Possession Pioneered American Gynecology

by yaleglobalhealthreview, posted in Uncategorized

BY BERNADETTE NWOKEJI

When Serena Williams delivered her first child in 2017, she almost died due to her concerns not being taken seriously by the team of medical professionals assigned to her.1 This alarming childbirth story rose to national news because of William’s status as a high-achieving athlete, but the story resonated with a specific community – Black women. With Williams disclosing her childbirth experience, an outpouring of accounts from Black women ensued, depicting the horrors endured at the hands of medical professionals: 

“The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB-GYNs in her seventh month, only to suffer a fatal postpartum stroke.”2

Each account converges on the commonality of Black women being dismissed and unfairly judged in their attempts to seek obstetric and gynecological care, which hints at a larger phenomenon at play. A phenomenon that intersects racial and gender bias in medicine and coalesces into observable disparities between Black women and their counterparts. The Centers for Disease Control & Prevention (CDC) highlights this by noting that Black women are 243% more likely to die from pregnancy or childbirth-related issues.3 However, simply noting these statistics without delving into the historical context leaves room for strawman arguments that often propel victim-blaming and distract from the mechanics that need to be analyzed. For instance, the uniqueness of this phenomenon is that the propensity does not diminish as socioeconomic status improves; rather, the propensity remains the same for all socioeconomic groups of Black women. Hence, why Williams and the Florida mother-to-be can have similar childbirth experiences despite being a part of vastly different socioeconomic circles. This phenomenon pertains to obstetric and gynecological care, so the historical context of these fields will be addressed.

The Mothers of Gynecology

Within the United States, gynecology originated from the manipulation of the legal infrastructure that protected the institution of slavery. Due to the historical climate, the logic and, consequently, the implementation of gynecology dramatically differed for different races. For enslaved black women, gynecology centered on recursive logic, as gynecology was not intended to promote enslaved black women’s health, but rather strip enslaved black women of their health to promote the health of white women. Moreover, the implementation of this recursive logic was rooted in possession and is best exemplified through the work of James Marion Sims, MD.

James Marion Sims, MD built his medical career on developing surgical techniques for complications that arose from childbirth. Most infamously, the repair of the vesicovaginal fistula; a complication that can cause prolonged urine leakage due to a rupture between the uterus and the bladder.4 The vesicovaginal fistula was widely regarded as untreatable, so the development of a method that would treat this complication was viewed as revolutionary, solidifying Sims’ position at the forefront of gynecology. But in the background were the enslaved Black women from which Sims developed the techniques, who endured repeated, non-anesthetic supplied procedures.5 Thus, possession was the mobilizer for the pioneering of American gynecology. 

Through the institution of slavery, enslaved Black women were under the posession of their slaveholders, and this possession was extended to being coerced to take part in gynecological experiments they did not willfully consent to. As Vanessa Northington Gamble, a physician and medical historian at George Washington University notes, “these women also had value to the slaveholders for production and reproduction — how much work they could do in the field, how many enslaved children they could produce … by having these fistulas, they could not continue with childbirth and also have difficulty working.”6 Hence, the enslaved Black women were forced into these experiments, not only so a surgical technique could be invented to ease the social and self stigmas faced by white women with fistulas but also to guarantee the future capital of slaveholders. Through the Hereditary Slavery Law Virginia 1662-ACT XII7, the children of enslaved women were also born enslaved; so, it was of great financial importance that there were designated techniques to repair fistulas, or there would be significant impediments to enslaved Black women’s ability to propagate, threatening the institution of slavery. As, the institution of slavery survives through claiming posession to a person, extorting capital from coerced labor, and establishing a legal infrastructure that condones this cycle to be implemented on the successive generations. 

The identities of the enslaved Black women of whom the gynecological experiments were conducted on are relatively unknown, except for three names: Anarcha, Lucy, and Betsey.8 Anarcha, Lucy, and Betsey all came into Sims’s custody through similar means – their slaveholders sought to repair the fistulas they got from childbirth. And by that time, Sims was well known amongst rich, white, slaveholders in the South, so he was highly sought out. Sims convinced the slaveholders to trade possession over Anarcha, Lucy, and Betsey for six months to acquire full access to their bodies, and in that time, Sims promised to cure them of their conditions. During these months, Anarcha, Lucy, and Betsey were forced to undergo non-consensual experiments without the comfort of anesthesia and naked, in front of an audience of doctors eager to observe the procedures. This pledge, though, became null and void when Sims did not return on his promise due to all his operations on Anarcha, Lucy, and Betsey resulting in failures. This prompted the medical community in the South to abandon Sims, leaving Anarcha, Lucy, and Betsey with the task of becoming the medical practitioners that would aid Sims in his experiments on other enslaved Black women and being intimidated into working on Sims’s plantations. 

