In the 2014 sitcom, Black-ish, season three finale, Rainbow Johnson, Tracee Ellis’ character has to undergo an early delivery via C-section after she is diagnosed with pre-eclampsia — a potentially dangerous pregnancy complication characterized by high blood pressure that can lead to severe complications including death if improperly treated. On the operating table, Bow is taken aback when she notices that the white anesthesiologist is about to put her under using some generic drugs. “Give me what you give Jenifer Lawrence if she’s having a baby. I didn’t go to Med school to not get the JLo baby drugs”, she retorts.
Sadly, this is a mild example of what most black women go through when they visit health facilities. In the short film Stories of Black Motherhood, co-produced by Harvard T.H. Chan School of Public Health Student Tariana V. Little, Josette Williams one of the three women talking about how race, class and gender have shaped their feelings about motherhood and the healthcare system in the United States, reveals that, “As a woman of color when you are at the hospital, often you feel a bias.” Josette refers to the nuanced and oftentimes overt ways that Black African American mothers are treated in hospitals as a result of embedded structural violence in healthcare. “There’s just too many layers of this that I have to fight through to get the person on the other end to look at me as a human being,” Josette attributes this treatment to race and class differences.
The Listening to Mothers Survey III, a report of the Third National U.S. Survey of Women’s Childbearing Experiences, sampled 2,400 women who gave birth in 2011 and 2012, found that one in five Black and Hispanic women reported poor treatment from hospital staff because of race, ethnicity, cultural background or language, compared with 8 eight percent of white mothers. The evidence continues to astound as the survey also revealed that more than a quarter of black women meet their birth attendants for the first time during childbirth, compared with 18 percent of white women. For many years, women of color more so black women have been proportionately disadvantaged by the healthcare system.
Well, there might be a broader explanation for this. A 2016 study by researchers at the University of Virginia scrutinized why African-American patients are systematically undertreated for pain comparative to not just white patients, but also relative to the World Health Organization’s guidelines. The study linked disparities in pain management to racial bias. The study found that a substantial number of medical students and residents often hold incorrect, harmful and sometimes strange biological fallacies about racial differences in patients. For example, many believed that black people’s blood coagulates more quickly than whites, that blacks have thicker skin than whites, and perhaps more disturbing that blacks have less-sensitive nerve endings as compared to whites. Researchers placed the blame for these assumptions, not on individual prejudice but deeply ingrained unconscious stereotypes about people of color, as well as physicians’ difficulty in empathizing with patients whose experiences differ from their own.
The lived experiences of black women in the U.S. as a result of racial bias greatly exacerbates their health maternal outcomes. Arline Geronimus, a public health researcher and professor at the University of Michigan School of Public Health and member of the National Academy of Medicine developed a hypothesis more than 25 years ago to explain how exposure to racialized stress as a result of socioeconomic disadvantages and discrimination over time, led to riskier pregnancy at an earlier age among black women. Arline later said that she termed the concept weathering, a metaphor for what was happening to black people’s bodies as a result of the toxic stress associated with racial discrimination — a sense of erosion from constant stress that accelerates aging and increases health vulnerability.
Arline’s research did not gain traction immediately as it elicited some controversy. In her research, she had pointed out that being a teen mom in the black community was not a terrible thing, it was better. Her staggering research, even to her, found that white women in their 20s were more likely to give birth to a healthy baby than those in their teens. However, among black women, the opposite was true: The older the mother, the greater the risk of maternal and newborn health complications and death. Her data suggested that black women may be less healthy at age 25 than at 17. The implication was that young black women were already showing signs of weathering.
In 1993, the tide on Arline’s research began to turn as the science around genetics and stress physiology became better understood. The physiological mechanism that would finally explain weathering was the allostatic load, which is the accumulation of wear and tear on the body as a result of exposure to repeated or chronic stress. The body can heal itself from short term stress, because the body’s biochemical homeostasis quickly returns to normal. However, chronic threats and hardships linked to racial biases, causes the fight-or-flight response to never abate. Arline once said it’s like facing tigers coming from several directions every day and the damage is compounded over time.
Studies that collaborated the weathering hypothesis seemed to topple over each other. In the early 2000s research on telomeres — protective caps on chromosomes, provided more evidence on weathering being a biological reality. Allostatic load causes cells to divide much faster to keep self-repairing and each time cells divide, telomeres get a little shorter resulting in earlier deterioration of organs and tissues, basically premature aging.
As a wind of change is sweeping the U.S. through the revitalized movement, Black Lives Matter, as a result of the fatal police brutality against George Floyd, perhaps the nation will begin to more broadly address the systemic racial discrimination against colored people, more so black people. To meaningfully improve maternal health outcomes, there is need for systemic change that starts with the healthcare system. Improved access to care and a fair and more responsive healthcare to the needs of black women. Only then will black women be able to achieve optimal health outcomes and well-being, including if they choose, to bring offspring in to the world. Then women like Josette won’t have to fight through layers of barriers to get the people on the other end to look at them as human beings.