Feb. 2024 Meeting: Davis’s Reproductive Injustice

Our February 2024 LMCC meeting took place on Wednesday, February 28 at 5:30pm in UNC’s HHIVE Lab (Greenlaw 524) and via Zoom. We discussed Reproductive Injustice: Racism, Pregnancy, and Premature Birth by Dána-Ain Davis (NYU Press, 2019). Specifically, we discussed:

• Introduction (pp. 1-26)
• Chapter 1: “Premature Predicaments” (pp. 29-58)

In addition to this reading, several of our LMCC members also attended an online talk with Dr. Dána-Ain Davis, sponsored by the Moral Economies of Medicine (MEM) working group at UNC, on Fri. Feb. 23. That event was titled “Black Anti-Bodies and the Repercussions of Obstetric Racism” In preparation for the talk, Dr. Davis shared a work-in-progress for attendees to read. At the talk, she spoke for about twenty minutes, followed by about an hour’s worth of discussion and Q&A on this specific work-in-progress as well as on her scholarship and her activism. The insights gained from that event were then integrated into the LMCC’s meeting on Feb. 28 as a supplement to our discussion of her book, Reproductive Injustice.

If you missed the meeting on February 28, you can still access the text on the Readings page of this site!

You can also access the recording of our meeting here.

Our next meeting will take place on Wednesday, March 27 at 5:30pm in UNC’s HHIVE Lab, Greenlaw 524. If you can’t attend in person, you can attend in real-time via our usual Zoom link. We will send out an announcement soon with more information for that meeting.

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Some key concepts from the event on 2/23:

• The Black body is not always killed but is always wounded and traumatized; perhaps that’s the goal.
  • Other countries also have racism but still have better birth outcomes.
• Black bodies as both extraordinary and atypical (weaker and stronger, with strength associated with being primitive)
  • Common assumptions: Prone to pelvic disease (due to hypersexuality) but not endometriosis; more tolerant to pain
  • Endometriosis often associated with women who waited to reproduce; associated with the “moral duty” of women to reproduce
• Six dimensions of obstetric racism:
  • Diagnostic lapses
  • Neglect, dismissiveness, or disrespect
  • Intentionally causing pain
  • Coercion
  • Ceremonies of degradation
  • Medical abuse
• Katia (from the work-in-progress) almost expecting obstetric racism in her healthcare encounter to give birth: prepared to take notes and document everything
• Three ways to resist obstetric racism (ways to mitigate racist experiences in healthcare):
  • Racial reconnaissance
    • Extensive research
    • Visiting numerous doctors and caregivers
    • Extensive notetaking
  • Outright resistance
  • Outright refusal
  • See also: Davis, Dána-Ain, Cheyenne Varner, and LeConté J. Dill. “A Birth Story.” Anthropology News, 27 August 2021. https://www.anthropology-news.org/articles/a-birth-story/.
• Norplant was known to have adverse effects on Black women: contributed to obesity, high blood pressure, and something else Davis couldn’t remember right now
• Patient-Reported Experience Measures (PREMs): eventually included obstetric racism
• Quality control and improvement departments are actually where lots of hospital decisions are made.
• Prenatal care was a eugenic project initially.
• Black women need someone who knows “the language” but who isn’t invested in the financial outcome of the hospital, providing the right advice and asking the right questions to healthcare workers:
  • How are you going to do this? What type of antibiotic? At what levels or rates?
  • And other ways to work within a system that you can’t fully change
• It’s important to remember that, yes, race and racism is a system, but we need to also remember that racism also takes place on a personal, daily level.
• Hospitals are ultimately beholden to insurance systems.
  • Residents are basically often free agents, and so they can be sites of resistance or change since hospitals rely on their labor.

 

Today’s text:

Davis, Dána-Ain. Reproductive Injustice: Racism, Pregnancy, and Premature Birth. Anthropologies of American Medicine, vol. 7. NYU Press, 2019. https://www-jstor-org.libproxy.lib.unc.edu/stable/j.ctv12fw5vq.

