‘Racialized Myths,’ Medical Exploitation, and Dire Results

Modern gynecology can be traced to experiments by Lancaster, South Carolina-born J. Marion Sims on enslaved Black women in the 19th century. Sims’ experiments were done without their permission or painkillers, and his observations led to racialized myths that still exist.

America's maternal mortality gap can be traced to slavery-era medical exploitation.

Black women are up to four times more likely to die due to pregnancy- and birth-related complications than their white counterparts. Among the reasons are a legacy of experiments on Black women by white doctors since the first Africans were brought here as chattel and racist assumptions that underpin gaps in cultural competency today.

“You have to consider the history and the context that the medical profession has been trained in over generations, and a lot of it is rooted in these racialized myths about Black people, especially with this idea of race as biology rather than race as a social construct,” said Keisha Bentley-Edwards, an associate professor at Duke University School of Medicine. “So with that, you can look at J. Marion Sims and his decision not to provide appropriate anesthesia to enslaved women [during surgery] along with Black people being perceived as not experiencing pain in normal ways that can be connected to treatment.”

---

As a nonprofit journalism organization, we depend on your support to fund journalism that addresses the crisis of institutionalized racism in America. Donate any amount today to become a Pulitzer Center Champion and receive exclusive benefits!

---

Sims’ attitude toward the enslaved women he subjected to experiments set a historical precedent for medical mistreatment of the poor and people of color – which still have an impact on Black Americans regardless of economic or social status.

“Disparities when it comes to diagnosis – and a lot of the more than 80% of maternal deaths are preventable – sometimes it's because when Black women report pain, they are not believed,” Bentley-Edwards said. “You can point to … this idea of Black women specifically being somewhat histrionic or overemotional and attention-seeking. So, when you combine those two, it sets up for disaster, and you can see that these myths about having thicker skins and oral tissues, exaggerating pain, being overemotional instead of being seen as self-advocating for your care.”

U.S. medical history is impossible to uncouple from the nation’s colonial enterprise. In the 2006 book “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present,” author and medical historian Harriet A. Washington combed through medical journals, records, and studies from medical colleges to the United States government, to chronicle the use of Black bodies for state violence and profit.

Eugenics, bodily autonomy, and population control of “undesirables” are clear strategies that large-scale medical systems, educational institutions, and even the federal government had a hand in with acknowledging or making amends for their participation.

When enslaved Africans were brought to this continent, a pseudo-scientific body of “medicine” that proved Africans’ “lower level of human development” was being developed. It coincided with non-consensual and cruel invasive procedures at the behest of Africans’ white owners for the purpose of maintaining and securing a maximum amount of profit. Enslaved Africans deemed not fit enough – meaning not sexually attractive or able-bodied – to perform labor or found with illnesses in the Middle Passage were thrown overboard.

Historian Todd L. Savitt, in his article “Slave Life Insurance in Virginia and North Carolina,” published in The Journal of Southern History in 1977, argues that “The North Carolina Mutual Life Insurance Company of Raleigh was probably the major insurer of slaves in the Carolinas,” listing the company was established in 1849 – before its acquisition by freedman John C. Merrick in 1898. Citing Savitt’s work, Washington writes that

“In 1858, 75 percent of [the company’s] policies were written on slaves.”

Sims, one of the best-known names in Western medicine, is generally acknowledged as the “father of modern gynecology” for his research on Black women. Sims, who was born in Lancaster, South Carolina, in 1813, was educated at the South Carolina Medical College and Jefferson Medical College in Philadelphia. Most of his groundbreaking work was performed on enslaved women in Alabama without their consent or knowledge in the 1840s.

A common comorbidity of childbirth at the time was tearing of the vagina, which left openings between the bladder and rectum, leading to incontinence, infections and excruciating pain. This condition, called vesicovaginal fistula, rendered these women “unfit for work.”

“He wasn't the only one,” Bentley-Edwards said of Sims, “but he was one of the most successful.”

After building his reputation on Black women, Sims moved to New York to open the nation’s first hospital for women – exclusively white – using state-of-the-art equipment and pain management. In 1878, he was elected president of the American Medical Association, the nation’s largest professional group for doctors and medical students.

Although, Washington writes, there was not yet an acceptance of correlation between unsanitary conditions and illness, Sims blamed African mothers for “poverty, filth and laziness…intellectual capacity is cramped, the moral and social feelings blunted,” for the illness and deaths of their offspring.

Washington describes how Sims documented mutilating newborns’ skulls for “research.” At the time, skull shape was correlated with the “race science,” which purported to prove that Africans were of a lower status in human development.

Sims promised to board 11 enslaved women suffering from vesicovaginal fistulas in exchange for the opportunity to experiment on them to find a cure. Washington writes that doctors flocked to gawk at nude women on all fours propped open with Sims’ speculum, a tool used to widen the vaginal opening for examination and operation. Other doctors physically restrained the women undergoing procedures.

Due to the common belief among the medical establishment that Africans did not experience pain in the same way – which endures today – Sims did not administer anesthesia. Sims’ technique was to abrade (scraping to scar) the edges of each vaginal tear before suturing them together, only for them to become infected and reopen.

Using silver for sutures, which do not harbor pathogens, Sims announced he had successfully cured vesicovaginal fistula in 1849, after having conducted over 30 operations on one enslaved woman, Anarcha Westcott. A statue of Sims once stood in Manhattan’s Central Park, but it was removed in 2018.

Sims is but one example of the cruelty perpetrated against Africans in the United States for the benefit and profit of white people. In the 1920s, eugenics – the study of arranging human reproduction to increase the occurrence of desirable characteristics – became largely accepted by a segregated medical industry as well as states that passed sterilization laws to support the initiative.

