mother and child are safer under the care of a medical professional. However, in a State where the infant mortality rate lags behind some third world countries, it’s easy to question the efficacy of medically provided post and prenatal care.

Beyond the fact that Medicaid covers nearly half of the births in Alabama, government intervention into the most private of family matters is a good starting point to reexamine the nanny-state.

The term “nanny-state” refers to an overprotective government which interferes excessively in its citizen’s personal choices. This form of government overreach falls under the notion that “government knows best,” and that the State must protect its people from themselves. Each lawmaker who supports the continued criminalization of midwifery stubbornly refuses to answer this fundamental question: “Do you think the government has a right to tell a woman how and where she may give birth to her child?” Each answered with a series of reasons why the State should limit a woman’s birthing choices. Not one would outright say the State should have the right to tell a woman how and where her child should be born.

This issue should not be confused with Pro-Life or Pro-Choice, as these women are clearly committed to having their children, just not like the State demands. Of course, it is not the State that wants to regulate how and where a woman gives birth but the Medical Association of the State of Alabama (MASA) and its related organizations.

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Politics is about who gets what and MASA, along with others, not only want the steady flow of cash that comes with such regulations it also wants to maintain its grip on all things it deems medical.

A study in the Stanford Encyclopedia of Philosophy, on “Pregnancy, Birth, and Medicine,” looks at the ethics of reproduction and specifically the medicalization of childbirth. Part of the discussion involves two camps: the medical community and natural birth advocates.

“{B]irth has been heavily medicalized in contemporary North America, while at the same time a vocal ‘natural birth’ movement has pushed against medicalization. The disagreement between these two camps often circulates around whether birth is best thought of as a dangerous and abnormal process best managed by medical experts in an institutional setting, or as a ‘natural’ or ‘normal’ bodily function that requires formal medical intervention only in unusual cases.”

To summarize the debate playing out at the State House where HB316, a pro-midwifery legislation, faces a challenge from HB344 which would continue to restrict those who favor home childbirth.

HB316 sponsored by Representative Ken Johnson (R-Moulton) would allow for home births attended by midwives while HB344 written by the Medical Association and carried by Health Committee Chair April Weaver (R-Alabaster) would continue to restrict where and how a woman gives birth. Both Weaver and Johnson offer reasoned arguments in defense of their bill, but Weaver failed to answer if she believes the State has the right to tell a mother where and how she should give birth.

Here again, the issue of State vs. individual choice lands hard against the lobbying efforts of the monolithic Medical Association.

Speaker Mac McCutcheon recently informed those gathered for the Family Advocacy Day that he supports Johnson’s bill to legalize midwifery. McCutcheon is increasingly showing all the signs of a compassionate conservative who believes in individual liberty and personal responsibility.

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It has been over a generation since a US President embraced the idea of personal liberty as a driving force in matters of policy.

President Ronald Reagan in his farewell address to the Nation reflected on his mission to undo government rules and regulations that were, “taking more of our money, more of our options, and more of our freedom.”

Over the last 30 years, conservatives have sought to limit rules and regulations on businesses and taxes, while utterly failing to protect most individual liberties.

Here in the South, the kind of paternalism once used as justification for slavery has barely moved beyond the Bourbon’s who shaped the State’s 1901 Constitution.

Reagan’s final thoughts on the American prospects of liberty came on January 11, 1989, a frigid day in Washington DC, where the core of his message is frozen in time. “I think we have stopped a lot of what needed stopping. And I hope we have once again reminded people that man is not free unless government is limited. There’s a clear cause and effect here that is as neat and predictable as a law of physics: As government expands, liberty contracts.”

The Midwifery Bill will serve as a test of what kind of conservatives now have charge of State government. Will it continue to be a paternalistic nanny-state or one that values the ideals of liberty?


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Bill Britt is editor-in-chief at the Alabama Political Reporter and host of The Voice of Alabama Politics. You can email him at [email protected] or follow him on Twitter.

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