• Preface (pp. ix-xvi)
• Introduction (pp. 1-26)
• Chapter 1: “Premature Predicaments” (pp. 29-58)

 

Some key concepts from today’s text and our discussion:

• There is a tendency for systems and people to acknowledge class/socioeconomic status rather than race, as well as a tendency towards asking/expecting patients to advocate for themselves (unfair burdens or expectations).
• Some people interviewed didn’t feel that they experienced medical racism; Davis includes such content and provides her own interpretation on such experiences, as still embedded within racist systems (research/ethnographical heterogeneity and transparency vs. a kind of scholastic paternalism/condescension?)
• Physicians talking around race rather than about race, especially when it comes to Black individuals.
• “Weathering,” the cumulative stress of existing within racist structures, can lead to negative health outcomes, often overlooked.
• Obstetric hardiness assumption (connected either inherently to Black bodies or the misguided belief that Black “hardship” has hardened them), or the belief that such individuals are simple exaggerating their pain.
• Fear among patients for annoying healthcare workers in order to maintain good care; the desire to be a “good patient.”
  • Depending on privilege, some patients are more or less likely to be perceived as “good” or “appropriate” compared to others.
• Janet Shim: “Cultural health capital,” the “right” kinds of patient behavior and presentation to have capital while interacting with healthcare workers (https://doi-org.libproxy.lib.unc.edu/10.1177/0022146509361185)
• Eeva Sointu: “‘Good’ Patient/‘Bad’ Patient: Clinical Learning and the Entrenching of Inequality” (https://doi-org.libproxy.lib.unc.edu/10.1111/1467-9566.12487)

 

Some key passages from today’s text, Reproductive Injustice:

Preface (pp. ix-xvi)

“Black women have higher rates of premature births than any other women in America, and these rates of prematurity go beyond class. One might expect that lower-income and poor women would have higher rates of premature birth because of lack of care or resources. Yet among Black women, being middle- or upper-class provides little protection from the precarity of prematurity, in ways that do not hold true for women of other racial backgrounds. This book looks into the dynamics of how this may be the case. Placing these differences in birth outcomes into a historical context, the book shows how contemporary ideas about reproduction and race have been influenced by ideas that developed during the era of slavery” (Davis ix).

“Ashley’s description of how she was treated during not one but two pregnancies raised a number of questions about the racial dimensions of prematurity and the technologies used to save premature infants born to Black women. Ashley felt that doctors had misdiagnosed issues that arose during her pregnancy and that racism had something to do with the care she received. I began to wonder what other women, especially women of color, thought and felt about giving birth prematurely, and what role they believed race and racism played in their pregnancy, their treatment, and the admission of their children into the NICU” (Davis x).

“…it seemed as if he was trying to find within my narrative a stereotypical thread about the young-looking twenty-two-year-old Black woman who sat before him. That is how I would characterize the doctor’s questions—predicated on assumptions that my family or I were potentially pathological from his perspective. My perception was that he was judging me, based on ideas nourished by my race, my age, and the fact that I needed charity care. There was nothing in particular about what he said, but there was something about his tone and how he asked questions. I was just uncertain that he was not insinuating something based on his questions” (Davis xi).

“Inspired by the similarities in our respective situations, the focus of this project centered on Black women’s specific experiences with prematurity. The research was also driven by the fact that in US politics, as many scholars have pointed out, women have been largely erased from the issue of reproduction. Indeed, the politics of reproduction have generally centered on fetuses, newborns, and infants (L. M. Morgan and Michaels 1999). This book brings women—specifically Black women—to the center of inquiry on the social context of reproduction” (Davis xii).

“However, class is also raced in different ways, depending on gender. For instance, women who are working and middle-class are often understood to be white, whereas Black women are often viewed as being low-income or poor (Bettie 2014, 34)” (Davis xiii).

“Race mattered for us because white women do not fit into the dominant narrative that moves across the American imaginary about who gives birth prematurely. It is Black women who hold that place, and it is Black women who are castigated for their reproduction” (Davis xiv).

“That is what this book is about: Black women’s narratives of prenatal care, pregnancies, and prematurity and their understandings of the racism they experience as they strive to give birth to children who will thrive and to give voice to the ongoing legacy of racism in the way they are treated— a legacy now several hundred years old” (Davis xiv).

“Being born prior to full term almost always leads to admission of a newborn to the NICU. So, the NICU became the conversational place of departure from which I learned about Black women’s thoughts on prematurity. I wanted to hear their viewpoints regarding what contributes to premature birth and to experiences in the NICU. I was especially interested in how they and their infants were treated by doctors, nurses, and others involved in the care of their children” (Davis xiv).

“Although you have probably read about Black women and infant mortality, Black women and low-birth-weight infants, and Black women whose babies are born too early, this book tells the contemporary story of pregnancy and premature birth against the backdrop of the legacy of slavery. It underscores the history of Black women’s reproductive exploitation and reminds us that Black women have had to endure a medical structure that has historically not really viewed them as worth caring for—I mean really caring for” (Davis xiv).

