Dorothy Roberts Lays Out a Damning Exposé of Medical Racism and “Child Welfare”

Part of the Series

The Road to Abolition

There is an old saying that “when white folks catch a cold, Black folks get pneumonia.” That saying speaks to a fundamental truth about the U.S.: Black people are positioned to catch hell because of historical and contemporary systemic forms of inequality.

After the overturning of Roe v. Wade in 2022, I recall the sense of alarm communicated by Black women. There was the painful recognition that they would be hurt disproportionately by the decision. This raises important questions about how Black people suffer relative to other matrixes such as gender, class, ability, sexual orientation etc. To critically engage the complexity of how Black women have been dehumanizingly perceived and treated in the U.S., I had the honor of speaking with scholar Dorothy Roberts, who is the George A. Weiss University Professor of Law and Sociology at the University of Pennsylvania. Her major books include Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century; Shattered Bonds: The Color of Child Welfare; and, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty.

In this interview, Roberts brings her wealth of knowledge to bear upon the history of white racist mythmaking regarding the “sub-humanity” of Black women, while also demonstrating how such processes have violently manifested themselves within the context of Black women’s health, sexuality, childbearing, parenting, and their relationship to larger family dynamics and the state. Black women have been depicted as “pathology,” a myth that has devastating implications for the stability of family life itself, including the ways in which child welfare and foster care systems police and victimize Black families. For Roberts, not only is hope necessary, but a commitment to the struggle for abolition is indispensable if we are to live in “a more caring and humane world.”

George Yancy: In my attempt to come to terms with the white gaze and how it perceptually distorts the Black body, I have used the term Procrustean to capture that distortion. The term derives from “the bed of Procrustes.” The mythological figure, Procrustes, was a thief who waited for strangers to come along, and he’d force them to fit into his bed. If they were too short, he would stretch their bodies to fit. And if they were too long, he would cut off their legs. The motif here is that he used his power to force the human body to fit within the structure of his bed. It is the control, distortion and violence that are important here. Similarly, the white gaze distorts the Black body to fit within its violent, hegemonic perceptual framework. In Killing the Black Body, you explore the power of myths. Like the white gaze, racist myths also function according to a process of procrustean violence. You write, “Myths are more than made-up stories. They are also firmly held beliefs that represent and attempt to explain what we perceive to be the truth. They can become more credible than reality, holding fast even in the face of airtight statistics and rational argument to the contrary. American culture is replete with derogatory icons of Black women — Jezebel, Mammy, Tragic Mulatto, Aunt Jemima, Sapphire, Matriarch, and Welfare Queen.” Like the white gaze, which “sees” a gun in the hands of a Black person who is holding a wallet (think here of 23-year-old Black male Amadou Diallo in 1999), these racist myths depict Black women in ways that are not true and yet such myths violently impact the lives of Black women. How do you think about the process of demythologization? What must be done to attack America’s anti-Black-woman grammar, its mythmaking, its denigration of Black women?

Dorothy Roberts: Once when I was interviewed for a documentary about reproductive justice, I discussed the myths about Black women that have upheld the infliction of state violence against us. The interviewer stopped me before I went on: “Now, please explain that these myths aren’t true.” I was initially taken aback: It hadn’t occurred to me that I would have to dispel the litany of falsehoods about Black women’s sexuality and motherhood. Then I realized that many people — perhaps most white Americans — believe the deeply embedded images about Black women’s depravity.

As I wrote in Killing the Black Body, even airtight statistics and rational argument aren’t sufficient to demythologize conceptions of Black women. I think the first step must be to understand the function these myths play in U.S. society. They aren’t just the random outgrowth of prejudiced feelings against Black women. The images are very specific and operate in a specific way to uphold specific aspects of U.S. racial capitalism and white supremacy. To refer back to your metaphor of Procrustes, the myths are deployed to force ideas about Black women to fit into a particular bed — a bed structured by intersecting capitalist, racist, and patriarchal ideologies and objectives.

By casting Black women’s sexuality and childbearing as the source of Black people’s subordinated status in America, of Black children’s deprivation, and of America’s social problems more broadly, this mythology serves to deflect attention away from deep structural inequality and toward carceral approaches to meet human needs. It both obscures the need for radical social change and turns Black women’s resistance into crimes.

In Killing the Black Body, for example, I argued that the prosecutions of Black women for being pregnant and using drug s— supported initially by the now-discredited myths of the irredeemable “crack baby” and “pregnant crack addict” — constituted punishment of Black women for having babies and blamed them for harms to Black children that were actually caused by poverty and other consequences of racial capitalism.

