Abstract
Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization, written by Khiara Bridges, professor of law and anthropology at Boston University, is a thought-provoking ethnography that challenges dominant discourse around the provision of health care to low-income, high-risk, pregnant women. In doing so, Bridges aptly uses participant observation and in-depth interviews with providers and pregnant patients and their families, at a hospital-based women’s health clinic in New York City, recognized for its ability to provide top-notch care to the most medically underserved. While the perinatal care is lauded and highly sought after, it comes at a cost; pregnant patients, as a result of their Medicaid status, are reduced to a pathologized and ignorant homogeneous population who must relinquish the right to privacy and self-determination in favor of state management and social control.
Bridges uses powerful anecdotes and facts about hospital and state policy to highlight the individual and institutionalized racism that exists to justify both the medicalization of poverty and the management of pregnant women’s “unruly” bodies, where the hospital serves as a microcosm of U.S. health-care system for low-income individuals (p. 74). Ties are made to Foucault’s notion of biopolitics whereby low-income, racially minoritized pregnant women are a targeted population made vulnerable to state regulation and intrusion. For instance, the Personal Care Assistance Program via New York State Medicaid requires patients to meet with a nurse or health educator, HIV counselor, nutritionist, social worker, and a financial officer in exchange for government funded prenatal care. Other requirements include repeat testing for gestational diabetes and sexually transmitted infections, although none of these requirements apply to a predominantly white, privately insured population. Although the pursuit of prenatal care is not mandated by state or federal law, the moral sanctions associated with a lack of compliance is significant enough to effectively police pregnant women as a means to ensure a healthy workforce.
Bridges cites a few painful examples of social workers abusing their power and utilizing fear to promote treatment compliance among pregnant patients. This behavior is unethical and opposes social work’s values and mission, which includes honoring diversity, engaging in partnerships to create social change, and working to dismantle oppressive social, economic, and political constructions that do not support the liberation of all people. Social workers are taught to recognize how social, cultural, economic, and political structures create increased health risks for some women. However, Bridges explains how high-risk categories are used negatively to remove individual difference, promote otherness, inequality, and general assumptions about entire populations. The text challenges social workers to consider how they may have unintentionally participated in behaviors that serve to reinforce discriminatory treatment and medical disenfranchisement. How can we be sure that our work challenges the dominant discourse related to race, gender, and class and does not inadvertently perpetuate the disempowerment and marginalization of women?
Reproducing race starts with an examination of class and moves into a focus on race where vastly diverse individuals are lumped together into a single category of a non-white, high-risk patient population. Bridges reminds us that explicit and implicit individual racism coupled with institutional racism create and perpetuate health disparities and serve to reproduce race. The book may have been strengthened by considering the impact of intersecting systems of oppression for perinatal women who defy heteronormativity.
Notwithstanding the grim content of the book, she concludes with a note about hope and possibility. Throughout decades of social control in reproduction, even the most marginalized women participate in acts of resistance; they get pregnant, they omit information to protect their privacy and avoid judgment, and they unapologetically love and care for their children and others despite constant messages that degrade their mere existence in the world. Bridges invites contemplation and conversation about ways we can alter our inherent unjust systems of health care to create a more equitable society. Furthermore, this eye-opening text incites social work practitioners and scholars to thoughtfully contemplate how to best join, alongside perinatal women, in the resistance against stratified reproduction.