Race, Gender, and the Biopolitics of Birth, Care, and Neglect

Over the last few years, a number of high-profile Black women, such as Serena Williams, Beyoncé, Shalon Irving, and Kira Dixon Johnson have brought increased attention to the ways in which race and birth precarity intersect to reproduce a consistent narrative of medical neglect. Adamant demands prevailed upon medical personnel prevented almost certain death for Williams and Beyoncé. Irving and Dixon Johnson were not so fortunate. Irving, a PhD epidemiologist with the Centers for Disease Control and former officer with the United States Health Service and Dixon Johnson, daughter-in-law of television’s Judge Glenda Hatchett, both died of complications related to childbirth, despite repeatedly describing the severity of their complaints to physicians and requesting appropriate care.

In Reproductive Injustice: Racism, Pregnancy, and Premature Birth, Dána-Ain Davis brings trenchant gravity to the high rates of premature birth among Black women in the US, regardless of socioeconomic and educational status. In rich ethnographic detail, Davis links this ongoing birth precarity to slavery’s legacy of dehumanization and medical racism, particularly for Black women. Based on extensive qualitative research, including over fifty interviews, the book fills a research void in scholarship examining the social contexts of Black women’s reproductive lives. Davis locates this contextual focus narratively within historical and ongoing tensions between patriarchal medical authority and the ascendant birth doula movement. In doing so, Davis demonstrates how doulas, birth activists, and birthing Black women themselves contest medical racism embedded in traditional approaches to reproductive care.

Reproductive Injustice skillfully traverses the relatively unpaved intersections of STS, anthropology, and Black Feminist scholarship. While previous scholarship has focused on assemblages of medical technology, expertise, and authority in relation to women’s bodies, less attention has been given to the ways that different notions of racial value affect Black women’s experiences during pregnancy and delivery. Bridging this research gap, Davis shows how, in practice, such putatively objective assemblages collide with social estimations of racial value. Davis describes this collision as the “refereeing” of Black parents’ worthiness for care, itself predicated on a fundamental disrespect of Black mothers (77). Reproductive Injustice contests assumed linkages between biological race and risk by showing how possibilities for successful birth outcomes depend not necessarily on science, but on care. Davis’ crucial ethnographic intervention points to the raison d’etre of doula and midwifery work by focusing on alternative forms of care to traditional medical models as means for achieving reproductive justice. Medical care before, during, and after pregnancy determines health outcomes for mothers and babies. Indeed, as Davis shows, forms of injustice at all stages of reproductive treatment and care are linked to health disparities throughout the life course, particularly for racialized and gendered bodies.

Davis argues that reproductive justice for Black women does not necessarily imply or generate political solidarity among women across race. White women in the South, who took advantage of Jim Crow segregational access to nursing education, worked to disenfranchise Black midwives’ legal ability to practice. In effect, white women who would have become midwives – and who may have even learned from Black midwives – became part of a nascent medical elite who claimed authority over expertise and knowledge production, and who benefitted from intergenerational social status elevation, from and over Black women. A subsequent devaluation in traditional birth knowledge, or “wisdom,” made way for the racialized monopolization of professional experience. During this period, nursing, like teaching, gained prominence as a high-status occupation for both Black women and white women; however, the latter enjoyed more access to employment and status within the patriarchal systems of modern medicine and racial science. Policed by standards of care and the scope of practice, midwifery found its epistèmes, ontologies, and praxes relegated to subaltern, counterpublic spaces until the 1960s when white women, such as Ina May Gaskin, formed a social movement that contested the patriarchal politics of obstetrics and delivery. As the doula/midwifery movement gained traction over successive decades, biomedicine began to steadily adopt and co-opt many of its practices into the clinical theater. However, this social and political process of integrating alternative forms of reproductive care into medical practice both exposed the racial and gender disparities embedded in the fabric of the nation, and reproduced them in practice.

Black women’s reclamation of birth sovereignty departs from Gaskin’s and others significantly in ways they could never encompass, much less translate, culturally, historically, and socially. Given both the (intra-) gendered history and the patriarchialized genealogy of the obstetric present, Davis cautions that the wider social project of doula/midwifery work must avoid replicating the racialization characteristic of the biomedical gaze upon Black women’s bodies. This conscious reclamation of birth sovereignty animates a different dialogic field of ethical and political action for Black women, and their families and communities. However, claims by institutions to foster what Achebe called “dialogue” while actively engaging in a racialized monologue, expose power’s simultaneous inability to reflect upon itself and its ability to dictate the parameters of discussion (Achebe 1988: 15). In contesting patriarchal, racial, and intra-feminist medical hegemonies, a Black feminist reclamation of birth sovereignty faces the challenge of constructing an egalitarian dialogue across the very asymmetrical fields of duplicitous power that produce and maintain reproductive injustice. Reclaiming knowledge, the body, and praxis rightly places Black women’s voices, both practitioners and birth mothers, front and center.

As a Black feminist response to maternal health disparities, Reproductive Injustice makes an essential theoretical contribution to studies of the racial politics of life itself. Combining this approach with an anthropological dimension, Davis’ analysis also extends beyond the academy; themes of food justice, community gardening, decarceration, and environmental justice initiatives and social movements attest to the collective responses of Black women and women of color to life-denying political economies of social death that operationalize medical economies of birth precarity. Davis pushes both scholars and physicians to decenter their attention from a proscriptive ethics rooted in and routed through extant social facts. The book instead constitutes a prescriptive call to action as an ethical imperative that demands medical justice, not as an exercise in power, but the actualization of its very democratization.

James Doucet-Battle is an Assistant Professor in the Department of Sociology, and Affiliate Faculty at the Science and Justice Research Center, and in the Department of Anthropology at the University of California, Santa Cruz. A medical anthropologist, his work examines the intersections of health disparities, race and gift exchange, and bioscientific knowledge production within and without diasporic and transnational Africa. He is the author of Sweetness in the Blood: Race, Risk, and Type 2 Diabetes (U. Minnesota Press, 2021). Email:

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