Over the past two weeks, we have witnessed an incredible outpouring of highly justified protest against racial injustice following the brutal murders by police of George Floyd and Breonna Taylor. These crimes are stark reminders that despite progress, the world we live in is still profoundly unjust.
As a white global health student at Duke University, I have most often viewed race through the lens of public health. Implicit biases within the healthcare system very often result in worse outcomes for Black people. Indeed, racial injustice permeates every system in this country—from policing to housing to education to employment to health and environmental safety.
Black women, in particular, deal with the double burden of discrimination for their race and their gender. Inequality in the healthcare system for Black women is especially salient when it comes to reproductive health. And this inequality has been clear since the development of modern gynecology when doctors performed experimental procedures upon enslaved women without anesthesia, consent, or regard for their suffering.
Today in the U.S., Black women are more than three times more likely to die from pregnancy-related causes than white women. This disparity persists over age, education levels, and state lines. The pregnancy-related mortality ratio for Black women over 30 years old is four to five times that of their white counterparts. Health outcomes for their children are significantly worse as well. In 2016, the mortality rate for Black infants (11.4 per 1,000 live births) was over twice that of white infants (4.9 per 1,000 live births).
The fact that these disparities are found in a system that exists (in theory) to help and heal makes these statistics truly enraging. Most maternal deaths are preventable! Add in how poorly the overall U.S. maternal mortality rate compares to the rest of the developed world—it’s abysmal—and the case is even more tragic.
And, these statistics have long been documented. Most notably, research concerning racial disparities in modern health care was outlined in the extensive 2003 congressionally mandated report Unequal Treatment. So why are we still seeing such stark differences in care and outcomes nearly two decades later?
Structural racism in the U.S. is extremely pervasive, and combating it must factor into our fight for reproductive rights for all. Implicit bias and outright racism are forms of violence visited upon Black communities in so many ways. Here in the U.S., the adverse effects of environmental threats disproportionately affect communities of color and low income areas—in the same way that the burden of climate change falls most heavily on the poorest communities in the global south.
This is why we need to ensure that everyone has access to equitable, high-quality (read: non-biased), and affordable healthcare services, including reproductive health and family planning. Through a greater exercise of reproductive autonomy, we will see improved outcomes for individuals’ and communities’ health and well-being. And by lowering rates of unintended pregnancy in the U.S. and in countries that request our foreign assistance, we can slow population growth and improve environmental sustainability for generations to come.
Our country is losing Black men, women, and children to violence, whether it be from murder by police, implicit bias in healthcare, or the effects of environmental degradation and climate change. We cannot achieve reproductive or environmental justice without achieving racial justice.