How the Medical System’s Bias Impedes Black Motherhood

Institutional racism caused me to have a medical emergency a month after giving birth to my son.

The emergency was entirely preventable. Following the birth, I knew something was wrong because I couldn’t walk two feet without extreme pain and was passing large blood clots. I made phone call after phone call to three different hospitals. I informed the attending physician immediately after birth but was told everything looked fine. A couple of weeks later, I went to the emergency room, but when I showed up, I was told large clots and exhaustion were normal postpartum experiences.

After a month of phone calls and visits, a doctor finally listened to me long enough to discover that after giving birth, I had retained a piece of placenta inside my uterus. All of a sudden, the medical establishment acknowledged the dangers of the situation I was facing: increased risk for hemorrhaging, infection, and even death.

I was rushed into an emergency again in a different state where they determined I needed a dilation and curettage procedure to remove the piece of placenta. The emergency procedure could have been prevented if my attending physicians had done a more thorough assessment to examine my discomfort before releasing me.

Naturally, I was afraid that the experience had left physical scars to match the emotional ones. I was told the chances of lasting uterine problems were low but that anything was possible.

A year after the emergency procedure, I was diagnosed with uterine fibroids and was curious how that would affect my ability to become pregnant again. My past experience, however, left me hesitant to seek care. And I was embarrassed about speaking with a fertility specialist as a Black woman in her mid-20s. In the Black community, there is often a heavy emphasis on “God’s timing” and our society expects young women to be fertile. I was facing intracommunity and gender-based stereotypes. I was too young to need this kind of help.

From the moment the medical professional who would be leading my appointment arrived, the environment felt cold. She sat down and harshly asked me why the information reported from my last annual exam showed I wasn’t trying for a baby. It didn’t matter that I wasn’t comfortable revealing that information at the time of my last appointment. To her, I’d been caught in a lie and needed to be punished. In the following moments, she made me take an informal quiz to “prove” to her that we had indeed been trying to conceive. Then she made comments on the fact that I already had a child — as if secondary infertility didn’t exist — and asked me if I was with the same partner as before, despite the fact that I was still clearly a dependent on the same military installation.As the wife of an airman, I was relying on a clinic at the local military base for care. I was pleasantly surprised that the clinic had an opening the following business day. But from the moment my son and I were called out of the waiting room, I began to feel uncomfortable. As a Black woman, I am well aware that both my sexuality and my reproductive decisions exist under increased surveillance. Still, I didn’t expect to experience this so acutely.

Facing this dismissive treatment in a vulnerable time crushed any ounce of trust I had left. I left feeling like I’d been put on trial for seeking help. Her inquisition was enough to make me never want to seek reproductive advice again.

The experience weighed so heavily on me that I cried while reflecting on it later. There were plenty of women on our military base with multiple children who had gotten fertility assistance. I couldn’t help but wonder if my appointment and question would have gone the same way had I been a white woman.

I also wondered how many Black women like me have been continually let down by the reproductive health care system. How many of us have reached out for help only to be forced to prove our struggle, or turned away completely? As much as I wanted to ignore it, my experience reeked heavily of the institutional racism that permeates the health care system.

Lately, there has been a lot of attention paid to the fact that Black women are three times more likely than white women to die from childbirth-related conditions, such as postpartum hemorrhage, preeclampsia, uterine rupture, spontaneous coronary artery dissection and peripartum cardiomyopathy. However, our national dialogue still overlooks the fact that Black women’s reproductive risks start long before childbirth. Every stage of the reproductive process comes with additional risks if you’re a Black woman.

