COLOURBLIND HEALTHCARE Kayonne Christy

COLOURBLIND HEALTHCARE:

Examining Pregnant Black Women’s Experiences Of Medical Racism In Jamaica And Canada

KAYONNE CHRISTY

During her pregnancy, Michelle* decided to visit her midwifery clinic after having concerns about skin discolouration. Her midwife, who was white, dismissed these concerns by telling Michelle that, “Black people have differences in their skin tone, that’s totally normal,” and sending her home. A few days later when Michelle went in for a checkup, she was told that she had preeclampsia and had to be induced unexpectedly. After reflecting on this experience, Michelle shares:

“Yeah, I feel if I had met caregivers that cared more about me as a person and didn’t say, ‘Oh, that happens to everyone’ because I’m not everyone, it would’ve made a difference. To them, everyone is a white female or someone who has a lighter skin tone and I don’t fit into that box, so when I say that there’s an issue, you shouldn’t be saying that you don’t recognize the issue, instead, you should try to figure out, ‘Okay, what is the issue?’ And help me solve it and help me fix whatever the problem is.“

Michelle*

Given that Black women are not only at a higher risk of developing preeclampsia, but that we are also up to four times more likely to die from preeclampsia-related complications than white women,1 this type of medical oversight is a textbook example of what I refer to as ‘colourblind healthcare’—an elusive form of medical racism.

Pregnant Black women experience racism within all social institutions, including healthcare, where their experiences have regularly been characterized by overt discrimination and outwardly hostile medical environments.2-4 However, we know that in addition to overt expressions, racism also manifests more covertly in the 21st century. Over the past several decades, colourblindness has become a popular way of thinking and talking about race.5 Racial colourblindness refers to the idea that race is no longer an important category of difference in our society. When your colleague tells you that they “don’t see race,” that’s racial colourblindness.

Both Canada and Jamaica embrace racial colourblindness; albeit, in different ways. By brand ing itself as a ‘creole’ society, Jamaica attempts to minimize racial differences by fusing different racial and ethnic groups into one common national identity. An early example of this was the declaration of the Jamaican national motto, “out of many, one people,” in 1962. Canada, on the other hand, brands itself as a ‘multicultural’ society, and in doing so, attempts to minimize racial differences by supposedly integrating and celebrating different cultures in Canadian society.7 An early example of this is the declaration of multiculturalism as an official government policy in 1971.8 The problem with these types of colourblind discourses is that they obscure how white supremacy has been central to the national identity of both the Jamaican and Canadian colonial projects,9,10 and minimize how racial differences are related to structural inequality. In this way, ‘creole’ and ‘multicultural’ colourblindness ignore how power structures inequality along racial lines, and in turn, ignores the existence of racism.

As a Jamaican-Canadian medical sociologist, I have spent the last year investigating how this type of racial colourblindness shapes the prenatal healthcare experiences of Black women in Canada and Jamaica. Through interviews with Canadian and Jamaican Black women, I developed the concept of ‘colourblind healthcare’ to explain how medical racism, which is often understood as an overt phenomenon, is also a covert and structural one.

Colourblind healthcare is a form of allegedly ‘race-neutral’ or ‘non-racial’ healthcare delivery. It happens when healthcare professionals 1) privilege biomedical approaches to healthcare delivery over race-conscious ones, and 2) ignore the race of their patients when providing care. At this point, you may be asking yourself, “Okay, well, why is race important in the healthcare setting anyways? Shouldn’t we all be treated the same regardless of race?” Well, yes…and no. Let’s unpack this a bit.

Medical Racism refers to racism that is experienced within the healthcare system.

To begin, we have to debunk the idea that medicine is an objective, socially neutral science. It isn’t. Western biomedicine, including obstetrics and gynecology, was developed almost exclusively by white European men.11 Because of this, the knowledge base of the discipline reflects both Eurocentric and masculinist ways of thinking and knowing about health and illness. Racism has also been central to medicine’s development, as the discipline was built on histories of slavery and medical experimentation.11,12

In the case of obstetrics and gynecology, some of the most pioneering techniques and medical equipment in the discipline, such as the caesarean section and the vaginal speculum, were developed by slave-owning physicians who experimented on the bodies of enslaved Black women without their consent.13 Owens and Fett (2019) argue that the way “gynecology advanced from American slavery means that Black people have always had a precarious relationship to the field and its practitioners” (p. 1343). So, when providers privilege biomedical approaches to healthcare delivery, they are, in fact, exalting a knowledge base that is rooted in racism, sexism, and eurocentric and masculinist ways of knowing about health and illness. This is critical because such approaches seldom appreciate how racism shapes the health of Black communities.

