Dimensions of Oppression in U.S. Institutional Medicine

Reproduction print of the original watercolor painting “Black Orchid Blindfolded” by Polina Bright

Black women face higher risks of medical complications while giving birth in the United States. From access and assessment to treatment and recovery, the institutional barriers to receiving safe healthcare cannot be viewed individually or as rigid category. In 2022, Serena Williams published an article that discussed how being a world-renowned professional athlete did not exclude the occurrence of systemic harm in her childbirth experience. Despite wealth, health, and notoriety – the continued lack of awareness and action (re: privilege) in postcolonial countries may suggest “post-racial” societies are among the deadliest factors of maternal mortality. This analysis observes the relations between social location and social status through women’s and gender studies theory by applying concepts of hegemony, structural inequity, intersectionality, and double binds.

HEGEMONY & STRUCTURAL INEQUITY

Hegemony can be defined as “legitimizing norms and ideas” to assert or maintain dominance over particular subsets.[2] Examples of hegemonic culture in the United States include the enforcement of superiority via race (re: white), gender (re: cisgender), orientation (re: heterosexual), class (re: upper), age (re: productive), ability (re: able-bodied), religion (re: Christian), citizenship (re: natural-born), patriotism (re: colonialism), etc. Serena Williams never used the words racism, sexism or discrimination in her commentary to reference individual acts or patterned experiences within institutions. Yet, she wrote, “Giving birth to my baby, it turned out, was a test for how loud and how often I would have to call out before I was finally heard.”[9] When synthetic portrayals of power are centered as “natural” realities in society, powerholders and participants alike fortify their inherited values through engagement with physical infrastructures, hierarchical institutions, and generational beliefs. The pervasive, interwoven nature of these perspectives makes it difficult to see or move beyond manufactured narrations that continue to uphold and create structural inequity.[14]

INTERSECTIONALITY & DOUBLE BINDS

National data shows Black, American Indian, and Alaskan Native women face an increasing and disproportional spike in preventable pregnancy-related morbidities and mortalities.[4] How can this be when women-identifying populations currently occupy most of the healthcare industry at a staggering 78.7%?[16] Further contextualizing the practitioner/patient dynamic is a key component. Two-thirds of U.S. medical faculty are non-Hispanic white women,[11] with 61.4% of health administrators and 53.2% of patient advocates also being non-Hispanic white.[8] How were Williams’ multiple requests for blood thinner medications post-surgery dismissed by multiple same-sex medics despite her known history of clot complications? “I spoke to the nurse. I told her: ‘I need to have a CAT scan of my lungs bilaterally, and then I need to be on my heparin drip.’ She said, ‘I think all this medicine is making you talk crazy.”’[9]

Civil rights scholar Kimberlé Crenshaw’s concept of intersectionality can help investigate this paradox. The framework suggests multiple systems of operation cause harm in connected and collective ways.[10] The sexism experienced by Black women is not interchangeable with that experienced by white women – as it fails to differentiate the compounded and simultaneous racial inequity. Therefore, oppression cannot be remedied by increased representations of sex alone. “The dispersal and assimilation of women throughout classes and races divide us against each other practically and economically, thus, attaches interest to the inability to see.”[6] The ‘angry Black woman’ stereotype may have been projected onto Williams, regardless of her actualized conduct or circumstance, due to conditioning that shapes the thoughts and actions of clinicians.

This creates a double bind for Williams – which can be described as an illusion of choice.[3] If she voices concerns about the nurse’s dismissal of her pain, this could potentially reinforce a racialized trope of being “ill-tempered,” which further impacts the care provided. However, if she betrays her intuition and does not voice these concerns, she could be complicit in her own dehumanization to the extent of death. In sharing her story, we better grasp the embedded distress that Black women in institutional medicine uniquely experience. It’s also important to remember that this is only part of Serena Williams’ complex history of grappling with disparities in the U.S. Research is now investigating the long-term implications of chronic stress exposure that links socioeconomic disadvantage to discrimination – as well as its applications to the lethal dangers Black women face disproportionally during healthy pregnancies.[7]