Although infertility affects women of all races at a rate of 6 percent, Black women face increased risk and are 1.8 times more likely to be infertile than white women. A telling indicator of the reproductive health issues faced by Black women is our disproportioante risk of contending with the “benign” tumors in the uterus that are referred to as uterine fibroids. Fibroids are three times more common in Black women than in white women. Black women’s fibroids also appear earlier, are larger and cause more pain. Fibroids can increase the chance of problems like preterm delivery and placental abruption — a condition in which the placenta partially or completely separates from the uterine wall. While the reason is unknown, Black women with polycystic ovarian syndrome have an increased risk for metabolic syndrome and cardiovascular disease. Black women also have worse outcomes for cervical cancer. And for treatment of these conditions, Black women are more often advised to seek a hysterectomy — a procedure found to have many long-term consequences, such as higher potential for high blood pressure and higher risk for heart disease. Additionally, women who had the procedure under the age of 35 had a 4.6-fold increased risk of congestive heart failure and a 2.5-fold increased risk of coronary artery disease.

According to the Centers for Disease Control and Prevention (CDC), 12.1 percent of women ages 15-44 nationwide experience “impaired fecundity” (being able to become pregnant but struggling to carry a child to a live birth), and 6.7 percent experience infertility.

With so much at stake, it is particularly important that Black women have access to gynecological and reproductive services. But unfortunately, this is seldom the case. Only 12 percent of women ages 12-44 have ever accessed infertility care, but according to the CDC, white women are nearly twice as likely as Black and Latina women to have ever used medical help to get pregnant: only 8 percent of Black women and 7.6 percent of Latinas have done so.For Black women, the numbers are even higher, and we also face increased barriers to care: Reaching out to a reproductive specialist as a Black woman requires contending with providers influenced by stereotypes about Black women only having unintended pregnancies. It also requires overcoming valid mistrust of medical institutions based on the historical abuses against Black women that range from experimentation on slaves to involuntary sterilization and our current maternal-mortality crisis.

Perhaps Black women are less likely to take part in these resources due to the myriad financial and sociocultural obstacles in the way. In 2015, authors of the University of Michigan report “Silent and Infertile: An Intersectional Analysis of the Experiences of Socioeconomically Diverse African American Women With Infertility” found that Black women are more likely to deal with infertility alone. The research found that infertility affects Black women’s sense of self and gender identity. Religious messages on reproduction also contributed to their negative feelings, as did the expectation for Black women to be strong and deal with trials head-on.

Not surprisingly, few if any reproductive health programs are prepared to address the ways that infertility and other reproductive issues uniquely affect Black women. The lack of cultural competence is so vast within our medical system that there are still professionals who believe Black people have higher pain tolerance than people of other races. It is also likely that, like me, other Black women have also sought assistance only to be turned away due to false perceptions of Black women’s fertility or left uncomfortable after being subjected to embarrassment via interrogation.

Black women are also more likely to be employed in low-paying jobs that don’t provide insurance benefits that cover these types of services. But even Black women with good benefits can be placed in financial strain with in vitro fertilization starting around $12,000 at the very minimum. The price tag might be seen as even more frustrating since racial disparities in in vitro leave Black women with higher rates of spontaneous abortion post-procedure.

Continuous exposure to racism, also known as toxic stress, has already been linked to the maternal and infant mortality crisis in the Black community. Despite the fact that the health care system should be a bias-free safe haven for assistance, institutional racism in health care continues to run rampant. Sometimes dealing with the same prejudiced attitudes in the medical system that we deal with in everyday life is too much to bear. As a result, racism is surely another reason for Black women’s reproductive health disparities.

The mistreatment I have received within the health care system has made me hesitant to reach out for assistance in the future. But I know there are culturally competent professionals to fill the gap. In the last decade, organizations like Fertility for Colored Girls have been created to provide Black women with the holistic fertility awareness they deserve. Similarly, organizations that circulate first-hand accounts of Black women dealing with infertility, like The Broken Brown Egg, are working to normalize conversations about infertility among women of color. Other websites like Resolve provide a more general look into infertility.

My experiences have shown me just a couple of the many ways in which the reproductive health system ostracizes Black women. It is especially important that Black women have access to quality reproductive care because — all too often — our very lives are at stake.