By: Adaora Ntukogu
The compromised reproductive health of black women in America is linked with discrimination in healthcare that is rooted in the historical treatment of black women in the United States. Black women, from slavery through post-civil rights, experienced rape for sexual pleasure and economic gain, public nude auctions, genital mutilation, and hypersexual stereotyping, to name a few atrocities. They were continuously degraded and treated as sub-human and this racist treatment was paralleled in the healthcare setting.
For example, black women were used as props to perfect medical procedures. James Marion Sims, known as “the father of modern gynecology,” perfected his surgical techniques by operating on enslaved black women without anesthesia. Non-consensual gynecological and reproductive surgeries, like cesarean sections, were performed countless times on enslaved black women with no regard to the physical, mental, and emotional toll it had on them. Jim Crow Laws enforced unequal health care services, which, coupled with generational poverty, segregation, and racism, only increased health disparities for black women.
Current Day Health Outcomes
The historical and present-day treatment of black women demonstrates how social determinants affect health status. These grotesque, racism-related experiences that began in slavery have been found to influence sexual and reproductive health today. For example, black women die from causes linked to pregnancy and childbirth at more than three times the rate of white women. Additionally, black women have a significantly higher infant mortality rate than non-Hispanic whites. It has been thought that education levels, poverty, and insufficient access to adequate health care services may explain these disparities. However, when controlling for socioeconomic status, it was found that high levels of education and social status are not protective. Present day stereotypes of black women emerged in the past and affect treatment today, regardless of status.
A systematic review published in Academic Emergency Medicine analyzed all peer-reviewed research that had physicians take Implicit Association Tests as a measure of implicit bias as well as assessments of physician clinical decision making. The majority of studies found an implicit preference favoring white people was common across providers, regardless of specialty, and two studies found a relationship between this bias and clinical decision making. Doctors already have their own biases against minority patients and these attitudes affect how patients are diagnosed and treated. The poor treatment of black women in health care is the result of the lingering specks of American history; high income and education levels are not enough to dust them away
For the Future
What does all this mean? Babies are growing up without mothers. Mothers never get the chance to witness their child’s first birthday. There should be national outcry about this health disparity but it is not getting the attention it deserves, despite the magnitude of this disparity.
Racism—whether implicit or explicit—in medical care is affecting the sexual and reproductive health of black women. One possible strategy for change is taking advantage of doulas, an alternative care method discussed in a previous Destination HealthEU post. Using doulas is one way to increase culturally competent care for black women. However, black women should be able to comfortably seek the medical care of a physician and this is going to take a lot of work.
More minority women need to be trained in healthcare professions, particularly as physicians. Unfortunately, a recent JAMA Network Open study found that reductions in black women both applying to and getting into medical school.
Socioeconomic barriers need to be torn down to mobilize minority communities to pursue a healthcare profession. Physicians should be more closely scrutinized for racial bias and face more severe consequences for violating civil rights laws. The racial history of medicine should also be in the curriculum for aspiring health care professionals, as many of the techniques they will learn came to be at the expense of black women.
1. Prather, Cynthia et al. (2018, September 24). Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167003/
2. Colb, Sherry F. (2016, March 30). The Hidden Atrocities Behind Medical Progress. Retrieved from https://verdict.justia.com/2016/03/30/the-hidden-atrocities-behind-medical-progress
3. Bridges, Khiara M. (2011, March 18). Reproducing Race : An Ethnography of Pregnancy As a Site of Racialization. Retrieved from https://ebookcentral.proquest.com/lib/emory/reader.action?docID=656673&query=
4. Kothari, C., Romph, L., Bautista, C., & Lenz, T. (2017). Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative. Maternal and Child Health Journal,21(Supplement 1), 49-58.
5. Dehon, Erin et al. (2017, May 4). A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13214
6. Lett LA, Murdock HM, Orji WU, Aysola J, Sebro R. (2019) Trends in Racial/Ethnic Representation Among US Medical Students. JAMA Netw Open. Published online September 04, 2019 (9):e1910490. doi:10.1001/jamanetworkopen.2019.10490