SUNY series in Black Women's Wellness

Strategies to Name, Locate, and Change Systems of Power

Stephanie Y. Evans, Sarita K. Davis, Leslie R. Hinkson, Deanna J. Wathington, Stephanie Y. Evans, Sarita K. Davis, Leslie R. Hinkson, Deanna J. Wathington

• Publisher: SUNY Press
• Year: 2022
• ISBN:
  9781438487335
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

2022 CHOICE Outstanding Academic Title Black Women and Public Health creates an urgently needed interdisciplinary dialogue about issues of race, gender, and health. An enduring history of racism, sexism, and dehumanization of Black women's bodies has largely rendered the health needs of the Black community inaudible and invisible. Grounded in the lived experiences and expertise of Black women, this collection bridges gaps between researchers, practitioners, educators, and advocates. Black women's public health work is a regenerative practice—one that looks backward, inward, and forward to improve the quality of life for Black communities in the United States and beyond. The three dozen authors in this volume offer analysis, critique, and recommendations for overcoming longstanding and contemporary challenges to equity in public health practices.

PART I

NAME INEQUITY

SECTION OUTLINE: LESLIE R. HINKSON

Until the lion learns how to write, every story will glorify the hunter.

—African proverb

Since its institutionalization as a profession in the late nineteenth century, medicine in the United States as a discipline and a practice has been significantly informed by the dominant scientific and popular discourses surrounding race. In the early twentieth century, the rise of the medical profession and the biomedical model of disease exerted formative influences on the development of public health as a field in the US. What this meant in practice was a public health discipline that largely framed discussions of Black health and illness in terms that downplayed the effects of environmental and societal factors and highlighted notions of alleged biological racial inferiority to explain the health profile of a people newly freed from slavery and having to navigate a society that not only seemed to begrudge them their freedom but their very lives as well.

W. E. B. Du Bois’s seminal works The Philadelphia Negro (1899) and “The Health and Physique of the Negro American” (1906) are perhaps the earliest published public health studies in the US. Challenging the predominant notion that Black and White differences in both mortality and morbidity were driven by innate biological difference, Du Bois illustrated the significant role that environmental conditions (e.g., poor sanitation, high rates of population density) and socioeconomic status played in explaining these disparities. Yet even as Du Bois’s methodological innovations would in many ways revolutionize the study of disease in the US, it would take decades before his contribution would be widely recognized. Just as importantly, his theoretical framing of “Negro health” as primarily informed by environment and resources would go largely ignored by the mainstream of both American medicine and public health. Yet, a growing number of Black lions—and lionesses—would join Du Bois in not only questioning the predominant narrative of Black biological inferiority in explaining health disparities but centering that narrative around the lived experiences of African Americans through the twentieth century and the significant role that racism, discrimination, and racial oppression played in explaining them.

The first four chapters of this volume focus on the history of Black women in public health—both as active agents in improving the health of Black women and communities and as the victims of a history of dehumanization that would inform both clinical practices and social policies that worked to undermine their health and well-being for over a century. In all four chapters, the authors illustrate the importance of naming and framing public health through the history and experiences of Black women in order to understand the present-day challenges they face in attaining wellness and health justice.

In “Reversing the Dehumanization of Black Women,” Tiffany D. Thomas and Mandy Hill examine the history of reproductive health in the US in order to shed light on the historical abuse and present-day neglect of Black women and their health. The chapter reveals how the broader societal dehumanization of Black women throughout the history of the US was translated into clinical practice. Just as disturbing, the authors highlight how the historical dehumanization of Black women became internalized within Black communities, leading to behaviors that have contributed to poor reproductive and sexual health outcomes.

Next, Rebekah Israel Cross, Brittney Butler, and Mya L. Roberson highlight the contributions of Black women activists from the late nineteenth century to the present in their chapter, “An Overview of the Past, Present, and Future of Black Women in Health Policy.” While almost none of the women included in the chapter contributed directly to the crafting of health policy or to the fields of medicine or health more broadly, their activism focused on improving areas of life that research on the social determinants of health has subsequently identified as crucial to supporting the health and well-being of the populace writ large and Black women in particular. Given that at least since the nineteenth century Black women have been advocating for improvements in housing, education, sanitation, nutrition and food access, health care, and a host of issues directly linked to better health outcomes, why haven’t we incorporated their activism into the history of public health and its development as a field? Why was much of their work largely ignored in the crafting of public health policy in their day? And how might deliberately incorporating the voices of Black women activists into public health research and policy significantly improve the health of Black women and communities today and into the future?