Examining the myths with their oppressive functions in mind reveals their inherent contradictions. Some people are confused by reproductive health policies that both deter, punish or prevent Black women from having children and prevent them from having access to abortion. These policies are in tension but further a common objective — to devalue and diminish Black women’s autonomy and freedom, which has always paved the way for greater policing of everyone. (The prosecutions of Black women for being pregnant and using drugs in the 1980s and 1990s, for example, set the precedent for more widespread criminalization of pregnancy, intensified even more by the Supreme Court’s Dobbs decision.)

In February 2011, for Black History Month, anti-abortion organizations erected a giant billboard at the intersection of Sixth Avenue and Watts Street in New York City’s SoHo neighborhood. The billboard displayed the image of a 6-year-old African American girl beneath the words: “THE MOST DANGEROUS PLACE FOR AN AFRICAN AMERICAN IS IN THE WOMB.” That statement is practically the same eugenicist rhetoric politicians and pundits used to advocate for state sterilization of Black women.

I find a similar contradiction in the way the child welfare system (what I call the “family policing system” in my latest book, Torn Apart) weaponizes Black children against their mothers. The family policing system is built on the racist myth that Black mothers are incapable of caring properly for their children and don’t really love them. This lie about Black mothers is exemplified by the welfare queen, who supposedly had children just to get a welfare check and then spent all the money on herself.

There is a long history of the white elite, on one hand, devaluing Black mothers’ relationships with their children while, on the other hand, using the threat of child removal to control and punish Black mothers. Part of the excuse white enslavers constructed for the horrors of family separation was the myth that Black people lacked the capacity to feel emotional pain or to care deeply for their children.

Slaveholders could threaten enslaved women who were rebellious with the sale of their children to make them more compliant. Enslavers used children as hostages to prevent bonded women from running away or to lure escaped women back to plantations.

Today, studies show that doctors are more likely to suspect, test for and report child abuse in the case of Black children than white children, and it takes less risk of maltreatment for caseworkers to remove Black than white children from their homes. Yet the family policing system gets its power to regulate Black families largely from the terror it inflicts on them by threatening to take away their children. It is precisely because of Black mothers’ loving bonds with their children that family separation is such a powerful tool to police Black communities.

These contradictions help to make it clear that there is an underlying purpose that makes the myths about Black mothers useful and resilient to evidence that discredits them. Recognizing their function to uphold racist capitalism and obscure the suffering it causes reveals the carceral logic that reconciles the contradictions. Recognizing how the myths function also shows that dispelling them must be connected to movements to end racial capitalism and white supremacy.

The family policing system gets its power to regulate Black families largely from the terror it inflicts on them by threatening to take away their children.

Finally, we can learn from ways in which Black women have resisted the disparaging mythology about them for centuries. In the decades after emancipation, Black women established hundreds of clubs and church groups dedicated to improving the status of Black families and providing services to Black mothers and children. Although we can critique their emphasis on respectability, Black club women also emphasized enhancing families’ material circumstances and children’s opportunities, in stark contrast to the child welfare system’s reliance on punishing mothers and removing children from their homes.

They also integrated child welfare work into an agenda that encompassed a broad range of anti-racist activities, including agitation “against lynching, the Convict Lease System, the Jim Crow Car laws, and all other barbarities, and abuses, which degrade and dishearten us” as Mary Church Terrell, first president of the National Association of Colored Women, wrote in 1899. When Black people in the South were shut out from hospitals that served white patients only, Black midwives routinely provided excellent labor and delivery care in their communities — a tradition that continues today.

Today, Black women continue to work collectively to imagine and build ways to liberate their sexuality, childbearing and parenting. Black women developed the “reproductive justice” framework that includes the human right to have children and to raise them with dignity in a safe, healthy and supportive environment, along with the right not to have a child that dominates mainstream pro-choice advocacy. Black women have created political, artistic and everyday spaces like these to imagine sexualities and mothering, as I wrote in my chapter “Race” in The 1619 Project book, that are “freed from the legacies of slavery, from regulation for the sake of those in power, and from stereotypes created to excuse the violence inflicted on them.”

