Compared to white women, black mothers die at three times the rate during childbirth. Racism in healthcare has consistently failed women of colour. History of inhumane experiments on slaves has institutionalized stereotypes regarding how black people should be cared for. Many doctors still hold the belief that African Americans can handle more pain, leading to late and often incorrect diagnosis. Serena Williams’ experience regarding her complications with childbirth and racial bias sheds light on an extremely common experience among black women. Shortly after Williams gave birth to her daughter, Alexis Olympia, she fell short of breath. In 2011, Williams underwent emergency treatment for a pulmonary embolism. Williams immediately alerted a nurse about her symptoms. After walking out of the room to not worry her mother, Williams told the nearest nurse that she needed a CT scan and IV heparin (a blood thinner). However, the nurse thought her pain medicine might be confusing her and began performing an ultrasound on her legs.
I was like, a Doppler? I told you, I need a CT scan and a heparin drip.
After the ultrasound found nothing, a CT scan was performed. Several blood clots were found in her lungs, and minutes later, she was on a drip. Later, her coughs caused by the embolisms were so severe that her C-Section wound would split. When she went in for surgery, the doctors found a hematoma (collection of blood) in her abdomen, as a result of the blood thinners. When she returned home, Williams was on bed rest for six weeks.
Williams experience is among the 50 000 women (an estimate that researchers believe is on the low side) who face dangerous or life-threatening complication during pregnancy and childbirth. Black women are disproportionately likely to face complications, and being 3 to 4 times more likely than white women to die from pregnancy complications, they continually fall victim to America’s maternal mortality crisis. According to ProPublica and NPR, many of these deaths are preventable, but due to impacts of systemic racism and medical bias, black women are more likely than any other racial group t die from pregnancy. Williams story shows how this bias transcends even economic income and status.
In 1999, the human genome project proved their is no genetic definition of race. Despite this position, many physicians and medical scientists continue to use race in genetic studies, drug testing, and general practices. The existence of this bias is apparent in the eighteenth century, when medical professionals attempted to define racial differences. In the 1790s, Benjamin Rush, an early medical professor at the University of Pennsylvania, introduced racial differences into the curriculum. Rush taught his students that blackness was a form of leprosy that could be cured; Rush defined the future of America as white. Rush and other doctors believed they could cure blackness, but they still believed that white and black Americans were the same animals. However, after the American Civil War, many doctors and scientists signed to the theory of polygenesis, the idea that each human race is a separate species, fit to live in their “native” environments. Physicians of the time believed that African Americans were better fit to live on plantations with the diseases of tropical climates. In an 1857 essay, physician Josiah Nott argued to properly treat plantation workers, doctors must understand the natural relationship between African Americans’ bodies and southern, malarial climates. Firstly, Nott claimed that black people had a much higher tolerance to heat than whites.
[African Americans] can lie down and sleep on the ground in a temperature of at least 150 of Fahrenheit, where the white man would die in a few hours.
Nott also believed that African Americans were immune to the worst diseases of tropical climates, such as malaria and yellow fever. This position was also held by medical students all across the U.S. Although contemporary science has shown that antigens in sickle-cell trait has provided some protection against certain strains of malaria, there is no evidence regarding racial protection against diseases like yellow fever. Nott also provided vital moral reasoning for slavery by attempting to prove that black people are more suited for hard labour than whites. These types of medical theories resulted in vastly different treatment towards black people. Aside from the inhumane treatment provided to African Americans, slaves in the south were often exploited at the expense of medical research. Historians James Breeden and Todd Savitt uncovered the deep history of using slave bodies in classrooms, bedside demonstrations, operating amphitheatres, and in experimental facilities.
Outright experimentation upon living humans may have occurred more openly and perhaps more often owing to the nature of slave society… the situation may have been (and probably was) worse in the Deep South.
An example of this experimentation is wholly displayed by the elite enslaver and physician, Charlestonian Bennett, who consistently performed human subject research under American slavery. Bennett wrote about a patient who had developed,
a small tumour the size of a ten cent piece
when she was just four weeks old. Bennett, who was trying to become a doctor was desperate to perform a surgery. Bennett made a viciously crude attempt to remove this growth without anaesthesia and asepsis, which didn’t exist at the time. The interference with the enslaved child caused an extreme inflammatory reaction and excessive growth of the tumour, or quite possibly the lymph node. When the child was six, Bennett described the tumour as being the size of an ostrich egg. Before her death, the tumour reached an extraordinary size. Bennett noted,
An imperfect outline of the results furnished by the examination of the tumour, when I obtained the head, or at least so much of it as remained.
These types of experiments and tests were careless and violent, held in the belief that black people can handle more pain, and often the tests go unrecorded and ignored. The remains of the enslaved girl’s skull became a pathological specimen in the University of Maryland’s medical museum collection.
The deep history of racism and ignorance towards black people in medicine has led to a sustained mistreatment in contemporary practice. In the United States, maternal mortality rate has been on the rise, and it’s much higher than most of the developed world. Between 2000 and 2014, the U.S.’s maternal mortality rate rose 27% to 24 deaths per 100 000 births. This rate is more than three times the maternal death rate of the United Kingdom, and about eight times the rate of Netherlands, Norway, and Sweden. The crisis gets more complex as one recognizes the growing gap between the deaths of black mothers and their white peers. From 2011 to 2013, black women experienced roughly 43.5 deaths per 100,000 live births on average, compared to 12.7 deaths for white mothers. Research has shown that many factors like limited access to prenatal and postnatal care, chronic stress, the effects of racism, and inadequate medical treatments preceding childbirth likely play a role in a black woman’s likelihood to suffer from life-threatening complications. The maternal mortality disparity might appear to stem from economic differences, but research has found that black women in higher economic brackets are still more likely than white women to die from pregnancy and childbirth related problems. In a story from ProPublica, Annie Waldman illustrates why black women can’t educate or earn their way out of this crisis.
