A healthcare crisis exists in the United States, in which women are often dismissed regarding their medical—particularly gynecological issues—concerns. For Black women, a greater struggle exists in the quest for comprehensive healthcare from medical providers who listen to these patients in order to optimize their health.
The challenges faced by Black women in the United States healthcare system trace their roots back to slavery in the country. In addition to living as trafficked humans, forced to work stolen land, and subjected to having their babies torn away from them and sold, these women also existed within a system that allowed doctors to use them as subjects to perform horrific medical experiments. African American women were also subjected to inhumane treatment during these experimental procedures without anesthesia.
In a 2018 NPR story by Camila Domonoske titled “‘Father of Gynecology,’ Who Experimented On Slaves, No Longer On Pedestal In NYC,” physician and medical historian Vanessa Northington Gamble named three of the many victims subjected to J. Marion Sims, a gynecologist who experimented on enslaved women. Gamble described the experiences of Anarcha, Lucy, and Betsey, who retained no power over their own bodies when Sims used them to find a solution for fistulas.
“These women were property,” Gamble said in the piece. “These women could not consent. These women also had value to the slaveholders for production and reproduction—how much work they could do in the field, how many enslaved children they could produce. And by having these fistulas, they could not continue with childbirth and also have difficulty working.”
While the horrid actions of using U.S. slave-trade era human-trafficking victims as unwilling test subjects for medical experiments is abhorrent, inexcusable treatment of Black women within the medical community continued well into the 20th century. Under a eugenics program within the United States, forced sterilization of citizens who were viewed as “undesirable” was legal in certain states, according to an article by the Equal Justice Initiative. Eugenics, the belief that the quality of a human population can be improved by preventing reproduction among certain citizens who are believed to be less desirable, or encouraging those thought to have the best characteristics to procreate, was so common in the U.S. that Nazis in the 1930s and 1940s used this country’s model for its own program that sterilized hundreds of thousands of Jewish people and others deemed undesirable. The EJI notes that between the 1920s through 1970s—yes, only 50 years ago, or less in certain states—thousands of Black women who had not consented to sterilization procedures were sterilized.
“Most states abandoned eugenics programs after World War II, but sterilization increased in Virginia, Georgia, North Carolina, and South Carolina, coinciding with growing Black political power, mandatory integration, and the civil rights movement. Some states continued to sterilize into the 1970s,” the organization stated. “Though this history is largely unknown, compulsory programs sterilized an estimated 65,000 individuals in more than 30 states, and the number is likely much higher.”
Still today, there lingers within medicine the vestiges of this mindset that places African American women in a different category than white women. Speaking with Black women about their own experiences and those of their female family members, there are countless stories about the dismissive manner in which doctors view their pain and illness. Many of these stories go unheard.
One tragic tale, the story of Anna Brown, made headlines but only after the life of this young Black woman was extinguished due to medical negligence. In 2011, 29-year-old Brown died in police custody, after she was being held following her arrest for trespassing at St. Louis, Mo., medical facility St. Mary’s Health Center. Brown refused to leave the hospital after doctors claimed to have found no evidence of a medical issue. Hospital staff dismissed Brown as a drug seeker, or a person who feigns illness in order to secure medications that are classified as controlled substances. Brown was discharged but refused to leave the hospital, at which point doctors contacted police and authorized them to haul the patient to jail. In police custody, she died on the floor of her cell from blood clots that traveled to her lungs after forming in her legs due to deep vein thrombosis.
In an article titled “How We Fail Black Patients in Pain” by Janice A. Sabin, PhD, MSW, of the Association of American Medical Colleges, an examination of white medical trainees showed that many believed common myths about Black patients. These lies are dangerous for Black patients. Of particular concern are those untruths supporting the belief that Black people are less sensitive to pain. Citing a report from the Proceedings of the National Academies of Science titled “Racial Bias in Pain Assessment and Treatment Recommendations, And False Beliefs About Biological Differences Between Blacks and Whites,” Sabin is stunned to discover that half of the trainees who responded held one or more of these false beliefs.
For Black women, these types of biases can prove deadly. As the number of reported pregnancy-related deaths has declined in other parts of the world, maternal mortality rates in the U.S. have risen from 7.2 deaths per 100,000 live births in 1897 to 16.7 deaths per 100,000 live births in 2016, according to the Centers for Disease Control and Prevention. Between 2011 and 2016, Latinx women experienced 11.3 deaths per 100,000 live births and, among white women, there were 13 deaths per 100,000 live births. With an MMR of 42.4 deaths per 100,000 live births, the disparity in maternal health for Black women, compared to their counterparts from other racial groups, is a profound signifier of all the work that must be performed to support female members of the African American community.
While Black women must remember that they have to trust their instincts when seeking care, it is also a responsibility of allies to offer support. By accompanying Black women to medical appointments, non-Black friends and loved ones are able to, not only show support, but also bear witness to treatment by doctors and staff. Recognizing these discrepancies in care and helping Black women overcome these healthcare obstacles by holding accountable medical personnel is one of the most-effective methods to combating racism in medicine.