“Yet it is important to point out that even if the people with whom I spoke reported not having had to confront racism during their medical encounters, this does not mean racism is not operating within the medical system. One of the primary claims of this book is that in issues of reproduction and prematurity, race matters. Racism matters. This holds true even when there is no direct impact perceived by those receiving treatment. The data and statistics support—and plainly illustrate—this claim” (Davis xv).

“Focusing on how race and racism are understood and felt by Black women in their medical encounters while pregnant and after their babies are born and enter the NICU, this book looks at experiences of racial inequality at the very start of life, and from the point of view of racialized childbearers—that is, Black mothers. At the heart of this book are an understanding and an analysis of how these women characterize their interactions with medical professionals regarding the care they received (or did not) during and after their pregnancies, and the ways that medical racism continues to contribute to differential life chances in the contemporary United States” (Davis xv).

“Medical racism also includes the sometimes subtle and sometimes not-so-subtle ways in which the medical complex, in each of its parts, cumulatively dismisses, misdiagnoses, and undermines women’s feelings and intuitions about their reproducing bodies and, more specifically, disproportionately undermines Black women’s reproduction. This book, then, views medical racism as a problem that transcends individual doctors and medical professionals. It also views medical racism as compromising more than individual women. In exploring the meaning and interpretations women have of racism by analyzing their oral histories, here referred to as birth stories, this book examines medical racism and Black women’s reproduction as a complex cultural system with deep historical roots” (Davis xv-xvi).

“…these women’s accounts illuminate the ways in which historical structures and conceptions of race are inextricably tied up in contemporary medical understandings of prematurity and pregnancy in the twenty-first century, drawing our attention to the existence of a medical racism that continues to operate today, often similar to ideas and practices that originated during the era of slavery” (Davis xvi).

Introduction (pp. 1-26)

“Black women are more likely than any other women in the United States to experience premature births, and to have low-birth-weight infants. This book, in part spurred by that fateful conversation with Ashley, undertakes a historically grounded discussion of this phenomenon. Ashley’s story is one of the many I collected during seven years of research that have culminated in this book. I argue that some pregnant Black women, like Ashley, experience medical encounters reminiscent of racist medical practices and beliefs that have persisted from the 1700s. My attempts to understand the historical roots of those experiences took me to medical journals, historians’ accounts, and other sources ranging from the 1700s to the twenty-first century. Using the afterlife of slavery framework as a critical lens to situate medical professionals’ practices, this book explores how Black women’s prenatal care, labor, birth, and treatment in medical environments, are extensions of eighteenth-, nineteenth-, and twentieth-century racial thinking. My analysis shows that despite the determined efforts of medical personnel, of the staff of agencies working to reduce adverse birth outcomes, and of birthing and reproductive justice advocates, the power of race and racism cuts across the American class divide, producing racial disparities in infant mortality and prematurity rates that call into question the efficacy of the ‘technologies of saving’ pursued by advocates of NICUs and the health education campaigns used by public health proponents” (Davis 1-2).

“Ashley believed that her care was compromised by the fact that she was young and the assumptions that the staff made about her education and economic status. These issues, combined with her race, led to medical professionals treating her dismissively. It did not matter if the medical professionals were Black or white, because Ashley’s providers were both. One of the points here is that as a cultural system, medical racism can be enacted by people of any racial or ethnic background; what matters more is who is being acted upon, and who suffers the consequences” (Davis 6).

“She [Ashley] felt that her race combined with her age and the fact that she received assistance meant that the medical staff considered it unnecessary to treat her with respect or take the time to explain what was going on in a way she was able to comprehend. Ashley’s summation suggests that when age and race intersect with type of insurance, that combination comes to stand in for one’s class and one’s ability to synthesize medical information, and these things together can influence how a person is treated. Preconceived ideas about Black women and public assistance certainly circulate in the popular realm and in the medical profession. Notably, receipt of public assistance is not necessarily indicative of a lack of education or lack of health knowledge. Nonetheless, poor women and women of color are often viewed with contempt by medical professionals and are seen as having ‘unruly bodies’ (Bridges 2011, 16) and are easily disregarded” (Davis 6).

“What may have been useful was for Ashley to have support, someone to serve as a mediator between her and the medical professionals—a person to advocate for her and on her behalf, as well as to be a witness during her medical encounters. Although her grandmother and aunt could have served that purpose, they did not live nearby” (Davis 7).