CONCLUSION

Complicating healthcare outcome differences among sociodemographics cannot be overgeneralized or oversimplified. Recommendations for systemic change (to include abolition) must be thoughtfully and routinely scrutinized and prioritized. The cultural, historical, ideological, and institutional forms of oppression that derive from America’s colonial heritage should be approached with nimble social justice practices that center on empowering the most marginalized, affected, and harmed members of today’s society.

by Bria Nesryn | 02.24.2023
Sociology and WGS student, College of Charleston

REFERENCES

  1. Bergerra, P. (2019, October 5). Summary- identities and social locations: Who am I? who are my people? Rachel Berger. Retrieved February 24, 2023, from https://blogs.oregonstate.edu/rachelberger/2019/10/05/summary-identities-and-social-locations-who-am-i-who-are-my-people/
  2. Britannica, inc. (n.d.). Hegemony. Encyclopædia Britannica. Retrieved February 24, 2023, from https://www.britannica.com/topic/hegemony
  3. Cambridge Dictionary. Double bind: definition (n.d.). Retrieved February 24, 2023, from https://dictionary.cambridge.org/us/dictionary/english/double-bind
  4. Centers for Disease Control and Prevention. (2022, April 13). Infographic: Racial/ethnic disparities in pregnancy-related deaths – United States, 2007–2016. Centers for Disease Control and Prevention. Retrieved February 24, 2023, from https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html
  5. Crenshaw, K. (2016). Kimberlé Crenshaw: The urgency of intersectionality | TED Talk. Retrieved February 24, 2023, from https://www.ted.com/talks/kimberle_crenshaw_the_urgency_of_intersectionality?language=en
  6. Frye, M. (2007). The politics of reality: Essays in feminist theory. Crossing Press. Retrieved February 24, 2023.
  7. Geronimus, A.T. (1992). The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity & disease. Retrieved February 24, 2023, from https://pubmed.ncbi.nlm.nih.gov/1467758/
  8. Health Services Administrator Demographics and Statistics: Number of health services administrators in the US. (2022, September 9). Health Services Administrator Demographics and Statistics [2023]: Retrieved February 24, 2023, from https://www.zippia.com/health-services-administrator-jobs/demographics/
  9. How Serena Williams saved her own life. ELLE. (2022, April 5). Retrieved February 24, 2023, from https://www.elle.com/life-love/a39586444/how-serena-williams-saved-her-own-life
  10. Kimberlé Crenshaw on Intersectionality, more than two decades later. Columbia Law School. (n.d.). Retrieved February 24, 2023, from https://www.law.columbia.edu/news/archive/kimberle-crenshaw-intersectionality-more-two-decades-later
  11. Laughlin, L. (2021, October 8). 22 million employed in health care fight against COVID-19. Census.gov. Retrieved February 24, 2023, from https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html#:~:text=About%20two%2Dthirds%20were%20non,year%2Dround%20health%20care%20workers
  12. Library guides: Is everyone really equal? Book discussion series: Ch5 – oppression & power. Library subject and class guides. (n.d.). Retrieved February 24, 2023, from https://instr.iastate.libguides.com/c.php?g=862840&p=6185829
  13. Lubell, J. (2022, January 17). What drives black maternal health inequities in the U.S. American Medical Association. Retrieved February 24, 2023, from https://www.ama-assn.org/delivering-care/population-care/what-drives-black-maternal-health-inequities-us
  14. Sensoy Ö., & DiAngelo, R. J. (2017). Is everyone really equal?: An introduction to key concepts in Social Justice Education. Teachers College Press.
  15. The misconception of ambition with Serena Williams. Spotify. (2022, August 23). Retrieved February 24, 2023, from https://open.spotify.com/episode/1hHiWVcdfFi7HxswWSuiJ4?si=6530c71a49fd459d
  16. U.S. Bureau of Labor Statistics. (n.d.). Over 16 million women worked in health care and social assistance in 2021. U.S. Bureau of Labor Statistics. Retrieved February 24, 2023, from https://www.bls.gov/opub/ted/2022/over-16-million-women-worked-in-health-care-and-social-assistance-in-2021.htm