African‐American Midwifery, a History and a Lament

• Date: 01 January 2017
• DOI: http://doi.org/10.1111/ajes.12173
• Author: Keisha Goode,Barbara Katz Rothman
• Published date: 01 January 2017

African-American Midwifery,

a History and a Lament

By KEISHA GOODE* and BARBARA KATZ ROTHMAN†

ABSTRACT. The medicalization of fertility and infertility, pregnancy,

abortion, contraception, childbirth, and postpartum care has not always

worked in the interests of women. It has had particularly devastating

effects on African-American women. Their fertility has been managed for

hundreds of years, first as slaves forced to have children for owners, then

as objects to be experimented on without anesthetics, and finally as

mothers sterilized without their consent. The relatively high rates of infant

and maternal mortality, along with limited access to safe and high-quality

reproductive services, are continuing signs of such devastation. This article

discusses the history and consequences of the medicalization of

pregnancy, contraception, and abortion in America. Attention is drawn to

the ways in which the profession of medicine took control away from

midwives, the traditional birth attendants and pregnancy caregivers, and

the particular consequences for African-American women. Ultimately, we

posit that greater access to midwifery care could lower infant and maternal

mortality rates and improve reproductive services. The reintroduction of

spirituality through midwifery would also restore the important role of

“wise women” in supporting women, babies, and communities.

Introduction

Getting pregnant, staying pregnant, avoiding getting pregnant, getting

un-pregnant, completing a pregnancy with a successful birth—these

are issues that have faced women in all times andplaces. It is only with-

in very recent yearsthat all of these have become medicalized, meaning

*Visiting Assistant Professor of Sociology, SUNY College at Old Westbury; Member

of the Board of Directors of the National Association of Certified Professional Mid-

wives. Email: kgoode@gradcenter.cuny.edu

†Professor of Sociology, City University of N ew York. Most recent book: ABuninthe

Oven: How the Food and Birth Movements Resist Industrialization. Email: BKatzRothman@

gc.cuny.edu; Website:www.BarbaraKatzRothman.com

American Journal of Economics and Sociology, Vol. 76, No. 1 (January, 2017).

DOI: 10.1111/ajes.12173

V

C2017 American Journal of Economics and Sociology, Inc.

that the profession of medicine has renamed these situations and condi-

tions as medical problems and declared physicians to be the most

appropriate and often the sole permitted providers of the associated

services. The medicalization of fertility and infertility, pregnancy, abor-

tion, contraception, childbirth, and postpartum care has most assuredly

not always worked in the interests of women. This, too, is something

that all women face—but it is the most vulnerable women in society

who are also the most vulnerable in the face of medicalization. In this

article we will discuss the history and consequences of the medicaliza-

tion of pregnancy in America. We will discuss the ways in which the

profession of medicine took control away from midwives, the tradition-

al birth attendants and pregnancy caregivers, the consequences, and in

particular the consequences for African-American women.

The relatively high rates of infant and maternal mortality among

blacks in America are partly embedded in wealth and income dispar-

ities and larger structural racism, but medical management also shares

some of the blame for this situation. We can trace some of the mortality

differentials to James Marion Sims, the “father of modern gynecology,”

who developed his techniques on the bodies of slave women (Wall

2006). Contemporary medical racializing perpetuates the differentials

through the concept of “obstetrical hardiness,” the belief that black

women are somehow more primitive and feel less pain (Hoberman

2012; Bridges 2011). In general, the relationship between medicine and

black women has been and remains troubled. Access to reproductive

services of all kinds—abortion, birth, infertility, contraception—remains

problematic for b lack women in America.

The state’s hi storical and contemporar y regulation of the black b ody,

specifically the economically unprivileged black body, is clear. Consid-

er the numerous episodes in the long history of degrading black wom-

en’s bodies for programs that did not benefitthem:

sexual abuse during slavery (Schwartz 2006),

involuntary sterilizations in Mississippi and other parts of the

deep South during the 1920s and 1930s (Roberts 1997; Washing-

ton 2006),

the non-consensual removal of cancer cells for medical research

purposes from Henrietta Lacks in the 1950s (Skloot 2011),

The American Journal of Economics and Sociology66