“Ashley’s story offers insight into the sometimes complicated relationship that Black women have with medical professionals with regard to reproduction, and specifically with regard to pregnancy and childbirth. She is one of the many African American women who have given birth prematurely in the United States and whose reproductive lives are often conveyed in terms of statistical data. Black women are more likely to die in pregnancy or childbirth, at a rate of three to four times that of white women (Maron 2015); according to the March of Dimes (2011), Black women in the United States are two times more likely to give birth prematurely than any other group of women. Ashley’s reproductive outcome is thus common among Black women who, regardless of class, have higher rates of premature births and low-birth-weight infants (Mullings and Wali 2001)” (Davis 7).

“Among the range of health concerns Black women face during pregnancy, childbearing, and after birth are inadequate receipt of prenatal care, the prevalence of preterm birth, fetal mortality, restricted fetal growth, and maternal mortality. All these problems vary by maternal race/ethnicity (Bryant et al. 2010)” (Davis 7-8).

“This book explores how medical racism—that is, the ideas and practices that perpetuate racial hierarchies and compromise one’s health or facilitate vulnerability to premature illness or death—influences medical encounters in the United States, particularly as it relates to Black women’s reproduction. It argues that Black women’s pregnancies and premature births are important sites of analysis to help us to understand medical racism” (Davis 8).

“Black women’s poor reproductive outcomes are often seen as a woman’s personal failure. For example, Black women’s adverse birth outcomes are typically discussed in terms of what the women do, such as drinking alcohol, smoking, and having less than optimal eating habits that lead to obesity and hypertension (Florido 2014). In other instances, their low earnings or their age is the focus of blame (Shamus 2016). The may be seen to be at risk based on the presumption that they are ‘single,’ when in fact they have a partner—but are unmarried. Whatever the circumstance, Black women become wedged between embodying risk and being the targets of intervention” (Davis 8).

“What makes this book unique is that it centers on women whose social location—through their attainment of higher education and professional status—complicates common presumptions about who ‘carries’ the risk factors leading to adverse birth outcomes. In this book, it is Black women—and those who are professional and college educated—who are central. Importantly, they too give birth prematurely at higher rates than white women with the least amount of education” (Davis 9).

“Additionally, this book is distinctive because discussions of premature birth generally privilege the infant and treatments used to address issues of fetal viability or underdevelopment. Here the focus is on mothers, placing Black women at the center of an analysis of reproduction. This approach is acutely important because the rise of reproductive technology has tended to decenter or displace women. Because of the degree to which technology mediates reproduction, much of the research has made technology the object of reproductive investigation” (Davis 9).

“It [this book] goes beyond discussions of the socially constructed nature of race and attends to how racism in practice, a fundamental element of the social structure, is captured in women’s impression of medical encounters…. Because it appraises experiences rather than extrapolating data in the way that epidemiology does, this book offers a critical voice to the medicalization of pregnancy (Scheper-Hughes and Lock 1987)” (Davis 9-10).

“This book draws on ethnographic interviews with nearly fifty people, including professional Black women (and three fathers), as well as doctors, nurses, March of Dimes administrators, and birth justice advocates, with the goal of examining pregnancy, prematurity, and NICUs as sites through which medical racism can be understood. Those narratives place this project in the tradition of Black feminist thought in the United States, as this research focuses on Black women to understand everyday life. As used here, a Black feminist approach resists the erasure of Black women’s lives and recognizes their experiences as sources of knowledge production. It takes seriously the credibility of Black women’s interpretive lens and privileges their feelings and analysis of the world, in this case of medical encounters (Collins 1991; Mullings 2000). As Lorde (1984) and Anzaldúa (1987) remind us, the details of the everyday and the particularities of lay knowledge stimulate an understanding of and ability to dismantle power” (Davis 10).

“…by exploring what it means for Black women’s reproduction to be abridged or neglected by medical professionals, this book also investigates the role played by reproductive care providers and advocates. Thus, the book asks, what are the ways in which pregnancy, labor, birthing, and having a premature infant in the NICU intersect with articulations of medical racism, and what strategies are used to address these problems?” (Davis 12).

“Importantly, the difference in rates of prematurity by race in the United States has held strong since the time of enslavement. Thus, it is also useful to ask, how can historical references help us to understand how Black women are cared for and treated during medical interactions today? What form does contestation against the power of medical professionals take in stemming the tide of premature births among Black women?” (Davis 12).

“Even when women have positive encounters, they are giving birth in an anti-Black society, one that has continued to treat Black people with disdain, and they are experiencing their pregnancies and labor in a time that is the afterlife of slavery” (Davis 12).

