I was interested in learning about this topic because it is an issue often ignored by mainstream media. I think that stigmas surrounding both race and women’s health have allowed this to occur, making it crucial to research and raise awareness around this issue. I first gained interest in this topic in seventh grade, when a peer shared a presentation on the book Medical Apartheid by Harriet A. Washington. In the presentation, the horrifying medical abuse of enslaved women was described. I also learned about forced sterilization and was appalled that such a terrible human rights abuse has gone undiscussed for so long. Furthermore, after learning about the high mother and infant mortality rate among women of color, I wanted to look more into the modern-day racism in women’s healthcare.
History of the problem:
Early forms of medical abuse against women of color were perpetrated by doctors during the early 1800s, when the reproductive medical industry was expanding. This expansion was due in part to the 1808 ban on the trans-Atlantic slave trade, which encouraged doctors and slaveholders to “protect” enslaved women’s reproductive health to increase the slave population (Owens 15). The heightened importance of gynecology also encouraged many white, male doctors to begin working in “midwifery,” a field which had previously been reserved for women (Owens 16). These male midwives took advantage of enslaved and poor women to further their gynecological research (Owens 17). For example, James Marion Sims, often considered the “Father of Modern Gynecology,” performed many experimental reproductive procedures on enslaved women without anesthesia (Prather 251).
Unfortunately, medical racism continued long after slavery ended. In the early 20th century, African American, Native American, and Puerto Rican women were targeted for “involuntary, coercive, and compulsory sterilization” under compulsory sterilization laws (Nuriddin et al.). The first such law was passed in 1907, but similar laws became widespread in the 1920s. These laws were weaponized against poor, disabled, and institutionalized people of color. For example, 5,000 out of 8,000 people sterilized by the North Carolina Eugenics Board during this time were African American (Nuriddin et al.). Additionally, some African American women were told that welfare benefits or healthcare would be denied to them if they did not undergo sterilization (Prather 252). The inhumanity of these laws is further exemplified by the fact that one “California [sterilization] law… serve[d] as a model for other states and for the sterilisation [sic] law in Nazi Germany.” In all, 60,000 people were sterilized under these laws (Nuriddin et al.).
While these sterilization laws were repealed in the 1960s and 1970s, racially charged sterilization abuse continued into the late 20th century, particularly against Native American women (Carpio 41). The Indian Health Services (IHS) was largely responsible for this abuse (Carpio 41). IHS doctors often used consent forms for medically required sterilization rather than forms distinguishing mandatory sterilizations from voluntary ones (Carpio 42). Sterilization abuse was also prominent in delivery rooms, when women are most vulnerable. For example, a woman was sterilized when she was coming off anesthesia and exhausted by delivery in a Pennsylvania country hospital and did not find out about her sterilization until a year later (Carpio 46). Furthermore, doctors often gave women misdiagnoses and false information surrounding birth control and sterilization. For instance, one woman was given “vitamins” at a doctor’s appointment that were actually birth control pills. Another woman seeking medical treatment for severe headaches was told that they resulted from a “fear of pregnancy,” and a sterilization was recommended (Caprio 46).
Current day issue:
A major area of inequity is in neo- and post-natal care. Black women are three to four times more likely than White women to suffer severe disability from childbirth and to die from pregnancy-related complications (Beim). From 2006 to 2010, Black women delivered only 14.6% of live births but accounted for 35.5% of maternal deaths (Eichelberger). Furthermore, Black infants die at twice the rate of White infants: 0.49% compared to 1.14% (Russell). Black women also have a higher preterm birth rate of 13.4% compared to 9.1% for White women (Eichelberger). Racial disparities are present in many other aspects of healthcare as well. Over 30% of Black women of childbearing age experience infertility, while only 12% of all women experience infertility. However, only 8% seek medical help, compared to 15% of White women (Beim). There are also racial disparities in breast cancer survival rates. As of 2007, 90% of White women survive breast cancer, while only 76% of Black women survive (Arriola 2). Black women are also diagnosed with breast cancer at later stages, and between 1998 and 2002, although the mortality rate declined 2.4% for White women, it only declined by 1% for Black women and 1.8% for Latina women (Arriola 5-6). Black women also face longer delays in treatment and are “less likely to receive treatment according to recommended guidelines” (Arriola 6).
