How Perceived Racial Differences Created a Crisis in Black Women’s Healthcare

In 2016, a black baby born in Charlottesville, Virginia, was almost ten times more likely than a white baby to die in their first year of life.1 That same year, researchers from the University of Virginia revealed that nearly 21% of first-year medical students at the school believed that black patients had stronger immune systems than white patients. In the second-year class, 15% believed that black couples were more fertile than white couples. Over 40% of first- and second-year medical students, and a startling one-quarter of residents, believed that black patients’ skin was thicker than that of white patients. These numbers have real, deeply troubling ramifications; medical practitioners who demonstrated this racial bias were less accurate in their treatment recommendations 15% of the time.2

These statistics are not unique to Charlottesville, but they reflect how false beliefs about racial differences have led to a crisis in black women’s healthcare in the United States. In order to understand this systemic inequality today, we must first examine how the legacies of slavery and modern-day racism have shaped our understanding of black motherhood.

Over two hundred years ago, Thomas Jefferson — the founder of the University of Virginia — signed into law a bill that banned the transatlantic slave trade, ending the importation of black labor into the United States. In order to increase the enslaved labor force — the backbone of the American economy — slaveholders increasingly intervened in black women’s reproduction. This ban invariably limited black women’s ability to determine their reproduction, as enslaved women were coerced and often violently forced into motherhood.

In order to justify slavers’ unconscionable reproductive attitudes, black women were stereotyped as “natural mothers.” According to Marie Jenkins Schwartz, an expert on enslaved motherhood, “owners

An enslaved family, c. 1850. (Courtesy Accessible Archives)

adhered to a racist assumption that all black women were fecund — more so than whites — and would breed if given the chance.”3 When black women were barren or lost their children (often as a result of hard labor and poor nutrition), they were blamed and punished by white slaveholders and physicians for being unable to fulfill their “natural duties” as mothers.4

In an attempt to regain reproductive control, enslaved women used natural substances like cotton root to prevent and terminate pregnancies. Yet, contraceptives and abortifacients were condemned, not out of moral concern but because they infringed on white masters’ property rights.5 In the Works Progress Administration slave narratives, William Coleman, a formerly enslaved man from Tennessee, recounted that a slave owner “would almost kill a negro woman if he caught her chewing cotton-root, but still that did not do much good, they would slip and chew it in spite of all he could do about it.”6 Women defied their masters at great personal risk, but reproductive resistance led to increased policing of black motherhood and resulted in deep-seated mistrust in black mothers.

Even after the end of slavery, these racist ideologies persisted in the United States and negatively affected black women’s ability to access equal healthcare. In the 1940s, Americans continued to perpetuate the myth that black women were self-reliant, natural mothers in order to deny unwed black mothers welfare benefits. Though unwed motherhood was deeply stigmatized at the time, it was deemed permissible for black women. “Experts” at the time claimed that black women had children out of wedlock “simply because they were ex-Africans … and ex-slaves,” asserting that illegitimate children were an unchangeable aspect of black culture.7 By becoming mothers, even unwed mothers, black women were seen as simply doing what came naturally to them and thus were undeserving of official care.

Historian Rickie Solinger calls this public attitude “benign neglect,” yet it was anything but benign.8 Black women rarely received adequate welfare or equal medical treatment, despite being in a health crisis. In 1940, the Birth Control Federation of America reported that half the black population were undernourished; black children had an infant mortality rate 60% higher than whites; tuberculosis and syphilis were five to six times more prevalent among black people; and black mothers had twice the rate of mortality in childbirth as white mothers.9

Any social assistance, however, gave white politicians cause to accuse black women of healthcare fraud, justifying neglect and perpetuating the century-old myth that black mothers were not to be trusted. According to Solinger, “spokespeople for this point of view believed that black unmarried mothers should pay dearly for the bad bargain they foisted on society, especially on white taxpayers.”10 These spokespeople did not suggest the same for unmarried white mothers.

When black women did receive medical attention, it was not for their own well-being, but because they were seen as a financial and social threat to white hegemony. After World War II, organizations like Planned Parenthood entered almost exclusively low-income African American communities in order to provide women with contraception.11 Politicians asserted this was to preserve black mother’s health, which was indeed worse than white mothers, but it also effectively regulated, even reduced, the black population at the height of the eugenics movement.

