What it means to name obstetric racism

A patient says something is wrong and feels dismissed. A procedure moves forward before the conversation feels complete. Pain is minimized. A request for more information is stopped, corrected, or treated as hostility. Each experience may be explained as one busy shift, one communication problem, or one difficult interaction.

Then another person tells a similar story. And another. The hospitals are different. The clinicians are different. The details are not exactly the same. But certain parts keep repeating.

For a long time, the language used to discuss these experiences did not fully hold everything Black women were describing. Medical error could explain care that fell below a standard. Implicit bias could explain how unconscious beliefs influenced a person's judgment. Poor bedside manner could describe a disrespectful interaction. All of those ideas were useful, but none fully connected the patient's experience to the history of obstetrics, the power held by medical institutions, and the repeated racial patterns seen across many places.

Medical anthropologist Dr. Dána-Ain Davis gave that pattern a name: obstetric racism. Her research centered the experiences of Black women during pregnancy and birth and showed that many of these encounters were larger than one person's prejudice or one provider's mistake.

Naming obstetric racism gave people a shared language — a clearer way to talk about a problem that was previously only living in handfuls of separate anecdotes.

Unnamed experiences are easy to separate from one another. One patient is told she is anxious. Another is pressured to agree to a procedure. Another reports pain and waits too long for someone to respond. If each story stays on its own, every event can be treated as an exception. A shared name makes it possible to place those stories beside one another and ask whether they form a pattern.

We have seen this in other areas of health and social life. As we shared in the last chapter, Dr. Arline Geronimus used weathering to name the physical wear connected to long-term social stress. Kimberlé Crenshaw used intersectionality to explain how people can experience race, gender, and other parts of identity together in ways that cannot be understood by looking at only one. The experience came first. The language helped people study it, recognize it, and respond to it together.

Obstetric racism can appear in moments that do not look dramatic from the outside. A patient's pain receives less urgency. Consent is reduced to a form that was quickly signed on the way to an intervention. A symptom is assigned to anxiety, poor nutrition, weight, etc. before other causes are explored. A person asking questions is described as difficult or noncompliant. Any one of these moments might seem small. Across many patients and institutions, they become harder to dismiss as unrelated.

The term can also change the questions we ask. Instead of stopping at whether a clinician intended to cause harm, we can ask how authority was used, which assumptions shaped the decision, whether the same thing happens more often to Black patients, and what policies made the experience more likely. As we said in an earlier chapter: This is not just about intention.

Naming a thing is what makes it possible to measure it. Dr. Karen A. Scott, an obstetrician and researcher, took Davis’s dimensions of obstetric racism and built them into the first validated instrument for the problem — the Patient Reported Experience Measure of Obstetric Racism, developed with and for Black mothers and birthing people. In her SACKRED Birth Study, 806 Black women reported on births across 348 hospitals in 34 states. The scores did not vary with clinical risk. Whether a birth was vaginal or cesarean, whatever the gestational age or the BMI, what the measure was picking up was not the pregnancy. It was the treatment.

For clinicians and institutions, understanding and knowing how to engage with this language can support better research, quality improvement, and accountability. For patients, it can make an experience that felt confusing or isolating easier to understand. Being able to say what happened does not repair the harm. But it can help someone see that they were not imagining it and that their story may be connected to something larger.

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