Interrogating Obstetrical Racism

Dána-Ain Davis’s Reproductive Injustice is a remarkable book by a remarkable anthropologist, published at a remarkable time in United States reproductive political history. In the contemporary United States, white supremacy, xenophobia, racism, and sexism threaten every foundation on which the struggle for reproductive justice has been built. This threat is borne out in rising neighborhood and job and food insecurity; cutbacks in healthcare in general and specific support programs for maternal/child wellbeing; and slashed services for kids and adults with disabilities. In this context, “all politics have become reproductive politics” (Briggs 2018). For Black women and their newborns, in particular, rates of maternal/infant morbidity and mortality continue to rise at a frightening pace. Davis understands the public health discourse and interventions that have been applied to this devastating social fact for decades; however Reproductive Injustice presents an important argument for why these contemporary infringements on the right to life cannot be effectively combatted through individualizing public health interventions. Rather, Davis argues, these infringements must be understood in the context of the communal aftermath of slavery.

This is the background to the story (or rather, multiple stories) Davis so sensitively and skillfully tells in the book’s intellectual, ethical, political and ethnographic commitment to critique the predominant US liberal discourse that reduces race to class. Such discourse produces a contradictory masking effect: while public health concern with racialized health disparities acknowledges previous eras of murderous discrimination, this history is framed as long behind us. Indeed, public health discourse tends to reject this historical haunting as insufficient explanation for why Black pregnant women and their babies remain vulnerable to harmful birth outcomes in the present. Behind this empiricist rationale, mainstream public health’s reduction of “race” to a proxy variable for the historical effects of economic, political, and educational inequality conceals the current, ongoing forms of racialization and racism. As a result,  healthcare providers serve Black clients with little to no understanding or acknowledgement of the structural conditions within which Black mothers practice routine pregnancy and early neonatal care.

Davis’s research disentangles this public discourse on race-as-class from deeply-embedded racist practices that continue to structure Black women’s at-risk pregnancies and premature births. Rather than focus on “risky” pregnancies and experiences of premature birth among low-income Black women, Davis focuses on the narratives of well-educated, Black professionals. Through these stories, it becomes clear that whether or not individual women view their pregnancy and neonatal care as tinged by racism, they are always operating in a system that is continually “recalibrated” (Davis’s term) to see and treat them as if they were willfully ignorant, oblivious to their own and their fetuses’ health, irresponsible with regard to their reproductive choices. In other words, Black women’s class position, professional status, and education are not protective against devastatingly high rates of life-threatening pregnancy complications and the always-potential-catastrophe of caring for prematurely-born babies. Indeed, the women Davis spoke with share experiences of dismissal by healthcare providers who can neither see nor hear them when they ask questions, query diagnostic lapses (Davis’s emphasis), or stand vigil in NICUs. Despite the many ways in which the service-providers Davis interviewed are continually confronted with Black women’s experiences of racialized and racist care, the reduction of race to class persists in dominant understandings of how social factors affect birth outcomes. Further, this racialized reduction enables healthcare workers, maternal-fetal specialists, NICU nurses, social workers, clinic administrators, and other actors working in the sphere of reproductive health delivery to focus on the task of saving babies, while ignoring the ways they are “reproducing race” (Bridges 2011).

Reproductive Injustice offers two primary insights: first, Davis argues that the NICU is an assistive reproductive technology (ART). While US ART literature tends to focus on the fertility challenges of White and other non-Black reproductive subjects, Davis analyzes the NICU as a technology designed to save the lives and protect the health of babies whose outcomes have already been shaped by structural and environmental racism. Davis asks: rather than rely on the NICU as a “salvage technology” what about communal preventive solutions instead? In her final chapters, Davis discusses the role of doulas, midwives, and community support as forming the backbone of pathways to prevention. These care workers and other participants in the reproductive process all have the potential to work collectively rather than individually. Davis offers us this class-and-community-oriented picture of racialized reproduction to argue that better outcomes for Black women and their babies would be possible if appropriate support were made collectively more available.

The second insight offered by Reproductive Injustice is Davis’s insistence that the maternal/neonatal health outcomes of Black women’s pregnancies be viewed as the afterlife of slavery. As Davis shows, this legacy is a point of contention in public health discourse: epidemiologists and health service analysts are accustomed to statistical proof and are suspicious of social explanations. However, statistics also show that decades of well-intentioned interventions have not improved health outcomes for Black pregnant women and their newborns; indeed, these interventions have too often inadvertently mistaken symptoms for causes  (Giurgescu et al. 2015) (Krieger et al. 2013) (Hogue and Bremner 2005)(Villarosa 2018).  Further, Davis’s work with a coalition of birth justice activists provides the material for policy recommendations that emerge from and valorize community support. For example, drawing on activists’ experiences, Davis suggests that doulas actually offer Black women less stressful, more supportive guidance than traditional medical models of prenatal, natal, and neonatal care.  Yet, doulas often face challenges with regard to certification and compensation. Indeed, the debate over the use of doulas as a low-cost non-medical reproductive care strategy has highlighted many structural inequalities that accompany what Harriet Washington long ago called “medical apartheid” (Washington 2006). Many doulas, for example, are justifiably resistant to being herded into one-size-fits-all certification programs after which they are likely to become just another cog in the low-paid, racially hierarchic world of stratified healthcare (Villarosa 2018).

Davis concludes this moving, powerful book by reprinting an image from the cover of the Nation magazine (March 6 2017) entitled, “Black Births Matter.” Davis describes the cover drawing as showing a Black mother holding on to her infant for dear life. As readers, we should take note of Davis’s powerful theoretical and empirical contribution: Reproductive Injustice insists we acknowledge what it means to hold on for dear life in the aftermath of slavery.

Rayna Rapp is Professor Emerita of Anthropology at New York University. She is a co-founder of the Center for Disability Studies. She has made essential contributions to feminist anthropology, and edited the groundbreaking Toward an Anthropology of Women. Her work on the anthropology of reproduction, reproductive technology, and disability contributes to debates on the politics of reproduction, science, technology, and gender.

Works cited

Bridges, Khiara
2011   Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. Berkely & Los Angelese: University of California Press.

Briggs, Laura
2018   How All Politics Became Reproductive Politics. Berkeley & Los Angeles CA: Univ. of California Press.

Giurgescu, Carmen, Dawn P. Misra, Shawnita Sealy-Jefferson, et al.
2015   The Impact of Neighborhood Quality, Perceived Stress, and Social Support on Depressive Symptoms during Pregnancy in African American Women. Social Science & Medicine (1982) 130: 172–180.

Hogue, Carol J. Rowland, and J. Douglas Bremner
2005   Stress Model for Research into Preterm Delivery among Black Women. American Journal of Obstetrics and Gynecology 192(5, Supplement). Optimizing Pregnancy Outcomes in Minority Populations: S47–S55.

Krieger, Nancy, Jarvis T. Chen, Brent Coull, Pamela D. Waterman, and Jason Beckfield
2013   The Unique Impact of Abolition of Jim Crow Laws on Reducing Inequities in Infant Death Rates and Implications for Choice of Comparison Groups in Analyzing Societal Determinants of Health. American Journal of Public Health 103(12): 2234–2244.

Villarosa, Linda
2018   Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis. The New York Times, April 11., accessed March 13, 2020.

Washington, Harriet
2006   Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present: New York: Doubleday.

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