Contours of Injustice: Unveiling Racial Bias in Obstetrics and Gynecology Through a Feminist Lens

by Biankah-Precious Destin, Women’s Studies

Abstract: The main argument of feminism is fighting for equality and bridging the gap in how societies treat people based on their sex and gender. This extends gender in such areas as physical health, mental health, and well-being. Evidence has shown that in addition to someone’s gender, several factors play a significant role in their perception of the world and lived experiences, including but not limited to their race, class, ethnicity, and sexual orientation. As a result, there is a push to focus on intersectional identity when examining the impact someone’s identity has on their life. The disparity between the care that people receive based on their gender is widely recognized, however, greater focus should lie on the role intersectionality plays in these disparities in addition to gender differences. Calling into play such external factors as race leads to a difference in the roles that society demands of women—or really all who do not identify as cis-gender men—and the care that is received. Those who identify within this space often require the services of an OB/GYN (Obstetrician/Gynecologist). In this paper, I focus on the experiences of Black women to argue there is a significant disparity that people of color face in the presence of OB/GYNs.

black women, obstetrics and gynecology, women’s health, feminist theory, modern medicine and healthcare


Gender disparity and inequality is a problem that exists on an international scale. Whether you look at it from an economic, societal, health and wellness, or political perspective, it is ever-present in society; after all, feminist issues are almost always at the front of political and societal issues. Examining these issues from an intersectional perspective, two of the most distinctly contributing factors to the quality of healthcare people receive are their race and socioeconomic status/class. Those outside higher economic classes often cannot afford the higher-quality procedures that are necessary for the conditions they have developed. This reflects the services providers offer when patients cannot afford the encouraged procedures (Yearby, 2018). The disparity in the level of care that people of color receive from their Obstetricians/Gynecologists (OB/GYNs) as opposed to their white counterparts is an issue that should be increasingly important to the feminist movement.

Race affect’s healthcare experiences differently. Most medical textbooks and resources explain patients’ signs and symptoms from the perspective they have deemed as the ‘normal’ for those in the white majority (Louie and Wilkes, 2018). This stress on race as a dominant factor calls for the employment of a womanistic perspective. Alice Walker coined the term womanist to refer to Black feminists and feminists of color and their unique approaches to socio-political issues. She stressed that “womanism derives specifically from black culture, language, and history” to ensure that people who chose to identify as womanists were aware of the cultural and racial relevance of the identity (Ahmed, 2017). The matter of reproductive autonomy is a concern of both womanists and feminists across the country.

In light of the Supreme Court’s decision to overturn the Roe v. Wade decision, the conversation of people’s autonomy over their bodies and the necessity of particular procedures has been a focus of the feminist movement. Audre Lorde (1989) used her work “The Master’s Tools Will Never Dismantle the Master’s House” to convey that “difference must not merely be tolerated, but seen as a fund of necessary polarities between which our creativity can spark like a dialectic.” This creates the perfect platform to call attention to the most prominent issue presented to people of color [especially Black women] within this practice.

Through this paper, I call attention to the incongruent nature of the experiences of people of color with OB/GYNs in comparison to the white population while focusing specifically on the experiences of Black women. While some people may not see this disparity as prevalent, it is evident when looking at the situation from a historical, familial, and data-based perspective that acknowledging the intersectionality between race and class is vital to the obstetric/gynecological treatment and care someone receives.

Black Women and the Second Wave

The historical perception of feminism is that it occurs in a series of waves based on the period and objectives. It is widely accepted that the Second Wave of feminism occurred between the 1960s and 70s and mainly focused on the emerging issues of discrimination and equality (Thornham, 2004). As this wave was post-World War II, it can be understood that the driving demands of this wave came as a response to the expectation that outside wartime women should return to domestic life. Essentially, women had a taste of financial liberation and wanted to hold onto it while simultaneously demanding the same benefits as the men around them in similar situations. This focus on discrimination and equality led to rising tension between Black and white feminists as they had differing experiences and perceptions concerning these issues.

