Compass Gender Black History Month Special: Outside the Pro-Choice vs. Pro-Life Debate
When asked about the current landscape of abortion and reproductive health in the United States, most Americans would describe the ongoing battle between the Pro-Life and Pro-Choice lobbies. However, this highly politicized debate fails to capture the intersectional nature of race, racism, and women’s health. Throughout U.S. history, Black women have born the brunt of discrimination against female bodies and have pioneered activism geared towards ending it.
The Destruction of the Granny Midwife
Dating back to the period of slavery in the U.S., systemic racism has inhibited Black women’s access to reproductive health services. As such, a culture of Black women providing reproductive health care to Black mothers naturally arose. These women, referred to as “granny-midwives” or simply as “grannies,” made up half of all reproductive healthcare providers before the Civil War. These skilled granny-midwives delivered babies and provided contraceptives and abortions, both of which were legal.
When slavery was abolished, skilled granny-midwives had to work within a culture of continued white supremacy in the reunified Union. Furthermore, they challenged the authority of white obstetricians, who despised the idea of Black healthcare professionals. On a more practical note, granny-midwives competed with them for jobs.
Black midwives remained the dominant practitioners of reproductive health until the 1800s. (Twitter)
To remove their competition and reinforce their egos, white doctors used the political and legal system to push granny-midwives out of practice. They announced that midwives were out of touch with modernity, unhygienic, unskilled, and unprofessional. “The midwife has been a drag on the progress of the science and art of obstetrics. Her existence stunts the one and degrades the other,” said Dr. Joseph DeLee, a 20th century OB-GYN.
The white obstetricians were systematic and ruthless in their approach. Beginning in the early 1800s, politicians gradually passed laws banning midwifery, thus establishing a monopoly of male gynecologists at modern hospitals. Furthermore, the American Medical Association (AMA), founded in 1847, actively prevented Black doctors from practicing.
White doctors also utilized moral arguments against abortion to frame their campaign to push women, specifically Black women, out of health care. This development led to many of the country’s earliest abortion bans that lasted in many states for more than a hundred years.
By the 1970s, midwifery was all but wiped out, with only 0.3 percent of all births performed by midwives outside hospitals. This systematic destruction of granny-midwives has had devastating consequences for Black women who still face systematic racism in the medical industry.
Black women continue to face extraordinarily high barriers to entry into the medical industry today.
Dr. Princess Denner was suspended from her role as program director at Tulane School of Medicine on February 11 following a lawsuit she filed against the school. She alleges that the school’s upper administrators discriminated against her based on race and sex. According to Denner, while being interviewed for the position, the dean of the school said, “I’m afraid that white medical students wouldn’t follow or rank a program favorably with a Black program director.”
Denner’s suit is only one of several ongoing discrimination suits against the school.
Treating Black Patients Without Black Doctors
In the United States, Black women are two to three times more likely to die from childbirth than white women, according to the CDC.
Part of the issue regarding disparate maternal mortality rates is the systematic undertreatment of Black people due to false medical beliefs about racial differences stemming from the historical lack of Black women within the medical community. These include the ideas that Black people have less sensitive nerve endings, thicker skin, and blood that coagulates more quickly than white people.
A 2016 study in the Proceedings of the National Academies of Science found that half of a sample of medical students believe in at least one of these false notions. These participants rated Black patients’ pain as lower than white patients, resulting in less appropriate treatment decisions.
A 2012 study in the National Center for Biotechnology Information found that the greater a healthcare provider’s bias for white people, the less likely they were to prescribe a Black patient the appropriate pain medication.
In a meta-analysis of 20 years of pain treatment disparities, Black people were 22 percent less likely than white people to receive painkillers and 29 percent less likely to receive opioids for similar instances of pain than their white compatriots. In a study on racial bias in pain recognition, white participants identified pain less readily on Black faces than white faces.
These false conceptions of pain date back to slavery. Before the Civil War, physicians in America and the West Indies constructed the notion that Black people had fundamentally different bodies that were naturally immune to certain diseases, less immune to others, more tolerant of pain, and that needed different treatments.
Physicians peddled pseudoscientific beliefs that Black people are biologically distinct from white people; some such ideas were that Black people had thicker skulls and less sensitive nervous systems and predispositions to diseases inherent in dark skin. They used these false beliefs to justify using Black people for slavery and unethical medical testing.
Dr. Samuel Cartright, a 19th-century doctor and proponent of slavery, wrote that Black people have a “Negro disease [making them] insensible to pain when subjected to punishment.” At the same time, other physicians thought that Black people could handle surgery without experiencing pain, leading to racial experimentation in the 20th century. These beliefs were further compounded by the ousting of Black doctors and midwives from the medical community.
These ideas continue to be reinforced and normalized today by popular stereotypes that Black people are naturally better athletes or that Black women are supposed to be strong and resilient rather than complex and vulnerable to pain. Research reveals that the belief that race is biologically determined increases acceptance of racial inequities.
Compounding Structural Inequities
Inequities in access to resources due to generational racism also play a part in maternal health disparities.
Since the end of the civil war, Black families have been denied opportunities to build wealth, such as access to educational opportunities and high-paying jobs. Because enslaved people could not own property, their descendants inherited less wealth from their ancestors than their white counterparts.
Furthermore, housing discrimination and racial terror made it more difficult for Black people to maintain their footing. On the one hand, white mobs frequently destroyed any progress within prosperous Black communities, as seen in the Rosewood and Tulsa massacres. On the other hand, redlining, which began in the 1930s, plotted which neighborhoods would receive investments and which would be marked as “high-risk.” The practice of redlining led to the denial of federal housing assistance and local bank loans for Black families who often lived in redlined neighborhoods due to the generational wealth gaps stemming from slavery.
