by Anonymous
From the author
In the United States, medicine is often imagined as objective and scientific. However, it takes only a surface level investigation to reveal that American healthcare systems have participated in the construction and preservation of racialized violence since their inception.
Black women in particular have endured centuries of reproductive exploitation and neglect. Many people in positions of privilege choose to understand this violence as documented history, but neglect to acknowledge or understand the extent to which medical racism continues to shape the experiences of Black women seeking reproductive care today. The frequency with which healthcare systems dismiss Black pain, invalidate autonomy, and fail to provide culturally informed treatment demonstrates that medical racism is neither a problem of the past nor an issue of individual prejudice; contemporary racialized, reproductive injustice is pervasive, and a consequence of centuries of violence and structural failures of medical education.
Even so, Black communities have resisted racial oppression by channeling joy and identity through storytelling. Oral histories have allowed Black Americans to preserve cultural memory, challenge racist stereotypes, and reclaim their own narratives. For Black women in particular, storytelling has served as a means of survival in a society that has consistently worked to diminish their agency and visibility. I argue that storytelling can be a particularly powerful tool for centering the lived experiences of Black women in reproductive medicine.
In this essay, I provide a brief history of medical racism in the United States, examine the significance of storytelling within Black communities, and connect narratives of reproductive injustice with the shortcomings of medical education. Ultimately, I argue that incorporating Black women’s storytelling into medical school curricula is essential to dismantling structural medical racism in the United States because narratives humanize Black women, challenge racialized assumptions in medicine, and help to fill the gaping omissions in medical educational materials.
Black reproduction in the United States has always been characterized by exploitation and control; the violent denial of autonomy and commodification of reproduction during slavery defined Black women’s earliest experiences in America. Because procreation sustained slavery as a system, white enslavers had “an economic incentive to govern Black women’s reproductive lives.” Enslaved women were denied autonomy over their own bodies, pregnancies and children. Transforming their reproduction into an economic institution ensured that Black motherhood was only understood as valuable when it supported the interests of white people. As well as being sanctioned by the law, the violation of Black women’s bodies was normalized socially and justified scientifically.
White Americans needed an ideological justification for slavery, so they constructed biological distinctions that positioned Black people as naturally inferior and therefore deserving of enslavement. Much of medicine in the United States was built upon horrific violence, all enabled by the framework of scientific racism. For example, the exploitation and torture of enslaved women’s bodies formed the foundation of gynecology as a medical specialty. In her book Killing the Black Body: Race, Reproduction, and the Meaning of Liberty, Dorothy Roberts explains the necessity of scientific racism in upholding white supremacy: “ Only a theory rooted in nature could systematically account for the anomaly of slavery existing in a republic founded on a radical commitment to liberty, equality, and natural rights.” By portraying Black people and biologically inferior, and subsequently Black procreation as degeneracy, white Americans legitimized racism as scientific truth.
This racist framework is also what allowed the policing of Black reproduction to continue after the abolition of slavery; when white people could no longer control Black women’s bodies by enslaving them, they turned to other strategies of reproductive policing. By defining race as an inheritable, genetic trait, white people used criminalizing and interfering with Black reproduction as a strategy to sustain racial hierarchies. In the beginning of the twentieth century, medical journals increasingly promoted forced sterilization of “degenerate men” in order to prevent “race suicide,” which would be the deterioration of the country caused by unchecked Black reproduction. Eugenics movements popularized the idea that the population should be controlled on the basis of race, and that white reproduction should be encouraged and Black reproduction should be discouraged or forcefully prevented.
In the 1920s and 1930s, birth control advocates such as Margaret Sanger weaponized racist eugenic rhetoric to gain political support for their cause. Although contraception should be a tool to increase women’s reproductive autonomy, many white women promoted it because of its utility in reducing the birthrates of communities they deemed “unfit.” After explaining how white supremacists often used contraception in their efforts to “[exterminate]” Black communities, Roberts is still careful to emphasize that Black women were never just ignorant, “unwilling” victims. Many Black women were righteously suspicious of the motivations of white doctors providing these resources, but fought for and took advantage of them on their own terms. This distinction is important because it minimizes the reduction of Black women to exclusively victims and the erasure of their resistance.
By the 1970s, reproductive injustice continued through widespread sterilization abuse. While some sterilizations of Black women were still “performed under the auspices of the eugenic laws,” many were committed by physicians employed through government healthcare programs. Medical residents in teaching hospitals used poor Black women to practice hysterectomies and routinely sterilized Black women in the south without informed consent or medical necessity. In the 1990s, reproductive policing continued through the widespread coercion of poor women into implanting Norplant, a device that requires medical assistance to remove; governmental programs targeted low-income communities, but disproportionately affected Black women’s reproduction, yet again posing it as a social problem requiring regulation.
Even this incredibly simplified overview of medical racism in the United States demonstrates that reproductive oppression was never accidental; the regulation of Black women’s bodies was systematically embedded into legal, political, and medical institutions to uphold white supremacy. This history is essential in contextualizing the distrust of many Black women in healthcare systems; the fear so many women feel is not irrational or unfounded, but emerges from generations of institutional violence and betrayal.
