Recently I took to re-reading Sister Citizen by Melissa Harris-Perry and see how the main findings of my dissertation work pointed to the misrecognition of young Black women in contraceptive care settings. As Harris-Perry describes, "as members of a stigmatized group, African American women lack opportunities for accurate affirming recognition of the self and yet, must contend with hyper-visibility imposed by their lower status" (p.91). A key finding from qualitative interviews with Black women ages 18 to 29 years was that they had interactions with health care providers tinged with apathy and limited empathy for them or their health concerns.
Even when women described exposing their vulnerability to providers, they were still not cared for in affirming ways. For example, during a pap test where a woman was partially undressed and had her legs in stirrups, she began crying and shaking. As she stated, she thinks the provider tried to ignore her reaction and proceeded with the examination. She was later left alone in the exam room to collect herself before she departed the clinic and did not receive any comfort.
Other women came to their visits to discuss contraceptive options and also address other reproductive issues they were experiencing, such as severe vaginal pain, uterine cysts, and more. Women had to rely on their providers to get answers to the questions they had. Many felt uncomfortable, scared, and uncertain and tried to open up to their providers. Unfortunately, those with some of the most severe health concerns reported that their pain and their fear were ignored by providers. Women's concerns were dismissed or flatly denied--"…a birth control method could never cause that!" or "…you feel pain when I do this? are you sure? Are you sure?" These examples demonstrate how health care providers ignored these young Black women's humanity.
What strikes me most about these findings and subsequent conversations with others in the reproductive health field is that I am often told that most providers believe they are already providing high-quality, affirming, and respectful care. As I am also often told, such findings as these do not illuminate new or actual problems that can be solved (since providers already offer Black women high-quality care). I am left wondering, then how come Black women have been saying that they are not the recipients of such care for decades?
For decades, new strides have been made in medical advances and reproductive technologies, yet the treatment of Black women, in this case, young Black women, in health care spaces has not vastly improved. While this work centers young Black women, this analysis of the crooked exam room Black women find themselves in is representative of the exam rooms and clinics in which other Indigenous, Latinx, and people of color find themselves. The history of reproductive oppression in the United States is not limited to racial/ethnic identity and womanhood, but also to the health care experiences of other historically and currently marginalized groups, such as poor people, immigrants, queer folks, non-binary and trans people, those with disabilities, and many others.
Additionally, other commentary that I have heard from reproductive health care providers and others in the reproductive health care space is a shift of blame from using this information to improve health care provision to blaming the media for covering Black women's narratives of disrespectful and harmful care encounters. In essence, because of the news coverage, now more Black women think they do not receive respectful and appropriate care. This shift ensures that the actual problem, structural oppressions through mechanisms of racism, sexism, classism, etc., are not addressed. This also perpetuates the misrecognition of Black women and their humanity.
Instead of listening to the lived experiences of people who have faced and continue to face significant marginalization, we assume that these narratives are exaggerated and aren't really as harmful as they actually are. The goal of that project was to show the beauty and complexity of young Black womanhood. The resilience, intelligence, fortitude, vulnerability, savvy, and uncertainty that's part of navigating reproductive health care spaces while Black and woman. As Harris-Perry states, this group of people "desire recognition for their group but also want recognition of their distinctiveness from the group" (p. 91). Contraceptive care for Black women can and should hold space for them to bring their multiple group identities while also providing equitable, affirming, and person-centered care that recognizes their individual needs, wants, and desires related to their sexual and reproductive health. Instead of Black women contorting to fit the crooked room, health care needs a transformation to provide care to this population.
“It can be hard to stand up straight in a crooked room.”
-Harris-Perry
To read the most recent open access publication describing young Black women’s contraceptive care experiences, click here.