April: The Origins of American Gynecology and Their Implications for Care Today
Written by Ananya Pani
Point of View:
MEDICAL BONDAGE: RACE, GENDER, AND THE ORIGINS OF AMERICAN GYNECOLOGY
Owens’ Introduction and Chapter 1 of Medical Bondage: Race, Gender, and the Origins of American Gynecology cite the narratives of the Black women whose labor and bodies go unrecognized in discussions of the origins of American gynecology. From 1844 to 1849, Anarcha, Betsey, and Lucy – in addition to nine unidentified enslaved women – lived and worked in the first hospital for enslaved women in Montgomery, Alabama. The hospital was founded by Dr. James Marion Sims for the purpose of performing gynecologic reconstructive surgeries to treat enslaved women. Not only did the women who lived and worked at the hospital perform the duties of enslaved people under Sims’ command, but also served as Sims’ assistant nurses for his surgical procedures. Sims, amongst other White male physicians at the time, utilized enslaved women not only as sources of labor but as sources for experimentation, exploiting them on the basis of antebellum-era theories of racial formation; they justified their experimentation on Black women’s bodies due to their “higher pain tolerance” and “physical superiority,” both of which exemplify antebellum-era theories of racial formation in medicine and medical racism based on biological racial differences that were fabricated by white American male gynecologists to ‘advance’ American gynecology. “For pioneering gynecological surgeons, Black women remained flesh-and-blood contradictions, vital to their research yet dispensable once their bodies and labor were no longer required”. While Black women were critical towards American gynecological research and much of modern gynecological practice, their bodies were viewed solely as sources of labor and considered disposable once they no longer served White male gynecologists’ purpose. James Marion Sims has long been considered the ‘father’ of American gynecology after opening one of the first women's hospitals in 1955. The failure to credit the enslaved Black women who were foundational to American gynecological research perpetuates the neglect of the field’s racist origins as well as the maintenance of Anti-black racism in American gynecology today.
Resource:
DIVERSITY, EQUITY, AND INCLUSION TOOLKIT FOR AMERICAN OBSTETRICS AND GYNECOLOGY
This toolkit, created by the Association of Physician Associates in Obstetrics and Gynecology (APAOG), emphasizes the importance of OB/GYN clinicians having an in-depth understanding of historical accounts towards mitigating health disparities. Included in this toolkit are Books, Articles, Webinars, and Podcasts regarding the roots of American Obstetrics/Gynecology, Anti-Black racism in American Obstetrics/Gynecology, and Anti-Black racism in the United States. Recommended resources include, but are not limited to,: “The Case for Reparations,” Remembering Anarcha, Betsey, and Lucy: The Mothers of Modern Gynecology, Medical Bondage: Race, Gender, and Origins of American Gynecology – whose themes are introduced in this blog. While the APAOG DEI Toolkit is primarily directed towards OB/GYN physicians, it includes important works that are accessible to all interested in understanding the history of American gynecology and mitigating Anti-Black racism in gynecology and medicine more broadly.
News Story:
WHY DO SO MANY BLACK WOMEN DIE IN PREGNANCY? ONE REASON: DOCTORS DON’T TAKE THEM SERIOUSLY
“The advancement of obstetrics and gynecology had such an intimate relationship with slavery, and was literally built on the wounds of Black women,” says Deirdre Cooper Owens, author of Medical Bondage. A shared reality amongst Black women in the U.S. are the disproportionate disparities associated with pregnancy and birth. Angelica Lyons, a Public Health professor at the University of Alabama at Birmingham, knows the dangers of giving birth as a Black woman in the U.S. and reinforces to her students that the rate of maternal mortality is three times as high amongst Black women as it is for any women of any other race. Lyons’ Public Health teachings became a scary reality for her own pregnancy during which she recalls being repeatedly shrugged off by physicians despite reporting severe abdominal pain; she was ignored by the physicians at the hospital affiliated with the very institution she taught at. Physicians dismissed Lyons’ symptoms as “normal Braxton-Hicks contractions”3; it wasn’t until her baby’s heart rate dropped that she was addressed and rushed in for an emergency cesarean section, almost dying of septic shock. Lyons' experience is not an isolated instance and exemplifies the ways in which the racist origins of American gynecology and institutionalized racism contribute to medical discrimination and racism. “The way structural racism can play out in this particular disease is not being taken seriously… we know that delay in diagnosis is what leads to these really bad outcomes,” says Dr. Riley, chief of OB/GYN at Weill Cornell Medicine and New York Presbyterian Hospital.
Scientific Publication:
CRITICAL RACE FEMINIST BIOETHICS: TELLING STORIES IN LAW SCHOOL AND MEDICAL SCHOOL IN PURSUIT OF “CULTURAL COMPETENCY”
The historical accounts of Anarcha, Betsey, and Lucy illustrate how enslavement, race, and gender are inextricably intertwined with American gynecology. Washington utilizes historical narratives to demonstrate the ways in which Black women were regarded as sources of both labor and reproductive labor citing that “some slave owners identified slaves for breeding and paired them”. The use and the characterization of enslaved Black women as ‘breeders’ by enslavers is inherently dehumanizing and reinforces how Black women and their children were regarded as sources of labor. Washington addresses Sims’ use of Black women as sources of experimentation based on the fabricated notion that Black women have a higher pain tolerance. Washington writes, “[Sims] purchased slave women in order to operate experimentally on them. Giving them no anesthesia due to their racial ‘differences’ (Blacks purportedly did not feel pain), he addicted them to opiates to regulate their bowel and bladder function. He operated on several of these women 20 or 30 times before obtaining the results he wanted”. In analyzing historical accounts, Washington emphasizes that while truth-telling is a central tenet of biomedical ethics, biomedical ethics must expand to include historical truth-telling. Historical truth-telling is critical for restructuring medical education in efforts to improve current and future generations of physicians' ability to exercise both cultural competence and cultural humility when treating patients.