Racism in Healthcare

When a Failed System Costs your Life

Imagine that you’ve just found out you’re going to be expecting a baby. Your mind comes to grips that you’re about to embark on a privileged journey that should feel like a birthright but you also understand is a blessing that many others won’t receive.  Carrying a baby will be an adventure- an emotional one with ups and downs. Now, let’s fast forward.  During your prenatal visits, you notice that your partner isn’t very involved. Not because they don’t want to be, not because they aren’t asking questions but because your doctor is ignoring them.  The provider talks through them, over them, or around them and when speaking to you they don’t really address any of your concerns or questions. Something doesn’t feel quite right about it, but you tell yourself you’re over thinking because your doctor is the smartest person in the room after all.  They’ve learned more about your body and how it’s supposed to operate in their time in medical school then you do instinctively, or at least that’s how they make you feel.

Then the moment of truth comes, you’re going into labor. So much is ahead of you, graduations, holidays, driving lessons, first day of school. Sounds amazing doesn’t it? Well if you’re a Black woman you are 243 percent more likely to never see any of these things happen, because you will die as a result of childbirth related causes.  If you’re a Black woman and you survive, your baby may be twice as likely to die before the age of one than a white baby.  Such an amazing experience, an amazing story full of possibilities that you may be robbed of depending on your skin color.

Because of systematic and structural racism within our healthcare system and with direct service providers, many black families never get to see their futures come to fruition.  Racism that is entrenched not only in our systems but in the minds of our healthcare providers, often silence Black women who try to advocate for themselves. When some Black women try to make providers aware of something not feeling right or being wrong, they are told to tough it out.  There are often internal discussions held between medical personnel to delay procedures and ignore the woman’s pleas because “she’s just trying to get extra pain meds” or “aren’t Black women supposed to have a higher pain tolerance?” While these conversations are happening, a Black mother is suffering, bleeding out internally because her provider, the person she’s trusting her life with, is relying on white supremacist myth and ideology about who or what Black women are. This neglect inevitably leads to the death of another mother, never able to watch her child grow, see his or her first day or school, graduate, or get their first job.

This same white supremacist ideology is what made the doctor to remove the father from the delivery room causing him to miss the birth of his child. All the while, he is also being threatened to be removed from the hospital by security or police entirely because the doctor was frightened and mistook the father’s requests to be informed of what’s going on during labor and/or why the staff weren’t following the birth plan, as a perceived threat to the provider’s safety. Imagine an inquiry into the safety of your wife and unborn child resulting in an indirect threat to your safety at the hands of law enforcement on what should be the most amazing moment of your life? What do you do when you feel powerless as a parent, as if your life is in the hands of someone that doesn’t see you as a human being?

Doulas and midwives have been in existence for hundreds of years.  In the days before medicalized healthcare, they were seen as prestigious roles in various tribes and communities across the world.  Fast forward to the present day, where hospitals have seemingly absorbed the bulk of birthing duties. In America, the role of a doula or midwife has emerged as more of a luxury for middle class or wealthy white women who are looking to take a more natural or holistic approach to childbirth.  It’s become a luxury that has been made inaccessible to lower income and Black or Brown families.  The tragedy is that for this same demographic of individuals, the role of a doula or midwife can be a matter of life or death, not merely an option.

The role of the doula or midwife (a knowledgeable birth attendant comfortable navigating healthcare systems that can seem confusing and in some ways negligent and predatory) is important to Black and Brown women because this knowledge, along with the rapport established with the birthing parent, is what is needed to combat and confront the arrogance and total disregard for these parents. These attitudes are only afforded to the healthcare providers because of systematic racism. The atmosphere in a delivery room can be rendered either neutral or in favor of the patient when healthcare providers are made aware that they don’t have free reign to do as they please because they are no longer the only one in the room who is aware of all the options and standards that are supposed to be made available to all families regardless or race or gender.

Earlier I listed a statistic, and that stat was 243 percent.  If the stat read 2.43 percent more black women die of childbirth related causes than white women, the number would be so small it could be dismissed as an anomaly. It we wanted to move that decimal point over to the right one more, it becomes 24.3 percent and it would still be small enough that scientists or public health professionals may try to explain the difference away by bringing social determinants of health (where one lives, what they eat, lifestyle etc) in to play as a reason for the disparity.  But when we have a number as large as 243 percent, and we know that biologically, there is no physical difference between Black women and their white counterparts, we then have to have a discussion about the structures and people in place that are responsible.

Although this has been an issue for decades, it took the story of Serena Williams, a high profile athlete with influence, getting up from her hospital bed to demand her doctors pay more attention to her and address her needs in her near death experience postpartum.  Serena Williams is a woman and mother like others on this planet.  She wants the best for her daughter, to see her grow, provide for her, see her future.  But despite her being a mother like any other, and being a world class athlete, it took her asserting her privilege and influence to make sure that she was not yet another black woman who would be a statistic and tragic maternal death story. What will we do to ensure that other Black women without her fame can be heard and helped? What will we do to ensure other Black women without her money and influence feel assertive enough to be able to advocate for themselves, to be heard or have the resources for an advocate? How can we make sure that every woman matters by not letting healthcare systems determine who lives or dies based on skin color?

By William Moore, Health Educator, Doula, Lactation Educator & COO of Black Prāṇa Magazine

Photo by @dioburtophoto