BY GRACE UDOH
America is failing its Black mothers. A study by the American Journal of Managed Care identified the United States as the worst country for Black women to give birth in the developed world. According to the Centers for Disease Control and Prevention, Black women are three times more likely to die from a pregnancy-related cause than White women in the United States. These disparities can be ascribed to underlying racism and implicit bias, which results in lower-quality healthcare experiences for Black women. This is a public health crisis embedded in the foundation of the country. The roots of this disparity can be traced through the legacy of slavery in the United States. The system of chattel slavery, which commodified the enslaved childbearing process by allowing automatic enslavement of the children of the enslaved, encouraged increased attention toward the reproductive lives of enslaved women. The plantation setting, hard labor, and poor nutrition endured with silent strength by slave women were reflected in the high infant mortality of Black mothers in contrast to that of White mothers. An unrealistic expectation was set for women to be able to endure these harsh plantation environments and maintain a mortality rate similar to that of White women in milder environments. Historians at the National Library of Medicine estimate that “50% of enslaved infants were stillborn or died within the first year of life”. Slave women were blamed for this through “harsh gendered and racist language” [1]. Consequently, the perception of African American mothers became villainized in healthcare settings. Ultimately, this allowed for racial medical biases to develop and become the foundation of modern American pediatrics and gynecology care. Racial medical bias is when attitudes and judgments about race affect personal thoughts, decisions, and behaviors [2].
In overall pain assessment and healthcare treatment, fortitude and long-suffering are disproportionately expected from Black women than their White counterparts. Although individual strength should be admired and valued, the glorification of the strength and resilience of Black women has allowed for their mistreatment in the healthcare system, therefore; women must be empowered and institutionalized racism must be deconstructed to promote equality in the American healthcare system.
There are many cases of Black women being disproportionately subjected to pregnancy complications due to prejudiced treatment. Obstetrics Racism, an investigation by Dána-Ain Davis, the Director of the Center for the Study of Women and Society at New York University, follows the stories of multiple pregnancies of Black women. One Black mother, Yvette Santana, details her experience with a gynecologist who labeled her a “hypochondriac” and refused to take her concerns seriously. After giving birth to twins 26 weeks early who were immediately admitted to the neonatal intensive care unit, she links her experience to prejudice “that racialized the strength and survival of Black infants”. She theorizes that “had she and her children been White, they would have been viewed as fragile and treated differently” [3]. Davis’ surveying of the cases of over fifty families and mothers of varying socio-economic status reveals a cycle of presumed incompetence of pregnant Black women which leads the hospital staff to withhold information and downplay complications [3]. Ultimately, this works to increase the risk in these women’s labor and delivery processes and strip Black women of their autonomy in healthcare settings.
This pattern of negative pregnancy outcomes due to the neglect of Black mothers in the American healthcare system is upheld through racial medical bias. A study in the Proceedings of the National Academy of Sciences, conducted at a medical school campus, investigated the widely promoted misconceptions among medical students of biological differences and “higher pain tolerance capacity” of Black patients compared to their White counterparts. This study found that “about 50% [of medical students and residents] reported that at least one of the false belief items was possibly, probably, or definitely true” [4]. This is significant as these biases, in turn, determine treatment and prescription plans for patients. Furthermore, this again allows for Black mothers to be denied autonomy in their own healthcare by refusing to justly acknowledge their pain and biological processes.
This silencing of Black women and other marginalized groups has become ingrained in medical practices and patient-physician interactions. Minority students at Stephen F. Austin State University explored this through a study, Healthcare Experiences: A View-Point from Young Adult Minorities. With the use of surveys, this research found similar themes among the complaints of minority patients including “Communication between patient and physician, Trust of Physician, Comfort/Empathy, Relatability, and Healthcare Setting“ [5]. These themes shape relationships between patients and physicians and, when handled improperly, create an atmosphere of discomfort and distrust.
