As a medical student interested in the field of obstetrics and gynecology (OB/GYN), it was humbling to confront the reality of the field’s origins in order to understand how to truly serve a community. The coined ‘father of modern gynecology,’ Marion Sims, performed all of his research by experimenting on Black enslaved women without anesthesia. We only know the names of three of these women: Anarcha, Lucy, and Betsey, but there were many more. (1) Any advancement made by Marion Sims is over-shadowed by the heinousness of his crimes and the ripple effect that this has had on Black mothers today.
Today, the U.S. has the worst maternal mortality rate of any similarly wealthy country. Even worse, Black women are three to four times more likely to die from pregnancy-related causes than their white counterparts. Why is there such a disparity? The racial differences in maternal health outcomes can be attributed to differences in healthcare quality, structural racism, implicit biases, and the long-term psychological impact that racism and sexism has on Black women. Education and occupation do not play a role. (2, 3)
As I have dived into my medical education, I have learned more and more about reproductive justice and Black maternal health. Now in my second year of medical school, I am learning that reproductive justice encompasses much more than the field of OB/GYN. The term “Reproductive Justice” was coined by a group of Black women (Toni M. Bond Leonard, Reverend Alma Crawford, Evelyn S. Field, Terri James, Bisola Marignay, Cassandra McConnell, Cynthia Newbille, Lorretta Ross, Elizabeth Terry, ‘Able’ Mable Thomas, Winnette P. Willis, and Kim Youngblood) in 1994 in order to recognize the need for a more intersectional view of reproductive health. (4,5) Reproductive Justice centers the needs and experiences of the most marginalized communities, focusing on addressing power systems, intersecting oppressions, and issues of access.
Through a Reproductive Justice lens, we can acknowledge the racist history of OB/GYN and begin to understand how to approach the Black maternal health crisis with solutions that all mothers, not just white, cisgender women, can trust. After doing research, I believe that one possible avenue includes wide-spread access, education, and funding for community-based Black doulas.
In 2021, The Daily Orange, published an article entitled “Wary of hospitals, pregnant Black women in Syracuse look to doulas”. (6) This article includes stories from Syracuse mothers, detailing their experiences with pregnancy and birth and how doulas helped them achieve positive outcomes. What exactly is a doula and what do they do? Doulas are trained professionals who provide support to pregnant people before, during, and after delivery. Doulas also serve as advocates for birthing people, helping them stick by their birth plans and creating a peaceful birthing space. (7) Community-based Black doulas particularly provide a deeper sense of connection to their clients, due to similar life experiences and an intricate understanding of the area they serve.
Doulas can significantly improve health incomes for pregnant and birthing people. Pregnant people who receive doula care experience birth complications two times less and are four times less likely to have a low birth weight baby. (8) Doula-guided pregnancies have also been shown to end in significantly shorter labor times, help with facilitating fewer C-Sections, and help decrease the rates of postpartum depression. (2,7) Unnecessary C-Sections are a problem in our own community: a 2019 article entitled “Many NY hospitals perform too many C-sections for low-risk births, report says.” published to syracuse.com explains a report stating that many NY hospitals perform too many C-sections on low-risk births, adding unnecessary trauma to the birthing experience. (9)
With the Black maternal mortality rate so high in the U.S., doulas fill an especially important role for Black women. Using community-based education, doulas are able to start combatting structural racism’s effect on reproductive health. As stated prior, doulas are able to act as an advocate for mothers. Implicit biases within our own medical providers causes Black women to not be believed or taken as seriously. Doulas can be there in order to guide the pregnant person, educate them about the risks of pregnancy, and advocate for them if their concerns aren’t being met by a healthcare providers.
Birthing people deserve to know all of their options before, during, and after birth, to be empowered to make decisions, and to have those decisions respected by medical professionals. Improving maternal health outcomes will require a multi-pronged approach, but in the course of my research and in speaking with a local community-based doula, it is clear that expanding education and access to doulas is an important starting point. It is important to serve birthing peoples and to make sure that doulas are able to receive a livable salary as well. I encourage readers to do their own research into doula care, see how you can support your local community-based Black doulas, and spread awareness about this potentially life-saving resource.
1. Holland, Brynn. “The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Enslaved Women.” History.com, A&E Television Networks, 29 Aug. 2017.
2. Eliminating Racial Disparities in Maternal and Infant … https://www.americanprogress.org/article/eliminating-racial-disparities-maternal-infant-mortality/.
3. Artiga Samantha, Pham Olivia. “Racial Disparities in Maternal and Infant Health: An Overview – Issue Brief.” KFF, 10 Nov. 2020.
4. “Birthing Reproductive Justice: 150 Years of Images and Ideas.” Omeka RSS.
5. Victoria Guerrero Thursday, February 25. “The Black History of Reproductive Justice.”.
6. Cammett, Danis, et al. “Wary of Hospitals, Pregnant Black Women in Syracuse Look to Doulas.” The Daily Orange, 2 Mar. 2021.
7. “How Community-Based Doulas Can Help Address the Black Maternal Mortality Crisis.” Institute for Healthcare Improvement.
8. Doula-guided pregnancies have also been shown to end in significantly shorter labor times, help with facilitating fewer C-Sections, and help decrease the rates of postpartum depression.
9. Mulder, James “Many NY Hospitals Perform Too Many C-Sections, Report Says.” Syracuse, 16 May 2017.