By Vanessa Grubbs, California Health Care Foundation, September 25, 2020
Black mothers die in hospitals at nearly four times the rate of White mothers — an appalling disparity that has persisted for decades despite state and national quality improvement initiatives, clinical safety innovations, and technological advances. This disparity persists regardless of patient income, insurance, education, comorbid conditions, or prenatal care. The fact that many clinicians, decisionmakers, and policymakers continue to believe this excess incidence of death is the result of something inherently wrong with Black women is a symptom of America’s entrenched obstetric racism.
As anthropologist Dána-Ain Davis, PhD, explains in her book Reproductive Injustice: Racism, Pregnancy, and Premature Birth, obstetric racism takes many forms. There is the “medical abuse” form of obstetric racism dating back to 19th century physician J. Marion Sims, whose experimentation on enslaved Black women without anesthesia earned him the moniker “the father of modern gynecology.” The “diagnostic lapses” form arises from de-emphasizing or ignoring patients’ symptoms, as seen in the story of Kira Johnson, who bled to death after what was supposed to be a routine cesarean section. The “ceremonies of degradation” form made Johnson’s Black husband Charles hesitate to speak up forcefully in his advocacy for her out of fear the police would be called.
Traditional interventions have focused on the victims of racism, with the goal of trying to teach patients to speak up. In contrast, Karen Scott, MD, MPH — a community-based obstetrician/gynecologist for nearly 20 years and a self-proclaimed “reproductive justice avenger” — is working to disrupt birth inequities with the SACRED (examining Safety, Autonomy, Communication, Racism, Empathy, and Dignity) Birth Study. She is applying rigorous research methodology to Davis’s obstetric racism framework in order to put the onus of behavior change on providers and hospital systems. To that end, she is developing a quality improvement tool — the Patient-Reported Experience Measure of OBstetric racism, or PREM-OB Scale. The aim of this work is to capture patient-reported experiences of obstetric racism among Black mothers and birthing people* who seek help or health care in hospital settings during labor, birth, and postpartum.