When Talking About Reproductive Health Inequality, We Must Do It Intersectionally

by Shannon Shird

It was mid-February when I found out I was pregnant.

I took both kits in the box to make sure and when they both turned blue I sat down on the floor of my bathroom and felt a heavier weight than ever before.

I evaluated myself in this moment. This was my first pregnancy at 27 and while I was doing alright, I didn’t know if I was doing well enough to support a family.

On one hand, I had recently completed grad school and I was employed. I was also in a loving partnership and we had just moved to a bigger apartment. I knew that my partner’s family and mine would rally all their resources and support to be there for us and our child in this time of need.

On the other hand, I was underpaid, swaddled in debt and living paycheck-to-paycheck. When I took my position as a community organizer I knew that I wouldn’t be getting rich or even paying off my debt, but I did it for the love of Brooklyn and the community I built there. I was kicking myself for choosing the cheapest healthcare plan I could afford earlier in the year and was worried about my ability to feed another mouth when I skip meals regularly just to save money.

I was more than a little worried. Now, in the midst of this I began to second-guess a lot of decisions.

I was also more than a little scared. I thought about the social and political climate around me and felt intense fear at bringing a Black child into this world. I thought of the huge responsibility to protect them and most importantly teach them how to protect themselves. I also knew that I could do everything in my power, but that the state or the streets could take them away from me suddenly and without explanation.

I wouldn’t just be having a child. I would be having a Black child in a violent and aggressive world.

I had never felt more like an adult in my life.

My partner and I went to Planned Parenthood for one more test and to find out how far along I was. The nurse figured I was about a month pregnant, talked to me about my options, and recommended physicians and prenatal vitamins.

I took a leap of faith. I attempted to alter my diet and habits. I immediately started taking more care to wake up and eat breakfast, drink more water, and incorporate even more leafy greens than usual into my diet.

A few weeks later I woke up in the middle of the night. I had terrible cramps that caused me to bend over in pain and I was sweating with a fever. I was terrified to find myself bleeding profusely.

My partner and I got in a car and spent the night into the morning in the emergency room. After a while, two nurses and a doctor told me that there was nothing they could do, that I was “barely” pregnant at 5 or 6 weeks. After taking my blood they said my pregnancy hormones were at about 10 or 20 when the level should have been in the hundreds, and that it was likely that the pregnancy was terminating itself.

I hung my head in overwhelming sadness and disappointment. I didn’t want to look my partner in the eye. I felt like I had failed us.

But I also felt enormous relief, followed by guilt; because though I was prepared to meet the challenge and thrill of having a child, I felt no urgency to shoulder the huge lifelong responsibility. The whole ride home from the hospital I sat with my conflicting feelings. When I got home I just felt numb and weary.

Miscarriage, stillbirths and infant mortality were never new to me. Born and raised in Baltimore City where health inequality varies wildly depending on the neighborhood in which you were born, I have known many families over the years to suffer this particular hardship, including my own. My mother suffered through three miscarriages and a stillborn baby girl before having me. She always told me how happy she was when I was born healthy after years of heartbreak between the birth of my brother and me.

My mother and I both have a number of friends--all Black women--who have experienced issues with reproductive health and infant mortality. We’re not the only ones. Across education, class, and geography, Black women in this country face higher rates of miscarriage and infant mortality than any other racial or ethnic group.

The Sojourner Syndrome: An intersectional approach to health inequality

One way to approach this reproductive health inequality is the Sojourner Syndrome, an intersectional approach that requires the examination of how racism, classism and gender operate in the lives of Black women produce increased risk of miscarriage, stillbirth and infant mortality.

Developed by Doctor Leith Mullings, Presidential Professor of Anthropology at the Graduate Center of CUNY, it is named for historic abolitionist, suffragist and spiritual leader Sojourner Truth, widely considered the mother of Black feminism for her early work at the intersection of women’s voting rights and slavery abolition.

Much as the day-to-day life of Sojourner Truth was a testament to the resilience and resistance of so many oppressions, the Sojourner Syndrome recognizes Black women’s resilience and leadership in the family and community. The Sojourner Syndrome is a lens that recognizes the harm of systemic oppression, which helps identify why Black women are at higher reproductive health risks.

It’s well known that Black women are more at risk for heart disease, diabetes, and certain types of cancer. For some time, public health officials have been looking at race as a contributing risk factor for this.

But the Sojourner Syndrome looks at racism, rather than race in this instance, gender discrimination rather than gender, and classism rather than class to understand the root causes of these problems.

Compounding factors that lead to health disparities

In the aftermath of my miscarriage, I was out of work for a day. That’s all I could afford. I went to the doctor for a follow-up that week.e

“Next time you want to get pregnant,” she told me in a monotone voice, “make sure your body is relaxed and you aren’t so stressed out.” She told me I was free to go, but should schedule a follow-up in a month. I left the office feeling intensely confused.