A risk of engaging this history is potentially homogenizing the experience of racism and reducing Black women solely to passive victims; it is essential to emphasize the centuries of
Black women’s resistance and resilience in the face of this abominable violence. From the beginning of slavery in the United States, Black people have tapped into the power of storytelling to share in joy together and combat hateful stereotypes that justify oppression. Autobiographical works allowed formerly enslaved individuals not only to expose the injustices they faced, but also “to contest white-controlled narratives of blackness by authoring and authorizing their selves.” In her article “Claiming Power in African American Women Storytelling,” Heather Bergeson describes the evolution of storytelling as a tool: “Slave narratives sought to expose injustice, Civil Rights activists wrote to fight for equality, and black voices today share their experiences with racism through digital and social media channels to promote social and legal reform.” Although the forms of storytelling have changed, the underlying purpose persists. In a dissertation on storytelling as resilience for Black women, Kimberly R. Miller argues that, because Black women have had to silence themselves for centuries, storytelling in a supported environment “develops resilience in Black women, enabling them to thrive after overcoming adversity by elevating their voices.” Today, many Black feminists emphasize the importance of uplifting untold Black stories. Journalist Melanie Burney explains that sharing the untold stories of Black women is particularly important because “when the white community has a cold, the Black community has the flu.” Here, Burney captures the ways that racial disparities in dominant institutions intensify suffering within Black communities but are constantly overlooked. Sharing experiences through the medium of stories has played and continues to play an essential role in uplifting the perspectives of Black women that are overshadowed by racism.
Because the concept of race was socially constructed and falsely legitimized through biology, racism inevitably became embedded within science and medicine. Shameka Poetry Thomas, an assistant professor of bioethics at The Ohio State University College of Medicine, explains that “too often, the canon of any given research discipline, including bioethics, centers White groups as the standard reference group,” thus “[homogenizing] the experiences of all people…as though they were like those of White populations.” This overemphasis on whiteness within medical research results in educational institutions failing to adequately prepare providers to recognize the experiences of anyone except white people.
Throughout the history of the United States and still today, white women have been encouraged to reproduce while Black motherhood has been seen as transactional or discouraged; as such, racial stereotypes influence reproductive science particularly. For example, “young, poor Black women and their behaviors are seen as lesser, down to some fundamental level” and they are “perceived culturally and perhaps biologically as ‘naturally’ having higher rates of pregnancies, STIs, and ‘unruly bodies.’”
In order to better understand how these systemic problems affect actual patients, it is necessary to turn to and uplift Black women’s own narratives regarding their experiences with reproductive injustice. A narrative-style qualitative research study analyzed interviews with Black women in Iowa discussing their experiences when seeking reproductive healthcare. The study found that nearly all participants “had a story about feeling physically or emotionally invisible, not being listened to, and/or feeling underinformed or uninformed.” The theme of invisibility appeared in 83.3% of interviews–that is, 83.3% of these Black women felt invisible while seeking reproductive healthcare–demonstrating the prevalence of dismissal and neglect.
This invisibility manifested in numerous ways. One young woman explained that she waited in the hospital with severe cramps and bleeding for five days before finally receiving attention. When a doctor eventually performed a vaginal examination, she recalled, “It was my first exam…that [experience] was scary for me and it felt like I wasn’t really being heard or understood.” Another participant described how physicians dismissed her lupus pain during pregnancy because they believed they knew her body better than she did. For one woman, a survivor of sexual violence, a provider’s refusal to listen to her resulted in extreme discomfort: “I’m usually in tears [during vaginal examinations], it’s really difficult…I went to a primary care provider for an exam, I asked her to stop and take a break. She was like, ‘No, I’m almost finished.’” In these instances, providers’ refusal to listen to or acknowledge these women replicated for them a loss of bodily autonomy.
Most of the women in this study directly attributed their poor treatment in healthcare to their identity as Black women. One woman shared that, “I definitely know that being Black has a lot to do with it…It’s not the first or last time I’ll experience lack of compassion when working with a healthcare provider.” This quote highlights the exhausting normalization of neglect, and how mistreatment becomes an expectation. Many of these women also described feeling uninformed about their own reproductive health and available treatment options, particularly when seeking birth control. One participant explained, “My doctor really pushed one specific birth control. I was interested in other ones, but they really were pushing the one that they prescribed me…as a young Black woman, I think that my doctor felt that she knew what was best for me, and that I wasn’t able to make the decision myself.” These repetitive failures on the part of providers leave a lasting impact on these young women, and often result in a deep distrust in healthcare systems. The pervasiveness of these experiences proves that they are not isolated incidents of individual prejudice, and suggests that they stem from broader structural failings in the medical education of providers.
One of the most common recommendations offered by these women was dishearteningly simple: healthcare providers must genuinely listen to their patients. Each of these painful situations could have been avoided if providers had treated them as knowledgeable participants in their own care rather than passive subjects. One woman expressed her belief that “once you decide that you want to become a medical professional, [diversity and cultural competency training] should start at day one, not day two.” Her statement reflects the urgent need to address racial bias early on in medical education.
