Gendered Racism in Reproductive Healthcare

In the complex intersection of race, gender, and healthcare, middle-class Black women often find themselves navigating gendered racism, especially within reproductive health systems. A recent data analysis by Howell (2023), published in the Psychology of Women Quarterly, explores these women's experiences with gendered racism, shedding light on the subtle and overt forms of discrimination they face even within the supposed safety net of middle-class status.

The Legacy of Historical Trauma

The study situates these experiences within the broader historical context of slavery and the exploitation of Black women's bodies in the development of American gynecology. This historical backdrop isn't just a distant memory; it haunts modern medical interactions, influencing how Black women perceive and experience care. For instance, in the antebellum South, medical schools and doctors partnered with enslavers to monitor the reproductive health of enslaved women, to ensure a population of enslaved individuals, and to uphold profits from slavery.

Participants in this study expressed a deep awareness of this legacy, connecting the dots between chattel slavery and the current Black maternal health crisis. Many participants described an embodied sense of unease during gynecological visits, a feeling that their discomfort and feelings of dehumanization and objectification are rooted in this traumatic history.

Experiences of Dismissal and Violation

One of the core findings of the study is the pervasive sense of dismissal and violation that middle-class Black women experience in reproductive healthcare settings. These women often feel unheard and disrespected by their providers, who may unconsciously perpetuate racist and sexist stereotypes.

For instance, one participant recounted a dismissive encounter with her gynecologist, who did not offer pain relief during an IUD removal despite being offered pain medication by a previous doctor five years earlier during insertion. The participant reported feeling that her doctor did not care about her experience of pain.

Another participant reported feeling pressure to have her tubes tied after the birth of her second child. Such experiences left the participants feeling violated, dehumanized, and objectified.

The Role of Social Class

While middle-class status provides certain protections—like access to better healthcare providers and insurance—social class does not protect Black women from the impacts of gendered racism. The study highlights that, despite their socioeconomic status, these women often anticipate and experience discriminatory treatment.

They use various strategies, such as coming to the appointment with "roleflexing," emphasizing their education and professional status to gain respect from healthcare providers. Other strategies include dressing nice and looking professional for doctor's appointments, even during an emergency. However, this psychological labor adds an additional burden, exacerbating the stress they already experience.

Coping and Resistance

Some women adopt a protective emotional stance, disengaging from potentially harmful interactions by "slipping into moments of 'it’s cool,'" as one participant described it, meaning to dismiss or block out microaggressions. Others seek out Black women gynecologists, hoping for a more empathetic and respectful experience.

Despite these efforts, the emotional toll of navigating gendered racism remains significant, creating psychological consequences that continue to affect these women, such as "imprinted memories of racialized encounters that are recalled years later."

Implications for Practice

Howell’s (2023) research underscores the urgent need for systemic changes in reproductive healthcare. To mitigate the harms of gendered racism, it is essential to implement anti-racist training for healthcare providers, particularly in obstetrics and gynecology. This training should not only address the historical context of medical racism but also teach providers to recognize and respond to how gendered racism manifests in their interactions with patients.

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Moreover, the study calls for greater attention to the psychological burden that middle-class Black women experience in reproductive healthcare settings. Therapists and clinicians should be prepared to validate Black women's experiences and help them develop strategies to cope with the stress of gendered racism. Clinicians should avoid relying on Eurocentric models and focus on using culturally relevant frameworks.

Conclusion

Middle-class status does not insulate Black women from the harmful effects of gendered racism in reproductive healthcare. Howell’s (2023) study provides a crucial framework for understanding these dynamics, highlighting the need for both individual and systemic interventions. As the healthcare system continues to grapple with issues of racism and sexism, the voices and experiences of Black women must be at the forefront of efforts to create a more inclusive and equitable environment.