How systemic racism affects black maternal mortality and much more
By Cecelia Ottenweller
Moms in the United States are in a crappy position. Did you know we’re more likely to die or suffer debilitating illness due to the experience of pregnancy than any other developed country in the world? Astounding, isn’t it? But the numbers can’t be denied: 17.4 women per every 100,000 in the US die because of pregnancy and 7 of every 100,000 die in France, number 9 on the list, for the same reason.
And the stats get uglier when you dive closer: Black and Indigenous women in the U.S. are in some cases 4 to 5 times more likely to die than their White counterparts and that’s not even counting the number of women suffering debilitating illness due to pregnancy and delivery.
I did a research project in 2019 to get some insight into why this problem is happening and looked at both sides of the equation here in Houston and Harris County. I interviewed Black women who were moms, Black women who were moms and family health professionals, Black women who were just medical pros, and female medical professionals who were not Black. 11 women participated and gifted me with over 15 hours of their personal stories. I sifted them, then looked for common threads.
Their stories revealed a number of truths, but the most common thread was that not just medicine, but our entire society – all of us, you, me, the person sitting next to us, ALL of us – is participating (oftentimes unconsciously, though not always unknowingly) in bullying women who can somehow be labeled “different.” This especially includes Black and Indigenous moms.
There are huge repercussions. The bullying results in not just the death and debilitation of new moms but it is also at the root of many of our systemic ills such as poverty, drop-out rates, crime, gross levels of incarceration, and the unbalanced burden of COVID in our communities.
The technical term for the bullying I’m describing is “systemic racism.” Dr. Joe Feagin, a sociologist at Texas A&M University defined systemic racism in 2006 as a distinctive social work that unequally benefits a particular segment of society physically, economically, socially and culturally. It is “a material, social and ideological reality” that was rooted from the earliest moments of the founding of our country and society.
Americans largely thought and still think in terms of a divide based on skin color because we are fed a racialized perspective from the cradle. We check off boxes at the post office, doctor… we measure our community successes and ills in Black and White (and other socially constructed categories). Systemic racism was embedded in the foundation of our national culture; it is in our very groundwater:
The constructs of “White” and “Black” are not natural, yet they perpetuated with the first coining of the terms in 1680, just after slavery was racialized by Europeans.
Our entire national culture evolved on a foundation of prejudices, negative beliefs and differential negative behaviors by individuals and institutions against “Others” (and that’s not just to folks with Black skin either. One only has to look at violence against people of different immigrant groups and religions to see evidence of this.) You didn’t read this in your high school history books, but 90% of our national story is dominated by stories of genocidal acts against indigenous peoples, forced enslavement of dark-skinned people from Africa, and legalized segregation that denied equitable access to resources to people who didn’t look like the dominant group. These behaviors were sanctioned and even mandated by social, political, and community-level leadership.
The American practice of obstetrics and gynecology was founded and built based on discoveries and methods developed through experimentation on “Other” bodies. These bodies were most often enslaved Black women who had no choice. (The father of American medicine, Benjamin Rush, felt that Blackness was the result of a genetic pathology. Still, today, research in physician attitudes reveal some that believe Black skin and pain thresholds are different from White). But, medical experimentation was also perpetrated against immigrant women, such as the Irish.
What the women told me:
Increasing awareness is a great start to addressing the issue and the women I interviewed provided some much-needed perspective on how systemic racism happens and how it impacts the mental, physical and spiritual health of Black people, especially women, not just in Houston, but American society in general:
African American women viewed as THE problem by Medicine:
Penny (Black OBGYN pro and mom): “We have text books that tell us high blood pressure is prevalent in African Americans. Well, why? It’s not just prevalent … we weren’t made differently, our bodies are not predisposed to having high blood pressure, that’s not how it works! But when it’s printed that way, then you’re taught and you just believe, “Well if they’re black and they show up with high blood pressure, well that’s what it says in the text books, so that’s on them.”
Charlotte (Black OBGYN pro and mom): “We look to the patient. The patient is the problem: the patient is too fat, too thin, too black, too… you know, problematic… Can you imagine every conference that you go to for 30-something years – and they put up slides and every single thing that is bad or negative in healthcare is Black or African-American: We have the most sexually transmitted diseases, the most babies that die, the most women that die, the most diabetes, the most dying early, the most bad – whatever…”
The medical system is having trouble wrapping its collective heads around how systemic issues affect maternal health:
Helen (Black OBGYN professional): “Okay, but the reason why they're going into preterm births a lot is not because there's something intrinsically wrong with their cervix or their ability to hold a pregnancy. Okay? Yes, there is a subset of patients that they may be true for…
It's because of racism and stress and social economic disparities and all of that stuff coming together right that it's probably contributing to that problem.