Protestors denounce the forced sterilization of black women in the United States. (Courtesy Women Africa)

Black women directly — and permanently — suffered from the eugenic movement’s medical racism. Beginning in the 1930s, eugenicists sterilized poor and institutionalized black women, whom they deemed unfit to reproduce. Even as state-run eugenics programs ended, this discriminatory practice continued into the 1970s as black women were coerced or forced into sterilization by their white physicians.12 Sociologist Dorothy Roberts writes:

But most sterilizations of Black women were not performed under the auspices of the eugenic laws. … During the 1970s sterilization became the most rapidly growing form of birth control in the United States … It was a common belief among Blacks in the South that Black women were routinely sterilized without their informed consent and for no valid medical reason. This sort of abuse was so widespread in the South that these operations came to be known as “Mississippi appendectomies.”13

Healthcare was not meant to be a benefit for black women, but rather a way for white Americans to police — and even prevent — black motherhood.

Throughout the twentieth century, black motherhood was stereotyped, regulated, and even prevented due to perceived racial differences between white and black mothers. Today, before African American women even enter a hospital to give birth, the cards are already stacked against them.

In 2019, the Centers for Disease Control and Prevention (CDC) reported that black women in the United States are over three times more likely to die from pregnancy or childbirth-related causes.14 The CDC also reported in 2017 that black babies are twice as likely to die within their first year compared to white babies.15 According to the Brookings Institution, education and income make little difference. In fact, a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.

To explain this healthcare crisis, researchers at the University of Virginia did not blame poverty, education, or individual prejudice, but instead examined how decades of racial stereotypes and misconceptions have affected the way we treat black mothers. A year before the University of Virginia report came out, however, Mother Health International, a nonprofit dedicated to improving reproductive healthcare in areas with the highest infant mortality rates, opened a branch in Charlottesville. This organization, called the “Sisters Keeper Collective,” matches mothers of color with African American and Latinx doulas who provide perinatal support and advocate for mothers to ensure equal care.

For African American women in Charlottesville, the University of Virginia’s groundbreaking research was old news. In Charlottesville, and across the United States today, black mothers are in a fight for their — and their babies’ — lives against the same forces that have held them back for over two centuries.

Notes

  1. Dayna Bowen Matthew, “Community-Engaged Research in Public Health and Law,” Lecture, University of Virginia, Charlottesville, December 2, 2019. Return to text.
  2. Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver, “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites,” Proceedings of the National Academy of Sciences, no. 16 (April 19, 2016). Return to text.
  3. Marie Jenkins Schwartz, Birthing a Slave: Motherhood and Medicine in the Antebellum South (Harvard University Press, 2006), 15. Return to text.
  4. Deirdre Cooper Owens and Sharla M. Fett, “Black Maternal and Infant Health: Historical Legacies of Slavery,” American Journal of Public Health 109, no. 10 (2019): 1342–45. Return to text.
  5. Montia Gardner, “The Reproductive Resistance of Enslaved Women in the Antebellum South,” Lecture, International Center for Jefferson Studies, Charlottesville, VA, July 26, 2018. Return to text.
  6. Gardner, July 26, 2018. Return to text.
  7. Rickie Solinger, “Race and ‘Value’: Black and White Illegitimate Babies in the USA, 1945–1965,” Gender and History 3 (1992): 352. Return to text.
  8. Solinger, 352. Return to text.
  9. Linda Gordon, The Moral Property of Women: A History of Birth Control Politics in America (University of Illinois Press, 2002), 250. Return to text.
  10. Solinger, 354. Return to text.
  11. Gordon, 259. Return to text.
  12. Dorothy E. Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (Vintage, 1999), 90. Return to text.
  13. Roberts, 90. Return to text.
  14. Emily E. Petersen, Nicole L. Davis, and David Goodman, et al, “Racial/Ethnic Disparities in Pregnancy-Related Deaths – United States, 2007–2016,” Morbidity and Mortality Weekly Report 68, no. 35 (2019): 762–65. Return to text.
  15. T.J. Mathews and Anne K. Driscoll, “Trends in Infant Mortality in the United States, 2005–2014,” National Center for Health Statistics, no. 279 (2017). Return to text.

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