Pain has no color. But for black women, how they are treated—and not treated—for reproductive-health pain resonates deeply with historic roots in slavery and brutality.
A new study from the University of Virginia shows a proven racial bias in how medical providers assess black patients’ complaints of pain, guaranteeing that medical providers consistently undertreat black patients and ignore their symptoms.
This means that some physicians—all of whom take the Hippocratic oath, promising to refrain from “therapeutic nihilism” and instead to treat patients with “warmth, sympathy and understanding”—may break this sacred commitment.
For women, specifically, this can mean symptoms of pain connected to their reproductive health are routinely ignored or dismissed by their doctors and medical-care providers.
For instance, endometriosis is diagnosed as 33 percent more prominent in white women than in women of color. Endometriosis affects 176 million women worldwide and approximately 2-10 percent of American women between ages 25 and 40.
There are several issues associated with diagnosing and treating endometriosis among African-American women and other women of color. It takes an average of six to 10 years to diagnose from the onset of symptoms.
Black women who present with symptoms of endometriosis are often misdiagnosed with pelvic inflammatory disease—a condition that is sexually transmitted. Research on the illness in black women and other women of color is limited.
A doctor can only make an accurate diagnosis through laparoscopic surgery—a procedure that insurance companies consider elective. The decision to move forward with this surgery lies in the doctor’s validation of the patient’s complaints of pain.
In my own recent annual exam, the medical provider asked me a barrage of questions listed on her laptop computer:
“Are you currently employed?”
“I am a postdoctoral fellow and I teach at Brown University.”
“What do you teach?”
“I do research on environmental issues and their impact on the reproductive health of women of color.”
Her response: “Black women don’t care about their bodies.”
The provider saw me simply as a black body and interacted with me through the racist ascriptions she held about black women. The fact is, I was seeking preventive health care because I care about my body.
Tragically, the wedded relationship between history, medicine and science provides us with evidence of the racial undertones associated with the validation process of pain. It is a legacy that must end.
As slaveholders and U.S. political leaders sought to justify the institutionalization of chattel slavery in the 19th century and establish the normativity of the black body as property in person, they turned to the scientific community to produce evidence that would substantiate this initiative.
Veiled in secrecy and protected under the pretext of “objective” scientific pursuit, scientists engaged in a racially biased research agenda that gave birth to biological and environmental determinism during the late 19th and early 20th centuries.
The narrator in Colson Whitehead’s The Underground Railroad (pdf), which just this week earned Whitehead the Pulitzer Prize in fiction, highlights this issue when depicting Ajarry’s experiences as a female slave: “The trader called upon the tobacco plantation looking for slaves of breeding age, preferably with all their teeth and of pliable disposition. She was a woman now. Off she went. She knew that the white man’s scientists peered beneath things to understand how they worked.”
Under this banner of knowledge production, elite white male scientists deemed African Americans as a collective biologically and morally inferior to whites.
In 1851, Dr. Samuel Cartwright published “Diseases and Peculiarities of the Negro Race,” asserting that black skin embodied “partial insensibility” that gave them a higher threshold for pain and made blacks suited for enslavement.
This flagship of ascribed moral depravity and insentience onto the black body ushered in the branch of medicine in obstetrics and gynecology during the 19th century. It is when the womb of the black female slave served as the unbridled space for experimentation on women’s diseases.
Undermedicated and unprotected, the black female slave’s body functioned as the laboratory and surgical specimen for white male doctors such as Dr. J. Marion Sims (pdf), who in the mid-19th century built his career as “the father of gynecology.”
He had unfettered access to these women’s most sacred inner sanctum, free from any moral, political or economic recourse. He routinely used black women as guinea pigs for experimental surgeries without anesthesia and owned female slaves for the sole purpose of operating on them.
In contrast, Sims administered anesthesia to examine a white female patient of high social status who suffered from a phobia of vaginal penetration. Sims even refused his peers’ recommendations for surgical intervention in this case, stating, “They seized on the idea and insisted on the operation, which I declined to perform, on the ground that an untried process was not justifiable on one in her position in social life, the Hospital being the legitimate field for experimental observation.”
Although history venerates Sims, the social customs and laws worked in tandem to historically silence the very bodies that transformed his career. The social customs prescribed under the Cult of True Womanhood in the 19th century argued that women belonged in the private sphere in order to protect their piety, purity and fragility, according to findings from a researcher at St. Cloud State University.
These structural mechanisms thus doubly disenfranchised black slave women and excluded them from shaping the conversations around their reproductive health. In the 20th and 21st centuries, we have witnessed the continuance and transference in the silencing of the black body partly in the name of medicine.
In his 1982 lecture (pdf), Harvard University zoologist and author R.C. Lewontin critiqued this form of biological determinism when he stated, “It follows from such a reductionist view that improvements in the general level of psychic and material welfare of society as a whole can come only by changing the mix of individuals that make it up. That is, general social amelioration can come only from eugenic measures.”
In 2003, Lewontin reaffirmed this critique when he asserted, “ … race and racial categorizations serve a very important social function, namely, they justify the inequalities that exist in a society which is said to be based on equality.”
Today it is imperative that in 2017 a patient can experience her most vulnerable moment and be respected and valued. No matter who she is. With President Donald Trump on Thursday signing legislation that allows states to withhold federal dollars from Planned Parenthood, the threat to the health needs of all women is fierce.
We need to ask and answer poignant questions on how the racialized and gendered biases of medical providers and those in the scientific community contribute to the improper treatment of black women and other women of color when it comes to reproductive-health illnesses.
It is a painful issue, to be sure, but enough is enough.
The Root aims to foster and advance conversations about issues relevant to the black Diaspora by presenting a variety of opinions from all perspectives, whether or not those opinions are shared by our editorial staff.
Vanessa Fabien is a presidential postdoctoral fellow in Africana studies at Brown University. She earned her B.A. in women’s studies from the University of Florida and her Ph.D. in Afro-American studies from the University of Massachusetts, Amherst. She is a fellow with the Public Voices Greenhouse through the OpEd Project.