Trust Also Means Centering Black Women's Reproductive Health Narratives

Abstract

This commentary responds to Yolonda Wilson's article “Is Trust Enough? Anti‐Black Racism and the Perception of Black Vaccine ‘Hesitancy’” by connecting mistrust to the phenomenon in the United States of blaming Black women for their own adverse health outcomes, particularly in the context of maternal and reproductive health. When medical practitioners and researchers fail to recognize and understand the racist social context of health problems, Black women and other minoritized groups are socialized to mistrust their bodies; as a result, these groups can come to mistrust medical institutions, and medical institutions to distrust patients from these groups. Highlighting the disproportionately and unjustly high maternal mortality rates among Black women, this commentary warns that neglecting to center the narratives of Black women tells an incomplete story of reproductive health disparities in the United States. Drawing on firsthand experience conducting qualitative reproductive‐health research with Black women, the author urges professionals in reproductive medicine and bioethics to use the tools of narrative medicine to listen to and center Black women's accounts of their lived experiences in order to deconstruct blame and work toward eliminating reproductive health disparities.

Addressing Anti‐Black Racism in Bioethics: Responding to the Call

“…is not only fundamentally flawed but also blames and shames those most affected by health inequities. 33 Thomas argues that the United States health system's dark history of structural and scientific racism demonstrates a lack of respect for Black bodies, and particularly for Black women in the context of reproductive health care. Thomas emphasizes the utilization of analytical approaches, such as narrative medicine, to center Black women's lived experiences to foster health justice.…”

“…Wilson offers a Black feminist analysis of racial injustice in medicine to emphasize the role that health care institutions have played in fostering a climate of distrust for Black people. An accompanying commentary by Shameka Poetry Thomas uses a reproductive justice and narrative medicine lens to further support the notion that merely focusing on the question, “Why don't Black people trust?” is not only fundamentally flawed but also blames and shames those most affected by health inequities 33 . Thomas argues that the United States health system's dark history of structural and scientific racism demonstrates a lack of respect for Black bodies, and particularly for Black women in the context of reproductive health care.…”

A Model of True CHOICES: Learnings from a Comprehensive Sexual and Reproductive Health Clinic in Tennessee that Provides Abortions and Opened the City's First Birth Center

“…21(p 12) The pathologizing of Black pregnant bodies in spaces where the interest of the fetus is prioritized over the interest of the birthing person leads to the overmedicalization and push for medically unnecessary interventions such as the overuse of cesareans. 20,21 Overuse of cesareans due to medical racism has been documented about Black women and can lead to unnecessary poor outcomes such as maternal mortality and morbidity and high rates of depression. 22 Risk factors often associated with Black pregnant and birthing people include gestational diabetes, hypertension, and obesity, as well as Blackness itself; some health systems list Black race as an indication for antenatal testing.…”

“…When a pregnant person's eligibility for midwifery care is being evaluated, their desired birth location is considered, and their previous birth history is reviewed with them in detail, along with their previous medical history, current health status, and social support system. We listen to our patients’ lived experience to center them and avoid pathologizing them because of either their Blackness or their pregnancy 20 . As Black feminist bioethicist Yolonda Wilson puts it, by centering patients we avoid the pathologizing trope that “there is something wrong with Black people rather than something wrong with the conditions within which they exist.” 21 (p 12) The pathologizing of Black pregnant bodies in spaces where the interest of the fetus is prioritized over the interest of the birthing person leads to the overmedicalization and push for medically unnecessary interventions such as the overuse of cesareans 20,21 .…”

“…We listen to our patients’ lived experience to center them and avoid pathologizing them because of either their Blackness or their pregnancy 20 . As Black feminist bioethicist Yolonda Wilson puts it, by centering patients we avoid the pathologizing trope that “there is something wrong with Black people rather than something wrong with the conditions within which they exist.” 21 (p 12) The pathologizing of Black pregnant bodies in spaces where the interest of the fetus is prioritized over the interest of the birthing person leads to the overmedicalization and push for medically unnecessary interventions such as the overuse of cesareans 20,21 . Overuse of cesareans due to medical racism has been documented about Black women and can lead to unnecessary poor outcomes such as maternal mortality and morbidity and high rates of depression 22 .…”