Not, “Oh my God, we’ve got to come up with a medication and fix it.” It's like no you to fix America. You need to fix the society. That's what you've got to fix if you want to make things better.”
Black women are under siege from systemic racism and bias throughout society:
Carol (a Black mother with 5 children): “They thought I was a statistic. People assumed that I was nothing because I had four kids, you know, before I had Kai. They assumed I’m just an unwed mother of four. Even still to this day. If I meet people, and I’m like, “Oh I have five kids…” If you would see the looks.So the men are like, “oh, she a easy smash.” The women is like, “oh, she a ho.” And the professionals are like, “oh my gosh she must get a ton of food stamps and welfare,” you know, like that’s the motive!”
Helen (Black OBGYN professional): “Yeah. My mom is from Greensburg, Louisiana – we’re 1 from 10. Like I said, five boys five girls. My late grandfather was a business owner, and he had a lot of respect from a lot of the white people within his community because he was a really good business owner. However, just up the street where they were raised, was like this huge tree – very scary tree now – and that's the one where they used to lynch people..... But, I think his being respected kind of protected them to a certain extent… but, it was still reminders everywhere that there's only so far to the line that you will go. Or you will quickly be brought back to be reminded that you are still black in America.”
Gwen (Black medical professional and mother): “And then my husband said that’s how he survived in south side Chicago. His parents paid for private school. All the kids at…all the kids, all the boys that survived the neighborhood, that did not get shot – some still got shot and killed – but that did not get totally immersed in gangs, their parents paid for them to go to Catholic school. Now they were not Catholic, but it has nothing to do with religion. It has to do that we’re paying for…we’re paying for safety.”
(silence)
What kind of crap is that?
…Yeah, that’s what being black in America is.
So, to sum up…how do we go forward?
Get involved: Medicine is beginning to confront inequities in leadership and training and that’s great news. I’m a member of the racial equity work group for the Texas Coalition for Healthy Mothers and Babies and this February our symposium drew hundreds of medical pros and interested people from around the country. A day before the conference, we hosted Joyce James and her Groundwater Analysis Workshop examining racial inequalities in society and medicine. Keep your eyes open for other opportunities to engage, but even better organize your own racial equity experience. Don’t wait for someone else to do it – get up front and lead!
Challenge yourself and flip the script: Only you hear what those little voices in your head say about the people around you, but chances are sometimes they’re not good. Here’s something to chew on: the negative thoughts you have about someone else are actually telling you more about what you think of yourself. Ouch! So, when you hear that voice, hit the pause button and actively challenge the message you’re hearing. What are the positives you can see about that person? What can you understand and have compassion for in their experience? How can you express that and change the experience for both of you?
Advocate! The U.S. need more pregnancy health professionals and that means challenging the paradigm of OBGYN-led birth experiences and having more midwives and doulas at mothers’ sides. I’m directly quoting from The Commonwealth Fund research here: “Midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetrician-gynecologists, or ob-gyns (see box).9
The U.S. and Canada have the lowest overall supply of midwives and ob-gyns — 12 and 15 providers per 1,000 live births, respectively (Exhibit 3). All other countries have a supply that is between two and six times greater.”
Vote with compassion: The United States punishes mothers in many ways. We have no mandated maternity leave, no standard for medical home visits following delivery, no comprehensive medical care coverage for mothers – in fact, Texas stops coverage for women who deliver without insurance 60 days after they have their baby. Fact: 52% of pregnancy-related deaths occur between 1 and 365 days after delivery.
We need more minority and female leadership in medicine and research: In the first decade of the 2000s, three-fourths of medical practitioners were White and the majority of the heads of major medical practices, medical systems, and institutions of public health are White (and male.) The researchers are also white: 90% of NIH and branch lab chiefs are White as are 83% of senior investigators.
Want to read more?
Bair, Barbara, and Susan E Cayleff. Wings of Gauze: Women of Color and the Experience of Health and Illness. Detroit: Wayne State University Press, 1993.
Black Mothers Respond to Our Cover Story on Maternal Mortality,” The New York Times, April 19, 2018, accessed November 20, 2019,https://www.nytimes.com/2018/04/19/magazine/black-mothers-respond-to-our-cover-story-on-maternal-mortality.html.
Feagin, Joe R. and Zinobia Bennefield, “Systemic Racism and U.S. health care,” Social Science and Medicine,” No.103.
Gilman, Sander L., “Black Bodies, White Bodies: Toward an Iconography of Female Sexuality in Late Nineteenth-Century Art, Medicine and Literature,” Critical Inquiry, Vol 12, No. 1., 1985, pp. 204-242.
The research I discuss in this piece was done for my MA thesis in Cultural Sustainability at Goucher College in 2019 in Houston, Texas and won the program’s 2020 Rory Turner Capstone Prize.