My mother had an ambulance called for her at work on April 15, 2022. By the time the Emergency Medical Technicians (EMTs) arrived, my mother was drifting in and out of consciousness and complained of an excruciating headache and pain in her neck. After checking her vitals, the EMTs concluded that she was dehydrated and asked if she wanted to be transported to the hospital. They warned her, however, that she would likely face a long wait in the emergency room (ER) as patients with more severe conditions would be seen first. She declined transport, not wanting to sit in the ER for hours. Yet, her condition worsened after the EMTs left.

She was later rushed to the hospital in a personal vehicle. Upon arriving, she was diagnosed with a ruptured brain aneurysm and airlifted to a local hospital for emergency surgery. My mother made a full recovery, but I still wonder whether her race (Black) and gender (woman) affected the EMTs’ misdiagnosis of her initial symptoms. Did her identity affect the care that she received and the EMTs’ perception of her? 

What is Misogynoir?

Coined by Kimberlé Crenshaw, intersectionality is the theory that different aspects of a person’s identity — such as race, gender, class, sexuality, etc. — intersect to create unique relationships to privilege and oppression. The closer a person’s identity is to the dominant identity in society, the more likely they are to experience privilege. In contrast, the further their identity is from the socially dominant one, the more likely they are to experience oppression. 

In 2010, Moya Bailey, an associate professor at Northwestern University, took this concept further by creating the term “misogynoir” to describe the unique experiences of being a Black woman. Misogynoir refers to the specific oppression and prejudice that Black women experience due to the dual harms of anti-Black racism and misogyny. While Bailey first used misogynoir to describe prejudice in the media, the term has evolved to encompass the experiences of Black women in various aspects of society, including their experiences with the medical field.

Historical Roots of Misogynoir in Medicine

The history of misogynoir in the medical field can be traced to the creation of gynecology.

During chattel slavery, Black women were the constant victims of rape and forced pregnancy to maintain the supply of enslaved persons. Yet, pregnancies during this time often left the women with significant health complications. In cases of severe complications from childbirth, slave owners would bring women to physicians like J. Marion Sims. Sims was a physician who moved to Montgomery, Alabama, and routinely experimented on enslaved Black women to find cures for complications related to childbirth. He performed these experiments without anesthesia, because he believed that Black women could handle large amounts of pain. 

Sims’ low regard for Black women’s bodies and pain is unfortunately not unique. This treatment has been ubiquitous in the medical community for centuries and affects other ways medical professionals view Black women, particularly regarding their bodily autonomy and agency. In the 1960s, activist Fannie Lou Hamer underwent a standard uterine surgical procedure. During the procedure, however, the doctor also sterilized her without her knowledge or consent. After becoming aware of her own sterilization, Hamer learned that this involuntary procedure was a common occurrence for other Black women in her Mississippi community and named it the “Mississippi Appendectomy.” It wouldn’t be until a 1973 Senate hearing on sterilization abuse that the prevalence of these forced sterilizations against poor Black women living in the South would be revealed.

Misogynoir in Medicine During the Crack Cocaine Epidemic

In the 1980s and 1990s, Black women again experienced misogynoir at the hands of the medical community during the crack cocaine epidemic and the creation of the term “crack baby.” When crack cocaine proliferated through the United States in the 1970s, President Richard Nixon declared a “War on Drugs” and began harsh punishments for drug-related offenses. The 1986 Anti-Drug Act instituted mandatory minimum sentences and imposed a 100-to-1 crack versus powder cocaine sentencing scheme — thus, making sentences for crack-related offenses more severe. Black urban communities were targeted during the enforcement of drug laws, and Black women were portrayed as threats to their own children. Black women were thought to be causing a public health crisis through their birth of “crack babies,” a concept referring to children who were exposed to crack cocaine in utero. The phrase began as a joint campaign between the medical field and the media to warn the public about the potential consequences of crack cocaine usage during pregnancy. 

Many studies released during this period about crack cocaine usage during pregnancy used inflammatory language and over-exaggerated the effects of the drug on the fetus by claiming that these children would have reduced intelligence and social skills. This campaign led to a mistrust of Black women giving birth and over-surveillance of these women during delivery.

In 1988, the Medical University of South Carolina, which treated predominantly low-income Black patients, routinely conducted drug tests on pregnant patients without their consent and reported these Black pregnant patients to the City of Charleston Police Department for prosecution. A decade later, the Supreme Court found this practice to be unconstitutional. However, the damage was already done. By then, the medical field viewed Black women giving birth as not to be trusted. 

Modern Misogynoir in Medicine

The thread of misogynoir from J. Marion Sims still exists in the medical field today. In particular, some physicians today still hold Sims’ belief that Black women have higher pain thresholds. The Proceedings of the National Academy of Sciences found that many medical students still assume, to this day, that there are biological differences between Black and white individuals and, thus, believe that Black individuals have higher pain tolerances than white individuals. This misconception often leads to medical professionals not accurately recognizing or treating Black women’s pain — decisions that could have dire consequences. 

In 2023, April Valentine, a Black woman, went to a hospital in Los Angeles, California, to give birth. During delivery, she complained of swelling and numbness in her leg, to which her care team attempted to reassure her was normal. However, she died the next day from a blood clot that had traveled from her leg to her lungs. Her story, unfortunately, is not uncommon.

Black women are currently 2.6 times more likely to die from pregnancy-related complications than white women, often from preventable conditions. A study of the maternal mortality rate for five pregnancy-related conditions — preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage — found that the maternal mortality rates for Black women were 2.4 to 3.3 times higher than those of white women for these conditions. 

Outside of childbirth, Black women are also more likely to face longer diagnostic times for issues like breast cancer — leading to unforeseen but preventable disease progression. A study from the Journal of American Radiology found that, on average, Black women experienced 10 days longer delay for breast cancer diagnosis than white women did. Those who experience delays in diagnosis — typically Black women — are then more likely to have later-stage tumors and face higher rates of breast cancer mortality. 

The mistrust of Black mothers from the crack cocaine epidemic still affects Black women giving birth today. According to a study published in the Journal of Women’s Health, Black women are 1.5 times more likely to be tested for drugs during childbirth than non-Black women, despite the lack of correlation between race and a positive result.

For centuries, Black Women have faced misogynoir at the hands of the medical community. This issue is only exacerbated by the lack of trust Black women have in health institutions — resulting in worse health outcomes for Black women.  In honor of Black History Month and Women’s History Month, I urge the medical community to reflect on the historical and contemporary effects of misogynoir in the practice of medicine. Until the medical community reconciles with its problem of misogynoir, Black women will continue to lose their lives from preventable causes. Black women’s health matters today and every day.