However, incorporating cultural competency training alone is often insufficient. In a 2022 study on racism in medical school curricula, one student noted that “all teachers who are teaching about diversity are white.” Today, medical schools remain overwhelmingly white spaces, which limits the ability of diversity initiatives to meaningfully include marginalized perspectives; it is unlikely that predominantly white teachers are adequately teaching their predominantly white students about experiences that none of them have encountered.
The underrepresentation of Black people within medical education extends beyond cultural competency training. A 2018 study examining race and skin tone in medical textbooks found that light skin was overrepresented–74.5% light skin, 21% medium skin, and 4.5% dark skin–in three of the most commonly used texts in medical schools. Authors asserted that “the presence or absence of certain racial groups may inform the association doctors make between race and disease risk.” When educational materials overwhelmingly center white bodies, students unconsciously learn to treat whiteness as the medical norm while viewing blackness as secondary or abnormal.
Participants in the Iowa study shared the need for clinical tools that are actually based on Black bodies: “That stinky [BMI chart] is not made for Black women. It’s made for white women.” Her frustration reflects the awareness of Black women that many supposedly universal medical tools used in their treatment are only designed to accommodate white bodies Simply emphasizing equality of care in medical schools is not enough to counteract the harm of excluding Black representation in both textbooks and the institutions themselves.
Ideally, medical institutions would comprehensively revise educational materials to be more representative of more people and restructure their programs to be more accessible and inclusive of a significantly more diverse demographic. However, while these transformations are necessary long-term goals, introducing new course content offers a more immediate and accessible intervention. Incorporating Black women’s storytelling into medical curricula can supplement omissions in standard materials while actively challenging racialized assumptions within healthcare training.
The persistence of reproductive injustice reveals major systemic failures within medicine. Healthcare is frequently presented as being objective and based on evidence while ignoring the ways racism shapes diagnosis, treatments, and patient experiences. Of course, much of this violence results from the racist beliefs, either explicit or internalized, of the providers; however, if not all health providers are intentionally and violently racist, these patterns necessitate another explanation. Medical racism in the United States is not inherent, but is preventable and is facilitated by failures in the educational training of our medical professionals. Because Black people are underrepresented in medical educational institutions, we must use creativity to insist upon their authentic representation by stepping outside of the westernized approach to science.
“Narrative medicine” is a clinical approach that emphasizes listening to patients’ own stories of their lived experience. Poetry Thomas argues that this framework “can be used to avoid pathologizing Black women.” I agree entirely, and suggest extending the same principle to medical education. From only a brief summary of the history of reproductive racism in the United States, it is impossible to minimize Black women’s fear of and distrust towards the healthcare system. It is also clear that educational materials consistently fail to represent Black bodies, and most of the people teaching and learning in medical schools are white. However, if medical students repeatedly encounter authentic stories from Black women describing their experiences with invisibility, dismissal, and neglect, it is much harder for them to avoid confronting their simplistic assumptions about Black patients. Rather than reducing patients to symptoms and stereotypes, this pedagogy that includes Black women’s narratives encourages providers to see them as complete human beings shaped by their identity and lived experiences.
A powerful example of this framework’s potential appears in the Young Women’s Project, a study involving predominantly Black adolescent girls living in low-income neighborhoods in Indianapolis. Participants received reproductive care, which involved self-administered vaginal swabs to test for STIs, treatment when necessary, keeping “daily coital diaries” where they were able to reflect on their sexual experiences, and face-to-face interviews with research staff who guided them through the process, forming connections. Although these young women had experienced racism and reproductive injustice throughout their lives, the study created a rare environment in which they felt heard and respected. In her analysis of the narratives of some of the participants, Elizabeth Pfeiffer explains that these women “used their stories to reclaim agency, as they uniformly described [the project] as granting them temporary access to…an unanticipated network with staff who provided a salve to soothe the effects of racism and living in a gendered and economically violent and inequitable world.” Pfeiffer’s analysis of their experiences demonstrates that healthcare has the potential to be transformative when providers genuinely listen to patients, connect with them, and validate their experiences. In addition to receiving clinical care, the young women in this study experienced emotional recognition and dignity.
Ultimately, the history of reproductive healthcare in the United States demonstrates that medicine cannot be understood separately from racism. From torturous experimentation during slavery to sterilization abuse to disproportionately high contemporary mortality rates, Black women’s bodily autonomy has been repeatedly attacked in healthcare. Throughout it all, however, Black women have consistently resisted these injustices by using storytelling to reclaim agency. It is time for the medical institutions that have perpetuated so much violence to finally step back and listen to Black women, and actively create space for their voices.
Although storytelling alone cannot undo the harm of centuries of reproductive violence, it can fundamentally reshape how future healthcare providers will understand and interact with Black women. Listening to Black women’s stories always, but especially in medicine, willfully creates space for them to authentically represent themselves within institutions that have silenced and exploited them since their establishment.
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