The Black Experience of Obstetrics & Gynecology

Anarcha, Betsy, and Lucy. If you have ever been to the gynecologist and had the doctor insert a speculum into your vaginal canal to conduct a pelvic exam, you have benefitted from the exploitation of these enslaved Black women. This harsh truth deserves to be discussed because the mistreatment and objectification of these women form the very foundation of our current system of obstetrics and gynecology. Additionally, the system that was built on the bodies of Black women is now neglecting them. The erasure of the abuse Black women endured has contributed to the unacceptable inequitable treatment and resulting racial health disparities they experience in our reproductive health system today. 

Slavery and OB/GYN Experimentation

Dr. J Marion Sims is known as the “Father of American Gynecology.” He worked primarily in Alabama during the antebellum slave era (late nineteenth century). During this time, reproductive medicine was used to maintain the success of southern slavery—the more fertile Black women were, the more children they could birth to provide additional slave labor. It also proved to be an effective way for White male American physicians to garner respect for developing new medical treatments. Additionally, when the medical experiments that were practiced on enslaved women were “mastered,” they were used to treat ailments of White women. These medical procedures included cesarean sections, ovariotomies, and obstetrical fistulae repairs (i.e. to repair tearing), procedures that are still used today. Thus, any woman receiving care from an OB-GYN has directly benefited from the nonconsensual exploitation and violation of slaves like Anarcha, Betsy, and Lucy. J Marion Sims has been respected for his work, but the contributions of these women go unacknowledged. These Black women were not only experimented upon, but were expected to play the role of patient, nurse, and midwife when needed.

The book Medical Bondage, by Deirdre Cooper Owens, details countless stories of Black women whom Sims experimented upon without anesthesia or consent. These women were stripped of their autonomy as, “Slavery and the rise of American gynecology were the vessels that poured both life and death into black women’s lives.”[1] Ultimately, experimentation on enslaved women, by J Marion Sims and other White male doctors, was a gross misuse of power. At the time, enslaved women were viewed as property as their bodies were used to further the success of the American medical system. As Owens details in her book, medical progress and capitalism were more important than respect for bodily autonomy. 

The State of Birth Care in America for BIPOC

This is the foundation of our current model of care for obstetrics and gynecology in the United States. Some people who have heard of the legacy of J Marion Sims speak of this mistreatment and systemic oppression as if something of the past, but injustices against Black birthing people still occur today. The United States has the highest maternal mortality rate of the developed world, for women of all racial identities—and it’s rising. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 16.9 deaths per 100,000 live births in 2016.[2],[3] Women seeking medical advice or birthing under the care of OB-GYNs are oftentimes not aware of their right to informed consent. They are not encouraged enough to assert agency, or to be active participants in their care.

Specifically examining the state of obstetrics care provided to Black birthing persons, the lack of autonomy, agency, and safety they feel and experience is evidenced by health disparities. Black women are three to four times more likely than White women to die due to pregnancy-related causes; in New York, they are 12 times more likely to die.[4] The pregnancy-related mortality of Black women with a college degree is 5.2 times higher than their White counterparts.[5] Additionally, Black women are more likely to have preterm babies, and have babies not survive the first year of life. These are not statistics that I raise simply to garner shock or pity, they are a testament to the fact our current medical model of care is continuing to mistreatment and neglect Black birthing persons. 

The Black Experience with Birth Professionals

To further comprehend these deplorable outcomes, it is important to investigate the experiences of Black persons with medical professionals. One way to do this is to examine communicative experiences between Black pregnant and birthing persons and their care providers. A 2018 study investigating pregnant, birthing, and postnatal birthing persons of color at risk for preterm birth in California found, “Participants described disrespect during healthcare encounters, including experiences of racism and discrimination; stressful interactions with all levels of staff; unmet information needs; and inconsistent social support.[6] It is also essential to recognize how a lifetime of exposure to chronic stress due to systemic oppression contributes to the wear and tear on a Black person’s body, and how that stress affects pregnancy.

I encourage everyone to be critical of the systems we are embedded in. My guess is that most people, myself included, were not taught about the exploitation of enslaved women or the atrocities of our medical system; however, we have been left with a flawed system and one that ultimately does not protect Black birthing persons. Change starts with engaging in conversations about these challenging topics. It’s a bleak reality to face and my intention is not to demonize medical professionals. Nonetheless, we cannot grow if we do not acknowledge shortcomings.

Suggested Reading: 

Medical Bondage: Race, Gender, and the Origins of American Gynecology 

Deirdre Cooper Owens

Killing The Black Body: Race, Reproduction, and the Meaning of Liberty 

Dorothy Roberts  

Reproductive Justice: An Introduction

Loretta J. Ross, Rickie Solinger

About the Author:

Bentley (she/her) is a birth, postpartum, and bereavement doula in Northern Colorado. She is passionate about providing intentional support to birthing persons through all stages of the birthing process, and witnessing birthing persons discover the power and wisdom of their bodies. Bentley is a member of the Inclusive Birth Collective, providing doula support to underrepresented community members in Northern Colorado. In addition to her doula work, Bentley is a graduate student in the Department of Communication Studies at Colorado State University, where she studies health communication, social support, and identity. Find more information about Bentley and her services on Instagram (@bentleypojo.doula) or on her website (www.bentleypojo.com). 

 

[1] Deidre Cooper Owens, (2018). Medical Bondage. University of Georgia Press, p. 44

[2] Centers for Disease Control and Prevention. Pregnancy Surveillance System. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpregnancy-mortality-surveillance-system.htm

[3] Petersen EE, Davis NL, Goodman D, et al. Racial/ethnic disparities in pregnancy-related deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019;68:762–765.

[4] Pregnant-Associated Mortality: New York City 2006-2010 https://www1.nyc.gov/assets/doh/downloads/pdf/ms/pregnancy-associated-mortality-report.pdf

[5] Centers for Disease Control and Prevention (2019). “Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths.” https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html

[6] McLemore, M. R., Altman, M. R., Cooper, N., Williams, S., Rand, L., & Franck, L. (2018). Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth. Social Science & Medicine, 201, 127–135. https://doi.org/10.1016/j.socscimed.2018.02.013