Health Care for Black Women: Why It’s Different

In her victory speech on November 7th, Vice-President elect Kamala Harris remarked that often the most overlooked women in women’s fight for equality and part of “backbone of our democracy” are Black women. Sadly, this theme is not isolated to politics. Extrapolating out, this week we wanted to shine a light on the history of gynecology and women’s health in America in regards to Black women and acknowledge the historical factors that make their current relationship with the medical establishment so tumultuous. 

The roots of the anti-Blackness within the medical community date back to the era of slavery according to University of Nebraska professor Deirdre Cooper Owens (and author of the Medical Bondage, a book about the history and sociology of gynecology). Dr. John Sims is well-known within the medical community for his pioneering of the vesico-vaginal fistulae in the 1840s, which garnered him the sole bearer of the title “father of gynecology.” Yet the history books don’t note that Dr. Sims heavily depended on Black enslaved women as both patients and nurses/surgical assistants and unfortunately don’t grant them with the well-deserved titles of “mothers of gynecology”. Undergoing the excruciating pain of gynecological procedures, the ten or so Black women crucial to the perfection of the vesico-vaginal fistulae often had to support and help operate on women undergoing the same procedures (without consent) that they went through. This was all in addition to their daily slave duties. Along with the injustice of the situation, this practice perpetuated the idea that the bodies of Black women were invincible and “immune to pain.” Studies have shown that as recently as 2016, 40% of medical trainees believed that “black people’s skin is thicker than white people’s” and that Black women are 22% less likely to receive pain medications than white patients because of the wholly inaccurate belief that the nerve endings of Black women are less sensitive than those of White women. 

We can’t discuss healthcare and Black women without talking about the staggering and devastating disparity in maternal and fetal death rates between Black women and their counterparts. In Grand Rapids alone, a Black baby is twice as likely to die than a White baby as of 2017 and in the state of Michigan, Black mothers are three times more likely to die from childbirth than their White counterparts. In some parts of the country - especially metropolitan areas -  the disparity can be four to five times higher for Black women. This stark difference can not be entirely explained by education level (in fact White uneducated women have lower maternal mortality rates than Black, educated women), prenatal care, weight, genetic correlations, or even environmental factors like diet, smoking, or alcohol use; thus far, the only statistically significant contributor to the Black maternal death rate is the cortisol effect. This states that the day-to-day stresses that Black women face (and unfortunately become their norm) from small microaggressions to explicit acts of discrimination, to the stress of picking which battles they want to fight, to even their statistical likelihood of being primary breadwinners all heighten their levels of the stress hormone cortisol in their bodies. The heightened levels of cortisol is normal for all women around pregnancy but its heightened nature in Black women throughout their lifetime can lead to inflammation that can restrict blood flow to the placenta and stunt infant growth. Higher cortisol levels can also trigger preterm labor which can disadvantage Black babies with a lower birth weight from the very beginning of their lives and contributes to the two-fold increase in low birth weight among Black infants. 

We recognize the tragic juxtaposition in Black women being the backbone of the medical system and yet the ones least benefited by it. As we strive to create a future where this health disparity no longer exists, we must remember that in the end it is racism, not race, that is the root of the problem. The complete diminishing of this gap will require reforms in housing, the criminal-justice system, education, environmental injustice and even the implicit biases within the medical establishment. While we recognize these changes won’t happen overnight, we can continue to promote an anti-racist culture in every facet of society. Afterall, it’s time. We have the data and certainly the means to do so. There is no good reason not to change and improve our systems.

Written by Akansha Das