Black Women’s Reproductive Health and Legacies of Distrust

This post is part of our forum on “Black Women and Reproductive Rights.”

The U.S. Supreme Court’s decision to overturn Roe v. Wade has further eroded trust between physicians and patients. Reports are circulating about practitioners withholding care from patients when they suspect they have had an abortion or are trying to have an abortion. Patients who experience reproductive complications (whether they have an abortion or not) are now more likely to get inadequate medical care and face criminalization. We know that the U.S. Supreme Court decision will disproportionately impact people of color, especially Black Americans and Black immigrants. Ciswomen, transmen, and nonbinary people of color have a long history of struggling to access medical care. For Black people, especially women, this history dates back to the era of slavery. However, there is also a coeval history of reproductive justice and collective struggle. We must reckon with the roots of both of these histories in the Black Atlantic and beyond.

In my essay in Medicine Healing and the Age of Slavery, I reappraised the racial and gender history of feigned illness in the eighteenth century.¹ I demonstrated that early modern racial and gender stereotypes, such as the idea that enslaved people were inherently lazy, dishonest, and usually physically hardy, engendered the belief that enslaved people feigned illness to escape slavery. Enslaved women were accused of feigning illness more often than enslaved men, and their health complaints often had to do with reproductive complications. The feigned illness accusations we find in archival sources likely represented slave owners’ racial and gender biases against enslaved women more often than they represented actual feigning. Unfortunately, the legacies of distrust that undergirded this stereotype are still with us.

Many of the feigned illness accusations early modern Black women faced had to do with reproductive health complications. For example, in the introduction to A Voyage the Islands Madera, Barbados, Nieves, S. Christophers and Jamaica (1707), Hans Sloane, a leading physician and member of the Royal Society, devoted an entire section to the “danger of using Medicines which cause Abortion.” He claimed that Jamaican women were “cunningly… designing to make the Physician cause Abortion.” Though Sloane was not explicit, his references to “cunning” women were likely referring to enslaved and free women of African descent since most of the women in Jamaica in Sloane’s time were of African descent. He encouraged physicians to withhold treatment in cases where women were suspected of trying to have an abortion.

Sloane’s publication reached audiences in England and its empire. Who knows how many women and girls struggled to get the medical treatments they needed when they encountered physicians, perhaps inspired by Sloane, who denied their suffering and accused them of deception in pursuit of abortion. Who knows how many were harmed as a result. Stereotypical representations of enslaved women feigning illness circulated well beyond England’s imperial borders in the eighteenth century, shaping discourses across the French, Spanish, and Portuguese empires.

The men who popularized the trope of the enslaved feigner were writing about Black people who struggled to survive in a society where they were denied bodily autonomy, faced wanton violence, and were forced to reproduce for someone else’s profit. Partus sequitur ventrem, the legal doctrine that ensured that enslaved women’s children would follow the status of the mother, ensured that slaveowners would profit off of enslaved women’s reproduction. It inspired forced birth. Nevertheless, there were women who survived all of this. What Sasha Turner has termed “reproductive body work,” including knowledge of abortion, was one of the tools enslaved women used to survive.

Historians Jennifer Morgan, Londa Schiebinger, Sasha Turner, and Deirdre Cooper Owens have shown that enslaved women were experts in a wide range of reproductive and neonatal care. Thus, it is more likely that Sloane’s decision to withhold treatment affected women earnestly seeking medical treatments other than abortion. Black women were already well versed in abortifacients. They did not need Sloane. Physicians’ incredulity left enslaved women to suffer needlessly when they sought medical treatment for legitimate complaints. Unfortunately, devastating stories of women being met with suspicion when seeking reproductive healthcare are all too familiar in our present.

All is not lost. We have each other.

Just as the history of practitioners’ racist and sexist incredulity dates to the era of slavery, so too does the history of Black resistance, community advocacy, and collective care. There is a coeval tradition of the pursuit of reproductive justice. Though this history is not as romantic as the history of revolution and revolt, it too is part of the Black radical tradition. We only glimpse it in the archival record. Nevertheless, the rare glimpse of enslaved collective action is a precious reminder of what likely happened over and over, plantation to plantation, island to island, and coast to coast in the Americas.

The French archives yield one particularly telling example from Saint-Domingue (present-day Haiti). Sometime in 1773, an enslaved woman on the Bertrand plantation became pregnant. It was no secret. It never was. As historians have shown, enslaved women knew about each other’s pregnancies and provided one another with prenatal care. However, in this woman’s case, nine months elapsed and turned to ten, then month after month, and year after year, she remained “with child.”² We will never know why she could not deliver. We only know that she did not. Instead, the necrotized fetus became a mass in her abdomen that protruded between her legs. She lived and labored like this for years. The overseer frequently beat her for working too slowly or not at all.

In 1778, the women on the Bertrand plantation approached a surgeon named Bouvier visiting from Nantes and told him about the woman’s complications. He did not believe them. Instead, he prescribed an alternative diet and wrote off her symptoms as digestive issues. It was not until a nurse on the plantation insisted that Bouvier agreed to examine the woman. He confirmed there was a mass and endeavored to remove it. His unsuccessful attempts were likely painful for the enslaved woman. Unfortunately, several weeks later, the enslaved woman died. Bouvier did the autopsy and discovered that the mass was indeed the remains of a fetus.

Though the enslaved woman and her kin were unsuccessful in saving or easing her life, their advocacy must be understood as part of the unromantic tradition of resistance and radical political struggle in the Black Atlantic. These struggles were radical because they asserted that enslaved women were worthy of care despite a social order that reduced them to chattel. The enslaved woman and her kin worked together to get her the care she desperately needed. They refuted the incredulous and violent overseer’s claims and insisted that the skeptical physician examine her. The nurse, an enslaved woman with some modicum of power, used her authority to get the woman access to an exam with the surgeon. Even though they ultimately could not save her life, they still organized. They still tried. We might imagine that similar events unfolded on other plantations. Perhaps women found success in some instances, one hopes.

To be sure, we live in very different times and under conditions very different from the ones enslaved women endured in the early modern Caribbean. Nevertheless, prejudice persists in modern medicine and is just as pernicious. We must remain vigilant about how race, gender, sexual identity, class, immigration status, and one’s status in the criminal justice system affect one’s access to reproductive care and the levels of distrust one may encounter in healthcare settings. It is imperative that we remain vigilant about who gets access to abortion, who does not, and who is criminalized for it. These unjust abortion bans and laws will not affect everyone equally.

Though times are different, we can find inspiration in the stories of people in the past who came to the defense of those suffering from reproductive complications and struggling to access reproductive healthcare, including abortion. We find similar inspiration in our present. Organizations like New Voices for Reproductive Justice, center the holistic health and well-being of Black women and girls in their fight for reproductive healthcare access and reforms. Women like the nurses and immigrants who reported the routine abuses of gynecologists in ICE detention centers remind us of our inheritance. They are the living legacy of women, like the nurse and other unnamed women on the Bertrand plantation who came to that woman’s aid. Even when the odds were against them, even though they ultimately could not save her, they still showed up. That unromantic struggle is the very struggle we face at this moment.

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