Issue No. 4: Black Maternal Health
Words - Dominique Paloma Bible

We have undergone 600 years of intensified and compounding racism that is now global. This racism is rooted in Western European anti-Black sentiments from the 1400s. This racism is rooted in the beginnings of imperialism and capitalism. This racism is the reason why a college educated Black woman is likely to fare worse in health care than their counterparts of all other races who not only didn’t attend college, but who dropped out of high school.

If you have an identity that is marginalized or multiple identities that are marginalized, you have less and less of a chance of being seen as your full, complex self. Your wholeness is less likely to be understood and respected, which negatively impacts the health care you receive.

When a Black mom-to-be walks into her doctor’s office, she is more likely to be seen as her labels. She is more likely to have a miscarriage and is more likely to die during childbirth. When you are understood as your labels instead of as your whole self, it breeds disconnect and increases stress and tension. We live in a society that categorizes people and compartmentalizes life. Racism is one festering, gargantuan tentacle of our shared system. Other unfortunate and sometimes fatal tentacles include sexism, homophobia, transphobia, ableism, and ageism, among others. These weapons of control repeat themselves on different scales, attacking from institutional as well individual levels.

Racism has proven detrimental effects on physical and mental health, and more research needs to be done about what racism does to the brain and body. Every human being is a part of their environment and their environment is a part of them. Whether that human being likes it or not, they are shaped and changed by what is around them.

If you have a job that involves servicing a living system (teacher, doctor, farmer, etc.), then you have a responsibility to do your best to understand and respect their complexity. Whatever profession deals with life, that professional has to take into account the environment of the patient, student, crop, or whatever. Know their context. Otherwise, you won’t be responding appropriately or serving that person in the best way. This is the philosophy behind systems awareness, an approach that aims to best respond to living systems.

For doctors, this means asking a range of questions that aren’t normally asked in the medical field. How’s your family? How’s your job? What keeps you busy these days? It means a comprehensive evaluation, which includes questions about diet, water, sleep, and exercise. It means your primary care physician asking about your mental health, and your psychiatrist asking about your physical health. With those answers, we are a few small steps closer to being systems aware.

Unless doctors are also cognizant of our racist environment and their susceptibility to racism or racist ideas, then they will still come up short when treating African American women. Racist ideas have tragically shaped us, both as patients and doctors. Doctors who treat African American women must study how racist laws and policies affect them and their families.

Black women consistently report being devalued and disrespected in health care practices. We cannot continue killing and hurting Black mothers and expecting mothers. We must commit to changing ourselves and our systems. When I say we, I am focusing on white people and cisgendered men. All people are connected and responsible for each other. There is a missing lived experience, a missing pool of insight and expertise that comes with being white or a cisgendered man in regard to treating Black mothers, and those identities flood the medical field. African Americans account for only 4 percent of the physician workforce nationwide.

We must constantly remember how institutional and individual racism emerge together, destroying the opportunities and lives of Black mothers across this Earth. Use that reminder as a way to stay aware. White people and cisgendered men, share peer-reviewed articles and reports detailing the impact of a racist health care system on Black women with your doctors. Ask them to read it, see what they think. Doctors, listen to African American women patients and trust them. Doctors, stay aware of racism—what it does to you, to your patients, and to your relationship with them. Stay aware of what it does to their heart and their kids. Your awareness of your susceptibility to implicit and explicit bias—a brutally honest and open awareness—is itself, a step forward. But it is not enough, either. We must attempt to recognize, understand, and respect the complexity of the people we serve.