“This book offers a critical analysis of Black women’s pregnancy and premature birth, arguing that ideas about Black women that have historically circulated in the medical field must be understood as an extension of what Saidiya Hartman calls the afterlife of slavery. More specifically, prematurity, the most common cause of infant mortality, is an expression of this afterlife of slavery, interpretable through history” (Davis 13).

“The afterlife of slavery is a critical framework that makes it possible to talk about the continuation of racism in the medical management of Black women’s reproduction. The precarities of chattel slavery continue to impose on the conditions of Black life. Whereas reproduction has been invigorated by past racial hierarchies, the dystopian past is not just the past. The dystopian past inhabits present practices, including the practice of medicine” (Davis 13).

“Both racism and slavery in the United States have facilitated a reproductive dystopia in which almost all aspects of reproduction idealize whiteness. From breastfeeding to the fragility of uteruses, the pretense of perfection and importance has been legitimated through white womanhood (Schiebinger 2004). Additionally, in obstetric medicine, physicians have increasingly rebuffed women’s sense about their bodies, relying less on patient narratives in diagnosing disease and more on physical examinations (Schwartz 2006, 129). These changes in medical practice have positioned women differentially: whereas white women’s reproduction has been depicted in terms of chastity, enslaved women’s reproduction was generally viewed as evidence of promiscuity and lasciviousness or as necessary for racial capital (J. L. Morgan 2004). As medicine garnered greater acceptance, slaveholders relied on physicians to determine women’s reproductive status, harnessing medical treatment and diagnosis to the racial calculus identified by [Saidiya] Hartman. The echoes of this racial calculus influenced the shift away from women’s narrative and feelings in diagnosis, a shift detected in current medical interactions, as is evident in Black women’s recollections of their birth experiences” (Davis 14).

“…methodologically, this book stems from questions about what happens if ideas about the prenatal body, laboring, and birth outcomes are put into conversation with archival sources of transatlantic slavery and its afterlife. This book contends that Black women’s higher rates of premature birth are an expression of the afterlife of slavery, interpretable through documents such as medical texts, reports, pamphlets, narratives, and historians’ accounts of pregnancy and birthing” (Davis 14).

“I argue that one way Black women’s prenatal experience, pregnancy, and birthing can be understood is as an extension of tropes, practices, and beliefs that can be traced back to antebellum and postbellum periods. What we see is that racism is continuously recalibrated—a racism that is a reinterpretation of enduring processes of slavery. In many ways, positioning biopolitics in this way, shuttling between the present and the past, shows, as [Saidiya] Hartman notes, that slavery’s imprint is demonstrated in all sectors of society and has resonances in the contemporary moment” (Davis 14-15).

“Taking up Indigenous education scholar Linda Tuhiwai Smith’s (2012) observation that many researchers and academics assume that our research will be beneficial, I intentionally sought out a community of people active in the reproductive justice movement to help me do more than deconstruct prematurity. I wanted the research to be useful” (Davis 15).

“Still committed to actualizing some form of feminist practice and choosing to be held accountable beyond the institutional review board, I invited a group of reproductive justice workers to join a reproductive justice interlocutor team. This was a team of people working in various realms of reproductive justice who were in dialogue with me from the beginning of the project. The four women who agreed to be part of this research endeavor are Toni Bond-Leonard, Andrea Queeley, Lynn Roberts, and Andrea B. Williams” (Davis 16).

“For me, a Black feminist approach to ethnography has always meant putting Black women’s voices front and center. Recollections and memory are fundamental to this project, which is why Black women’s words are at the center of this book. Some of their memories of medical encounters produce important knowledge about the experience of medical racism. That knowledge provides an emotional literacy that may be difficult to capture through other methods. It is through the braided research and analytical strategies, including face-to-face interaction, archival research, and ‘following the subject,’ that this ethnography gets at the meaning of people’s experiences. In sharing Black women’s stories from their perspective, and understanding at an intimate level how they negotiate the world and explain the things that happen to them, this book accomplishes what anthropological inquiry does best: calling attention to new issues and making connections between underexplored aspects of questions that cannot be adequately understood through broader strategies such as epidemiology or public health campaigns. Indeed, as I show, the processes that produce statistics and public health messages are deeply enmeshed with race. Through my research, I discovered that it was as important to understand the ways in which race infiltrates these practices as it was to expose the human toll that racial discourse takes upon Black women’s lives. The statistics show starkly that Black women’s bodies and babies are profoundly at risk. Thus, it is Black women’s words that we must hear if we are to understand the meaning and impact of that risk” (Davis 23).

