Abstract
In Reproductive Injustice, Dána-Ain Davis takes a black feminist approach to understanding the role medical racism plays in determining adverse reproductive outcomes for black women. Medical racism, according to Davis, is more than care rationed by the medical profession. It “includes the sometimes subtle and sometimes not-so-subtle ways in which the medical complex, in each of its parts, cumulatively dismisses, misdiagnoses, and undermines women’s feelings and intuitions about their reproducing bodies” (p. xv).
The book is divided into two parts. Part I engages the concept of the afterlife of slavery to investigate present-day prenatal care, labor, birth, and NICU admissions narratives in the context of the treatment of black women in the antebellum period by enslavers and plantation doctors. While the black women who shared their experiences with prematurity differed in age, education, insurance status, income, region, and type of facility in which they gave birth, their narratives share much in common, including being ignored by doctors when they expressed specific concerns about their pregnancy.
Part II reveals the disjointed ways in which the care of pregnant women and their fetuses have evolved in this country from the antebellum period to the present, particularly for black women. Technologies and other interventions developed not to help prevent prematurity (which would arguably improve birth outcomes for women) but to deal with the effects of prematurity in the infant. Davis ties these interventions to both historical conceptions of the hardiness of black bodies originating in the scientific racism of the nineteenth century and the narratives of the black women she interviews as they recount the ways in which their concerns and intuition during pregnancy were dismissed. Through failing to listen to these women—a possible simple, low-cost, upstream solution for reducing preterm births—the medical establishment as a whole puts their lives and those of their fetuses at risk while encouraging the development of downstream interventions that are costly and deal solely with the outcomes of prematurity without addressing its causes.
Reproductive Injustice is a timely contribution to the literature on health disparities. Aside from the factors listed above, by focusing on prematurity, Davis highlights a reproductive outcome that often serves to reproduce itself over the life course of the preterm baby. This cycle of reproductive injustices continues either through the increased risk of females growing up to deliver preterm babies themselves, or through an increased risk of black babies, regardless of sex, being born and living with a host of health issues.
Additionally, Davis’s examination of how doulas and radical black caregivers work to improve reproductive outcomes in the latter part of the book provides an understanding of what black women need beyond pregnancy. Their approach to care brings to light several areas of study needed to better understand how racism impacts the health and wellness of black women outside of reproduction. It also levels a critique of pregnancy’s overmedicalization and its impact on women regardless of race. Consider this: the US ranks first among all industrialized countries in rates of maternal mortality. While the rate of black maternal mortality partly explains the difference, isolating the maternal mortality rate of white women in the United States does not change the rankings. The medicalization of pregnancy in our society potentially renders the intuition of pregnant women of all races subordinate to the best guesses of medical practitioners, reducing us to vulnerable subjects of the biomedical machine.
My primary critique of the book concerns its treatment of statistics. Davis overstates the occurrence of premature birth among black women, at one point writing that this outcome is “common among Black women” (p. 7). At 13.6 percent, the rate of premature birth is more common for black women than for any other racial or ethnic group. However, to interpret this statistic as a common occurrence threatens to reduce black women’s varied reproductive experiences to one of premature birthers. Davis also states that birth outcomes for black women were significantly better during enslavement than today. That is patently false given the table on page 34. For example, in 1850, the infant mortality rate for black women was 340 for every 1,000 live births, compared with 14.1 in 2000. The racial disparity was lower in 1850. Focusing on the disparity in this case centers whiteness—not the profound reduction in these numbers for black women over time.
This critique aside, Reproductive Injustice lays the foundation for much-needed expansions in health disparity research. Rather than focusing on what doctors think about racial difference and how these ideas shape the medical encounter, Davis focuses on women’s sense of racism during these encounters. How do perceptions of racism themselves, whether during the medical encounter or in daily life, impact our health? Reproductive Injustice asks the question, What if black women were heard? And what if we cared about their perceptions?