A better birth is possible

September 2000 Atlanta. I had just celebrated my 23rd birthday. After a summer spent working as a $8.25 an hour cashier at Whole Foods and about to start my senior year at Spelman College, I was already planning my schedule. But for a moment all that concern faltered. I stood in my cramped bathroom at the apartment, my heart racing, and called Shawn over to me. Together we stared at the pregnancy test strip. Even though I already knew the result deep down – my cycle was going like clockwork – I still held my breath until the second pink line appeared.

When I walked into the campus gates this fall semester, I was carrying more than one baby. Also bound to me was the burden of a demeaning narrative about what it means to be young, pregnant, and black. Back then, the heated rhetoric of “babies get babies” was in the air, and while I wasn’t a teenager, I was much younger than most college-educated women who decided to become mothers. According to the stereotypes, I was lazy, promiscuous, and irresponsible—an image from which Spelman, an institution known as a bastion of black middle-class respectability, had sought to distance itself for over a century.

The year before I had come across a 1989 while browsing archives for a term paper time Interview with Toni Morrison, asking if the “crisis” in teenage pregnancy is depriving young women of opportunity: “Don’t you think these girls will never know if they could have been teachers?” Morrison replied:

You can be a teacher. They can be brain surgeons. We must help them become brain surgeons. This is my job. I want to take them all in my arms and say your baby is beautiful and so are you and darling you can do it. And when you do, give me a call – I’ll take care of your baby. That’s the attitude one has to have towards human life… I don’t think anyone cares about unmarried mothers unless they’re black – or poor. The question is not morals, the question is money. We are angry about that.

Almost a decade after the interview, the sociologist Kristin Luker published Dubious Notions: The Politics of Teenage Pregnancy, a powerful refutation of what politicians and pundits have dubbed the “epidemic of early birth.” Luker showed that contrary to the racist depictions of teenage mothers as black girls, most were actually white and of legal age at 18 and 19. Luker’s data also suggested that early birth was an indicator of poverty and social ills rather than a cause, and that postponing childbirth did not magically alter these conditions. So instead of stigmatizing and punishing young people for having children before they are economically independent, Americans should demand programs that expand educational and employment opportunities for impoverished youth. (Later, in graduate school at the University of California, Berkeley, I became a student of Luker—I processed the data after I had already experienced the story.)

As a pregnant college student, I didn’t have Luker’s stats handy. But I knew intuitively that many people who hold a eugenic-tinged worldview—political decision-makers and pundits, medical professionals and religious zealots among them—scoffed at procreation by whites, the rich, and the healthy at babies of color, children from poor families, and people with disabilities are often seen as a burden. Eventually, I would learn that cultural fears about “excessive fertility” among non-white populations and about declining birth rates among white populations are two sides of the same coin. No amount of moralizing about “babies having babies” could hide the underlying disdain directed at those who were not of “superior tribe.”

When I first stopped by the student hospital to ask if my health insurance covered pregnancy-related care, a black woman behind the desk, without looking at me, remarked, slightly irritated, that yes, it was covered, “like any other illness.” “. Pregnancy, but especially black pregnancy, was a disorder that required medical intervention. I realized that even in an institution created for black women, I could not expect care, concern, or congratulations. And while the words of the receptionist still ring in my ears, far more worrying are the disastrous effects when those in power pathologize black reproduction.

The real “crisis” of Black pregnancy is not youth or poverty or unpreparedness; it is death. Black women in the United States are three to four times more likely to die during pregnancy and childbirth than white women. This rate does not vary by income or education. Black women with college degrees have a higher infant mortality rate than white women who never graduate from high school. Black women are also 2.5 times more likely to give birth prematurely than white women.

Some observers attribute higher rates of maternal mortality and preterm birth among black women to higher rates of obesity, diabetes, and other risk factors. But as Elliot Main, a clinical professor of obstetrics and gynecology at Stanford, says, the focus should be on the treatment of black women by hospital staff: “Are they being listened to? Are they part of the team?” Too often medical professionals ignore the concerns of black women, downplaying their needs and viewing them as unfit mothers. The hospital staff callously questioned her sex histories and sent her home with symptoms that turned out to be severe. The experience for black LGBTQIA+ patients and people with disabilities can be even more alienating and dangerous. Taken together, this is what medical anthropologist Dána-Ain Davis calls “obstetric racism.”

In the PBS documentation unnatural causesAs her neonatologist Richard David put it: “There is something about growing up as a black woman in the United States that is not good for childbearing health. I don’t know how else to sum it up.” However, even this leads to misattribution of the source of the damage; The problem isn’t growing up black and female, it’s growing up in a racist and sexist society. Racism, not race, is the risk factor.

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