“The dominant angle [of the book] is rooted in Black feminist epistemology and centers women’s medical interfaces during various stages of pregnancy and the birth process. Other angles include looking at NICU technology and prematurity from the perspective of medical professionals. I also needed to look at prematurity from another angle, from the interventionist, educational, and preventionist domains” (Davis 24).

Describing chapter 1, “Premature Predicaments”: “Race and racial science animated the discovery and definition of prematurity, which are described in the chapter. To demonstrate the persistence of premature births among Black women in the United States, I share four women’s narratives of pregnancy and birthing, one each in the nineteenth and twentieth centuries, and two in the twenty-first century. The focus of their prenatal and pregnancy care sits at the intersection of race and the medical management of their reproduction” (Davis 24).

“This book elucidates how racism is experienced by Black women at a time when Black maternal and infant mortality and morbidity are a major concern in the United States…. Importantly, it is through the care practices of radical Black birth workers and expanding care and birth options that we find a potent response to medical racism and effective work to attain outcomes that are more in alignment with the goals of reproductive justice” (Davis 26).

Chapter 1: “Premature Predicaments” (pp. 29-58)

“This book represents a vantage point of reproduction that has been overlooked in the anthropological literature, that of Black women. It serves to illustrate how archival sources, of which slave narratives are but one example, can be used to contextualize current issues. In this book, the archives consist of materials—narratives, medical and popular journals, and autobiographies, among other sources. The time period of these documents ranges from the 1700s to the fairly recent past. Notably, the archival sources and primary documents elucidate contemporary concerns. Some aspects of Brent’s [Harriet Jacobs writing under the pseudonym Linda Brent] account of the premature birth of her son—the actual event and ensuing angst—echo those by the contemporary Black women whose stories we will hear. Black women’s reproductive lives have historically been controlled by a predominantly white medical profession (J. L. Morgan 2004; Schwartz 2006). This fact directs us to consider that Linda Brent’s owner was a physician. Even though medical knowledge—especially knowledge of reproductive health—was nascent at the time, that does not preclude raising questions about the medical care that Brent, as a Black woman, received. Indeed, the question is an entrée into considering the present-day prenatal and obstetric care Black women receive in light of their high rates of adverse reproductive outcomes. These are outcomes that exist despite advances in medical knowledge” (Davis 30-31).

“Brent’s account enables consideration of three questions this chapter seeks to answer. First, the passage suggests that prematurity is defined based on weight. Brent’s son, Benny, was not expected to live because he ‘weighed only four pounds’ at birth. But what is prematurity, and has race played a role in its definition? Although one might suspect what may have led Brent to give birth prematurely, no cause is mentioned in the narrative. Thus, the second question concerns: What is the etiology of premature birth? And third, what do Black women’s narratives about pregnancy and prematurity tell us about their medical care and race? These initial questions are important because reproductive disparities have beleaguered Black women for more than two centuries in the United States” (Davis 31).

“According to the table [Table 1.1 on p. 43], in 1850, the Black infant mortality rate was one and a half times higher than the rate for white infants. In 2000, the disparity was two and a half times higher. It is astonishing to see that even under the strictures of enslavement, Black women had significantly better birth outcomes than they do today” (Davis 32).

“…premature births, like infant mortality, did not become an urgent public concern until the early twentieth century (Zelizer 1994). Ultimately, both prematurity and infant mortality materialized as crises during the Progressive Era, leading to the establishment of the Children’s Bureau in 1912.3 At that time, the bureau sought to rectify the mercurial infant mortality rates in the United States, including by documenting rates of births and deaths. From that point on, life and death became institutionally ‘registerable’ events, with many states collecting birth and mortality statistics, although the entire nation did not participate in vital registration until 1933 (Haines 2008)” (Davis 32).

A summary of the chapter overall: “This chapter includes four sections. It begins with a discussion of how prematurity was defined. This was a process that began in earnest in the nineteenth century, and one that continues, relative to the way that prematurity needs to be medically managed alongside shifts in knowledge and technological advancement. Yet defining prematurity not only has served the purpose of medical management but also has been used as an adjunct of racial science—by which I mean aiding scientific inquiry for the purpose of proving the existence of racial categories in support of racial hierarchies. The second section brings select documents from the Children’s Bureau archive into conversation with the history of racial science through the lens of prematurity. The third section explores the causes of prematurity. The final section offers four accounts of pregnancy, labor, and birthing by Black women over three centuries” (Davis 32).

“This history of defining prematurity illustrates the medical construction of prematurity and how its definition shifted over time relative to the development of medical specialties such as pediatrics, public health, and obstetrics and gynecology” (Davis 36).

