Disclaimer: The purpose of this article is not to hierachise the suffering. Any pregnancy can be risky. The article aims to raise awareness of the situation of pregnant black women.
The first time I heard about how black women’s pregnancy and the issues related, was while listening to a podcast, how racial bias in medical care impacts pregnant black women’s health. The issue addressed was the caesarean that many African descent women experience in France.
The studies conducted in France usually disregard the racial aspect. The search for current information becomes harder. However, an article from la Revue des Migrations Internationales focused on the racialisation of black pregnant women in the medical field in France. This article brings together the few clinical studies on the perinatal health of black women. The rate of women having had a cesarean section is higher among Black women of African descent. Between 1988 and 1994, cesarean section rates were significantly higher for black women of African heritage, at 34% compared to 19% for the general population (Gayral-Taminh et al., 1999).
‘Another study conducted at Rouen University Hospital over the period 1998-2000 shows that the cesarean section rate for black women of African heritage is 38%, while it is 19.7% for other women (Benoit, 2004)’. The use of cesarean sections affects more black women from sub-Saharan African countries who migrated to France. They would be 33.3% compared to 19.3% for women born in France regardless of race. The willingness to subjugate black women, and African women, in particular, stems from preconceptions that African women have a smaller pelvis, with the ‘android-shaped character of the pelvis’ (Pambou et al., 1996: 375).
Pregnant black women are also treated differently when it comes to the time of gestation. Based on research from the United States, many health care providers in France decide to shorten the gestation time of pregnant black women. They argue that there is a different ‘pathophysiology’ concerning either the length of fetal gestation or placental maturity. For them, applying such a ‘protocol’ would make it possible to reduce perinatal foetal mortality. Such an arbitrary decision decides in the place of these women, who are not informed of it in the majority of cases. It is a decision that, moreover, generalises and does not provide any personalised medical assistance.
The issue is global. Black women’s pregnancy is everywhere risky.
In Canada, black pregnant women ‘have substantially higher rates of premature births than white women’. In the United Kingdom, Black pregnant women are eight times more likely to be admitted to hospital with COVID-19, while Asian women are four times as likely. They are five times likely to die due to complications than white women.
In the United States, where studies on black women’s pregnancy are pretty advanced, ‘Black women are 2 to 3 times as likely to die from a pregnancy-related cause than white women’. Although the issue is global, only a few studies are conducted on the topic and mainly come from the United States.
Racial bias in medical care for black women’s pregnancy affects all socio-economic backgrounds. Tia Mowry opened up about her endometriosis complicating her pregnancy, in her interview in Women’s Health. ‘I’d never really seen someone African American in the public eye talking about endometriosis or their struggles with infertility. And when you don’t know or see anyone else who looks like you talking about what you’re going through, you feel alone and suffer in silence’.Serena Williams, Beyoncé, also opened up about their difficulties during their pregnancy.
Commodification of black bodies
The reasons for recurrent mistreatments or misdiagnoses of black pregnant women are entrenched in the commodification of black bodies. Dr Sims is considered the father of gynaecology. He practised ‘operations’ for years on black women and children without anaesthesia and consent, being experimental subjects for developing gynaecology. The first patient he operated on was Lucy, 18 years old, who had given birth a few months before and had been suffering from bladder weakness ever since. The young woman underwent an hour-long operation, screaming and crying in pain, in front of a dozen impassive doctors. On another slave named Anarcha, he completed more than 30 operations, as he wanted to perfect his method before practising on white women with anaesthesia.
These practices have forged the idea that black women are more tolerant of pain, that they don’t need so much attention to their concerns, contributing to poorer maternal outcomes for black pregnant women.
Many factors impact racial disparities in health care
Assumptions, racial biases, lack of personalized medical care and lack of studies on black women’s pregnancy and invisibilization of black people in medical care could be, among many other factors, favoring racial disparities in healthcare. As a result, distrust is normalized and thought. I grew up in an environment where many people of African heritage would not trust medicine, not because they do not believe in it, but due to mistreatments and racial biases.
‘In a survey examining trust in physicians, hospitals, and health plans, Boulware et al. (2003) found that Black American respondents were significantly less likely than Whites American to trust their physicians. Black American respondents were also more likely than Whites ones to be concerned about the personal privacy and the potential for harmful experimentations in hospitals’.
Every pregnant person deserves to receive the most appropriate care, but for the moment this remains a utopian dream.
It is important that these racial biases are no longer a general truth that is wrongly scientized, to leading to continued mistreatment and wrong diagnosis.
Percevied racism and trust in health care, Sara N. Sayre