27 October 2020
A few weeks go I encountered my first hospital stay as someone with an autoimmune disease. While I was there, the world outside was marching in protest of the recent murders of Black people in our country—Breonna Taylor, George Floyd, Ahmaud Arbury, to name a few. During my stay, I was offered pain medication almost immediately after walking in and being admitted to the emergency room. I didn’t even have to inquire. The doctors, asking me to rate my pain, offered it as an immediate solution to my “about a five” response.
Since I had no previous experience with being prescribed pain medication, it wasn’t until I was sharing a room as an admitted patient that I was able to observe a stark difference between doctors’ reception of their patients. My roommate was a Black elderly woman, admitted for moderate to severe pain in her swollen legs. She was immobile and agitated, continually ringing nurses for relief. It was clear she was in active and persistent pain.
As a pre-medical student, I don’t have the credentials or personal knowledge of her medical history to refute the physician’s reasoning of only prescribing her Tylenol. But, without much effort, it was easy to recognize the contrast in attention, empathy and care between me, a young white woman on one side of a curtain, and her, an elderly Black woman, on the other side.
What this experience emphasized for me is what many Black people have already known and vocalized: the American healthcare system has two sides. While for white people a hospital is a safe and stable place, for Black people it can be cold, neglectful, and sometimes even fatal. It’s not unlike how the criminal justice system fails Black people in this country. As we continue to work to move forward from systemic racism, in addition to our political agendas, we must also look closely at our medical agendas to ensure that we address these harmful experiences and practices.
Examining the history of medicine in this country as patients, practitioners and medical students is a necessary path toward transformative medical justice. To do this, we will need to face, learn and reconcile the denial of care, and the trauma and suffering it leads to, in order to build a more equitable health system.
This article in no way covers the entirety or full depth of the relationship between Black women and American medicine, but it can serve as an initial starting point for those reading to further explore their own knowledge of, and relationships with this complicated history. As a continuation of this discussion, we’ve also included additional resources at the end of this article.
Racism in Obstetrics + Gynecology
One of the specialities most intensely intertwined with medical racism is Obstetrics and Gynecology. A fuller, more essential understanding of modern gynecology can only be achieved by first acknowledging the pain and suffering of Black enslaved women who were stripped of their humanity and dignity at the cost of medical advancement.
Referred to as the father of modern gynecology, James Marion Sims is credited for techniques like the Sims position, used in physical exams, and the invention of the speculum. These advancements, which are now common techniques and procedures, have bolstered his reputation in the medical community, overshadowing the violent and traumatic lived experiences that Black women have suffered from, including by the hands of Sims himself, in the name of scientific progress. As a surgeon during the 1840s, Sims committed heinous acts of medical violence to Black women, operating without anesthesia to perfect his techniques. After four years of operating on slaves, Sims perfected the technique of fistula repair. It wasn’t until then that he began performing this procedure on white women, with anesthesia.
American artist Robert Thom’s 1950s painting of Dr. James Marion Sims operating on three enslaved women, Lucy, Anarcha and Betsey. Photo: Today
His justification for these procedures without anesthesia was supported by a deeply accepted belief at the time: Black people do not feel the same level of pain as white people. This notion that Black people feel less pain was a central pillar in justifying their inhumane treatment. This belief is factually incorrect, and the reverberations of this once widely accepted notion continues to have severe consequences today for Black patients.
One 2016 University of Virginia study found that half of white medical trainees believed the myth that Black people have thicker skin or have less sensitive nerve endings than white people.
Sims eventually went on to become the President of the American Medical Association in the 1870s and became a member of the New York Academy of Medicine. His statue had stood directly across from the Academy of Medicine for decades, until 2018 when it was finally removed from Central Park. When we venerate these physicians, while blindly ignoring their exploitative and destructive paths, it builds toward this dangerous mindset that Black women and other minorities don’t need to be afforded the same dignity and care that others receive, and that their bodies can be used as contributions to modern medicine without their consent.
As patients, students, and professionals we need to acknowledge these medical achievements in tandem with their entangled connections to violence and suffering. Our healthcare system has relied on the exploitation of Black women for advancement (See: Henrietta Lacks) without giving them recognition, support, reparations, or equality. Part of creating more equitable care models today means addressing the foundational mechanisms that have allowed for the American healthcare system to deeply fail Black Americans.
Control Through Reproduction
The political game of capture the flag over a woman’s rights to her body is nothing new to the American public. When we begin to look at reproductive history in the United States with a more intersectional approach, the issues of control, access and freedom become even more acute. As with gynecology, we see that for Black women, healthcare disparities and control has its beginnings in slavery. We also begin to see that these damaging legacies and violent injustices have followed Black women for centuries: the denial of reproductive justice, differential access to quality care, denial of their own suffering, and the criminalization of reproduction.
In 1807 when Congress abolished the import of slaves to the United States, slave owners wielded forced procreation as another mechanism of power over their slaves. This was the start of pushing slaves to have children as a means to reproduce generational slaves for white plantation owners—ultimately, breeding people for labor. Yet it wasn’t just the economic value of labor on plantations that made control over Black women’s bodies advantageous. While academia often construes white women as passive participants during slavery, they too were violent aggressors. WPA reports have even suggested that white women would orchestrate sexual assault of their slaves so that their pregnancies aligned, guaranteeing a wet nurse for their future children.
