For Young Black Women Like Me, Reproductive Health Has A Troubling History

During my second semester of college, my roommates found me on the floor of my dorm room, shivering and doubled over in pain. They called for an ambulance, but the EMTs refused to take me to the hospital. I made an appointment with my general practitioner, but it took me months to convince my doctors to give me an ultrasound. When I finally got one, it showed the presence of ovarian cysts. I was wrongly diagnosed with Polycystic Ovarian Syndrome (PCOS), a hormonal imbalance that can require a variety of interventions, including birth control and hormone treatments. It wasn’t until I was 25, nearly six years later, that a gynecologist told me I don’t have PCOS; it turns out some people with ovaries are simply prone to cysts. As a young Black woman dealing with my reproductive health, my tale of ignored pain and misdiagnosis isn’t uncommon: Research suggests medical providers often falsely believe Black patients have a higher pain threshold than our white counterparts, which results in misdiagnoses and lack of treatment.

This story of condescension from medical providers is part of a broader legacy of medical mistreatment endured by Black women. It’s why my mother has always insisted my sister and I document our symptoms and fiercely advocate for our reproductive medical care. “For some time around my mid-20s, I stopped going to the gynecologist,” she told me recently. “They always asked me intrusive questions and assumed I knew very little about my own body and care. The gynecologist made me feel small and as a result, I missed out on important health care services.” Decades after these traumatic medical encounters, my mother’s pain is palpable. I can see the ways in which her past experience with medical racism continues to deeply impact her sense of safety and belonging.

According to a 2005 report published in Women & Health, many Black women, like me and my mother, report being met with racism and condescension from providers when seeking contraception and other reproductive health services. This, naturally, influences how young Black women navigate their reproductive care moving forward — and not for the better. According to reproductive health advocacy group Power to Decide, Black women who experience discrimination and coercion from providers are less likely to use the most reliable forms of contraception than our white counterparts. This includes long-acting reversible contraception (LARC) such as IUDs, contraceptive shots, and the pill. Black women are also more likely to utilize less secure alternative contraceptive methods, such as condoms-only, withdrawal, and natural family planning. The Bixby Center for Global Reproductive Health lists experiences of racism, mistrust of health care professionals, and DIY reproductive care methods as possible causes for the high rates of unintended pregnancy seen among young Black women.

Black women’s medical trauma doesn’t exist in a vacuum, but is part and parcel of a long history of medical racism.

My 30-year-old sister’s experience is telling. Recently, she explained to her doctor that she isn’t currently taking birth control but would like to know her options. Instead of listening, the doctor patronized her. “You know you can get pregnant, right?” the doctor said.

“It was demeaning and traumatizing,” my sister says of being dismissed and judged. “You’re already in such a vulnerable position, so to be mistreated and denied care like that, I felt especially unsafe.” Like many other Black women, she ended up taking her reproductive care into her own hands, and chose natural family planning over a potentially harmful experience with another medical practitioner.

Black women’s medical trauma doesn’t exist in a vacuum, but is part and parcel of a long history of medical racism. Even the field of gynecology is based in a legacy of violence on Black women’s bodies: Throughout the 1840s, J. Marion Sims, known as the “father of gynecology,” experimented on Black enslaved women to perfect various procedures, particularly the repair of fistulas. While Sims operated on numerous enslaved Black women, he expressly highlighted three Black women in his research: Betsey, Lucy, and Anarcha. Sims operated on Anarcha over 30 times, without the use of anesthesia, before successfully repairing her fistula. Once these procedures were “perfect,” Sims went on to perform the operations on white women — with the use of anesthesia.

In the decades following, Black women’s right to reproductive autonomy didn’t get much better. In the 1960s, poor Black women across a swath of the American South were coerced into being sterilized in exchange for the continuation of their welfare and other government services. The practice was notorious enough that Fannie Lou Hamer, a prominent activist who led the 1964 Black voter registration drive in her home state of Mississippi, famously called the sterilization of Black women a “Mississippi appendectomy.” There are decades worth of stories from Black women who report going to the doctor for other procedures, such as a cesarean, only to wake up sterilized without their knowledge or consent. While in 2020, most people understand eugenics — the systematic and non-consensual limitation of people’s reproductive choices on the basis of race, mental illness, or other characteristics — to be morally unacceptable, the echo of this racism reverberates through the experiences of Black women today. A 2018 study conducted by researchers from the Centers for Disease Control and Prevention (CDC) directly linked Black women’s troubling reproductive care encounters to the legacy of racism, exploitation, and manipulation of Black women’s reproductive choices.

Trauma is sneaky.

Racism and trauma aren’t confined to the context in which one is dehumanized. Trauma is sneaky — it lives in the interstitial spaces of the psyche, and its impact is felt long after the initial instance of racism passes. The chronic stress Black women experience as a result of racial discrimination is linked to a slew of health complications, including high infant mortality rates, heart disease, and decreased life expectancy. How our medical providers mistreat Black women compounds stress and harms reproductive health.

Young Black activists are working to make reproductive health safer and more inclusive. I look to groups like Sistersong, which fights for reproductive justice for women of color, as an example of what can be done. These activists advocate for reproductive justice on individual, organizational, and national levels and provide training on the implementation of inclusive frameworks to improve care. The fight for Black women to receive just and humane gynecological care is far from over. As people contend with the difficult truth that modern reproductive care is founded in racist medical practices, the work of reproductive activists serves as a reminder that Black women’s narratives and lives don’t end with dehumanization. Their work leaves me hopeful that the future of gynecological care can be one of inclusion and belonging.