Excerpted From: Ilse Turner, Praying for a Healthy Birth, Black Mothers Fighting Racism Even in the Delivery Room, 19 Journal of Health & Biomedical Law 175 (2023) (51 Footnotes) (Full Document)


IlseTurnerHaving a baby is one of the most anxiety-inducing experiences in a woman's life. The days leading up to birth are often filled with thoughts such as: will my baby be healthy? Will the doctor be on time? What if I need to have an emergency c-section? Black women, however, face an additional worrying question, will I receive adequate medical care? On average, Black women are two to three times more likely to die from pregnancy-related causes than white women. These trends persist even across states with lower pregnancy mortality rates and across women from all educational backgrounds.

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To understand the perpetuation of racism in the modern-day delivery room, one must understand the long-standing history of racism in all facets of Black women's reproductive health. At the start of American history, Black women's ability to procreate was harnessed to maintain the system of slavery by replenishing the enslaved labor force with every birth. Slave owners often used deceitful tactics to induce Black women and men to have sex to enhance the work force, often through preferential treatment or practices to encourage “prime” slaves to have sex to create an even better slave. During the post-Civil War era, Black women faced a new threat to reproduction, not the threat of hyper-fertility, but rather, the threat of sterilization. The turn of the twentieth century coincided with the popularization of eugenics, specifically in Black communities, where authorities like doctors and police officers, often deemed Black parents unfit, behaviorally challenged, and biologically deficient. Margaret Sanger, founder of Planned Parenthood, was a huge proponent of these eugenic practices. Sanger targeted Black neighborhoods as introduction points for birth control. Sangers goal with targeting Black neighborhoods was to tamp down populations that were seen as unfit and would have a negative impact on political stability in the United States.

As racism in the medical system grew, Black women experienced it at all fronts. Black women were routinely sterilized without consent and used as late-stage medical testing for birth control by doctors. Furthermore, Black women were routinely prompted to become sterilized in order to be able to keep governmental benefits by legislative and judicial officials.

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In an effort to combat racism in the delivery room, we must continue to shift the burden of improving health outcomes for Black mothers away from the individual woman giving birth and onto the system that has been designed not for her benefit, but for the benefit of the system. One way that this goal could be accomplished is if the CDC were to declare that racism is, in fact, a public health issue. This declaration would give even greater recognition to the issue of racism in healthcare. Federal recognition of systemic racism would allow the CDC to direct funding to further research the maternal mortality rate in Black women on a federal and grassroots level.

Furthermore, there needs to be a greater focus on system-level issues, such as the availability of adequate healthcare in the community, better screening practices for Black women of underlying health issues during their pregnancy, and access to support for navigating the medical system. Often, providers rush Black women through their appointments and do not give Black women adequate information to help them make the best decisions for themselves. These providers also often fail to advise Black women of warning signs about what preterm labor is and when to seek medical help. There also needs to be more implicit bias training in the healthcare field so providers can actively be educated on their biases and how they are negatively affecting their patients. This education of implicit bias works to break down internalized racism often held by doctors against their patients that providers might not even recognize that they have.

What is clearer than ever is that the delivery room is one of the most dangerous places for a Black woman to be, and there must be systematic changes to stop this injustice. An important change that the government and healthcare field can make is shifting from the view that a Black mother's health is an individualized burden to a reflection that Black mothers are forced to navigate a system rooted in racism. This reflection needs to lead to changes at all levels of the healthcare field to provide better protections for Black women in the delivery room.

Ms. Turner is a Law Clerk in the Indian Law Project at Nevada Legal Services. Ms. Turner may be reached for comment at iturner @nevadalegalservices.org.