The tensions worsened over time as the intersectional effects of race and class on gender equality and discrimination were pushed to the forefront of discussions. White feminists centered their perception of gender equality as an individual issue while Black feminists brought attention to how their status as women of color significantly exacerbated the oppression they faced in this regard. This discrepancy between the issues that people faced demonstrated exclusion and strengthened tensions between the two groups. In an article depicting the present tensions, the idea of “white racial consciousness” being another term for color blindness and how “the ability to overlook race was indeed esteemed as a moral/political accomplishment” (Clawson, 2008). The white feminists’ ability to disregard race as a factor in matters of social justice demonstrated their stance as a group in a privileged position with no knowledge or understanding of the suffering of their peers. These tensions can be connected to the historical racial oppression Black women were subject to in obstetric and gynecologic care. The intersectional strife of Black feminists in the Second Wave mirrors and demonstrates the disparities that are forced onto Black women in the quality of accessibility of reproductive healthcare.

Historical Lens

Considering the groups historically used as test subjects is imperative when contemplating the racial disparity within the practices of Obstetrics and Gynecology. The basis of medical practice in the fields of obstetrics and gynecology originating in the experimentation on Black enslaved women is no secret. In a piece entitled “The Race of Hysteria: “Overcivilization” and the “Savage” Woman in Late Nineteenth-Century Obstetrics and Gynecology”, Laura Briggs explored a historical phenomenon of hysteria amongst white women. The phenomenon resulted from an increase in gynecologic and reproductive concerns (prolapsed uteruses, ovary diseases, and long, difficult labor) which were observed and diagnosed, effectively lowering their fertility (Briggs, 2000). An article was published in the American Journal of Obstetrics following this phenomenon, that demonstrated its physician-contributors understood the implications of portraying “white women as weak, frail, and nervous while non-white women and poor people were described as strong, hardy, and prolifically fertile” (Briggs, 2000). Actions like this led to the normalization of a precedent of medical violence and abuse conducted against Black women who are seeking out the care of an OB/GYN.

Consequently, Black women are ascribed of being physically stronger than their white counterparts as a population and naturally having greater endurance. When looking at the effect that this has in medicine, it is evident that “physicians today still construe Black bodies through the prisms of biological race, and, as a result, as perpetually high-risk bodies. Biological race thus operates as both a cause of and a perverse justification for Black women’s overmedicalization and increased exposure to invasive risk management techniques” (Campbell, 2021). As demonstrated, continuing to operate based on biological race opens the floor to medical violence, and applying this idea to obstetrics and gynecology makes it even more severe.

This can be further explored by examining the historical injustices presented to Black women in this particular field centers around the topics of dubious consent and forced sterilization. As previously stated, the practice of obstetrics and gynecology demands a great level of vulnerability from the patient, making the use of dubious consent and racially-influenced forced sterilization all the more sinister. The argument that this phenomenon is racially influenced is substantially supported by a foundation of “beliefs of white supremacy, which perpetuates the notion that the lives of people of color are less important than the lives of the Anglo-Saxon population” (Alonso, 2020). Routinely stripping Black women of their right to informed consent due to preconceived notions based on their race has led to the increase in the perpetuation of racial bias and discrimination of patients by OB/GYNs. A vast history of eugenics and involvement in patient care have contributed significantly to the discrimination faced by Black women and their apprehension to obstetric/gynecological care.

Evidenced by the observation that “on average, Black and Brown people seek preventative and general medical care less often than White people” (Smaw, 2021). These practices share a commonality in their misleading/omitting nature that allows a patient misguided comfortability due to false reassurance. When people systemically conduct unwanted procedures on the body of another, one should expect that the patient takes legal action to protect themselves. Taking this route was often something that was not available to Black women as the practice arose at a time when there were legal limitations on their anatomical and human rights.