Even when accounting for risk factors like low educational attainment, obesity and neighbourhood poverty level, the city’s black mothers still face significantly higher rates of harm, the agency found. Of note, black mothers who are college-educated fare worse than women of all other races who never finished high school. Obese women of all races do better than black women who are of normal weight. And black women in the wealthiest neighbourhoods do worse than white, Hispanic and Asian mothers in the poorest ones.
Black women are 243% more likely than white women to die from pregnancy and childbirth, creating the largest racial disparity in women.
Black women have also heavily reported having their concerns dismissed by medical professionals. Americas healthcare system has a history of minimizing the needs of black women, creating medical facilities that are unequipped to handle their pregnancies. Journalists Nina Martin and Renee Montagne explain,
The feeling of being devalued and disrespected by medical providers was a constant theme. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB-GYNs in her seventh month, only to suffer a fatal postpartum stroke. Over and over, black women told of medical providers who equated being African American with being poor, uneducated, noncompliant and unworthy. “Sometimes you just know in your bones when someone feels contempt for you based on your race,” said one Brooklyn woman who took to bringing her white husband or in-laws to every prenatal visit.
Serena Williams’ story shows how being black and being female means it is impossible to escape scepticism and get adequate care. A growing number of black midwives have stepped in to provide adequate medical care, but activists argue that hospitals and doctors must also work harder to protect black mothers; it seems that they can start by listening to them. Only 5.7% of U.S. physicians are African American, out of a population that’s 13% black. However, outside of America, the crisis of inadequate care to mothers is still extremely prevalent
By the time Salome Karwah was 26, she had defied death three times. She survived the longest and deadliest Ebola epidemic in history, which killed over 11 000 people along with her mother, father, and uncle. Karwah previously fled two civil wars, which killed more than half a million Liberians. At 28, Salome Karwah died giving birth to her fourth child. According to the World Health Organization, maternal mortality kills 800 women a day. Karwah’s death is a reminder that women, especially women of colour can survive intense crisis, yet die giving birth. In December 2014, Karwah was on the cover of TIME, being honoured with four other Ebola fighters as the magazine’s Person of the Year. When her father fell sick to Ebola, her own headaches and symptoms arrived. She kept her pain a secret from the 10 people she shared a home with.
It was the worst headache of my life. The worst pain I have suffered—ever, ever. Like someone hitting me in my head over and over.
Karwah’s older sister, Josephine, said Salome powered through the pain, continuing to cook and care for her family. When her father died, Salome, Josephine, and their mother all went to an Ebola treatment unit. All were positive for the disease, and three weeks later, only Salome and her sister left the white tent.
Josephine was seven months pregnant when she returned home. Three days later, she gave birth a stillborn boy outside of the family house. An ambulance would not come to her aid, and as she screamed in the streets, the neighbours would stare, refusing to touch her because she was an Ebola survivor. Salome moved to a different town, but she was run out of her new house after her neighbours learned she was an Ebola survivor. Karwah struggled to understand the purpose of her survival.
But I realized I had survived for a reason,
she said,
And that reason was to help other people.
Six days a week she traveled to Monrovia and encouraged Ebola patients to eat spoonfuls of rice and take sips of water. The work gave her life purpose, she said. Ebola targeted the much needed health care workers in Liberia. Nearly 200 doctors, nurses and auxiliary staff died during the outbreak, and with that the maternal death rate spiked 111 percent. To begin with, Liberia had one of the highest maternal mortality rates in the world. In 2015, 1072 women died during pregnancy for every 100 000 births. Hemorrhage was the leading cause of death, along with prolonged labor, eclampsia, and dangerous abortions.
Salome Karwah’s story was reported by Seema Yasmin, who’s reporting from Liberia was supported by the Pulitzer Centre on Crisis Reporting. Yasmin explains,
She was a fighter. Salome fought a pain so deep she thought her bones were splintering. She also fought the cold stares of her neighbours, the crossed arms of the market vendor who refused to touch her money. She fought a disease that killed more than 11,000 west Africans, first as a patient and then as a caregiver. She survived all of those things and war—but it was becoming a mother that killed her.
The experiences of Serena Williams, Salome Karwah, and women across the world highlights the struggles of being a mother and how institutional bias can contribute to that. Yet, more than anything, their stories paint an image of resilience and strength that is defined by their ability to face ignorance and pain, while standing with their womanhood.
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A Note from the Author:
Personally, the thought of losing a child or passing away before being able to see your child grow up is terrifying. The fact that this experience is largely and unfairly shared by black women makes that experience even more heartbreaking. Equality in healthcare should be a basic right. What an individual needs for something as simple as survival should never be questioned. Not only do existing doctors need to work on recognizing their own biases and working to fix them by listening to all of their patients equally, representation in the medical field, educators, and in medical councils will allow more black people, women, and black women to be heard. The value of representation extends past an individual’s desire to see themselves on the big screen, often it can be a matter of life and death. By introducing this diversity, it allows black women to be surrounded by others who understand their struggles and will actually believe them. Serena Williams’ story shows that the implications of racial bias extend past any social standings. This makes the need for diversity even more dire, as that means all marginalized individuals are at risk of this deadly bias. Overall, these statistics of maternal mortality rates could be drastically different without the dark history of colonization around the world, but since we can’t change the past, we must actively use tools of diversity to improve the future.