How Racism and Stereotypes in Healthcare Impact the Lives of Black Women

Dr. Sonja Wiley decided she wanted to have children a little later in life.

But when she tried to have a child with her husband, she suffered a miscarriage. She said she was in excruciating pain after the miscarriage, and because “Black women are just notoriously, historically stronger,” as is too often thought by medical professionals, she wasn’t given proper pain medication.

She later found out that she had endometriosis, a disorder in which the tissue that normally lines the uterus grows outside the uterus, resulting in infertility.

“I did not know what endometriosis was,” she said. “No healthcare practitioner had ever educated me or talked to me to tell me that endometriosis affects infertility. So being 34 years old before deciding to have children, my endometriosis had just wreaked havoc on my reproductive system.”

Before she ever found out she had endometriosis, Dr. Wiley, who is an Associate Professor and Diversity Advisor in the Office of Business Student Success at Louisiana State University and a member of the PhD Project, said she and her husband went to doctors to diagnose what was wrong with her when they were having trouble having children.

“I wasn’t taken seriously at all,” she said. “A doctor told me I just wasn’t having sex right.”

Unfortunately, this medical mistreatment isn’t a first for Black women.

The Maternal Mortality Rate Among Black Women in the US

There’s a tragic epidemic happening in the United States: that’s the maternal mortality rate, which disproportionately affects Black women.

According to the Centers for Disease Control and Prevention, the overall maternal mortality rate in the U.S. in 2020 reached 23.8 deaths per 100,000 births, which is a huge spike from the 9.8 deaths in 2000.

The numbers are even more drastic for Black women. In 2019, there were 44 deaths for every 100,000 births and in 2020, that rose to 55.3 deaths.

This national health crisis has been brought to light in the new Hulu documentary “Aftershock,” which centers around the stories of two Black women who died due to pregnancy complications as told by their families.

Both women, 30-year-old Shamony Makeba Gibson and 26-year-old Amber Isaac Rose, had cesarean (C-section) births. Gibson died two weeks after giving birth to her second child from a blood clot and Isaac from blood loss during an unscheduled emergency C-section. Both women told doctors about their symptoms and were told to rest.

The Rate of C-Section Deliveries Among Black Women

The sad truth is that a high rate of Black women have C-sections and die due to pregnancy complications.

In the documentary, Neel Shah, Professor of Obstetrics and Gynecology at Harvard School of Medicine, shares how he noticed an “explosion in C-section rates” in 2018 after the federal government – and in turn, hospitals – started tracking the maternal mortality rate more systematically.

C-sections can save lives, but it’s still a major surgical procedure that could result in complications.

“Organ injury, hemorrhage and infection are about three times more likely to happen with a C-section than a vaginal delivery,” Shah said.

The rate at which Black women have C-sections has nothing to do with who they are or their biology. It has to do with racism and a calculator in many cases, Shah said.

“I started to think about my own practice and how it’s possible that well-intended people can be doing racist things. For example, when Black people are expressing concern around pain or other symptoms, they’re heard less,” he said. “And in medicine, we’ve literally created algorithms where we’ve conflated race and racism. You can help somebody understand their odds of having a successful vaginal delivery with a calculator. And if they’re Black, their odds drop.”

The rate at which C-sections are performed also has to do with cost. The cost of performing a C-section is less than doing a vaginal delivery, which puts more money in the pockets of the hospital, Shah said.

The Dark History of OB/GYN Surgery in the US

According to Helena Grant, Director of Midwifery at Woodhull Medical Center, another factor at play in the high number of women of color that die due to pregnancy complications has to do with the fact that Black women are often treated by resident learners and experimented on.

In the documentary, she noted that Black women might be cut open when it’s not necessary so that learners can learn how to sew. And this practice of mistreatment dates to the 1800s.

When Black people were enslaved, the worth of a Black woman was what her womb could produce for the plantation, Grant said. Black slaves were forced to have so many children that they started getting fistulas.

“Enter J. Marion Sims,” she said. Considered the “father of gynecology,” Sims decided he was going to get rid of these fistulas and ensure Black women could have even more children and be “useful for her slave master,” Grant said.

These Black women were cut open and experimented on. During his experimentation, Sims wrote modules about what was done to these women, saying that “they don’t feel pain, but the woman is literally screaming,” Grant said.

“And that’s how the United States [became] a superpower when it comes to OB/GYN surgery,” she added.

Addressing Racial Bias in Healthcare

The racism and lack of care for Black people from the healthcare system has to do with doctors and nurses not understanding the diverse cultural needs of the people that they serve, Dr. Wiley said.

“African Americans speak differently about their pain, so do Latin Americans, so do Asian Americans,” she said. “When you have a nurse, a nurse practitioner or a physician that is not well-versed in our cultural differences, our idioms, how we talk and how we present pain, then we are treated differently.”

Solving this problem comes down to educating healthcare professionals on how to understand these needs.

“I am a huge proponent of diversity, equity and inclusion education for all healthcare providers and an advocate for healthcare organizations partnering with community-based organizations, social organizations, sororities, fraternities, churches, in order to enhance our healthcare,” she said. “Because if we don’t do it at the individual level and at the community base level, then we will continue as diverse people to have the poorest health in the United States.”

Dr. Wiley was never able to birth children but adopted three children, one boy and two girls. While she says this was God’s plan for her, she wants other young Black women to be educated about reproductive health and to not suffer being misunderstood like she was.

“I share my story about my fertility. I share my story about how I was misunderstood and not treated equitably in the healthcare system as a Black woman. I share all of that with my students all the time, and it makes a difference in their lives, which I know they’re going to make a difference in the lives of people that they serve,” she said.

“And if they become CEOs of hospitals and healthcare organizations, hopefully, they will implement these diversity policies, these equitable and inclusion policies and community-based relationship policies so that they actually understand and have empathy for the people for which they serve.”