Jovonni R. Spinner, Sheila Carrette, and Joylene John-Sowah describe the disproportionately high rates of maternal mortality among Black women in the United States. The authors of “The Maternal Mortality Crisis in the Black Community” detail the biological, medical, and environmental causes of maternal mortality rates. Issues related to racism and implicit bias are also explored as contributing factors. The authors conclude with some innovative practice, community, and policy recommendations for reducing the disparities in maternal mortality rates among Black women.

In their chapter “Promoting Self-Care and Awareness of Stress, the Strong Black Woman Schema, and Mental Health Among African American Women,” Dakota King-White, Kelly Yu-Hsin Liao, and Elice E. Rogers examine stress-related factors and their role as obstacles (impediments) to prime physical and mental health for Black women. The chapter provides a salient discussion of types of stress, intersectionality, and the impact of tropes and stereotypes followed by strategies to help effectively manage these detrimental factors.

These chapters open the door to discussions of how to unpack characteristics of disparity, presented in the next section.

Chapter 1

Reversing the Dehumanization of Black Women

TIFFANY D. THOMAS AND MANDY HILL

Modern America perpetuates the false idea that Black women are not fully human and do not feel pain. Cultural and social norms here in the United States of America embrace ideals that render Black women unseen or unheard (McLellan-Lemal et al., 2013). Failure to recognize and acknowledge Black women as human beings with feelings and voices undermines the full human capacity of the Black woman. This is modern-day dehumanization. One aspect of the dehumanization of Black women is the process of racial devaluation. As it relates to Black women and health, racial devaluation in the medical encounter is a phenomenon whereby a Black woman’s race increases the likelihood that she will be “denied more advanced and riskier medical technologies” as part of her care and treatment regimen, in part because her position within the racial hierarchy deems her less worthy of these goods and services (Hinkson, 2015). The dehumanization of Black women, however, goes beyond processes of racial devaluation, calling into question not simply the worth of Black women because of their race but their humanity itself. Evidence of this motif permeates society and manifests as a wide array of health disparities, particularly in the areas of reproductive and sexual health. Black women have been dehumanized and continue to disproportionately experience negative outcomes stemming from the intersection between racism, sexism, and classism relative to other racial and gender groups (Centers for Disease Control and Prevention [CDC], 1999; Prather et al., 2018; Sheats et al., 2005; Wallace et al., 2013). This chapter explores the experience of Black women in totality, retells the history, evaluates societal implications on the human experience of Black women, and culminates with a plan to leverage clinical care as the change agent for the lived experience of Black women. In examining reproductive health specifically, the chapter sheds light on the historical abuse and present neglect of Black women and their health.

The Historical Timeline of Black Women as Less-Human Patients in Health Care

The current health-care system perpetuates the false idea that Black women do not feel pain. Failure to acknowledge pain creates a barrier to adequate health care for Black women whereby they are not heard and subsequently not treated. We cannot challenge the quality of health care Black women receive without examining the complex national race story.

Since slavery, and through the evolution of the US health-care system, Black women were excluded from full social citizenship, the ability to access and participate in political, civil, and social rights, and womanhood (Plous & Williams, 1995). This fact is evident in the countless examples of medical mistrust demonstrated through medical journals, institutional practices, and physicians’ writings, often supported by the law, particularly when it came to sexual reproduction. Half of the original articles in the 1836 Southern Medical and Surgical Journal issue deal with experiments performed on enslaved Blacks (Savitt, 1981).

Slave owners were motivated to provide a source of health care to their slaves based on economic return rather than humane compassion. Therefore, owners consented to medical treatment on their behalf without the consent of those being treated and regardless of the pain and level of recovery. Slaves did not have the agency to refuse, and, when they did, the slaveholders often ignored and disregarded their complaints.

