Sanguinity and the Black Body: African American Women, Hysterectomy, and Reproductive Freedom
Background: Evidence of racial disparities in health care is remarkably consistent across a range of illnesses and health care services (IOM, 2002). Health outcome and treatment differences persist after controlling for socioeconomic status (van Ryn & Burke, 2000) and although African Americans represent a sizable percentage of the middle class most disparities research does not address class heterogeneity. For example, across all income groups, black women are up to 2 to 3 times more likely to have fibroids compared to white women, to have them at a younger age, and to have continued growth of their tumors longer than their white counterparts (Wise, LA, et al., 2005). Fibroids are the leading cause of hysterectomy in the United States, accounting for between 33% and 40% of all hysterectomies performed (Wechter ME, Stewart EA, Myers ER, et al, 2011). Furthermore, as late as the 1960’s involuntary hysterectomies were routinely performed throughout the United States (Washington, 2006). This study explores connections between past regimes of reproductive control and contemporary reproductive healthcare.
Study Design: The study uses in-depth interviews and focus groups to explore the reproductive healthcare experiences of black middle-class women.
Population Studied: Thirty African American women between 38 and 67 in a large urban area. The women are defined as middle-class based on either education, income, profession, or home ownership.
Results: Out of 30 respondents, 9 had been advised to or had a hysterectomy, most before the age of 45. Study respondents described their reproductive health care experiences as fraught with stereotypes of black women, which they believed led to differential treatment based on race. The perceptions of respondents who had been advised to have a hysterectomy, or had gone through with the procedure, varied. Some agreed it was medically necessary while others saw it as a tool to control black women’s reproduction. What their experiences had in common, however, was that although the specific circumstances differed, each reported that physicians were quick to recommend removal of the uterus—regardless of the severity of the condition. Some women had asymptomatic pelvic conditions while others suffered from heavy bleeding that severely curtailed their quality of life. In spite of these differences, each felt that physicians defaulted to recommending the drastic surgical intervention.
Conclusions: Taken together, respondent’s stories point to the sometimes subtle and sometimes explicit ways long-standing stereotypes and negative judgments about black women—bolstered by a long history of discrimination—penetrate reproductive healthcare treatment. Their experiences support earlier research that found black women may experience differences in treatment‑‑affecting tests, diagnoses, and recommended procedures—because of long-standing negative perceptions about black women, including within the medical profession (Hoberman, J., 2005; Bridges, K., 2011). To fully support their clients in making reproductive health decisions, medical social workers should be aware of the continuities between past and present treatment practices.