In 2017, American tennis star Serena Williams experienced life-threatening complications from childbirth. Her cover story profile for Vogue discussed her experience of having to convince medical professionals of the severity of her complications — what she described as undoubtedly a pulmonary embolism — and the delay in proper treatment. Her story sparked public outcry against existing inequalities in the American healthcare system that significantly favor white patients over Black patients. What people found especially shocking was that a person as famous as Serena Williams could also be the victim of racialized medical negligence. It uncovered a disturbing truth: Race intersects with, and can even trump, socioeconomic class as a health determinant.
As a demonstration, Vermont remains overwhelmingly white (91.9%) and Middlebury is undeniably a predominantly white institution (56%, as of Fall 2023), enabling a culture of silence of medical and sexual intersectionality. In fact, Black women in the U.S. are a staggering three times more likely to die from pregnancy-related causes than white patients. According to the Center for Disease Control (CDC), 80% of pregnancy-related deaths are preventable. Similarly, Sexually Transmitted Infections (STIs) are more prevalent in non-white populations, despite similar sexual habits across community lines. HIV stands out in this category, as the new rate of HIV diagnoses among Black adults and adolescents is approximately eight times that of white people and twice as high for Latinos. On campus, SPECS strives to join the efforts at addressing historical legacies and contemporary medical realities by promoting awareness and disrupting its associated stigma.
It is impossible to talk about the inadequacies of sexual and reproductive health for Black women without discussing its racialized history; reproductive history in particular is intertwined with racism and American slavery. In 1808, the U.S. government banned the importation of African people to serve as enslaved people in the U.S. Once viewing slaves as disposable, enslavers now had a vested interest in maintaining the fertility of enslaved Black women, whose offspring could maintain the capitalist slave economy. This gave way to a greater number of white male physicians specializing in gynecology, a field previously dominated by midwives and sequestered to the domestic sphere.
One such physician was Dr. James Marion Sims, who established a small surgical infirmary in Montgomery, Ala. in 1845 for medical experiments on female slaves. Sims is now widely regarded as the father of American gynecology. He is attributed with pioneering the practice of repairing the vesico-vaginal fistula and developing the vaginal speculum. His work relied on enslaved women, whom he used as both subjects and trained nurses. Without anesthesia, these patients endured extreme physical pain and abuse. Sim’s work, and that of countless other doctors, hinged on the myth of higher pain tolerance of Black people. The chilling history of gynecology is a painful reminder of the intersectionality of sexual health and race; sexual health practices as we know them today could not exist without the exploitation of Black communities.
The centuries following Sims’ experimentation were wrought with continued abuse of Black communities. Perhaps the most well-known example is the Tuskegee Syphilis Study from 1932 to 1972, during which hundreds of Black men with syphilis were unknowingly withheld treatment (even though penicillin was introduced in 1943) as they were the “control” group in a study of the untreated STI. Government researchers sought to study the occurrence of syphilis in Black men, and originally told the mainly poor, Black sharecroppers that they had ‘bad blood’ — both misleading and decontextualized. Many of these patients and their infected family members died from the otherwise treatable infection. The U.S. Public Health Service and the CDC were complicit and instrumental in the operation and continuation of this study.
The communities most exploited by the US healthcare system are the least likely to receive its care and benefits. Rather, as the medical field has weaponized the sexuality of Black communities, it led to increased stigma surrounding sexual health, less access to sexual healthcare and broader distrust of medical professionals as a result of historical precedent. Despite evidence that disproves the theory, physicians are more likely to underestimate — and avoid treating — pain expressed by Black patients compared to nonblack patients. Slavery-era medical myths, such as that of hypersexuality and higher pain tolerance in Black women, continue to permeate both culture and medicine. Moreover, Black communities are less likely to receive comprehensive sex education, often primarily being taught abstinence-only education.
Historical abuses coupled with current inequities in sex education are at the root of alarming STI and pregnancy-related death statistics. SPECS recognizes that there are existing systems of oppression that affect one’s ability to obtain accurate sexual information, center consent and pleasure, and ultimately participate in a sex-positive environment. In an era marked by division and tension, it is up to our generation to acknowledge historical legacies, stand up for and empower vulnerable groups, and ultimately demand cultural, medical, educational and political change.
In the words of Harriet A. Washington in “Medical Apartheid,” systemic injustice in medical research “has played a pivotal role in forging the fear of medicine that helps perpetuate our nation’s racial health gulf.” We must heed her warning and not leave these racialized disparities unchallenged.