- Black women have a 58% cervical cancer survival rate, compared to a 69% survival rate among White women. They also have lower-quality screening and poor follow-up after finding abnormal results (Eichelberger).
- Only 31% of Black women survive five years after their ovarian cancer diagnoses, compared to 44% of White women (Eichelberger)
- Black women are also 1.6 times more likely to experience blood-vessel related symptoms during menopause but are less likely to be offered effective hormone replacement therapy (Eichelberger).
- Black women are given hysterectomies at a rate three times higher than White women, and Black people with diabetes are three times more likely to have a limb amputated (Rao).
While the intertwined nature of socio-economic status and race in the United States is a large contributor to these issues, racism within medical institutions is also at fault. When meeting with health-care professionals, Black women’s concerns are often dismissed or ignored, and they are required to “prove” that they are in pain and not in search of drugs (Rao). Additionally, Black women are often not thoroughly examined and are not informed of all available treatment options. This mistreatment is due in part to the implicit biases, which are internal and usually subconscious, of healthcare professionals. Other stereotypes that Black women often face are that they are not knowledgeable about their bodies, are difficult to deal with, do not have insurance, and have a higher pain tolerance (Rao).
Additionally, medical conditions that disproportionately impact Black women, like uterine fibroids, receive insufficient government research funding (Beim). Twenty-five percent of Black women ages 18-30 have uterine fibroids, while only 7% of all women in the same age group have them. However, annual funding for this disease by the National Institutes of Health (NIH) is only $17 million, compared to the $86 million for cystic fibrosis, which impacts far fewer women, the majority of whom are White (Beim). There are also racial biases in clinical trials. Only 15% of participants in studies related to uterine fibroids are Black women, even though they are disproportionately impacted by them (Beim).
Past and Proposed Solutions
Proposed solution: Training more Black doctors
Why it is not ideal: While training more Black doctors is important to increase diversity in the healthcare field, it is not a perfect solution to medical inequity, since Black doctors are often expected to solve racial issues without extra compensation (Douglas).
What we can learn: We need to find solutions that do not put too much pressure on individuals, especially people of color, because racism in women’s health care is an institutionalized issue that requires larger solutions.
Proposed solution: To expand the use of doulas, trained birth assistants, who can advocate for their clients and assist them throughout pregnancy (Hosseini).
Why it is not ideal: While this may help some women, it is not a large-scale solution and does not address the institutional problems at play.
What we can learn: We should develop solutions that target institutions and are accessible to everyone, regardless of resources or economic status.
Proposed solution: Educating women of color on self-advocacy and holding their health care providers accountable.
Why it is not ideal: This type of work only concentrates on the symptoms of this issue, rather than the foundation, and diverts responsibility onto those personally impacted by medical discrimination rather than holding those to blame accountable.
What we can learn: Solutions should be directed at the foundation of racism in women’s health care and should not lay the burden of solving these issues on those impacted.
As individuals, we can contribute to this institutional change by supporting organizations like the Black Women’s Health Imperative, which backs policy development efforts and community outreach programs (Toirac). We can also facilitate conversations around racism in women’s healthcare, as both of these topics are extremely stigmatized. Personally, I will donate to organizations that work effectively to invoke change and will continue to spread awareness around racism in women’s medical care.
The most effective solution is to introduce bias training into the medical school curriculum and to fund research into health issues that disproportionately impact Black women (Douglas). For example, in 2018, the Maternal Care Access and Reducing Emergencies (CARE) Act was introduced to allocate grant money for implicit bias training in health care institutions, specifically in the fields of obstetrics and gynecology (Hosseini). Additionally, state licensing boards and the American Board of Obstetrics and Gynecology should address maternal health disparities by mandating bias training (Beim).
- Read more of my work on the history of this issue here
- Learn more about the present-day implications of this problem here
- Did you know about any of these issues previously?
- Did anything in particular about this issue stand out to you?
- Did you find anything surprising?