“The search for ties between race and prematurity bends an ideological arc toward contemporary medical practices and care. In other words, racial difference releases a paradox. On the one hand, racial difference confounds the idea of a standard in biomedical research—the white male—against which diagnostic and analytic determinations are measured. On the other hand, racial difference becomes the point of departure for holding up white supremacy, because race has been viewed as medically meaningful (S. Epstein 2007, 10)” (Davis 37).

“What I attend to here is how the standardization of race has been linked to prematurity through scientific racism’s migration from the 1800s to the twentieth century. In this case, what is being manipulated into a racial category is the fetus and the prematurely born neonate” (Davis 37).

“Racial hierarchy proponents have used science to distinguish ‘Negroes’ from whites. It is interesting to consider that medical researchers viewed ‘Negro’ bodies as appropriate sites of knowledge for understanding prematurity, given the flawed status that accompanied all racially produced groups other than ‘whites,’ who are typically people without race” (Davis 38).

“Importantly, the scientific classification of race was not uniform; rather, it was the social conceptualizations of race that informed the categorization of racial subjects (Smart et al. 2008). Although science and technology scholar Andrew Smart and his colleagues (2008) discuss the use of racial classification in biomedical research, adopting such classifications, regardless of the sphere—be it biomedical, social, or legal—aligns with the state’s socially and politically constructed meanings of race with science” (Davis 38).

“Public education campaigns such as this one [referencing a CDC campaign illustrated via Figure 1.1, p. 42] can be harmful to the intended audience. Recent research assessing perceptions of alienation in health care contexts found that the experience of being evaluated is connected to negative opinions of health care. The extent to which people fear being judged on such factors as race/ethnicity and age holds implications for the success or failure of public health campaigns. For instance, exposure to a negative message, such as ‘Black race’ being a risk, is an example of a health care stereotype threat (HCST), which is ‘the threat of confirming negative group- based stereotypes’ (Abdou and Fingerhut 2014, 316). HCSTs, often used in health education promotion campaigns, reinforce ideas about certain groups of people. For Black women, HCSTs may be a barrier to health care utilization and result in negative assessments of providers” (Davis 41).

“Although there are multiple causes for premature birth, the primary reason is due to medically indicated birth induction or C- section” (Davi 41-42).

“Beyond tobacco smoke exposure, most preterm birth investigators overlook the environmental exposures that often correlate with poverty (Burris et al. 2016). For example, environmental exposure (such as lead in water) tends to track along both socioeconomic and racial/ethnic lines. However, the extent to which disparities in preterm birth result from interactions between the social and physical environments that produce epigenetic modifications remains unclear” (Davis 43-44).

“In troubling the assumption that low income is a primary determinant in premature birth, I draw from studies conducted with Black mothers, all of whom either have some college, have completed college, or hold advanced degrees. Higher levels of education are typically a good predictor of positive birth outcomes. Yet research has shown that Black women with the highest levels of education are still twice as likely as whites with the lowest levels of education to give birth prematurely (Mullings and Wali 2001; F. M. Jackson 2007)” (Davis 44).

“By presenting Black women’s birth narratives going back to the mid-1800s, the next section aims to illustrate just how long Black women have given birth prematurely and the circumstances under which they did so, thus offering some context for the contemporary complexities of birthing from their perspective” (Davis 45).

“Aunt Nancy’s story [an enslaved women also mentioned in Harriet Jacobs’s Incidents in the Life of a Slave Girl] raises several points. First, Dr. Flint’s children were able to flourish, but her children did not. She was available to care for his offspring while being unable to tend to her own health needs or those of her children. Second, her role as a mother was marginalized, a situation that has plagued Black women into the twenty-first century. In the following stories, we will see how the afterlife of slavery persists, influencing birth outcomes well after the time of slavery, up to the present day” (Davis 45-46).

“Black women’s care is cloaked by race and tense interactions with medical providers (Hill 2016), but one of the themes of Anne’s birth experience—and those of others in this book—is that tense interactions or overtly racialized experiences are not necessarily a consistent element. That is, despite positive experiences with health professionals, where care does not experientially take on a racialized or discriminatory tone, the subtle accretion of mistakes, errors, or bias can still result in racially unequal birth outcomes” (Davis 48-49).

“One of the important aspects of the afterlife of slavery is that racist intention is not necessary in the creation of racist outcomes. As recent studies have shown, a surprising proportion of US medical students hold erroneous racialized beliefs about Black peoples’ experience of pain; these beliefs may well contribute to the documented inequities in providing Black patients with appropriate pain relief (Somashekhar 2016). As a result of the lingering legacy of the afterlife of slavery, errors such as neglecting to note a particular condition—in this case placenta previa—may be more impactful for Black women because they are layered on a foundation where care and diagnosis are, potentially, already compromised” (Davis 49).

