Reading Dána-Ain Davis’s Reproductive Injustice has broadened my efforts to understand and scrutinize the violence of care embedded within medical and therapeutic practices in the United States. My own work on the violence of care focuses on how such practices are implicated in the past and present landscape of racial inequality in the U.S. I argue that the violence of care stems from the ways that the U.S. medical system is entangled with adjacent institutions, such as law, policing, and lab science. The entanglement of medicine with these other institutions produces competing interests that affect the stakes of care, often resulting in violence that harms gendered and racialized patients in particularly pernicious ways. In the world of prenatal care, specifically, Black maternal health disparities are the result of a professional and epistemological structure that perpetuates white ignorance within medical practice. However, Davis moves beyond simply critiquing prenatal care practices to center the voices of Black women and their advocates as they seek to form communities of support that shelter and nurture Black maternal and infant lives.
How does the violence of care in the world of medical intervention manifest in high rates of premature birth among Black women in the U.S.? Davis lays out how U.S. systems simultaneously recognize racial disparities in prematurity and maternal health while ignoring how racism shapes Black women’s experiences of being pregnant and giving birth. The technical assemblage that comprises the Neonatal Intensive Care Unit (the NICU) draws attention away from the role of racism in driving Black maternal health crises. Davis develops a deep critique of the NICU and marks it as a site of suspicion. Time and again, Davis shows how doctors and health professionals refuse to acknowledge the role of racism itself in Black maternal and infant health outcomes; for example, by conflating race with poverty. Prenatal caregivers’ refusal to name racism as the greatest threat to infant and mother survival results in a dual modality of harm. First, caregivers locate the risk to Black mothers and their infants within the Black maternal body itself. Second, and as a result, caregivers and other medical professionals capacitate systems of intervention that fail to address threats to Black maternal flourishing.
As Davis shows, the Black maternal body is signified and reinforced as a site of risk through the commonly-held beliefs about prematurity and low birth weight that characterize the prenatal health world. In Chapter One, “Premature Predicaments,” Davis includes a Centers for Disease Control (CDC) figure that lists “Black race” on a poster detailing “Factors Associated with Preterm Birth” (p.42). This transformation of “Black race” into a causal variable associated with pre-mature birth is enacted within the practice of pre-natal and neonatal healthcare, wherein birthing mothers are told time and again that the concerning symptoms they are experiencing are due to their own poor choices (see the case of Ashley on p. 50). Indeed, Davis highlights the guilt, shame, confusion, and anger expressed by birthing mothers forced to navigate a medical system and modes of care that locate risk, deficit, and pathology within the patient themselves.
Without a discussion of racism as a factor in poor maternal and infant health outcomes, medical institutions capacitate narrowly prescribed forms of intervention and technology. Davis argues that approaches to and understandings of prematurity are shaped by a standard medical protocol dictating a particular approach to prematurity. These approaches are further driven by an investment in technologies for intervening and responding to prematurity after the fact (e.g. low birth weight, etc.), rather than a focus on prevention. Medical professionals de-emphasize the social determinants of maternal and infant health in favor of practices that in fact contribute to harmful outcomes for birthing mothers and their babies. In particular, as Davis shows, by ignoring the violence and threat of racism, the medico-industrial complex fails to offer or withdraws care that might intervene to prevent those harms at a structural level.
What is to be done in the face of the violence of care in prenatal medicine? Davis models one reparative pathway in the crafting of her ethnographic project. Time and again, we see Davis engage in difficult conversations with medical practitioners, drawing attention to their silences and elisions and balancing these interludes with the strong voices of Black mothers and their advocates. Throughout Reproductive Injustice, Davis centers Black women’s voices in her critique of prenatal medicine and non-profit work, in order to demonstrate the possibilities for cultivating pro-maternal policies that empower and protect Black women. In short, this ethnography shows us what anthropology looks like when Black lives matter, and what prenatal care might look like when Black lives are centered.
Sameena Mulla is Acting Associate Professor in the Department of Women’s, Gender and Sexuality Studies at Emory University. Her work examines the effects of legal and medical intersections in U.S. interventions into sexual violence, and their investments in regimes of gender, race, and power. She is the author of The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Intervention, and Bodies in Evidence: Race, Gender, Science and Sexual Assault Adjudication with Heather Hlavka.