Blackness, Maternal Mortality, and Prenatal Birth: The Legacy of Slavery

As discussed in my previous post, racism and systemic oppression in the United States create a series of harms for women of color throughout their pregnancies and births. Drawing upon these themes, I now want to highlight some of the specific conditions Black women face within obstetrics in the hope of drawing attention to the need to alleviate wrongdoings. I also want to again acknowledge my position as a White female Yale student in sharing the sensitive and deeply traumatic stories of women of color, and my commitment to building allegiance among all women to create change. I hope this effort can play even a small part in sparking conversations about how we can amend these burdens and help raise up everyone’s voices for change.

Black women have long had to operate through both survivorship and resistance. Black women have resisted oppressors through the generational knowledge they carry and teach and through music, poetry, and family. Patricia Hill Collins, distinguished professor of sociology emerita at the University of Maryland, College Park, refers to “Black Feminist Thought” as expressing the importance of dialogue and then compelling us to discuss the concepts of knowledge production and its impact on Black women’s lives. Black feminism is an idea of liberation rooted in Black women’s experiences.

The fight for reproductive justice for Black women is more than just abortion access — as is popular in media today. Black women continually fight for the freedoms to bear or not bear children, to give birth as they please in a safe and informed manner, and to raise those children as they see appropriate. And there is deep mistrust of the U.S. medical system, which has not prioritized the lives and well-being of Black women and has actively harmed Black women through forced sterilization as well as experimentation. So, a history of violence and mistreatment is present at medical appointments, pregnancy, labor, and deliveries.

Because of racism rooted in enslavement, Black women face specific burdens in seeking out medical care that persist today. Black women will experience the subtleties (or more obvious examples) of medical racism as it poses barriers to safe and healthy motherhood. I hope to share the contemporary story of pregnancy and premature birth against the backdrop of slavery, underscoring the history of Black women’s reproductive exploitation. Black women have had to endure in a medical structure where they have historically not been believed or supported.

From youth, enslaved women of the 18th and early 19th centuries often assumed the role of forced child-raising in addition to manual labor. This coerced role often led to the unwilling neglect of their own children, as raising White children was necessary for their survival. This led to a system in which Black women’s reproductive lives were co-opted and no longer their own. For example, enslaved Black women were made to nurse White infants instead of their own children. Enslaved Black women were also habitually abused by slave owners — including physical, sexual, and emotional violence — and forced to reproduce, with some women having to bear children every 2 1/2 years.

Because of the history of slavery in this country, Black women continue to endure harms and stereotypes that have been propagated through the years by roles imposed upon enslaved Black women. For example, Black women today can be falsely labeled as hyper-fertile based on the forced reproduction of enslaved Black women. Historical and current oppression of Black women has been furthered by disparaging portrayals as “mammies,” “welfare queens,” “bad Black women,” and “strong Black women” — reducing Black women to caricatures, as Others. The term “mammy” comes from the idea of a Black woman serving as the wetnurse or caretaker for White children during enslavement. The idea of “welfare queens,” popularized in the 1980s and persisting today, emerges out of a derogatory sentiment of the reliance of Black mothers on public assistance for support. Black women are subjected to the dominant White group’s interest in maintaining hierarchies of race and therefore life, so these terms continue to circulate and harm women of color today.

These controlling images allow for a festering of medical racism because health care providers may view Black women through these biases and the prevalent spread of misinformation. Consequently, they may not treat their patients (and ailments) with the highest standard of care. For example, operating under the false assumptions that Black women need to be strong and can feel less pain harms women because their health needs may not be prioritized or even realized.

Dána-Ain Davis, PhD, MPH, and critical scholar of Black maternal health and outcomes, writes: “Obstetric racism is a threat to maternal life and neonatal outcomes. It includes, but is not limited to, critical lapses in diagnosis; being neglectful, dismissive, or disrespectful; causing pain; and engaging in medical abuse through coercion to perform procedures or performing procedures without consent.”

The mortality rates of Black women in the United States are more than three times higher in pregnancy or postpartum than they are for White women. And preterm delivery rates are around 14 percent for Black women compared with 9 percent for White women. Preterm deliveries confer risks to infants who likely must be supported in hospital neonatal intensive care units. NICU stays are financially costly and often emotionally traumatic for parents. Black women have cesarean section deliveries more frequently than other women with rates around 36 percent. These procedures, while lifesaving in many cases for both the mother and the child, do confer risks of their own, including blood clots and postpartum hemorrhaging.

Black women and their infants face risks in their pregnancies and deliveries as a direct consequence of obstetric racism and the interlocking systems of oppression that affect the lives of these women. For example, Black women are more likely to reside in lower socioeconomic status communities regardless of their own education or income (poverty rates are about 28 percent for Black women compared to 10 percent of White women) and are more likely to experience discrimination and racial bias at every level of society than their White counterparts. Economic inequality is also linked to systems of enslavement in the United States. Additionally, nearly 14 percent of Black women are uninsured despite some advances in the hope for equitable health insurance granted by the 2010 Affordable Care Act.

We must do better, rights should be prioritized, and medical racism is unacceptable. Medical education is continually improving, and providers should seek to counteract unconscious biases they may hold so that all of their patients may be afforded the highest standards of care. Medical institutions in this country should also seek to address these health inequities by improving prenatal and postpartum care and by addressing medical racism in their systems. We should seek to improve medical and scientific literacy and enhance access to scientific information, as we do at WHRY, so that individuals can better understand their own health concerns. We must advocate for ourselves and each other.

Patricia Hill Collins writes:

“By taking the core themes of a Black woman's standpoint and infusing them with new meaning, Black feminist thought can stimulate a new consciousness that utilizes Black women's everyday, taken-for-granted knowledge. Rather than raising consciousness, Black feminist thought affirms, rearticulates, and provides a vehicle for expressing in public a consciousness that quite often already exists. More important, this rearticulated consciousness aims to empower African-American women and stimulate resistance.”