“Regardless of where she received her medical care, whether it was a public or private hospital, whether she received public assistance or had private insurance, Ashley believed that racism played a part in how she was treated during her pregnancies. She was nineteen and twenty-three, respectively, when she had her children, Jamie and Justin. She was young enough to be on the receiving end of widely held assumptions about young Black women’s fecundity, immaturity, irresponsibility, and lack of knowledge (Luker 1996)” (Davis 51).

American Health Empire: Power, Profits, and Politics: “More than forty years ago, journalists Barbara and John Ehrenreich (1970) described the medical-industrial complex, which includes the entirety of the health care system, every single aspect, that is geared toward profit—not patient care” (Davis 51).

“From her [Ashley’s] point of view, racism played a role in her care based on the way doctors treated her—as if she lacked the ability to understand what they were explaining. Although the underlying causes behind the interaction between Ashley and her medical providers cannot be confirmed, the fact that she thought racism played a role draws our attention to the overall stressors faced by Black women in a society where bias—while not always observable—is indeed an ever-present possibility in the context of a medical structure that has historically failed to fully embrace caring for Black women” (Davis 51).

“The desire to conceive draws many individuals and couples into circuits of transnational reproduction—that is, the border-crossing threads of commerce that facilitate reproduction, such as surrogacy and use of ARTs—but Black women’s participation in this circuit is not well studied, except for scholarship illuminating how Black women are excluded (Campbell 2015)” (Davis 52).

“…in truth, not all Black women have had questionable or negative interactions with care providers. Indeed, Melissa was among the minority of people interviewed who leveraged better care or had more positive experiences due to having a doctor as a spouse or a family member in the medical field. Including her story, in fact, is a reminder of the productive tensions in research when some of our informants’ stories do not neatly align with the dominant analysis we are privileging” (Davis 55).

“Discussions of Black women’s reproduction tend to highlight the negative webs in which they are caught. The problems women experience are often structurally provoked, and yet these structurally rooted problems are typically interpreted as individual women’s bad behavior (K. R. Knight 2015). Generally, those webs are represented in the context of poverty or lack of access to resources. The stories are often of depraved circumstances” (Davi 55-56).

“In the aftermath of enslavement, Black women’s reproductive lives have habitually been ‘at risk.’ Despite the structural factors that challenge life chances, Black women frequently symbolize such reproductive atrocities as prematurity, infant mortality, and maternal mortality, as if they purposefully or willfully produce these outcomes in a surfeit of depravity. While it is true that Black women do have more frequent adverse birthing outcomes, the narrowly focused class dimension—typically a proxy for discussing behavior—inhibits the support of broad-based preventive measures in medical care. Indeed, US policies intended to address poverty and low income are often inadequate because poor and low-income people are reviled and blamed for their condition. Solutions that stress individual behavior change, for example, neglect the role of structure and infrastructure in providing access to the food, environment, education, and safety that are required for thriving communities, much less positive birth outcomes. To put it another way, in underserved communities, no amount of behavior change by residents can transform food deserts into sites of food abundance, provide experienced teachers and relevant curricula to schoolchildren, or create access to quality medical care” (Davis 56-57).

“If the broad statistics demonstrate starkly that there is, indeed, a nationwide crisis of prematurity among Black women, in individual cases it is difficult to isolate the exact causes of premature birth. The tendency to individualize Black women’s birth outcomes as a tactic for denying the well-documented truth that something is wrong is, once again, a tactic of the aftermath of slavery in which slaves’ resistance to their condition was medicalized as individual psychopathology. In the aftermath of slavery, it is more comforting to stick with the story that each woman has her own history, biological or genetic expressions, and environmental exposures that may have contributed to premature birth than it is to point to the structural condition of medical racism and the toll it takes on Black women, children, and families. The numbers tell us that today Black women’s birth outcomes are more tenuous than they were during slavery, but ethnographic inquiry is capable of bringing context to numbers, which is one of the goals of this book” (Davis 57).

“In examining these stories, it also becomes possible to discuss premature births as a more generalized issue among Black women, not solely as a problem that impacts poor or low-income Black women” (Davis 57-58).

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Note: The featured image for this post comes from Davis, p. 42: Figure 1.1, captioned as “Factors associated with preterm birth,” an infographic created and distributed by the CDC.