The theme for Black Maternal Health Week – Centering Black Mamas is a part of life for many providers who make it their life’s work to center Black bodies. On going conversations with Black Birth workers, Lactation Consultants, Midwives and more, who not only work in the space, but exist in the space, underline the frustration, stress and so many other emotions that are felt when working to fill gaps that affect Black existence when it comes to healthcare.
Disparities in Maternal Health, and more recently in Public health, with more disparities exposed by the recent Covid-19 Pandemic, are issues that remain under the watchful eye of providers who are trying to preserve the lives and experiences of Black bodies in medical spaces. Albeit with a tight bloodied fist grip on the strands of honor left for the community in healthcare at no fault of their own, the work is being done. The rest of the world is asking why are there are such vast differences in health outcomes, but many of us know the answer.
Its unfortunate that much of the blame and responsibility of such outcomes falls in the unsupported laps of black people and minority groups. Lack of education, lack of access, and lack of responsibility are pinned as the reasons more often than not. A quick glimpse into history and modern data highlights the true cause and the dire need for a shift in accountability. Do names like Marion Sims, Benjamin Rush, or even more recently the book Nursing: A Concept-Based Approach to Learning, ring a bell? To save you time here is a brief overview:
J. Marion Sims
Sims’s modern critics make three major claims about Sims and his early operations for vesicovaginal fistula. The first assertion is that it was unethical “by any standard” to perform experimental surgical operations on slaves because slaves, by definition, could not have given voluntary informed consent for surgery.9 Underlying this assertion is the hidden presupposition that enslaved women with fistulas did not want surgical care for their condition (vesicovaginal fistula) and that they were therefore coerced into having unwanted (and perhaps, unnecessary, surgery). The second assertion is that Sims’s failure to use ether anaesthesia during these operations was racist: that he did not use anaesthesia when performing fistula surgery on black women, but later, after he had developed his operation and moved to New York to found the Woman’s Hospital there, he routinely used anaesthetics when operating on white women who, it is alleged, unlike blacks, were unable to stand the pain involved.4,5,6,7,8 The third assertion is that the use of slaves for medical experimentation was unnecessary because substantial advances in medical care were made in the 19th century by Southern physicians who experimented in an ethical manner using white women from whom they obtained “informed consent”, a circumstance that modern critics assert did not exist with regard to Sims’s operations on these early slave women.
Benjamin Rush
Philadelphia’s yellow fever epidemic of 1793 was the largest in the history of the United States, claiming the lives of nearly 4000 people. In late summer, as the number of deaths began to climb, 20,000 citizens fled to the countryside, including George Washington, Thomas Jefferson, and other members of the federal government (at that time headquartered in Philadelphia).
At the urging of Benjamin Rush, the support of Philadelphia’s free black community was enlisted by Absalom Jones, Richard Allen, and William Gray, a fruitseller who along with Allen and Jones had secured support to build the African Church the previous year.
In an effort to prove themselves morally superior to those who reviled them, Philadelphia’s black community put aside their resentment and dedicated themselves to working with the sick and dying in all capacities, including as nurses, cart drivers, and grave diggers. Despite Rush’s belief that blacks could not contract the disease, 240 of them died of the fever.
As the weather cooled, the disease subsided, and the deaths stopped. Then accusations began against the black citizens who had worked so hard to save the sick and dying. The attack was led by Mathew Carey, whose pamphlet attacked many in the black community. A response to the pamphlet was published by Richard Allen and Absalom Jones.
Nursing: A Concept Based Approach to Learning
Nursing: A Concept-Based Approach to Learning, contains advice for nurses when administering pain relief to people from different ethnic backgrounds.
It begins: “A client’s culture influences their response to, and beliefs about pain. Some cultural common differences related to pain are listed here.”
The page contains headings for different communities. Here are some of the excerpts:
Arabs/Muslims
- May not request pain medicine but instead thank Allah for pain if it is the result of the healing medical process.
- Pain is considered a test of faith. Muslim clients must endure pain as a sign of faith in return for forgiveness and mercy.