Don’t be stressed out? But isn’t that the norm? I strained my memory to think of a time when I wasn’t stressed. I was a high-achieving student for most of my life and now I was an underpaid community organizer in New York City and the rent was too damn high. I couldn’t envision a time in the future when I wouldn’t be dealing with some level of stress.

When we use the Sojourner Syndrome to understand Black women’s reproductive health issues, we see that the overbearing weight of oppression and responsibility converge on our bodies, and over time increases stress in critically different ways than our white and Latino peers. This stress disparity is one of the leading factors for Black women’s overrepresentation in a number health issues, but especially miscarriage, stillbirth, preterm birth, and infant mortality.

This is because we have a lot to worry about.

While Black women are gaining more in higher education and have better careers than before, Black women continue to make less weekly earnings than Black men, white men, and white women.

Tougher still, is that we are missing the safety net of hefty financial savings and intra-family wealth that accounts for so much access and security for our white peers, who, on average, come from homes with nearly 13 times the wealth of Black households. The racial wealth gap is also startling when you consider households headed by single women: the median wealth of single black women is $100 compared to $41,000 of single white women.

Across the lines of class, income, geography, occupation and education, Black women face miscarriage, stillbirth and infant mortality rates twice the rate of white women. Our Latina sisters only fair slightly better but also face increased risk of complications. Interestingly enough, African and Caribbean women who come to the US have better reproductive health outcomes than U.S. born black women. Some have attributed it to diet, DNA, and geography. But the Sojourner Syndrome would allow us to look through another lens and see that foreign-born Black women have less experience with America’s particular brand of racism, sexism and classism; they experience and synthesize it much differently than US-born Black women.

The combination of daily microaggressions and larger structural and systemic oppression is deadly.

I know what you’re thinking. What gives? Why is this not being treated like the public health crisis it is? How can understanding the Sojourner Syndrome help us develop a framework for action against this crisis?

Taking action against everyday oppression

The Sojourner Syndrome is labeled a syndrome because a number of conditions continue to consistently occur. Half of that is the oppression, but the other half is Black women’s brilliance at resisting and preserving in the face of that. As much as this country is steeped in oppression, Black women are steeped in centuries of resisting this. We have a greater sense of community responsibility and activism. We have been leaders in every social movement in this country. We are much more likely to be active in our community associations, churches, PTAs, and social justice organizations than Black men. We are also more likely to help out our aging parents and relatives. We forego meals, sleep and personal time to meet all of these responsibilities and expectations.

This is our reality. We live, breathe, eat, sleep, love and procreate in a society that holds us to impossible standards, undervalues our worth and constantly demands the most. No wonder its impact on our reproductive systems, pregnancies and young.

This is the sophistication of centuries of inadequately unaddressed sexism and racism. It has mutated and spread like a disease that kills before arrival.

Weighed over a lifetime, this load can impact much more than just reproductive health. Luckily there are real innovative solutions to the Sojourner Syndrome made by Black women for Black women that everyone can support. Reflecting on my miscarriage now makes me feel less disempowered as I did in the initial aftermath knowing that there are decisive steps I can take to combat this inequality.

There are theories like the JJ Way® Model, an innovative alternative to traditional maternal health care, organizations such as The National Association of Birth Centers of Color where pregnant moms can get individualized birth plans, and scholarships for Black and other women of color to become doulas and midwives and help each other fight this disparity.

Going through my miscarriage was hard and made me deeply sit and consider many external and internal factors. Knowing what I know now, my self-care can’t be an afterthought, regardless of my reproductive decisions.

Knowing this, I implore Black women to center ourselves and our health. I know it's hard and I know the load is heavy but it can't be delayed or pushed aside. I call on our friends, partners and allies to step it up. Combating the troubling legacy of centuries of overlapping oppression is all of our responsibility, but Black women need your help. We must internalize the belief that "We must love each other and protect each other" so that all of us all can live healthier, safer lives.

Black women deserve health equity. We deserve reproductive justice. We want to live and reproduce without fear. And, at the heart of it all, our babies deserve a fairer chance at surviving and thriving in this world.

Do Something

  • Be aware of your own privilege, position and power; use that to empower and support the Black women in your circle.
  • Call out racism, sexism and classism - it operates internally, interpersonally, institutionally and structurally be aware of it and don’t be afraid to speak out against it.
  • Encourage Black women in your life to develop and maintain their personal self-care.
  • Support policies that end social and economic inequalities particularly helping low-income and working-class families.
  • Support initiatives that eliminate health disparities especially around health and birth outcomes for Black women.
  • Support (or become) Black women in roles related to reproductive health such as OB/GYNs, midwives and doulas.
This article was originally published on Everyday Democracy. It is republished with permission.

Photo: Shutterstock

Shannon Shird is a Brooklyn-based organizer, writer and filmmaker originally from Baltimore, MD. She is currently outreach director for 2014 documentary film, Black and Cuba, an organizer with the Black Alliance for Just Immigration and co-founder of ARTrepreneurship NYC. She recently completed her masters in international affairs at The New School and has a bachelors in history from Smith College. Look out for her first short film, BodyMore, in 2017.

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