While modern medicine has done so much to advance our world, it has seemingly done little to spare black girls and women from the abuse and neglect suffered at the hands of medical professionals. It is a popular belief that those who practice medicine, like those who are in the legal field, are objective and operate based on reason, fact and analysis. Therefore, it’s tempting to believe that medicine doesn’t involve irrational and subjective things like racism or white supremacy. But history tells a very different story—filled with cruel, unwanted and non-consensual medical experimentation on black people largely founded in racist beliefs, and proof of all of the social and economic realities that have prevented black people from receiving access to quality health care.
But we needn’t look at history to find evidence of brutality against black people, specifically black women, in medicine. Today, in America, we have one of the worst maternal mortality rates in the developed world and this is because black women are 300 percent more likely to die from pregnancy and childbirth-related causes than white women. For years, researchers thought this was because of genetics or lifestyle choices. That line of thinking, in itself, says so much about the insidious ways that racism infects the medical field. The assumption that black mothers are dying because they aren’t living right and abusing their bodies or are somehow genetically deficient tells us that racist stereotypes are often used to explain phenomena without bothering to understanding context. Turns out, there is nothing wrong with black mothers except their lived experiences with racism that make their bodies vulnerable to stress and illness (called weathering) in ways that aren’t experienced by their white counterparts. This is a pattern that is experienced by black mothers across socio-economic status.
But there’s more. It’s not just the daily racism outside of hospitals and doctor’s offices that is killing black mothers. It’s also the interactions they have with medical professionals who provide them with poor care or overlook dangerous lifethreatening conditions. This threatens their lives and also the lives of their children. Black mothers and babies face a crisis in America and nearly all of it is man-made and preventable. As Linda Villarosa writes for The New York Times Magazine:
In 1960, the United States was ranked 12th among developed countries in infant mortality. Since then, with its rate largely driven by the deaths of black babies, the United States has fallen behind and now ranks 32nd out of the 35 wealthiest nations. Low birth weight is a key factor in infant death, and a new report released in March by the Robert Wood Johnson Foundation and the University of Wisconsin suggests that the number of low-birth-weight babies born in the United States — also driven by the data for black babies — has inched up for the first time in a decade.
Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel. [...]
The United States is one of only 13 countries in the world where the rate of maternal mortality — the death of a woman related to pregnancy or childbirth up to a year after the end of pregnancy — is now worse than it was 25 years ago.
Essentially, progress for black babies and mothers is going way backward. And in 2018, with all the advancements in modern medicine, this should not be happening. Except it is. And this is where we must understand how issues of racial inequality and reproductive justice are intertwined. Part of what’s being uncovered as researchers and journalists look deeper into this is that medical providers often doesn’t listen to and make assumptions about black women and those assumptions impact treatment in a very serious and potentially deadly way. Black women have said for decades that they experience disrespect and, sometimes outright hostility, when interacting with doctors and nurses, the vast majority of whom are white. Perhaps now someone will actually start listening.
As the NYT Magazine explains, listening and understanding racial bias in health care is a part of addressing black infant and maternal mortality that has long been ignored.
[Societal] racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages.
“Actual institutional and structural racism has a big bearing on our patients’ lives, and it’s our responsibility to talk about that more than just saying that it’s a problem,” says Dr. Sanithia L. Williams, an African-American OB-GYN in the Bay Area and a fellow with the nonprofit organization Physicians for Reproductive Health. “That has been the missing piece, I think, for a long time in medicine.”
It is worth stressing multiple times that this is not only about poverty—though it certainly plays a role. We know that poor women, and especially poor black women, are likely to encounter barriers in accessing quality reproductive health care. And that will only increase as Republicans do their best to gut Medicaid, strip away family planning funding and close Planned Parenthood and other abortion and reproductive healthcare providers. But even when black women are wealthy and famous, they are at-risk of experiencing deadly complications during childbirth, especially when their physicians do not heed their concerns.
In February, tennis star Serena Williams shared a story in Vogue about her experience giving birth to her daughter, Alexis Olympia. And despite all her money and fame, she nearly died when she developed a pulmonary embolism after her C-section. This is after Williams specifically told doctors what her symptoms were and how she wanted them to treat her.
Serena Williams is a world-class athlete, in amazing shape, that knows her own body better than anyone. She’s also had a pulmonary embolism before—so she knew that what she was experiencing was familiar. And yet, her care team refused to listen to her and she had to fight to get the right treatment. And even after that, she experienced more complications that were life-threatening. As Vice notes:
She identified her own symptoms and asked for the care she knew she needed, but her nurse thought her pain medicine was making her confused. In fact, Williams was right.
In the days after, coughing fits from the PE made her Cesarean section wound re-open and, during surgery to address that, doctors found internal bleeding from the blood thinners used to treat the blood clots. She required an additional procedure to prevent more clots from traveling to her lungs, for a total of three major procedures in the first week after birth, a precious time of bonding with her daughter.
There are no easy answers to this problem. Recruiting and increasing the number of medical professionals who are women of color and black women, in particular, is one solution. But that doesn’t address systemic barriers that prevent access to the necessary education and training for those women. And because our system is so rooted in racism and white supremacy, it isn’t a sure guarantee that black women or other women of color will always do better in treating black mothers and babies.
But we’ve got to do something. April 11-17 marks the first ever Black Maternal Health Week. Led by the Black Mamas Matter Alliance (BMMA), it is intended to focus on activism, awareness and advocacy around black maternal health in the United States and to make it a legislative priority. One idea that BMMA is championing is holistic maternal care for black women. To that end, it’s possible that a look back at the past may provide guidance. Before delivering babies in hospitals was commonplace, and because of the history of slavery and segregation, midwives often delivered babies. And there is a long, rich tradition of black midwifery—especially in the South, where these women were known as “granny midwives.” Without ever having formal medical training, these women delivered thousands of healthy babies to black and white women before the medical profession tried to discredit them and, ultimately, eradicated this tradition.
As more women choose home-births and the midwife and doula (a birth coach) professions return to popularity among women of color, perhaps a combination of formal medical care and more traditional healing practices will help save the lives of black mothers and their children. But this requires investment. Currently, the cost of hiring a doula is not covered by most insurance companies and the out of pocket cost can be prohibitive for many women. So it really comes down to whether or not America is willing to make an investment in order to save the lives of black women and children. And if we use history and current practices to give us insight into this question, sadly, we already know the answer is no.
To learn more about granny midwives, click here.