Asians
- Chinese clients may not ask for medication because they do not want to take the nurse away from a more important task.
- Indians who follow Hindu practices believe that pain must be endured in preparation for a better life in the next cycle.
Blacks
- Blacks often report higher pain intensity than other cultures.
- They believe suffering and pain are inevitable.
Jews
- Jews may be vocal and demand assistance.
- They believe pain must be shared and validated by others.
Hispanics
- Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven.
- They vary in their expression of pain. Some are stoic and some are expressive.
Native Americans
- Native Americans may prefer to receive medications that have been blessed by a tribal shaman.
- They may pick a sacred number when asked to rate pain on a numerical pain scale.
Only after experiencing serious backlash in the media, Pearson, the publisher of this textbook, pulled this version and vowed to remove this section. Sadly, its too late, as much damage had already been done by the textbook and the would be medical personnel who studied and retained the stereotypes listed in this book. Let that sink in, providers were being taught to NOT respond or downplay the pain or illness of a person depending on their ethnic background.
For those moved more by data, no conversation on Maternal and Public health is complete without mentioning the Maternal Mortality rates in the USA. In 2018:
- 658 women died of maternal causes in the United States.
- The overall maternal mortality rate was 17.4 deaths per 100,000 live births.
- The maternal mortality rate gets higher with each older age group; women ages 40 and older die at a rate of 81.9 per 100,000 births, meaning they’re 7.7 times more likely to die compared to women under age 25.
- The maternal death rate for black women was more than double that of white women: 37.1 deaths per 100,000 live births compared to 14.7. It was also more than three times the rate for Hispanic women (11.8).
A study conducted in 2016 Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites looked more deeply into the fact that Black Americans are systematically undertreated for pain relative to white Americans. They examine whether this racial bias is related to false beliefs about biological differences between blacks and whites (e.g., “black people’s skin is thicker than white people’s skin”). What did they discover? Relative to white patients, black patients are less likely to be given pain medications and, if given pain medications, they receive lower quantities. Further study revealed that racial bias in pain treatment may stem, in part, from racial bias in perceptions of others’ pain, that people assume a that blacks feel less pain than do whites. Beliefs that blacks and whites are fundamentally and biologically different have been prevalent in various forms for centuries. In the United States, these beliefs were championed by scientists, physicians, and slave owners alike to justify slavery and the inhumane treatment of black men and women in medical research. 40% of the Medical Students that participated felt Black People felt less pain. A similar finding resulted from a study with pediatricians
Biases, and dare we mention it racism play a major part in the disproportionate outcomes in the health of Black bodies. The data is out there, the stories are hard to hear, but they are most certainly out there. It’s time someone started listening. “Some will call it pulling the “race card” scientist call it DATA”- Ayanna Pressley said in a public address on REVOLT with Diddy to alert the masses of a state of emergency for black bodies.
What needs to be done from here? There is a lot of work that needs to be done. Namely, providers need to address their implicit and at times explicit bias. These are ideas about a group that are collected over a lifetime that affect how we behave and treat others. Left unaddressed, much harm can be done. Need proof? Look at the current statistics, there are disparities at every turn. It is helpful to recognize that the systems that gave birth to things like food deserts, the availability and access to employment, gentrification, and weathering from racism have a serious effect on health outcomes.
Collect the data, and acutally use it to make the needed adjustments.
Education and Access there are programs in place that make black bodies a priorities. Learn about these organizations. Support them financially,, monies for organizations formed to support the black community are harder to come by. Promote these programs by talking about them to patients, and collegues and anyone who could benefit. Add these programs and organizations to your provider network.
Define Policies in medical spaces that limit the risk of individual discretion and promote a standard of care.
LISTEN TO BLACK VOICES
Thank you for listening to my “TED Talk”
-Editor
Coffee
@therealmzcoffee on Instagram and twitter
Founder of Spiltmilk and Genesis Birth Services
Acknowledgements:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563360/
https://www.pbs.org/wgbh/aia/part3/3p1590.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/pdf/pnas.201516047.pdf
