Abstract
This powerful, beautifully written book examining medical racism covers a great deal of ground, analyzing the neglect and abuse of Black bodies in the medical context of reproduction, from slavery to the present. A Black feminist anthropologist, Davis intentionally cites the work of women of color as much as possible, arguing that “race and reproduction are co-constituted” (p. 59). Interrogating the politics of reproduction, Davis joins threads from diverse sources including historical accounts of slaves’ childbirth experiences, documentation of “baby saving” efforts in the early 20th century, and current-day interviews with parents, neonatal intensive care unit medical providers, staff from the March of Dimes, and radical birth workers. The book is essential reading for social workers and anyone interested in understanding health disparities, especially crisis-level Black infant mortality rates.
The chapter, “Saving the Babies,” is particularly relevant to social work history. Davis critiques “baby saving campaigns”—efforts to reduce infant mortality—led by social workers of the U.S. Children’s Bureau. Despite higher Black infant mortality rates, the Bureau’s work focused on saving white babies. Social work’s historical complicity in institutional racism is clear. The chapter has implications and echoes of today’s “child protection” work, well known to disproportionately affect Black families, just one example of systemic oppression perpetuated in and by social work.
One of Davis’s most poignant discussions focuses on the importance of language. Her cogent critique of public health statistics reveals their reification of socially constructed racial categories. Nonetheless, Davis makes clear that the statistics are useful in highlighting persistent racial disparities. She argues that we need to be concerned with both what is said (via coded language) and what is not said in medical interactions. Davis describes how her interviewees “talked around race” (p. 60), avoidance behavior which, Davis argues, makes it nearly impossible to confront racism. Instead of talking about racism, neonatal intensive care unit providers attributed negative birth outcomes to “social determinants of health,” including low socioeconomic status and poverty, without acknowledging that institutionalized racism is a critical social determinant of health. Davis includes an example from an interview with a March of Dimes’ official who described preferring terms such as “health equity” to the more politically charged term “racism,” suggesting that talking and writing explicitly about “racism” would alienate potential donors.
In interviews, parents discussed ambiguous interactions with medical providers and wondered if racism played a role. Davis links accounts of childbirth during slavery with parents’ present-day experiences, and the similarities, despite the passage of time, are jarring. Davis writes: “racism dictates how Black people know the consequences of being Black in medical spaces—being dismissed, not being taken seriously, suffering mistreatment, and being misdiagnosed—and they self-consciously end up negotiating interactions to achieve better care” (p. 69). Davis’s arguments are supported by ample research describing racism’s role in the accumulation of toxic stress in Black bodies associated with poor birth outcomes.
Davis describes the efforts to reduce such stress using innovative models led by Black birth workers. Davis writes, “Black families require empowerment to facilitate the reduction of adverse birth outcomes and view those outcomes as being linked to social issues” (p. 175). Community-based doulas, radical birth workers, perinatal support professionals, and others who recognize how racism pervades the pregnant body are working to support and empower Black women and their families. Efforts are being made at all stages—through pregnancy, childbirth, and postpartum—to educate, advocate, help families navigate systems, and reduce ambiguity in medical interactions, to reduce women’s stress and ultimately improve birth outcomes.
Davis’s work is a call to action to medical providers, social workers, and those involved in health disparities research, practice, and/or advocacy. As social work, in particular, continues to explore how to deal with concepts such as diversity and the controversial “cultural competence,” the field must acknowledge how our profession has helped build, contribute to, and maintain racist social structures and protocols. We need to become aware not only of the structural violence racism inflicts but also of how we all contribute to it before working to actively destroy it through antiracist work in which we uphold core values of our profession: social justice, and dignity and worth of the person. Davis’s book makes an important scholarly contribution by bringing us closer to both understanding history and how we might forge better futures.
