When you go to a doctor, how often do you have to worry? What do you worry about? Do you have to worry about if they will care about your concern? Do you have to worry about if they will listen? Do you have to worry that they will force you to do things you don’t want to do? Is it easy to have a conversation with them? Are they friendly? Will they support you? Explain your options? What if they don’t share a common background with you?
Perhaps some of you have had at least one of these thoughts. Perhaps some of you have had all of these thoughts.
Perhaps the some of you that have had these thoughts know where I am going with this.
These thoughts, although many may have some just given how atrocious the healthcare system can be, are more likely to be had by people of color. And even within that, specifically, women of color.
This happens throughout the lifespan, even during pregnancy. That is what I want to explore today.
Women of color still face disparities when it comes to pregnancies. This is not due to some innate biological difference between racial-ethnic backgrounds. Rather, it is primarily due to differential treatment within healthcare on the basis of things like skin color, education, or other privileges.
In particular, people that are Native or Black tend to have it the worst with the highest rates of a pregnancy-related death (28 and 42 out of 100,000 respectively, compared to 13 out of 100,000 for White) (more info here).
In following this logic, we can see that, if doctors are not respecting the wishes of patients and are not listening to the general concerns they have, causing excess stress, then it is more likely that the birth of the baby will be compromised on some level. Honestly, this will affect the entire gestation period because these women will likely be in a heightened stress or anxious state more often which will affect both the mother and the baby.
So, how do researchers find out that this is happening? In this case, it was through interviews. This is particularly useful when there hasn’t been much research on a topic because it allows the real-world phenomena to not be obscured by researchers. People just talk and then researchers need to figure out what to do with all that talking.
By doing this, researchers found 3 main themes across women of color that had given birth within the past 6 weeks to 1 year. Themes were created because enough people talked about them in their responses during their interview. I’ll talk about these below.
1). The way providers saw their patients changed how they presented information to them.
When people are not seen as people, medical providers are less likely to treat you with respect. This means that women of color in particular felt like their autonomy was overrun. Doctors wouldn’t share with them all of the information necessary to make their own decisions. Instead, they sometimes even force decisions the patient doesn’t want.
For example, one patient started receiving treatment for a hemorrhage, but the medical staff did not tell her anything about what was happening to her.
That’s so wrong.
It also seems like sometimes, patients will be guilted into something. For example, here is a direct quote from one of the participants: “I told him that I wanted to do a little bit more research and that I wasn't going to get him vaccinated at that moment. And he was like, “Well, I thought that you cared about your children. But if that's not the case, then feel free to go.” It was like, “Really?” That's not okay”.
Instead, the doctor could actually explain alternatives and actual risks.
For these reasons, women of color tend to describe themselves as fearful, left out of decision-making, disrespected, violated, feeling not valued about, and even harassed and bullied. This all seems like accurate descriptions based on these cases so far.
2). Having a relationship with the provider is important and privilege plays a role in creating a relationship.
As one might think, women of color want to be able to have a stable relationship with their provider and medical team. However, the degree to which doctors do this is different depending on privilege of the patient.
Privilege comes in many forms. We all likely have at least 1 type of privilege and some have much going for them already. In the case of the medical system and pregnant women of color, it seems like doctors treat people differently depending on skin color and education.
Lighter skinned women of color are able to have more friendly conversations with their doctors. This can be great because you don’t want to just feel like a condition or a disease or a specimen. You are a human and should be treated as such.
More educated women also noticed the difference from before the doctor knew where they graduated from and after they knew. But, then, if they know your education, they may also start to assume you know things or have access to resources. Neither of which may be true.
What worked best for women of color was when their racial-ethnic background matched that of the doctor. It makes it easier to convey struggles and they might understand the experiences first-hand.
However, on the worst end, doctors may not be appropriate when it comes to how they treat women of color based on skin color, how much money they make, their education, or even the type of insurance they have (e.g., public insurance).
An example of this is when one time, a woman of color had a pregnancy test and the doctor came back with a positive result. Then he said, “you still have a few weeks left to get an abortion.” This is absolutely insane. Why assume abortion is even on the table? At most, it should be one option that is presented alongside multiple other options, not just the one and only option that is explicitly stated. But, really, that should just come from the patient more than anyone else.
3). Other bias and system-level barriers also get in the way.
There are plenty of other considerations to think through when it comes to racism. Aside from the explicit and implicit ways doctors may have bias against women of color, there are structural barriers.
These include: access to information, insurance, difficulty accessing services, fragmented care coordination, short visits, transportation services, childcare, location, inconsistent providers, lack of diversity within providers, and lack of racial-ethnic concordance between patients and providers. This last one just means that the doctor’s racial-ethnic background does not match the patient’s. This is actually a key factor in feeling supported and heard in medical systems; if there is racial-ethnic concordance, then patients feel more supported and heard.
To make matters even worse, doctors tend to think that these problems are just because of the women of color and NOT because of inherent problems in the system. This makes it harder for doctors to care about their patients and advocate for them. If they knew it was a structural issue, then they would be more compelled to do something about it.
If nothing else, I hope this article can help spread awareness about some issues that some of the most vulnerable people in society have to face. It is that much more pressing of an issue because when it comes to pregnant women of color, it is now multiple lives on the line. And yet, that is met with so much carelessness from the medical system.
Unfortunately, I don’t have a better note to end on, but perhaps that is for the best. This is a reality of our society and needs to be addressed. If there is anyone in a position of power to do something, feel free to reach out and perhaps together we can make some change.
Until next time.
-Alex
