This Expert Column is part of a series exploring the effects of Dobbs v. Jackson Women’s Health Organization on obstetrician gynecologists’ (OB-GYNs) mental health and emotional well-being. This piece focuses on the experiences of Black OB-GYNs, as they are likely to face particular challenges and have unique needs in the wake of the decision. Read the first part of the series here.
In the wake of Dobbs, the prevalence of racism and racial biases in various systems and institutions affects how Black OB-GYNs are likely to experience new threats of criminalization for providing medically-necessary reproductive health services. Racial discrimination in the workplace, namely health institutions, and longstanding racial disparities within the criminal justice systems are particularly relevant for Black OB-GYNs.
Racism in the Practice of Medicine
Studies show that Black physicians are likely to experience significant racism in their workplace settings, which can come from their patients, colleagues, and institutions — in many cases, due to unconscious biases. A study of physicians in various practice areas revealed that 71% of Black physicians had experienced some form of workplace discrimination during their careers. In the same study, 60% of Black physicians reported that they have had patients refuse their care simply because they were Black. In a study exploring the prevalence of institutional racism against physicians in health care settings, physicians of color, including Black physicians, reported experiencing microaggressions, feeling psychologically burdened, and being subject to assumptions based on stereotypes.
Black physicians also report being paid less, afforded fewer resources and training opportunities, held to higher standards, overlooked for leadership positions, and treated differently from their white counterparts. Knowing this, it is unsurprising that Black individuals are severely underrepresented in the practice of medicine (only 6% of all physicians) and in positions of leadership or influence within health care systems. Underrepresentation, as well as fears of retaliation from employers, discourage Black physicians from raising concerns about discrimination in the workplace to their supervisors.
Racism in the Criminal Justice System
Newly implemented abortion bans threaten Black physicians with engagement with a racist criminal justice system. Due to racial disparities in the criminal justice system, Black individuals are likely to experience threats of criminalization differently. Racial biases are woven into the criminal justice system in such a way that creates and perpetuates racial disparities at each possible decision point — resulting in disproportionate outcomes for Black people. Such biases result in more severe sentences and more disciplinary actions for Black people. Compared to white people, Black people are more likely to be arrested, more likely to be charged upon arrest, and more likely to be convicted once charged. Black people are imprisoned five times as often as white individuals and frequently receive harsher sentences when charged. Where discretion around reporting, arresting, prosecuting, and sentencing exists, racial biases and discrimination lead to disproportionately severe outcomes for people of color.
Particular Challenges for Black OB-GYNs Post-Dobbs
As discussed in a previous Expert Column, OB-GYNs constantly face threats of criminalization for providing medically-necessary reproductive health services in the wake of Dobbs. The uncertainty of this new legal landscape is taking a toll on OB-GYNs’ mental health and emotional well-being. OB-GYNs report having to delay care until patients are at risk of either death or permanent impairment or direct patients to care elsewhere and worry about their health outcomes. A recent study that surveyed OB-GYNs providing abortion care in states with abortion bans enacted post-Dobbs found that 87% of participants reported concerns about practicing in an uncertain legal climate. These concerns will be heightened even more for Black OB-GYNs post-Dobbs. In addition, Black abortion providers have long faced heightened and racialized violence and harassment for engaging in abortion care, and this will only be exacerbated. Long-standing racism in the medical field and in the criminal justice system is likely to intensify these concerns and present particular challenges for Black OB-GYNs.
The prevalence of individual and institutional racism in the medical field contributes to not only a stark underrepresentation of Black physicians, but also higher rates of emotional exhaustion, depersonalization, and burnout within that group. For Black OB-GYNs, workforce shortages in states that ban abortion and influxes of patients in states that permit the procedure will create new strains — further exacerbating preexisting burnout caused by racism. Moreover, given how often the concerns Black physicians raise about racism are ignored by their supervisors or institution, they may be more fearful than their white counterparts that their institutions will not adequately support them in navigating other challenging situations, such as how to provide patients with evidence-based care while complying with sweeping abortion bans. Finally, where states’ exceptions to abortion bans are narrow and vague, law enforcement and judges retain significant discretion when it comes to enforcement — meaning that Black OB-GYNs may experience heightened scrutiny, surveillance, investigation, and even prosecution due to racism.
Consequences for Health Outcomes of Black Patients
Driving Black OB-GYNs away from states with sweeping abortion bans will ultimately undermine patient care and worsen health outcomes, especially for Black individuals and communities. According to the Commonwealth Fund, “a diverse and representative health care workforce improves patients’ access to care, their perceptions of the care they receive, and their health outcomes.” Studies have also documented improved access, quality, and health outcomes when patients’ health care teams mirror their personal characteristics — fostering relationships that engender respect, empathy, and trust. In primary care, higher Black physician representation is associated with lower mortality rates among Black patients and with reduced mortality rate disparities between Black and white patients. Newborn–physician racial concordance is also associated with a significant improvement in mortality for Black infants.
In the wake of the Dobbs decision, Black providers are disproportionately and uniquely affected by the new threats of criminalization that have arisen. Individual and institutional racism affects Black OB-GYNs’ interactions with not only their patients and employers, but also with law enforcement, judges, and other actors within the criminal justice system. Documenting the particular challenges they face and ensuring their unique needs amid this uncertain legal landscape are met are essential. Failing to do so further undermines the health and well-being not only of Black OB-GYNs themselves, but also their patients and communities — particularly those who are already marginalized and underserved.
