Roots and Resistance: The History of Gynecology and the Impact on Black Women Today

By Asia Ingram, PhD Student

The Father of American gynecology is credited to a South Carolina born white-man who practiced his techniques on enslaved women. Lucy, Betsy, Anarcha and many unidentified women lived and worked as patients and assisting in surgeries in the slave hospital between 1844 and 1849, they are the Mothers of Gynecology. Due to the practice of chattel slavery, he had unfettered access to human female patients, who could neither consent nor refuse to participate[1]. This positioned American “doctors” to be a major source of medical knowledge globally in the early 1800s [1]. However, the negative stigmas surrounding the “Black Body” have infiltrated all aspects of American Society from Agriculture to Business to Medical Practices. In fact, the future dehumanization and mistreatment of Black people depended upon the fallacies that “Black Bodies” could withstand severe treatment. These ideologies were made concrete in the antebellum period with invalid race-based explanations deemed “medically relevant” [2].

Deidre Owens’ 2017 publication entitled “Medical Bondage” described the contradictory nature of the medical superiority of the Black woman while also acknowledging that “Blackness” was pathological and seen as a debilitating medical condition [1]. Owens suggests that the objectification of the enslaved Black female body hyperfocused on fecundity, hypersexuality and strength as a standard of medical superiority in comparison to the white woman [1]. Moreover, comparing the fortitude of Black women to that of the Black man led to severe treatment of women because they could withstand such abuse. It was believed that Black women were responsible for the failures of the Black family and that the delinquency was pathological and could be inherited [2]. Additionally, it was believed that the carelessness of Black mothers’ also led to the “smashed noses” associated with African features [2]. Dorothy Roberts wisely stated that these “myths are more than made-up stories. They are also firmly held beliefs that represent an attempt to explain what we perceive to be truth” [2]. Roberts wrote “Killing the Black Body” in 1999 detailing the “reincarnation” of racist pedagogy through policing of Black women’s bodies under the guise of family planning. This led to the heavy incarceration of Black women in the 80s due to the apparent abuse of drugs as well as legislation that allowed for eugenic practices and limited access to medical treatment [2]. While the determination and resistance of the Black community fuels our resilience there are still many hurdles to overcome. Examples of forced sterilizations and limited access to medical care are well-documented even as recent as 2010 for incarcerated women in Los Angeles largely validated by the “reincarnated pedagogy” of the antebellum period [3].

Numerous publications detail the inhumane treatment of enslaved women and poor Irish women during the antebellum period. They even try to explain the disparity in gynecological and obstetrical outcomes for Black and White patients today [4]. Conclusions often attribute these disparate outcomes to medical racism fueled by a history of legislative support and the accumulated pressures of structural racism [3-5]. Even after 246 years of enslavement and another 100 years of rape and subpar medical care during the Jim Crow era, the hypersexualization of Black women continued. Today, we suffer the greatest burden in terms of maternal mortality, infant mortality and STI transmission in the US [5]. Kelly Hoffman’s 2016 publication explored the systematic treatment of Black patients compared to white patients and exposes the false beliefs of biological characteristics of Black peoples’ bodies. Hoffman cited multiple publications that prove that a Black patients’ pain will be underestimated and undertreated in a clinical setting based on these same antebellum-derived fallacies even today [4].

Historically, community-based initiatives by Black organizations mitigate the impact of systemic racism. Examples of free-health clinics ran by the Black Panthers, the Freedom House Ambulance Service, the establishment of the National Medical Association for Black physicians and HBCUs that provided medical training to Black physicians have allowed us to establish alternatives to segregated medical institutions for the success and safety of our communities [3]. The same rings true today. Studies suggest that Black patients experience better outcomes and doctor-patient relationships with Black doctors. In fact, a study found that infant mortality rates amongst Black mother’s were cut by 50% when the physician was Black [6]. Additionally, research shows that for every 10% increase in Black representation amongst clinicians in a particular county, there was an associated increase in life expectancy amongst Black people in that county [6,7]. These studies cite better communication amongst patients and doctors and cited that patients were more likely to adhere to treatments. However, the reality is that only 5.7% of physicians in America are Black [6]. Therefore, we must be active participants in our medical journeys. While the Mothers of Gynecology, Lucy, Betsy and Anarcha, didn’t have the autonomy to protect themselves and were required to assist in treating other enslaved women, their legacy reminds us that we must remain dedicated to the health of our communities through fierce advocacy and self-compassion. 

References:

[1] OWENS, D. C. (2017). Medical Bondage: Race, Gender, and the Origins of American Gynecology. University of Georgia Press. https://doi.org/10.2307/j.ctt1pwt69x

[2] Roberts, D. E. (1999). Killing the black body : race, reproduction, and the meaning of liberty (First Vintage books edition.). Vintage Books.

[3] Nuriddin, A., Mooney, G., & White, A. I. R. (2020). Reckoning with histories of medical racism and violence in the USA. Lancet (London, England), 396(10256), 949–951. https://doi.org/10.1016/S0140-6736(20)32032-8

[4] Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113

[5] Prather, C., Fuller, T. R., Jeffries, W. L., 4th, Marshall, K. J., Howell, A. V., Belyue-Umole, A., & King, W. (2018). Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health equity, 2(1), 249–259. https://doi.org/10.1089/heq.2017.0045

[6]Boyle, P., By, Boyle, P., & 6, J. (2023, June 6). Do black patients fare better with black doctors?. AAMC.

[7] Snyder JE, Upton RD, Hassett TC, Lee H, Nouri Z, Dill M. Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Netw Open.2023;6(4):e236687. doi:10.1001/jamanetworkopen.2023.6687