What it means to name obstetric racism
For a long time there was no word for it.
Black women described experiences in labor and delivery that did not fit the available vocabulary. It was not quite malpractice, because the care often met the technical standard. It was not adequately captured by bad bedside manner, which sounds like a matter of personality. Implicit bias was closer, but it located the whole problem inside an individual’s unexamined assumptions, and what patients were describing was bigger and more patterned than that.
Without a name, each account stayed an anecdote. And anecdotes are easy for institutions to absorb without changing anything.
Dr. Dána-Ain Davis, a medical anthropologist, gave it one. Through years of interviews with Black women about their pregnancies and births, and in her book Reproductive Injustice: Racism, Pregnancy, and Premature Birth, she named obstetric racism and mapped its range — from the quiet forms that are easy to dismiss through to overt abuse.
That is what a name does. Dr. Arline Geronimus gave us weathering, and there was suddenly a way to study something clinicians had watched for years without being able to measure — that sustained stress wears a body down early, and that the damage adds up. Kimberlé Crenshaw gave us intersectionality, and it became possible to say why a Black woman’s experience is not simply racism plus sexism, and why a system built to address one of them keeps missing her entirely. Neither woman invented what she described. Each made it visible enough to study, to argue about, and to act on. Davis has done that for what happens to Black women in labor and delivery.
Exhibit — Plate
Read across each row. Her account on the left, the clinical response on the right.
Serena Williams
West Palm Beach, Florida · September 2017
What she said
What was done
Short of breath the day after her cesarean. A documented history of pulmonary embolism, and off her daily anticoagulant because of the surgery.
Tells the nearest nurse, between gasps, that she needs a CT scan with contrast and IV heparin — right away.
The nurse suggests her pain medication may be making her confused.
She insists.
A doctor performs a Doppler ultrasound of her legs.
“I told you, I need a CT scan and a heparin drip.”
The ultrasound of her legs finds nothing.
She is sent for the CT scan.
Several small clots are found in her lungs. She is put on the heparin drip.
She was right at the first row. It took four more to be treated as though she might be.
What followed took six more days. Coughing from the embolism tore open her cesarean wound. Surgery found a large hematoma in her abdomen, caused by the blood thinner that was keeping her alive. She returned to theatre again for a filter to stop further clots reaching her lungs, and spent the first six weeks of her daughter’s life unable to get out of bed.
Account as given by Serena Williams to Vogue, January 2018. Quoted words are her own.
Nothing in the right-hand column is necessarily explicitly rude or wrong. Every entry looked at on its own may seem like a reasonable clinical step, performed by people doing their jobs, and no single one of them looks like racism on its own. Yet the answer was in the left-hand column the whole time, straight from the sense and the words of the patient — and it was ignored, routed around until there was no other course to take.
That is what the term obstetric racism is for.
It gives a patient language for what happened, which makes it something that can be engaged and confronted. It gives a researcher a category, which makes it countable. It gives a hospital something to measure, which makes it — in theory — improvable. And it moves the analysis from the character of individual clinicians to the operation of a specialty, which is where the pattern actually lives.
It also sets the standard at the right place. If we describe the problem as rudeness, the remedy is politeness training and the outcomes do not move. If we describe it as racism operating inside obstetrics, the remedy has to include who is believed, who is consented, who is imaged, and who is sent home.
Naming is not the same as fixing. But nothing that has no name gets fixed.
When we can name a pattern, we can intervene earlier. When we cannot, every instance stays an anecdote.
Sources 7 entries
The scholars named in this chapter
- Davis, Dána-Ain. Reproductive Injustice: Racism, Pregnancy, and Premature Birth. NYU Press, 2019 — where obstetric racism is named and its range mapped.
- Geronimus, Arline T. “The weathering hypothesis and the health of African-American women and infants: evidence and speculations.” Ethnicity & Disease 2, no. 3 (Summer 1992): 207–221 — where weathering is proposed.
- Geronimus, Arline T. Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society. Little, Brown Spark, 2023 — the argument at book length.
- Crenshaw, Kimberlé. “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics.” University of Chicago Legal Forum 1989, article 8: 139–167 — where intersectionality is named.
- Crenshaw, Kimberlé. “Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color.” Stanford Law Review 43, no. 6 (1991): 1241–1299 — the framework developed.
The account in the exhibit
- Serena Williams’ own account of her delivery and the days after it, as given to Vogue, January 2018.
- NATAL: A Docuseries About Having a Baby While Black (2020). Executive produced and hosted by Martina Abrahams Ilunga and Gabrielle Horton; a collaboration between You Had Me at Black and The Woodshaw — the same ground covered in the families’ own voices.