The practice of forced sterilization as a form of eugenics through a lack of informed consent is largely illegal now; however, there is no system in place to reconcile with those who fell victim to this. Many states “do not require federal prosecutors or the American Medical Association to bring criminal charges and professional sanctions against the doctors and healthcare workers who forced and coerced African American, Native American, and Hispanic American women into sterilizations” (Smaw, 2021). The lack of legal consequences for those who utilized dubious consent to perform eugenics continues to play into the negative perception Black women have of OB/GYNs. How is it expected of the patient to be comfortable with their provider when they are aware of the oppression present and the omission of legal consequences for these actions?

In a field where the patient is so incredibly vulnerable, the provider must have no prior assumptions of the recipient based on anything but their medical records. The oppression imposed on Black women in medical spaces is reminiscent of the existence of “such a thing as racial-sexual oppression which is neither solely racial nor solely sexual” (Combahee River Collective, 1977). The medical violence that occurs within the field is a form of racial-sexual oppression. This oppression comes in the form of allowing medical personnel to strip someone of their autonomy under the guise of knowledge as a doctor while refusing to acknowledge the mental, physical, and emotional toll that these actions and interactions have on the patients in question. Shifting from the history of oppression in the field, implementing a personal and familial narrative provides a vivid account of the lived experience Black women have with this practice.

Familial Insight

Typically, when people consider the type of care provided by OB/GYNs, it is prenatal, natal, and postnatal care that comes to mind. This notion refers solely to the field of Obstetrics. When examining the care provided from a Gynecology standpoint, it is evident much of the focus is on the overall health of women, girls, and all who are not cis-gender men, especially if considering their reproductive system. While the field does extend well past pregnancy, we must look at the numbers obtained from the experiences of people who have had this level of care.

The divide in care that Black women receive as opposed to white women from their OB/GYN is a well-documented phenomenon which, despite the efforts of the women affected, rarely seems to gain enough traction from the masses. Over the past year and a half, we have seen many women who have reported a loss in autonomy when visiting providers and consequently turned to social media for reproductive care (Coen-Sanchez, et. al., 2022). Women of color, especially Black women, are subject to pervasive practices that are baffling as to how they were able to occur (Campbell, 2021).

As a Black woman myself, I have watched as many of my relatives had experiences that were detrimental to both their mental and physical health. At one point, one of my family members required a minor procedure performed on her uterus. However, as more and more things went wrong, she eventually had to have a hysterectomy—an operation where a person’s uterus was surgically removed. Throughout the conduction of the hysterectomy, there were still absurd complications that went underway. When my relative attempted to advocate for herself, the physician denied any part in the matter and acted like she should have been thankful for the procedure she underwent (despite it being preventable). The physician had taken advantage of their position of power when treating my relative; as though not being an OB/GYN herself, she could not recognize when there was something off about her own body.

People of color are no strangers to being forced into situations like this, for reasons that are nonsensical. For what reason should any group of people consider unnecessary procedures and continue to operate past what was indicated to them as normal based on any aspect of their lives? In an article surveying African American and mixed mothers for their opinions on what could be done to improve the quality of care that patients receive, it is revealed that not only did patients place importance on factors like cultural sensitivity, communication standards, and person-centered care, but also “privately and publicly insured mothers of color differed in structural and process elements of care in which they emphasize negative experiences” (Coley et. al., 2018). While insurance plays a role in the disparity, we must also consider the effect that race has on socioeconomic class. The systemic oppression imposed on Black women, who mostly are of lower social status, and thus, are publicly insured. Insurance status plays a role in setting Black women up in a situation where the care they would receive would be subpar or less than ideal. Transitioning from personal and familial narratives, we begin to explore the effects of racial bias in the practice from a statistically based viewpoint.

Empirical Exploration

To understand the present disparity, we must identify the reason for the disregard shown to people of color. One of the reasons for this is the idea that the medical model considers people of Caucasian descent as normal. Consequently, several medical textbooks refer to the signs and symptoms seen in white populations rather than from a vast gene pool (Louie and Wilkes, 2018). This idea that white is the normal in medicine is detrimental as it diminishes the experiences and nuanced aspects of life that women of color have, leaving the expectation that these are abnormal and are not to be considered when providing care and treatment. Such approach can be applied to concepts seemingly as superficial as class and family structure or as complex and more apparently vital as any common illnesses and predispositions present within the community. This is detrimental as these factors would be neglected when examining patients. Neglect of this magnitude leads to improper diagnoses, decreased quality of care, and an inevitable increase in discomfort.