An example of redlining can be seen in this 1971 real estate map from Arlington, Virginia, valuing houses in majority-Black neighborhoods as less than houses in white neighborhoods. Houses in neighborhoods marked as red were valued at $20,000 or less, while purple and blue neighborhoods were valued between $40,000 and $50,000. (ARLnow / Creative Commons)
Black neighborhoods’ underdevelopment has led to gaps in access to resources, impacting maternal health because of food deserts and lower quality or absent hospitals.
A clear example of these inequities is in Georgia, where 76 of the state’s 159 counties lack an OB-GYN or psychologist. Given that psychological problems can develop into physical ailments, the absence of these services raises several concerns. Studies show that the stress of living in a race-conscious society may influence racial healthcare disparities that affect Black people, especially Black women.
The stress of enduring racism has also been associated with high blood pressure, contributing to maternal complications such as eclampsia. This issue can be especially dangerous for pregnant Black women when biased doctors do not accurately prescribe medication during these complications because of false notions of Black pain.
Georgia has one of the highest Black maternal mortality rates in the country: 95.6 for Black women versus 59.7 for white women (per 100,000 live births).
Pro-Choice Without the Choice
While Black women are often the most affected by structural barriers to reproductive health, they also have until very recently been left out of reproductive health activism
Until the late 20th century, many mainstream reproductive activist organizations were dominated by wealthy and middle-class able-bodied white women. These organizations primarily focused on the “pro-choice” agenda: the legalization of abortion and contraceptives.
However, these organizations ignored the needs of women of color. For women of color facing structural barriers to economic and medical resources, simply legalizing care did not translate to access.
In fact, there were several times in which the “pro-choice” activism actively hurt women of color and Black women specifically. Throughout the 20th century, white doctors forcibly sterilized women of color who were deemed unfit to bear children. However, when women of color activists pushed for guidelines and regulations for sterilization, white feminists actively opposed these efforts. In the white feminists’ experience, instead of facing coercive sterilization, they were at times refused sterilization when they requested it. Therefore, they saw any attempts to further regulate sterilizations as infringing on their freedom of choice.
Another illustrative example is the pro-choice lobby’s universal support of mifepristone, a non-surgical pill used to terminate pregnancies. Despite the enthusiastic advocacy for the pill, many women of color displayed concern over the pill. They noted that testing on women of color was insufficient and that many women of color lacked access to the necessary follow-up medical care. Their concerns, overall, were ignored.
Taking Activism into their Own Hands
Reproductive Justice advocates take to Washington to protest limited access to birth control. (ALL / Creative Commons)
In response to the flawed advocacy of white feminists, Black women took the activism into their own hands and founded the Reproductive Justice (RJ) Movement. In 1994, a group of Black women called the Women of African Descent for Reproductive Justice met in Chicago to discuss the needs of working-class women and women of color. Following the meeting, the women published a statement with more than 800 signatures in the Washington Post calling for reproductive justice in the United States.
In 1997, a new Georgia-based organization, SisterSong, was founded to continue the push for RJ in America. SisterSong currently describes itself as the largest national collective representing women of color of all ethnicities as well as queer people.
“RJ is simply human rights seen through the lens of the nuanced ways oppression impacts self-determined family creation,” SisterSong writes on their website. “The intersectionality of RJ is both an opportunity and a call to come together as one movement with the power to win freedom for all oppressed people.”
Today, SisterSong continues this mission of focusing on reproductive justice for women of color. To combat the systemic injustices women face in Georgia, they are spearheading a Birth Justice Task Force to help people giving birth during COVID-19. This group is gathering information from doulas and birth workers who might not be able to enter the delivery rooms during the pandemic to investigate how to address community concerns.
SisterSong has also paved the way for grassroots RJ organizations to spring up across the country.
Black Mamas Matter Alliance (BMMA) is another project based in Atlanta that promotes reproductive health. By collecting and communicating information on reproductive health in Georgia, this alliance works to educate policymakers and legislators on Black maternal and reproductive health. Last year, the alliance urged the Georgia lawmakers to extend Medicaid for poor mothers from two months of coverage to a year. The legislature agreed to six months.
In 2021, BMMA is focusing on addressing restrictions to midwifery and doula care and alternatives to hospital births in the context of their racist medical history. In Georgia, where maternal healthcare deserts result in low access and high risks, expanding the availability of midwives would be crucial for Black women.
Black women have also brought RJ to the forefront of national politics. Representatives Lauren Underwood (D-Ill.) and Alma Adams (D-N.C.), co-chairs of the Black Maternal Health Caucus, and Senator Cory Booker (D-N.J.) introduced the Black Maternal Health Momnibus Act of 2021 last Monday.
The bill contains legislation almost identical to the package put forward with Vice President Kamala Harris as a lead sponsor last March before the pandemic, in addition to three new bills to promote maternal vaccination. The bill also includes funding for community organizations and local governments to work toward bettering maternal health outcomes, as well as bias, racism, and discrimination training in maternal care, and intentions to grow the perinatal workforce.
Grassroots RJ organizations like BMMA and SisterSong have rallied to support the Momnibus bill (Twitter)
The legislation also addresses access to housing, healthy food and water, transportation, childcare, and healthcare, which invariably affect health outcomes.
“When we talk about these kinds of long-standing disparities—housing, nutrition, transportation—there’s room to make sure that we are creating a structural environment that is responsive to these long-standing access issues. When we solve them, we will save lives.” Underwood said in an interview with the 19th.
To define America’s reproductive justice struggle solely with the “pro-life versus pro-choice” debate is to leave out a fundamental part of the American story. From the beginning of American history to today, Black women’s skills and advocacy have been central to the reproductive health of millions of women.