A prominent proponent of eugenics was Margaret Sanger, the founder of what is known today as Planned Parenthood. White supremacist fears of miscegenation that purported African genes would “degrade” the Anglo-Saxon were behind the movement.

Sanger’s American Birth Control League recruited Black leaders, including historian and sociologist W.E.B. Du Bois to write for her journal, Birth Control Review.

“The mass of ignorant Negroes still breed carelessly and disastrously, so that the increase among Negroes, even more than the increase among whites, is from that portion of the population least intelligent and fit, and least able to rear their children properly,” Du Bois wrote in an article.

Denigrated for generations by white people, Black Americans were deemed unfit for raising children. In the antebellum South, Black children meant profits, but with emancipation from slavery, it became moot.

North Carolina approved the sterilization of about 7,600 people between 1929 and 1974, mostly without their knowledge or consent. The Post in 2011 reported an estimated 1,500 to 2,000 victims were alive at time, including Lela Dunston of Raleigh.

In an interview with The Post, Dunston said after she gave birth to her son James at age 13, she was sterilized without her knowledge.

“They was trying to give my mother social services money, and they did that because they said I was a child,” said Dunston, who was 63 at the time of the interview. “I didn’t have any rights. I was unstable, and I was mentally disturbed, and I wasn’t able to take care of no more kids.”

The N.C. Justice for Sterilization Victims Foundation announced in 2012 that 111 people who underwent procedures were eligible for compensation after confirmation from Eugenics Board program records.

Forty-eight counties had at least one verified match, led by Lenoir County’s 18 among 61 recorded procedures.

Mecklenburg, which had the highest number of sterilizations of any county at with 495, was second in  matches (10 verifications) while Wake County posted nine. Three counties in the top 10 for number of procedures – No. 5 Buncombe (139), No. 8 Scotland (114) and No. 10 Hertford (106) – had no matches.

Gov. Michael Easley issued an apology in 2003 on behalf of the state to sterilization victims under authority of the state Eugenics Board, which was abolished in 1977. Sterilization laws remained in place until 2003.

“I don’t know why I can’t get enough sleep,” Dunston said. “It’s just there on my heart. I really would like to have had at least a daughter or something. I don’t have but one child.”

Washington writes that even before Adolf Hitler’s rise to power in the 1930s, Germans were obsessed with the concept of “regaining a Nordic purity.”

The International Society for Racial Hygiene, the Station for Experiment Evolution and the Eugenics Record Office were joint endeavors by German and American doctors. The German National Socialist Party, commonly known as Nazis, sterilized at least 385 children of Afro-German descent.

Sanger used racist dog-whistles like “Negro crime” in writing about “the parents of a feeble-minded girl, twenty years of age, who was committed to the Kansas State Industrial Farm on a vagrancy charge, [who] lived in a thickly populated Negro district which was reported by the police to be the headquarters for the criminal element of the surrounding state;” she also discarded terms like “good or bad breeding stock” in her publications in favor of “class” or “income level.”

Sanger was also a prominent proponent of the birth control pill, which Washington wrote was made available to poor Black women at no cost or at a discount from government-funded Planned Parenthood clinics.

Washington documented how poor Black women’s uteruses were removed without their knowledge or consent – 1960s civil rights activist Fannie Lou Hamer was one of the victims of the so-called “Mississippi appendectomy.”

Prophylactic measures such as Norplant, a hormone-releasing device implanted into the arm, and the Depo-Provera shot were first tested on birthing people in countries in the global south: Mexico, Africa, Brazil, Indian and Puerto Rico. Sometimes government benefits were cut off if women refused sterilization.  

Depo-Provera, in original testing, was found to be exceptionally cancerous; but researchers at Emory University prescribed it as an experimental contraceptive to healthy Native American and Black patients on the grounds that physicians may administer any legal medications for any use they deem appropriate. In 1978, the FDA censured Emory for endangering 4,700 Black women.

In the early 1990s, Norplant, an experimental birth-control device, was distributed in Baltimore public high schools, which are overwhelmingly African American, justified by the rate of teen pregnancies in the area. Washington’s research documents that more white teenaged girls than Black became pregnant and in 1992, 73% of 15-year-olds and 50% of 17-year-old girls were virgins. Teen pregnancy rates had been falling among Black girls at the time.

The Population Council argued for implantation in teenagers aged 13-17, pressuring school staff to reach a 100% participation rate. Parents were bypassed by confidentiality regulations. Commenting on the experiment, The Philadelphia Inquirer published an editorial in 1990, headlined: “Can Contraception Reduce the Underclass?”

The federal government has also been a participant.

In the 40-year Tuskegee Syphilis Study (1932-72), the U.S. Public Health Service withheld treatment for syphilis among nearly 400 Black men from Macon, Alabama after promising help. Syphilis is primarily transmitted through sexual intercourse, but it can also be passed from mother to baby during birth if it isn’t treated.

Former President Bill Clinton issued a public apology on behalf of the U.S. government in 1997, but the damage was done – and in some ways continues through distrust of the medical community.

“Within 10 years of the study beginning, penicillin became the standard care and effective care for penicillin, but the U.S. Public Health Service chose to continue the study and not treating Black men with penicillin so that they could see what they call the natural course of the disease and it took a big coordinated effort to do that,” said Bentley-Edwards, associate director of research for the Samuel DuBois Cook Center on Social Equity.

“I want to be clear, because a lot of times, especially in light of the covid vaccine, people are like, ‘Oh, they’re going to give you a disease.’ The point of the Tuskegee Study was that they actually withheld treatment from Black people until the 1970s. For me, that's still pretty recent … so I think it's still relevant because it's something that people may remember, or they heard their parents talking about it, or grandparents talking about the Tuskegee Study, when the story broke in the 1970s about this ethical violation.”