The life or death fear of childbirth for Black women is generations old, as we have believed it to be something that was innate to us and unchangeable. Premature birth, or a baby born before 37 weeks gestation, is by far the leading cause of infant death in the United States. Black babies, however, are two to three times more likely to die from all causes, including prematurity, than white babies in the United States.
It was exciting to see Serena Williams adding her critical voice to this conversation. And November 17th, World Prematurity Day, is an opportunity for Black women and our allies to continue calling out the true cause of the inequities in infant mortality—the impact of anti-Black white supremacy on Black women’s bodies—and then work to create policy and cultural changes to end this persistent and grave injustice.
There is a dangerous hierarchy of human value, based solely upon skin color, embedded into how we provide and research healthcare. This has been the case for 600 years. Some researchers hold the belief that these inequities are too entrenched to fix, but that callous lack of investment is detrimental for Black women and their children.
Addressing why women die in childbirth, and supporting policies like paid leave and equal pay that would mitigate these deaths, is critical, but I learned early that I couldn’t educate, work, or earn myself to a risk-free childbirth. When I was a 25-year-old 3rd year medical student, my son was born weighing 445 grams when I was 22 weeks pregnant. At the time, I was married and had no medical issues. I was average weight and I initiated prenatal care at 8 weeks pregnant. I also took folic acid while intentionally trying to get pregnant.
While in medical school in 1995, I was taught that my genes and therefore my race were tied together, which was the reason my son was in the NICU. I believed that I was genetically doomed to have my son too early because I was Black.
Why was I taught that?
Because the foundation of medicine in the United States was built and continues to rest on a racist framework. From the earliest beginnings, medical schools have propagated Dr. Samuel Morton’s racist theory of differential skull size and intelligence; so, it makes sense that, even today, it is relatively easy to channel millions of dollars into researching genetic causes of premature birth, while ignoring inequality and racism as factors. Dorothy Roberts calls this race-based medicine.
Researchers and eugenicists have used race as a rough proxy for many things like poverty and lack of insurance. Blackness is not the problem, though; white supremacy is.
We can discuss cortisol, epigenetics, and telomeres, sure. But my response in every meeting and lecture when they want me to keep giving them scientific data that racism is harmful is always the same:
How much data, and how many more sources, do we have to present before people accept that racism is harmful? And when we keep spending money for research on genetic causes or cortisol or telomeres, it begs the question: To what end?
Even if we identify the exact cortisol blocker to decrease prematurity, are we going to leave racism in place? White folks’ frustration with me saying the root cause is racism is only overshadowed by my frustration in their not believing it—or looking for a pill or shot to fix it.
Without equivocation, race was made up to harm—and it works.
Understanding that racism—structural, personally mediated, and internalized, as well as implicit bias, causes inequities in birth outcomes and maternal morbidity is imperative. Once we start with some historical truths, that Black women were enshrined in the U.S. Constitution with explicit devaluation based on race and gender, we can build policy and culture that, finally, values us all.
Joia Crear-Perry, MD, FACOG Founder & President of the National Birth Equity Collaborative.