Black, Pregnant, and Studying the Impact of Racism on Health

Rebekah Israel Cross


When you study something enough—and when you live it enough—you may think that you’re immune to its effects.

But no.

I’m a Black PhD student studying racism and health. And I’m pregnant. A few weeks ago, I found myself in the labor and delivery department at 25 weeks.

“I’m scared...” I was able to say through the tears.

“I know. Me too,” my husband whispered back.

That night I was in so much pain that I couldn’t sleep. Laying on my side hurt my ribs, laying on my back hurt my neck, sitting up straight relieved some pain but it wasn’t exactly a comfortable sleeping position. The cramps were getting stronger and stronger. I didn’t have a clock next to me but I would guess that they were about 10 to 15 minutes apart. One would end, I would get some relief, but then another one—bigger, stronger, longer—would be right behind it.

Other than the pain, the only thing I could think of was “I hope my baby’s okay. I hope her heart is still beating.” I felt her moving but I couldn’t tell if it was normal or a result of the cramping.

After about 8 hours of that torture, I told my husband that we needed to go to urgent care. This was not normal and I didn’t want to wait for it to “pass.” We threw on some clothes and were in the car within 10 minutes.

I’m glad I didn’t have to convince him. I didn’t have the energy.

The receptionist at urgent care asked me to repeat how far along I was.

“25 weeks.”

“Okay, we’re going to send you directly to labor and delivery.” Up until this point, I had not been thinking that my cramps could be labor contractions.

I was scared. Of losing the baby. Of having my own health complications. Of becoming a statistic.

Black maternal and child health

Maternal and child health is not my area of expertise in public health. I study neighborhoods. Particularly how Black neighborhoods—and the health of those living in them—are shaped by racist policies. I wanted to study racism because I grew tired of weak explanations for racial health disparities and firmly believe that health equity is unachievable without social equity.

Though I do not study maternal and child health extensively, being in a school of public health and studying racism, I would be hard-pressed not to know the statistics about Black maternal and child health outcomes.

We are 3-4 times more likely to die in childbirth. Our children are about twice as likely to be born underweight and almost three times more likely to die in their first year of life. A lot of people hear that and assume it must be related to socioeconomic status. “Well, Black women are more likely to be poor and undereducated,” they posit, “so maybe this is a result of lack of education, and prenatal care.” But the data don’t bear this out.

High income, highly educated Black women are still more likely to die in childbirth than low-income white women with no college education.

Elected officials are finally starting to give this issue the attention it deserves with the launching of the Black Maternal Health Caucus which aims to raise awareness about these dire inequities. Raising awareness is a great first step but we need to focus on the underlying causes.

Limits of Personal Responsibility

Talking about health disparities with the average person can be frustrating. Why? Because of the assumption that most health issues boil down to how well you take care of yourself. The U.S. has this disturbing obsession with individualism that clouds how we view—and ultimately deal with—our many social and structural problems. In the depths of the comment section in many articles about racial inequities in maternal and child health, you’ll find people blaming everything from biological differences, to “broken homes,” to Black women’s lifestyles. But, frankly, all of these explanations are unsatisfactory and racist.

...though it’s easy to blame individuals for their health circumstances, many factors influencing our health are beyond the scope of our personal behavior. Racism is one of them.

Besides, even middle-class Black women who do everything they’re supposed to do are not immune.

Take me, for example. I eat balanced meals with vegetables. Walk. Get enough sleep. Drink water. Take prenatal vitamins. Do not miss any OB appointments. Received genetic testing. Practice prenatal yoga. Got a doula. I did everything “right.” But there I was, in a hospital bed, hooked up to monitors to see if I was going to deliver 15 weeks too early. Personal responsibility was not helpful for me at that moment.

Rebekah Israel Cross_ MCH2

This should remind us that though it’s easy to blame individuals for their health circumstances, many factors influencing our health are beyond the scope of our personal behavior.

Racism is one of them.

Racism vs Racial Bias

When I went to the hospital, I was treated wonderfully. The midwives and nurses were awesome. They were all Black and made me feel very comfortable—to the extent that they could given that hospitals are not comfortable places. They explained each test, wire, and tube. They eased my concerns.

Sometimes when I talk about racism and health people jump to the idea of racial bias on the part of healthcare providers. Research shows that providers do treat Black people poorly in many circumstances. One prominent example is Serena Williams who nearly died after giving birth because her doctors refused to listen to her concerns about her body. And there are countless stories like Serena’s where racial bias worsened the quality of care Black pregnant women’s received.

…racism is bigger than individual beliefs or actions. Racism is a social system—it’s like the air we breathe.

Racial bias is important but it’s only one piece of the puzzle. The focus on racial bias misses the point that racism is bigger than individual beliefs or actions. Racism is a social system—it’s like the air we breathe. It can be seen and felt in our neighborhoods, in our schools, in our policies, in our workplaces, in our courtrooms, on the news. It’s everywhere. All the time.

If we are to really do something about racism, we have to have a better understanding of its reach.

Needing a Break

After performing all the tests, the medical staff told me it was stress-induced dehydration.

I wonder if being inundated with racism in my personal and professional life is adding stress to my body.

I’m fortunate to be able to have the resources to study racism. I’m also grateful for all the activists and scholars who are a part of #BlackMamasMatter who are seeking to address these inequities structurally.

But I think knowing what I know has added an additional layer of fear during my pregnancy. I’m worried if I’m too engaged in it all. If I’m so used to the stress of racism all around me that I don’t know what too much stress feels like.

When I was in the hospital, I told my husband, “sometimes I wish I studied something else,” which was really to say “sometimes I need a break from racism.”

But the reality is: I do what I do so my daughter won’t have to.

Rebekah Israel Cross is a PhD student at the UCLA Fielding School of Public Health and a Robert Wood Johnson Foundation Health Policy Research Scholar. Follow her on Twitter at @risraelcross.

Photos by Lauren Cowart Photography