Ultimately, Sims migrated to the North where he advertised his surgical techniques through an article that neglected to divulge the techniques were derived from the exploitation of enslaved Black women, and the enslaved Black women became proficient medical practitioners. Additionally, the article featured illustrations of clothed white women being operated on, and white women serving as the nurses. Sims carried out the remaining years of his medical career operating in Europe on white women who were given anesthetics9 while Anarcha, Lucy, and Betsey were sent back to work on the plantations they initially came from10. 

The tendency of history to focus on the actions of the oppressors has touted Sims with the title the “Father of Gynecology”, but it is more appropriate to recognize the contributions of the “Mothers of Gynecology”, Anarcha, Lucy, Bestsey, and many other unidentified enslaved women: who from their strength, one can thank for the advancements in a field rooted in recursive logic and perpetuated by possession, gynecology.11

The Myth of Medical Superbodies 

Sims’s influence did not dissipate after he passed away. Rather, the legacy of Sims’s unethical experiments is present in the myth of medical superbodies – a myth that intentionally overstates the strength and low-pain tolerance of Black women to perpetuate an agenda that dismisses and devalues the lived realities of Black women. Deidre Cooper Owens, the author of Medical Bondage: Race, Gender, and the Origins of American Gynecology, comments on how the myth of Black women being medical superbodies originated from how white society viewed Black women and acted towards enslaved Black women. “As medical superbodies, sick black women were expected to still perform the duties fit for slaves such as intense agricultural labor and domestic work even while pregnant, infirm, or recovering from illness”12, which is demonstrated in Sims refusing to medicate the enslaved women he experimented on with anesthesia while supplying the white women he operated on in Europe with anesthesia, and forcing the enslaved Black women he experimented on, like Anarcha, Lucy, and Betsey, to work on his plantation despite recovering from the procedures. Moreover, the myth of medical superbodies simultaneously served as a pacifier and a justification to the atrocities that were occuring at the hands of slaveholders willing to further exploit enslaved people to achieve more capital because the myth absolved the slaveholders from any responsibility due to the myth purposefully presenting Black women as workhorses. 

Unfortunately, the myth of medical superbodies has become pervasive within the medical field, and the implications are witnessed in the racial bias in pain assessment. A study was conducted by Hoffman et. al13 to ascertain if “white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites” for pain management, and the results concluded that “physicians were more likely to underestimate the pain of black patients (47%) relative to nonblack patients (33.5%)”.14 

This rudimentary belief in biological differences between Black patients and nonblack patients, combined with the myth of medical superbodies, and the historical context the myth derived from explain the phenomenon of why the propensity of Black women being dismissed and unfairly judged in their attempts to seek obstetric and gynecological care does not diminish as socioeconomic status improves: the myth of medical superbodies has not be resolved and the historical context providing the underpinning for the myth has not been adequately addressed. With this knowledge in mind, the sincerity of the obstetric and gynecological fields must be questioned, as both fields are founded upon principles of recursive logic cemented by possession. And yet, neither field has taken the steps to remedy this. 

Community Births on the Rise

An increasing percentage of Black women in the United States are questioning the sincerity of the obstetric and gynecological fields by not having child births in the infrastructure the fields mostly reside in: hospitals. Instead, the National Partnership for Women and Families demonstrates that from 2019 to 2020, 30% of community births increased.15 Community births have become the modern vernacular for childbirths that occur in birth centers or at one’s home. There, the community births are regularly monitored by midwives, “trained health professionals who help healthy women during labor, delivery, and after the birth of their babies”16, and doulas, a non-medical professional “who provides emotional and physical support to you during your pregnancy and childbirth”.17 

Moreover, community births, for the most part, allow the one giving birth the ability to decide the midwife and/or doula taking care of them. This autonomy is not present amongst hospitals where many encounter a ‘luck of the draw’ situation, which for Black women, leads to elevated risks of experiencing the medical superbodies myth and other forms of structural racism. 