James Marion Sims, who is lauded as the “father of gynecology,” is known for believing Black women did not feel pain (Hoffman et al., 2016). He promoted the idea by refusing to provide anesthesia to the Black women and girl slaves he used and abused to perfect his vesicovaginal fistula technique. Sims expressed that administering medication to reduce pain was not worth the trouble or risk and that his procedures were not painful enough for medication. One could argue his defense of refusal, especially since the use of anesthesia was in its infancy at the time. However, Sims always administered anesthesia to his White female patients in need of repairs to their vagina in 1840 (Harris, 1950).

For Black women, forced experimentation was the standard practice of care. Dr. François Marie Prevost, a physician from Donaldson, Louisiana, enslaved Black women for the sole purpose of practicing cesarean sections to perfect the procedure; between 1822 and 1831 he performed thirty-seven experiments on women, and thirty of them were oppressed Black women (Fisher, 1968; Slack, 1835; Louisiana State Medical Society, 1880). These incredibly painful surgeries were deemed too dangerous to perform on White women.

The medical community has benefited from the “greater good” of the medical trauma placed upon Black women while absorbing none of the pain or risks. A Black woman named Henrietta Lacks paid the ultimate price, without consent, for the advancement of medicine. Physicians voluntarily abandoned their ethical responsibilities when they stole cultured cells from a malignant tumor in her cervix and named them HeLa cells while she underwent treatment for cervical cancer. HeLa cells continue to revolutionize medical research at the expense of a Black woman. Today, HeLa cells have contributed to medical breakthroughs in science involving the polio vaccine, the AIDS virus, and cancer worldwide.

“The best way to hate a nigger is to hate him before he is born.”

—Louisiana Judge Leander Perez

Medical control of Black women’s reproductive roles evolved from forcing them to produce children to supply a workforce to removing their ability to reproduce, both without their consent. Fannie Lou Hamer is known for her bold and unapologetic stances regarding the political activities of Blacks. However, many are unaware it was her “Mississippi appendectomy” that motivated and shaped her political involvement (Hamer, 1967). In a Mississippi appendectomy, a doctor would tell a Black woman they needed their appendix removed and would ultimately give them a hysterectomy. Hamer was a granddaughter of slaves, daughter of sharecroppers, and one of the youngest out of her eighteen siblings caught in the cycle of poverty and uneducated. In 1961, during a routine uterine fibroid tumor removal surgery, Hamer’s uterus was removed from her body—without consent and more importantly without her knowledge. She was a victim of eugenics, a social movement to improve the genetic quality of a human population by discouraging reproduction by people with “undesirable” qualities, i.e., Black race (Black, 2003).

This is yet another example of how the US health care system medically misled Black women by refusing to extend to them full social citizenship. This practice was common, as procedures were often extended to women deemed feeble-minded, promiscuous, poor, or unfit to have children (Roberts, 1997). In reality, the targets of the eugenics practices like the Mississippi appendectomy were overwhelmingly women of color of all classes and poor women of all ethnicities. In this way, it served as a policy informed primarily by dominant intersecting systems of oppression—namely, racism, classism, and sexism.

Between the 1960s and 1970s, federally funded welfare programs promoted the forced sterilizations of thousands of poor Black women after giving birth in rural hospitals in the US South (Roberts, 1997). If Black women refused the service, their medical treatment or welfare benefits would be in jeopardy. Therefore, they “consented” to sterilization procedures through pressure. Continued discrimination through federal programming continued when social workers would perform “night raids” on the homes of Black women receiving welfare (Neubeck & Cazenave, 2001). If a man was identified in the house, their benefits were either threatened or they were offered sterilization as an option to guarantee no new children would be birthed for the state to support, promoting a single-parent family structure for poor Black families. The perpetual implications continue to persist today.

Failed social policies have continued to impact the health outcomes of Black women, as they have generally been drafted, passed, and enforced by legislation in states led by White, wealthy men. The Virginia Sterilization Act of 1924, which called for involuntary sterilization of individuals, heavily influenced the popularity of local states’ adoption ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgments
• Introduction: Race, Gender, and Public Health: Social Justice and Wellness Work
• Part I Name Inequity
• Part II Locate Disparity
• Part III Act for Change
• Afterword
• Contributors
• Artist Statement
• Index
• Back Cover