A Brief History of Medical Racism as it Relates to Birth
Written by Alyssa CarterRecent national dialogue has been stimulated in response to the data that Black birthers in America have over three times higher risk of death related to pregnancy and childbirth than white birthers. In some places, like New York City, this rate is quadrupled. This is regardless of other social factors, such as financial resources, education, even celebrity status (remember Beyoncé and Serena William’s birth stories?), and risk increases with age.
For years, Black birthers have felt these statistics as a morbid reality that could not be quantified. Only now that the data has been recorded and made clear and accessible, wider audiences are beginning to listen to Black birthers.
On one hand, this attention is great. Maybe it will spar action. On another hand, too much of a focus on the racial disparities in infant and maternal mortality contributes to a skewed perspective that pregnancy is dangerous. If pregnancy is dangerous, then having a home birth must be irresponsible, or a luxury reserved for the white and financially well off. If these numbers are so high, doesn’t that make birth a medical emergency?
This belief ignores a long history of traditional birthing practices in Black communities. It erases the history and value that Granny midwives had in attending births for both Black people and white folks in the rural south during slavery and beyond. It also silences the contemporary revival of the Black alternative birth movement.
Viewing birth as a medical emergency insinuates that there is inherent trust between Black people and the medical institution. It ignores the history of eugenics, of enslaved Black women being used to nurse white women’s children and not their own. It ignores the stereotypes of the Mammy and the strong Black Woman. Black birther’s hospital experiences and clinician interactions are laden with racism in American cultural attitudes, practices, and historical experience.
We must situate our current understanding of medical racism in birth in an awareness of the history that led us here.
An Example of the Origins of Medical Racism
James Marion Sims, previously touted as the “Father of Gynecology” has come under scrutiny in recent years. Statues previously erected in his honor have been brought down or relocated and accompanied by plaques that draw attention to his violent legacy and to the enslaved Black women that Sims brutalized in the pursuit of creating a technique to repair vesicovaginal fistula.
Sims began conducting these experiments in 1845 when gynecological medicine was nearly nonexistent. Doctors from all over observed and learned from him. After a few months, they became certified. James Marion Sims—the person who laid the framework for how we understand gynecology today—only had ONE YEAR of medical training himself!
There are ten women central to this story. Of these women, only three are mentioned by name. These women are Anarcha, Betsy, and Lucy—now respectfully referred to as the true “Mothers of Gynecology.”
Anarcha, just seventeen years old, became Sims' first patient. She survived thirty painful and unsuccessful surgeries between 1846-1849. Sims refused to use anesthesia in any of these surgeries (unlike the surgeries he later performed on white women, once his experiments were over). Some say he was under the terribly delusional yet commonly held notion that Black people, especially Black women do not feel pain. His journals, however, reveal that he said the experimental surgeries on his enslaved subjects were “so painful, that none but a woman could have borne them”.
Many studies demonstrate that medical professionals today perceive that Black people don’t feel pain, or have higher pain tolerances, which leads to disparities in pain management. This is one of the many ways that the legacy of slavery, the legacy of J. Marion Sims, impacts the treatment that laboring persons receive. Erica Chidi, author of Nurture: A Modern Guide to Pregnancy, Birth, Early Motherhood and Trusting Yourself and Your Body, reminds us that it is “important for patients and providers to be aware of and actively combat these assumptions”.
Much of the basis of our gynecological understanding today was nonconsensually extracted from these enslaved women and falls into a long history of medical apartheid that includes Henrietta Lacks nonconsensual medical contributions and the Tuskegee syphilis experiment, to name a couple.
Medical Racism as it relates to Birth-Today
These California-based statistics are collected from Battling Over Birth, a report of a participatory action research project conducted by Black Women’s Birthing Justice, a Bay Area based organization.
A Black baby born today is twice as likely to die as a white baby.
One in seven Black babies are born too small or too soon.
2014, 502,879 babies were born in California; 31,654 were to Black birthing persons.
67% of California babies are delivered vaginally, 33% are Cesarean.
In 2011, the cesarean rate for white women was 33%. Black births resulted in surgical delivery 39% of the time.
Black infants have a higher rate of premature birth (14.3%), low birthweight (9.7%), very low birth weight (2.6%) than any other racial or ethnic group.
The California Maternal Mortality Rate (MMR) has declined in maternal deaths since 2006, when it was higher than the US average at 16.9 maternal deaths per 100,000 live births — The MMR is often used as an indicator of a nation's overall health.
In 2015, the US was ranked 46/184 countries for which WHO has data, with a maternal mortality rate double Canada’s.
Black MMR in California is lowest since 1999 and maternal deaths in the state continue to decline.
Disparity between white and Black birthers persists—26.4 deaths among black pregnant persons per 100,000 births, compared to 7 for white persons (over triple).
Black women experience higher rates of hypertension, obesity, and cardiovascular disease—all known to complicate pregnancy. These conditions are often induced by the stress that racism causes.
Summary
The misguided notion that birth is a medical emergency, requiring further medical intervention has resulted in an expensive maternal healthcare system that throws millions at procedures that experts deem as unnecessary, while failing to provide culturally competent, accessible, and successful care to Black birthers and other marginalized communities. In order to work toward a more promising, joyful future for all, we must continually reckon with our nation’s disturbing legacy and interrogate our role—as birthworkers, medical practitioners, as community members—in beginning to repair the harm.
Resources for Further Learning
The AntiRacist Prenatal and Postpartum Care and
“Protecting Your Birth: A Guide for Black Mothers” created by Erica Chidi and Dr. Erica Cahill
Every Mother Counts AntiRacist Reading List
painting by Robert Thom, 1952*