It seems to me that the white gaze and anti-Black myths are not just abstract performances or restricted to the domain of the ideational. There are profound material implications that target, in this case, the bodies of Black women. I stress the material implications to challenge any doubt that the white gaze and racist myths impact the corporeality of Black female lived reality. I also want to emphasize the sheer unconscionable pain and suffering experienced by Black women. Again, in Killing the Black Body, you note, “Marion Sims, for example, developed gynecological surgery in the nineteenth century by performing countless operations, without anesthesia, on female slaves purchased expressly for his experiments.” As you know, in my own field, philosophers from David Hume and Immanuel Kant, to Georg W. F. Hegel held deeply anti-Black racist views. In fact, in his On the Genealogy of Morals, German philosopher Friedrich Nietzsche writes about the “fact” that Black people have the capacity to tolerate pain in ways that white people don’t. He writes that there is a doctor “who has treated Negroes (taken as representatives of prehistoric man) for severe internal inflammations that would drive even the best constituted European to distraction—in the case of the Negroes they do not do so.” Dorothy, here I think about the horror of gratuitous violence and suffering experienced by Black women and Black bodies, more generally. It is tragic to admit, but according to the literature Black people systemically continue not to be treated for pain relative to white people and their experience of pain. It is as if the institution of medical “care” itself is complicit. This brings us back to the procrustean gaze and myths. It is dumbfounding that in the 21st century, Black bodies are mythologized as biologically stronger. This isn’t just benign prejudices, but, as I quoted you earlier, “firmly held beliefs” regarding Black women who are stating, unambiguously, that they are in pain. Yet are doctors really listening? Could you speak to how racial biases are working here, and how Black women are not being respected as subjects of their own experiences? My sense is that this isn’t just a case of a few bad doctors. It feels more like an institutional form of biological policing.

The myth that human beings are naturally divided into biologically distinguishable races is one of the most destructive ideas ever invented. I use the word “invented” deliberately to emphasize that there is nothing natural about race; the very concept of race was made up by Europeans to implement and legitimize racism, white supremacy and enslavement. The biological concept of race persists in science and medicine because it continues to be useful for obscuring how “racial hierarchies” are enforced by power, not by nature.

The idea that human beings are naturally divided into races stems from Christian theology at the beginning of European enslavement of Africans and conquest of Indigenous peoples in the Americas. It was imperative to the trade in human beings for the Christian church to have an excuse for dispossessing, enslaving and exterminating people even if they became Christians. The excuse Christian theologians invented was that God divided human beings into different races, created white people in God’s image, and ordained that they dominate other races of people. At the turn of the 18th century, European scientists, as well as the philosophers you mentioned, simply adopted this racist theology wholesale into Enlightenment thinking, except they replaced “God” with “nature.”

As I write in Fatal Invention, many scientists today are refurbishing the discredited race myth in genetic terms by specifying that evolution is the force of nature claimed to have created human races at some mysterious point in human history. Some scientists still try to explain racial health and other inequities in genetic terms and to find some substructure in the human species that maps onto social concepts of race. Pointing to genetic explanations for persistent racial injustices is a way for conservatives to explain how these injustices could exist in a society they claim has eliminated racism and for liberals to avoid the need for radical social change.

I also write in Fatal Invention how genetic determinism and the biological concept of race work together to reinforce each other. The belief that races are genetically distinguishable and that racial inequities can be explained by genetic differences shores up the belief that genetics determines people’s behavior and status in life — and vice versa. One of the most resilient and powerful biological myths about race is what I focus on in Killing the Black Body — the myth that Black women’s childbearing is naturally pathological, that Black women as an intersecting raced and gendered status pass down a depraved lifestyle to their children.

Often, the myth of the dangerous Black mother is described in biological terms, as if Black women’s childbearing is both a biological threat and a social problem. The press reported, for example, that Black women who smoked crack cocaine were deprived of maternal instinct and gave birth to babies who were medically and socially irredeemable. A January 14, 1990, op-ed in the Houston Post stated, “Call the ‘welfare babies’, ‘crack babies’, or ‘deficit babies’ — by whatever term, they constitute a new ‘bio-underclass’ of infants who are disadvantaged almost from the moment of conception,” using clear code language to refer to Black infants and attributing their disadvantages in the womb to their mothers.

Doctors have been key promoters of racial thinking and the suffering it causes. They developed the racial concept of disease — the idea that people of different races have different diseases and experience common diseases differently. The racial concept of disease may seem very familiar because most medical schools still teach it in their curriculums, either explicitly or implicitly. Perhaps the clearest of these practices is race correction — the practice of automatically adjusting diagnostic tools according to a patient’s race. Race correction is grounded in assumptions of innate racial differences that are so prevalent that doctors can make automatic and categorical judgments based solely on the patient’s race.

Most doctors cling to racial thinking that originated in the 1500s instead of imagining a better way to practice medicine that doesn’t rely on false biological concepts of race.

