Systemic Racism: The Hidden Cause of Black Maternal Health Crisis

Описание: Disparities in black maternal health are not due to poverty or access, but systemic issues within healthcare.
Key Points:
Black women face higher maternal mortality regardless of income, insurance, or hospital quality.
Historical roots: James Marion Sims' non-anesthetized experiments on enslaved women.
Persistent myths: Pseudoscience on black pain tolerance still influences medical training and algorithms (e.g. eGFR Black Race Coefficient).
Weathering Hypothesis: Chronic stress from racism accelerates biological aging (allostatic load), leading to poor pregnancy outcomes.
Policy failure: Implicit bias training is insufficient; it fails to address deep structural problems.

Argues that disparities in maternal health for black women are rooted in the healthcare system's structure, not merely poverty or access. Black women experience significantly higher rates of maternal mortality and severe morbidity, a risk that remains high regardless of income, insurance, or hospital quality, indicating an institutional problem. This systemic bias originated with James Marion Sims, the father of gynecology, who perfected surgical techniques on enslaved black women without anesthesia while treating white women with pain relief. This historical cruelty was justified by pseudoscientific myths about black individuals having higher pain thresholds, beliefs that persist among medical students today and have been embedded in clinical algorithms like the eGFR Black Race Coefficient, leading to delayed critical care. The legal doctrine of Partus Sequitur Ventrem also established the black mother's body as capital, necessitating dehumanizing stereotypes that continue to affect treatment. The cumulative impact of systemic racism, discrimination, and microaggressions causes premature physical deterioration, known as the weathering hypothesis, quantified by allostatic load. Black individuals, especially women, exhibit significantly higher allostatic load scores, indicating accelerated biological aging, even when controlling for socioeconomic status. This physiological burden directly contributes to adverse pregnancy outcomes. Current policy efforts, such as implicit bias training, are deemed insufficient because they address individual biases rather than the deep structural issues.