As a mom, dietitian and Black woman living in the United States, I am acutely aware of the pervasive race-related bias in health care that places my children and me in harm’s way. Being Black while seeking out empathic, equitable and unbiased medical care takes attention — and intention.
The Centers for Disease Control and Prevention reported that the maternal mortality rate in the U.S. for 2018 was 17.4 per 100,000 live births. Black women fare much worse: the rate skyrockets to 37.1 deaths per 100,000 live births. Breast cancer death rates are also 40% higher for Black women compared with their white counterparts. “Black women are dying four to five times the rate of anyone (else) in this country,” said Tracie Collins, the CEO and founder of the National Black Doulas Association (NBDA) based in Suwanee, Georgia. “The odds are stacked against us. The question is, where are you going to fall?”
There are a number of reasons for these horrific outcomes. Black women have inadequate access to high-quality health care. They’re less likely to be routinely monitored and more likely to receive delayed diagnoses and treatment, as well as subpar care, according to researchers at organizations like the National Research Council. Simply put, racism in health care puts Black women’s lives at risk. There have been innumerable accounts where Black women, including celebrities, have cited racism and bias in health care. Articles have been written substantiating these experiences — and providers within the health care community have called this out as a public health crisis.
Even as a young, well-educated Black woman, I am no exception to this. My first pregnancy took an unexpected turn. Midway through, I began experiencing significant pain and immediately went in for an appointment. I was told that the fibroid I had was decompensating and that it “might hurt,” then was sent home with pain medication. Within 24 hours, the pain transitioned to early labor. I was under the care of one of the most progressive and highly skilled obstetricians in New York City, yet my pregnancy ended with the death of my first child.
My treatment and care weren’t intentionally biased, I believe I was just seen as a first-time Black mom who was strong. The stereotype and cultural construct of “the strong Black woman” has detrimental ramifications. Additionally, implicit bias (a type of prejudice in which racial stereotypes are formed without conscious intention) allowed my care provider to discount my pain. On some level, I too had internalized the bias in the air and thought I could manage. I’ve talked to a number of white friends who’ve had similar experiences with different outcomes. The major difference? When they reported pain during pregnancy, most were admitted for further observation — and not sent home.
How can Black women get the OB/GYN care they need?
The NBDA’s Collins strongly recommends that Black women become drivers of their own health care. This includes researching care providers and knowing how to ask questions and get evidence-based responses. It involves understanding how to demand further medical support when a treatment or intervention is necessary. Collins also suggests that all patients document interactions with medical staff and care providers.
When looking for a new health care provider, Collins noted how important it is to understand your insurance coverage and whether (or to what extent) it’s accepted at the provider’s practice. “I would go even further to understand and know statistics within the facility and with providers,” she said.
Mya Walker, a mom from Brooklyn, said she prefers to seek out Black women for her OB/GYN care. “I feel that I want someone that I can really talk to, and more importantly, have someone who I feel may be more predispositioned to care about me or even just relate to any issue I may talk about.” She said that in her previous interactions with white male doctors, they were quick to categorize her and offer a generic treatment. I’ve heard many of my Black women friends express this concern before.
Black women are entitled to health care providers who will listen to them and assure them that their concerns are being heard — providers who will respond with care, compassion and evidence-based advice specific to their health needs and the needs of their family.
“From a clinical perspective, the number one criterion for any medical provider is, do they listen? And are they hearing you?” said Juliette Blount, a nurse practitioner and health equity speaker based in New York City. And by listening, Blount added, “are they listening and nodding, but in their head, they have already decided what they will prescribe?” Or is the provider actively listening and truly hearing the patient. “If they are hearing,” said Blount, “they should be asking questions and seeking clarification based on the listening that they’re doing. You (the patient) should feel relieved versus frustrated at the end of the interaction.”
How to make sure you’re really being heard
Whether or not we’re really being heard by our health care providers is one of the common themes that comes up in our community time and again. Simone Toomer, a Brooklyn-based certified doula and mom of two children, stressed the importance of seeking out individualized care and questioning: “Are (you) being heard — and listened to? Are questions being answered and not brushed off? Is evidence-based care (being) given?”
Toomer emphasized that providers should be referring Black women and their family members to specialists when needed. Patients also need to advocate for themselves, she said. “If, for whatever reason, you feel unheard or disrespected, especially in the Black community, we don’t have to make excuses for that treatment and can change OBs, midwives and pediatricians at any point.” When preparing to switch providers, Toomer said it’s important to request that copies of all medical records be forwarded to the new provider. Additionally, she noted that it may be challenging to change obstetricians after, say, 20 weeks of gestation, and the switch could result in increased out of pocket costs.
I personally gravitate toward health care providers who listen and ask questions when I describe an ailment or express a concern about one of my children. I am most comfortable with providers who are partners in my care, rather than ones who blindly diagnose and prescribe. I look for practitioners who know their craft well and understand when to refer out — and who are thoughtful and practice with humility.
For some, however, self-advocacy may be difficult, especially after repeated experiences of being marginalized. “I would encourage folks to harness their ego strengths and search (for providers) with the feeling that you are in charge of the course of your health,” said Nardia Brooks, a psychotherapist who serves mostly people of color in the Bed-Stuy neighborhood of Brooklyn. When choosing an OB/GYN or pediatrician, Brooks said, “I would encourage strong advocacy for (your)self and (the) unborn child. Read, get your facts straight, have questions ready, interview as many OB/GYNs as your insurance, time and body allow. It’s your body, your child, your course.”
Taking the time and effort to find a provider that is in line with your values and one that you feel good about is well worth the effort.