Yet, even with the heightened sense of autonomy community births provide, they still are not risk free. As Dr. Timothy Fisher, the medical director for the Northern New England Perinatal Quality Improvement Network states, “even in a low-risk labor, there are situations that can arise where you very quickly go from a low-risk situation to a high-risk situation or emergency”.18 And in these high-risk situations or emergencies, the increased access to resources infrastructures, like hospitals have, are vital. Hence, community births cannot be viewed as the absolute resolution to the pitfalls the obstetric and gynecological fields have due to the fields’ inherent recursive logic championing possession and fabricating myths to absolve them of their wrongs. Rather, community births should be viewed as a choice for Black women, not a decision coerced because of structural racism contributing to a lower quality of care in a hospital.

Believe Black Women

Therefore, in order to combat the obstetric and gynecological disparities felt by Black women across all socioeconomic levels, from Serena Williams to the Florida mother-to-be, action must be enacted. However, it is action that is more than hosting anti-racism training, action that supersedes the strategies of remaining ‘colorblind’, it is action that is rooted in believing Black women. 

Bernadette Nwokeji is a sophomore in Morse College.

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References

  1. Williams, S. (2022, April 5). How Serena Williams saved her own life. ELLE. Retrieved from: https://www.elle.com/life-love/a39586444/how-serena-williams-saved-her-own-life/ 
  2. Martin, N., & Montagne, R. (2017, December 7). Nothing protects black women from dying in pregnancy and childbirth. ProPublica. Retrieved from: https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth 
  3. Martin, N., & Montagne, R. (2017, December 7). Nothing protects black women from dying in pregnancy and childbirth. ProPublica. Retrieved from: https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth 
  4. Cleveland Clinic. (2022). Vaginal fistula: Causes, symptoms and treatment. Cleveland Clinic.   Retrieved from: https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula 
  5. Spettel, S., & White, M. D. (2011, April 20). The portrayal of J. Marion Sims’ controversial surgical legacy. The Journal of Urology. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0022534711002278 
  6. Domonoske, C. (2018, April 17). ‘father of gynecology,’ who experimented on slaves, no longer on pedestal in NYC. NPR. Retrieved from: https://www.npr.org/sections/thetwo-way/2018/04/17/603163394/-father-of-gynecology-who-experimented-on-slaves-no-longer-on-pedestal-in-nyc 
  7. National Parks Service. (2022). NPS ethnography: African American Heritage & Ethnography. National Parks Service. Retrieved from: https://www.nps.gov/ethnography/aah/aaheritage/chesapeake_pop2.htm 
  8. Faith Crusade Ministries. (2022). Anarcha, Lucy, and Betsey. Anarcha Lucy Betsey. Retrieved November 28, 2022, from https://www.anarchalucybetsey.org/anarchalucyandbetsey 
  9. Lynch, S. (2020, June 20). Fact check: Father of modern gynecology performed experiments on enslaved Black Women. USA Today. Retrieved from: https://www.usatoday.com/story/news/factcheck/2020/06/19/fact-check-j-marion-sims-did-medical-experiments-black-female-slaves/3202541001/ 
  10. Boomer, L. (2022, July 8). Life story: Anarcha, Betsy, and Lucy. Women & the American Story. Retrieved from: https://wams.nyhistory.org/a-nation-divided/antebellum/anarcha-betsy-lucy/ 
  11. Faith Crusade Ministries. (2022). Anarcha Lucy betsey monument: Montgomery: More up campus. Anarcha Lucy Betsey. Retrieved from: https://www.anarchalucybetsey.org/ 
  12. Owens, D. C. (2022). Chapter Five: Historical Black Superbodies and the Medical Gaze. In Medical Bondage: Race, Gender, and the Origins of American Gynecology (pp. 108–121). essay, Open Library. Retrieved from: https://library.oapen.org/bitstream/handle/20.500.12657/30659/644220.pdf?sequence=1#page=125 . 
  13. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016, April 19). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/ 
  14. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016, April 19). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/ 
  15. National Partnership for Women & Families. (2022). More people giving birth at home and in birth centers. More People Giving Birth at Home and In Birth Centers. Retrieved from: https://www.nationalpartnership.org/our-impact/news-room/press-statements/more-people-giving-birth-at-home.html 
  16. Hurley, J. (2022, November 6). What is a midwife? WebMD. Retrieved from: https://www.webmd.com/baby/what-is-a-midwife-twins 
  17. Hurley, J. (2021, March 19). What is a Doula? WebMD. Retrieved from: https://www.webmd.com/baby/what-is-a-doula 
  18. Proujansky, A. (2021, March 11). Why black women are rejecting hospitals in search of better births. The New York Times. Retrieved from: https://www.nytimes.com/2021/03/11/nyregion/birth-centers-new-jersey.html

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