However, more than simply being ignored or misunderstood, the natal healthcare issues faced by Black women are actively stifled. Broadly, women in American culture are instantly associated with maternal roles. Women often find themselves confined to characters of unconditional love and quiet endurance. Consider the Migrant Mother photo in the 1930s by photographer Dorthea Lange. This powerful image of a mother with her three children leaning on her became the defining portrayal of the Great Depression and the Dust Bowl. This image is famed as depicting the fortitude of a mother’s love in the face of the hardships of the time. Mothers became a symbol of strength and the silent backbone of the family. These expectations for women and mothers have built sexism into the foundation of many public systems and institutions.
This characterization becomes toxic when combined with the stereotypes forced upon Black mothers. A study published in the Psychology of Women Quarterly by professors at the Department of Psychology at Rutgers University, suggests that strength rests at the foundation of the perception of Black mothers. Throughout American history, Black women such as Harriet Tubman and Sojourner Truth have been celebrated as “emblems of strength, who persisted against insurmountable odds” [6]. Similar to the Migrant Mother, this glorification of strength overshadows acknowledgment of the harsh and cruel environment these women were subjected to. Yvette Santana would likely agree that the assignment of strength to her as a Black woman was used to conceal the racial stratification that was at the foundation of her delivery experience.
Romanticizing the resilience and fortitude of Black women ultimately prevents change in the healthcare system. The medical culture and system overall is held back and encouraged to remain stagnant, rather than improve and advance. This static resilience, for Black women in American culture, is upheld through the Strong Black Woman archetype, which pushes Black women into roles “of caretaking, independence, and restricted emotionality” [6]. Although this schema is used within the African American community to “counter disparaging portrayals of Black women as subservient, hostile, and lazy” it can become negative when an acceptance of this title encourages Black women to internalize a harmful thinking towards resilience which “limits Black women’s personhood, including their ability to ask for help” [6]. These mindsets of resilience redefine self-care, action, and external support as shameful and weak which, in turn, prevents progress. Furthermore, as these stereotypes continue unaddressed, they inadvertently allow misconceptions among doctors and society overall, as seen in the racial bias of pain assessment, to thrive.
Some may argue that strength must be glorified and the discouragement of symbols of strength, such as criticisms of the Migrant Mother photograph and the Strong Black Woman narrative, encourage women to victimize themselves. However, these representations of strength, conceal issues and prevent change. By pushing women to conform to specialized definitions of strength, their emotionality is restricted and they are prevented from being vulnerable and this allows unjust, discriminatory systems to thrive.
Ultimately, American society has propagated a culture that glorifies the silence of Black women in their suffering and mistakes it for resilience. Embedded with oppressive expectations and stereotypes for Black women and mothers, the American healthcare system has allowed for a disproportionate maternal mortality and complication rate for African American women compared to their White counterparts. We must create an environment that values resilience and strength alongside vulnerability.
Grace Udoh is a first-year in Berkeley College.
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References
- Owens DC, Fett SM. Black Maternal and Infant Health: Historical legacies of slavery. American Journal of Public Health [Internet]. 2019 Aug 15;109(10):1342–5. Available from: https://doi.org/10.2105/ajph.2019.305243
- Lockett E. Racial bias in healthcare: What you need to know [Internet]. Healthline. 2022. Available from: https://www.healthline.com/health/racial-bias-in-healthcare
- Davis DA. Obstetric racism: the racial politics of pregnancy, labor, and birthing. Medical Anthropology [Internet]. 2018 Dec 6;38(7):560–73. Available from: https://doi.org/10.1080/01459740.2018.1549389
- Hoffman KM, Trawalter S, Axt JR, Oliver MN. 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 [Internet]. 2016 Apr 4;113(16):4296–301. Available from: https://doi.org/10.1073/pnas.1516047113
- Lakhani M, Cegelka D. Healthcare Experiences: A View-Point from Young Adult Minorities. Texas Public Health Journal [Internet]. 2022; 74(3):27–33. Available from https://web.p.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=0&sid=d16413c0-a2be-4146-a955-62e32b39a3df%40redis
- Nelson T, Cardemil EV, Adeoye CT. Rethinking strength. Psychology of Women Quarterly [Internet]. 2016 May 24;40(4):551–63. Available from: https://doi.org/10.1177/0361684316646716
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