By the early 1900s, when the eugenics movement flourished during the periods of mass immigration to the United States, a new wave of control over Black women’s bodies emerged. One main intention of the movement was to limit the fertility and child bearing ability of the poor, disabled and women of color. This presented itself on a national scale, with the Supreme Court voting 8-1 to uphold a state’s right to forcibly sterilize women in 1927, a decision that would allow for 32 states to have pro-sterilization laws.
Often sterilization was done without consent on Black women when they would go in for procedures unrelated to their reproductive health.
This practice was so common in the south that the term “Mississippi appendectomy” became the coded word for these sterilizations.
Even when these pro-sterilization laws began to be overturned in the 1960s and 1970s, the emergence of the oral contraceptive created a complicated divide in Black communities. With such a prevalent history regarding agency, sexuality, health, and family planning, this pharmaceutical innovation fanned generational fears and medical mistrust, reminiscent of the traumas of forced sterilization, the Tuskegee experiments, and racial eugenics.
From the marketing of Norplant to Black teenagers in schools in the 1990s, to using monetary incentives to coerce women on welfare to use long-term birth control methods, the United States continues to infringe upon and limit the reproductive and medical rights of Black women for its gain. As Americans, we have yet to grapple with and untangle this system that was built upon the intertwining of racism and medical advancements.
Racism in Pregnancy and Maternal Health
Knowing this gruesome history of obstetrics and gynecology, and reproductive health for Black women in the United States illuminates why Black maternal death is a silent public health emergency.
A Black woman in America has a 243% more likely chance to die from pregnancy or childbirth related causes than a white woman.
Even with adjustments for socioeconomic and education variables. We need to consider how racism, not race as a factor, becomes a determinant for complications or early death and our foremost responsibility is to stop blaming Black women for their own deaths.
The mistreatment and mistrust of Black mothers demonstrates how both sexism and racism are lethal at their intersection. Many Black women experience policing, coercion and are dismissed by healthcare practitioners, making pregnancy and childbirth a dangerous territory for Black mothers. The endured ‘weathering’ of these women—a term used to describe the cumulative results of toxic stress, mistreatment, and prejudices—materializes as physical health consequences, most acutely during pregnancy and childbirth. Specifically in medicine, this means Black people are under-diagnosed, mistrusted, micro-aggressed and dismissed compared to white patients. We must address not only the individual decisions of providers but the broader aspects that affect maternal health even before setting foot into a hospital.
Black maternal death had a moment in the national spotlight when Serena Williams, a world renowned athlete with 23 Grand Slam wins to her name, was not even exempt from a deadly encounter while giving birth. Williams, who has a history of pulmonary embolisms, alerted her doctors that she was having difficulty breathing the day after her C-section. She communicated her immediate need for a blood thinner to the staff. However, she was dismissed and her behavior and symptoms were attributed to the pain medication. Only after intense persistence and an incorrect ultrasound did the doctors confirm clots in her lungs. William’s experience only emphasizes how Black women’s intuition, trust and clearly stated needs are overridden by a tainted healthcare system.
Serena Williams shares a picture of her baby girl in 2018. Photo: CNN
Everyone deserves the right to leave the hospital with their babies and family members. With our medical system denying Black women safe and culturally congruent care, we are in essence abandoning these women. We’re further failing them because we are not putting their needs and experiences at the center of their care, or at the center of reproductive justice conversations occurring on a larger scale. Until large-scale reproductive justice conversations include these things, the transformation of maternal care in the United States remains incomplete.
Reproductive Justice—a term coined by Black women—means the human right to maintain personal bodily autonomy, have children, not have children and parent the children we have in safe and sustainable communities.
Monica Simpson from SisterSong, a reproductive justice group, speaks about the lawsuit challenging Georgia’s abortion law on June 28, 2019. Photo: Oreoluwa Adegboyega, SisterSong
It’s a call to support women who don’t have children, and for those that do, to support them through all stages of pregnancy, delivery and postpartum care, from medical environments, to social settings and workplaces. It also means supporting access to affordable care throughout all of these stages.
Supporting Reproductive Justice for Black women is multidimensional. It requires education and awareness, public support and research, accountability and training, behavior changes and investment. Ultimately, it requires white people like myself to understand the impact and damage we have historically been a part of, including the patriarchal and white-washed medical models that influence our ideas of patients, models of care and diagnostic procedures.
Where We Go From Here
Behind these statistics and historical accounts are the lived experiences and undeniable grief of Black people, women and their families. These stories appear in hashtags, and in our medical dramas, but the recurring issues still remain. The major disparities in race and medicine need to be addressed.
It is not enough to learn about them, but we must use our knowledge to dismantle and create actionable accountability for medical institutions. This article only covers a fraction of the history and individual experiences of Black women in healthcare. While doing research for this article, I came across a lot of great resources that help to further educate and drive support for these issues.
Read and Listen:
Support and Donate:
- The Black Women’s Health Imperative US
- Therapy for Black Girls
- Every Mother Counts
- National Birth Equity Collaborative
- Black Mamas Matter Alliance
- Saving Mothers