An article published in the New England Journal of Medicine in 2020 lists numerous similar race adjustments made in a startling range of medical fields, including cardiology, nephrology, obstetrics, oncology, pulmonary medicine and urology. One example that is very telling is the spirometer, a medical device that measures lung capacity. We can trace race correction in spirometry directly to Samuel Cartwright’s claim that Black people innately had lower lung capacity. This idea still circulates in medicine today, and there are some versions of the spirometer that allow the clinician to automatically adjust for the presumed lower lung capacity of Black patients. A 2021 study suggests that race correction in spirometry may underestimate the severity of chronic obstructive pulmonary disease in Black patients and cause doctors to miss their emphysema.

Another example that has been getting a lot of attention recently is the eGFR, or the estimate for glomerular filtration rate, which is a very important indicator of kidney function. The eGFR is routinely adjusted upward to a healthier number if the patient is identified as Black or African American. When I first saw the eGFR race correction, I could hardly believe my eyes. The adjustment was initially explained to me as accounting for the presumed greater muscle mass in Black people as a race, which is patently absurd. I understand that the muscle mass rationale has since been rejected, but the practice continues in most health systems around the country.

These racial adjustments reflect a failure to understand the meaning of race and its connection to racism and should be abolished for that reason alone. But a mounting number of studies are documenting the harms to Black patients from being denied care because of an adjusted diagnosis. For example, Black patients whose eGFR is adjusted upward to a healthier reading are less likely to be referred to specialized kidney care. A 2021 study calculated that, between 2015 and 2018, 31,000 more Black patients would have been eligible for kidney transplant evaluation and inclusion on a transplant waiting list if they were not subjected to the eGFR racial adjustment. It seems likely that the eGFR race correction has contributed to Black people’s higher rate of death from severe kidney disease. Yet most doctors cling to racial thinking that originated in the 1500s instead of imagining a better way to practice medicine that doesn’t rely on false biological concepts of race.

Many studies have shown for decades that Black patients are less likely than white patients to be treated for pain, even when their injuries, such as long bone fractures and appendicitis, are known to cause severe pain. The 2016 study you referred to was especially illuminating because it connected the longstanding and well-documented undertreatment of Black patients for pain to false beliefs about race-based biological differences. The study discovered that “a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites … [and] these beliefs predict racial bias in pain perception and treatment recommendation accuracy.”

These false beliefs included the myths that Black people have thicker skin and less sensitive nerve endings than white people. The study’s findings suggest that many white students enter medical school believing stereotypes about biological differences between people of different races, and medical school does little to disabuse them of these false ideas. In fact, medical education reinforces these ideas when the students are taught to treat patients differently based on their race.

These problems with race-based medicine are inextricably tied to the devaluation of Black women’s childbearing. Obstetricians apply race correction in treating pregnant Black patients with harmful results. For example, the calculator for determining whether someone who has had a C-section should have a subsequent vaginal birth (VBAC) factors in race in a way that is more likely to recommend against vaginal birth for Black patients — increasing their risk of having a C-section. Black pregnant patients are less likely to be treated for anemia because of race-based diagnoses. Unsurprisingly, recent studies have shown that these racial adjustments produce negative outcomes for Black women giving birth. Studies have also confirmed the inferior treatment by hospital staff that Black birthing women have been describing, including ignoring their complaints about experiencing pain before, during and after delivery. These injustices that are endemic to mainstream obstetrical care in the United States contribute to the abominably high rate of maternal mortality for Black women, which is twice as high as the already shameful rate for white women. A recent report noted that it is more dangerous for a Black woman to give birth in the Mississippi Delta than in Rwanda.

I think that your approach to framing the solution to the child welfare system and foster care in terms of abolitionism is crucial. I say this as your abolitionist approach overlaps with assumptions and energies underlying prison abolitionism. When I hear the term abolition, I also hear hope. I’m a bit more DuBoisian. I’m not hopeless, but unhopeful. I say this because I conceptualize anti-Black racism as recursive and consumptive. It can “eat” what we throw at it. My point here is that anti-Black racism will simply take another form. Anti-Black racism will continue to exist if hegemonic whiteness continues to exist. While I’m not a soothsayer, hegemonic whiteness will resist until the bitter end, which might mean bringing down the entire house in a destructive conflagration. What is it that maintains your sense of hope, and especially hope in abolitionism?