Another reason for this disregard is that racism has been heavily institutionalized into healthcare practices. A system that discriminates against the people it services based solely on their race will result in a lower quality of care offered to and emphasized for the oppressed party. An article focusing on the racial disparity from the clinical perspective addressed how “Clinicians’ biases and racism have been shown to be associated with poor health outcomes among Black compared with white patients… conveying how structural and institutional racism contributes to the clinicians’ implicit and explicit racial biases that then inform clinicians’ communication, screening, diagnostic, and treatment behaviors” (Chambers et. al., 2022). When racism comes into play, we can expect that there would be certain damage done to the patient simply on the medical standing. This is amplified when assessing the fact that the field is very intimate. The intimacy is rooted in the practice’s concern with the patients’ sexual and vaginal health before it takes into account their ability to conceive a child.

The continuous string of using medicine to strip someone of autonomy has driven Black women to search in other places with a mentality that is well laid out in the statement “our liberation is a necessity not as an adjunct to somebody else’s but because of our need as human persons for autonomy” (Combahee River Collective, 1977). Hence, they present the doctor—who already has a semblance of power over the patient based simply on status—with significantly more control over their mental and physical wellness.

As a result of their (understandably) increasing distrust, many Black women have begun to deviate from receiving the care of an OB/GYN and turned toward doulas—women employed to guide and aid a pregnant woman during labor—and midwives whenever possible. A friend of mine wrote an article on the defection from the reception of the care of OB/GYNs within the Black diaspora. She described the mentality behind this movement by stating “If these centers are where I feel heard and see, then this is where I will be” (Harris, 2023). Her statement reflects the most vital aspect of doctor-patient interactions: the reclamation of a person’s autonomy. Personally, I feel that patient care not emphasizing the patient’s autonomy is not only medical violence but a form of abuse. This is especially relevant in the pervasive nature of claiming someone else’s autonomy in such an intimate and vulnerable setting.

For us to truly understand the disparity, we must also examine women of color and their children’s survival vs. white women and their children’s survival. An article focusing on racial disparities and severe maternal morbidity (SMM) greatly discusses the risk factors that women of color face in labor/pregnancy. From this, it is evident that people of Latin, Asian/Pacific Islander, and Indigenous descent have a 20% greater chance of experiencing SMM while—in some areas—being twice as likely to die from a pregnancy-related condition. The numbers are different when we look at the values pertaining to Black women. We see that the chance of experiencing SMM has doubled, while the chance of experiencing pregnancy-related mortality is three to four times more likely (Wang et. al., 2020). A study that examined the differences between Black and white women’s experiences when in labor reinforced that Black women experience SMM at a rate that is more than double compared to their white counterparts. At the same time, they do also attribute some of their findings to differences found in the healthcare settings in which they receive their obstetric care (Howell et. all., 2013). Simply giving birth is such a risk for Black women due to the previously discussed inherent racism in the field. Incorporating statistical data in addition to history and narratives enables confrontation of the implications of racial bias in obstetrics and gynecology.


It’s high time we begin to make issues unique to women of color the concerns of all women. Despite the feminist movement’s tendency to focus only on the matters that affect the projected majority, issues that pertain to marginalized groups concern and affect all other people. The term ‘womanist’ is typically used and understood to describe a woman, a Black woman, who identifies with the feminist movement but would like to see emphasis and attention brought to the concerns of Black women. The statement “womanist is to feminist as purple is to lavender” refers to the more inclusive nature of womanism without discrediting feminism; essentially the two are the same, one is simply much more exclusive than the other (Walker, 1983). Society must take a womanistic approach to the disparity that Black women face when receiving services in the hands of OB/GYNs. Delegating these issues to be concerns of the majority rather than solely those who are marginalized elevates them to the point where others must recognize changes are necessary for the benefit of all affected.


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