Whether or not we experience overt racism every day, as Black people, our lives have been shaped by histories (past and present) of anti-Black racism. And these histories continue to impact all aspects of our lives—from education to employment, housing, law, and certainly health/healthcare. If we consider the contemporary impacts of racism on health more closely, we see that racism is an important structural determinant of health.

Because racism is a psychosocial stressor, having to deal with racism throughout our life negatively impacts our physical and mental health. This is important for all Black people, but particularly pregnant Black women, since additional stress during pregnancy can lead to poor maternal and infant health outcomes. Despite the importance of acknowledging racism as a determinant of health for pregnant Black women, many of the women I spoke with explained that healthcare providers did not bring up race in the prenatal healthcare context.

For Black women in Jamaica, many said that because the country is predominantly Black, race was of little importance in the medical setting. For example, Nia* (Jamaica) didn’t believe that race was important in her healthcare experiences, but discussed how her class shaped her experiences of care:

“You have some that live uptown, while we are downtown. The ones that live uptown, they can afford the private care. We live in the ghetto; we can afford the public because it is free.”

Nia*

It’s been well documented that the uptown/ downtown class stratification in Jamaica mirrors the colonial racial hierarchy. Although more Black people now live uptown, generally, those in closer proximity to whiteness tend to live in affluent ‘uptown’ neighbourhoods while Black, darker-skinned Jamaicans tend to live in ‘downtown’ lower-income areas. So, while the impact of class is indeed important in the prenatal healthcare setting,17 so too is the impact of race, since race and skin colour are inextricably linked with class in Jamaica and around the world.

For Black women in Canada, many explained that healthcare providers seemed hesitant to discuss race. For example, Jamila* (Canada) described that race was so rarely mentioned during her prenatal care that she was surprised when her Black midwife brought up race at all:

Structural Determinant of Health are various upstream social and economic factors that influence people’s overall health and quality-of-life outcomes

“My midwife who’s doing the post-natal appointments—she was Black—and she’s like, ‘yeah, that’s really common among Black babies’. And I was like, ‘hmmm! You actually like said I’m Black!’ Which shouldn’t be a revelation, but you know, there’s just a belief that being colourblind and shading everybody the same is best. But I kind of feel like acknowledging those differences and those lived experiences is necessary.” –

Jamila* (Canada)

As long as racism exists in our society, racism will impact health. And as long as racism impacts health, race must be acknowledged within the healthcare setting. When healthcare professionals provide colourblind healthcare by privileging biomedical approaches to health (which have epistemic foundations that are both racist and sexist) over race-conscious approaches to health (that are sensitive to racialized lived experiences), they are, in fact, providing pregnant Black women with lower quality care by overlooking a critical structural determinant of health among this population group.

“I get it, they’re professional, they’re probably like, ‘I see this all the time. It’s nothing,’ but then you hear about how so many Black women end up dying after childbirth, so I think that was also a fear for me—not having the proper care…When I would ask certain questions, the reassurance wasn’t, ‘You’re fine. Everything is good,’ the reassurance was, ‘It’s normal. We all go through it.’”

Tasha* (Jamaica)

Pretending to not see race will not make racism disappear. We cannot address the problems caused by racism by refusing to acknowledge its presence. This is true within and outside of the prenatal healthcare context. Race consciousness, a central tenet of Critical Race Theory, refers to an awareness of how race is related to structural inequality. Race consciousness is important within the context of prenatal care because it presents a way of challenging the colourblind assumptions that are central to upholding colourblind healthcare. While my research specifically examines pregnant Black women’s experiences of medical racism, I believe these findings are relevant to Black people across the diaspora. If you are a Black person navigating the healthcare system, do not be afraid to bring up your race with your healthcare provider. If you are a healthcare provider, it’s critical that you take a race-conscious approach to healthcare delivery. Healthcare professionals must be aware of how racism intersects with other systems of oppression (such as classism and sexism) to create differences in lived experiences and health outcomes among their patient groups. It’s time we abandon dominant colourblind discourses within the healthcare setting and embrace race-conscious ones. The health of all of us depends on it.

*=pseudonym used to protect the privacy of participants.

Kayonne Christy is a third-generation Jamaican-Canadian woman. She completed her undergraduate training at McMaster University, where she received her B.Sc. (honours) in the Life Sciences, and B.A. (summa cum laude) in Health Studies. She is currently a second-year sociology graduate student at The University of British Columbia. Her research interests exist in the nexus between race, gender, class and health. Broadly speaking, she is interested in the structural determinants of health, and the interplay between social and health inequities. She uses intersectional (Black, Caribbean, transnational) feminist approaches to examine how racial colourblindness shapes diasporic Black women’s experiences of health and healthcare. Importantly, Kayonne is an aspiring salsa dancer and wine connoisseur.

45