First let me explain why the child welfare or family policing system must be abolished and how that’s connected to abolishing prisons. The child welfare system’s purpose is not to support families and improve children’s welfare. Child welfare authorities police families: They accuse, investigate, regulate and punish families by relying on their power to forcibly remove children from their homes and separate them from their loved ones. The state targets this disruptive force almost exclusively on politically marginalized families. The vast majority of families in the system are poor or low-income and Black, and Indigenous families are the most likely to be investigated and disrupted. This demography is not an accident: The purpose of terrorizing these particular families is to reinforce the very hierarchies that subordinate them.

Hope is something we have to practice despite the historical resilience of anti-Black racism and white supremacy.

The family policing system’s current oppressive design results from an ideological foundation that was set centuries ago to support white supremacy and settler colonialism. Family destruction has historically functioned as a chief instrument of group oppression in the United States. Since its inception, the United States has wielded child removal to terrorize, control and destroy racialized populations and to quash their rebellions against white domination. Family separation was essential to the enslavement of Black people, to the reinstatement of white supremacy after the Civil War, and to the U.S. government’s military strategy in its wars against Native tribes. The system’s foundational ideology, that impoverished children’s economic deprivation is caused by “pathological parents,” is essential to maintaining racial capitalism.

Family policing is governed by a carceral logic that both resembles the criminal legal system in its punitive approach to families and operates in tight conjunction with police and prisons. Local child welfare and law enforcement authorities increasingly enter contracts to create various types of collaborations — from sharing information to engaging in common trainings, cooperating in investigations, and jointly responding to reports and tearing children away from their parents. Family policing and criminal law enforcement reinforce each other, expanding each system’s power to control marginalized communities.

The child welfare and prison systems are also deeply intertwined. Incarceration not only makes it extremely difficult, if not impossible, for parents to maintain a relationship with their children, but it is considered by some courts to be a reason by itself to terminate parental rights. Even when imprisoned parents can keep legal custody of their children, the penalties imposed on formerly incarcerated people create further impediments to maintaining a relationship with their children once they are released from prison.

Foster care criminalizes children. It systematically channels children into juvenile detention and prison. Black children placed in foster care are especially vulnerable to arrest, detention and incarceration while they are in state custody as dependent children and after they leave foster care as adults. They are also more likely to be placed in prison-like facilities, where some have been killed by staff. So, the child welfare, law enforcement and prison systems are integrated parts of a carceral web. Because this is the way family policing (like prisons) is designed to function, it can’t be fixed. The only way to end the egregious harms to Black families caused by family policing is to end family policing and replace it with a radically different way of supporting families and keeping children safe.

I recently came across this quote from James Baldwin when he was criticized for focusing so much on racism: “You want me to make an act of faith … on some idealism, which you assure me exists in America, which I have never seen.” His words made me think about the difference between acting on faith in a false ideal of American equality and acting on the hope in abolition of America’s unequal carceral systems. Baldwin’s criticism of U.S. idealism is that it isn’t grounded in reality. It is based on a mythical view of America as an equal society that has never existed. My commitment to abolition is just the opposite. It is based on facing the reality, grounded in a historical and political analysis, that the U.S. family policing system, along with other carceral systems, is causing immense harm to Black children and their families because it is designed to oppress them. If I face that reality, I have no choice but to seek the system’s abolition. That means not only working to dismantle it but also to create an approach to meeting children’s needs that makes family policing obsolete; it means building a society where forced family separation makes no sense as a form of child welfare.

Abolition is also realistic because we have many examples past and present where Back communities have developed ways of caring for children without interference from racist state authorities. These examples include the hundreds of clubs and church groups that Black women established after emancipation that I mentioned previously, as well as the care that was provided by Black midwives to Black people excluded from hospitals that served white patients only. In the 1970s, the Black Panther Party operated People’s Free Medical Clinics and a Free Breakfast Program through its chapters in dozens of cities. Today, as abolitionist organizers push for nonreformist reforms that shrink the child welfare system, they are also growing community-based ways to provide concrete resources to families that are completely disconnected from child welfare agencies. During the COVID lockdown in New York and other cities when child welfare interventions were dramatically reduced, the outpouring of mutual aid, along with the federal government’s distribution of income supplements to families, kept children safer in their homes with less family policing.

The astute abolitionist Mariame Kaba says, “Hope is a discipline.” Hope is something we have to practice despite the historical resilience of anti-Black racism and white supremacy. Abolition isn’t an end point we can see clearly in the distance; it is a horizon that we must continually struggle toward because we can’t accept the current suffering perpetrated by the carceral state, because we have experienced loving ways of relating to our fellow human beings, and because we are committed to hoping for a more caring and humane world.