March 6, 2022. WRAL, CDC Opinion. By Chinemerem Nwosu.
“I’m sorry. I’m not angry or crazy! I’m just worried.”
These were my Black patient’s concluding words in briefing me about her current pregnancy. They broke my heart for myriad reasons, one being that she even felt she had to justify her personality and state of mind. Her words were also familiar because I have used them myself in settings where I felt judged or needed to combat the “angry Black woman” stereotype that continues to harm Black women.
None of her concerns or the tone with which she voiced them suggested she was angry, let alone crazy. This was her first pregnancy in six years and with a prior C-section, history of mental illness and various social stressors, she felt overwhelmed and rightfully so. I reassured her that her concerns were valid and encouraged her to continue to share them without fear of judgment.
She told me healthcare workers have often dismissed her concerns about her pregnancy and she often felt anxious about how she would be perceived given her history of mental illness – though it is well controlled with medication.
Unfortunately, her story is not unique and did not surprise me. The experience she described was my motivation for co-founding the Black Maternal Health Equity Initiative at Duke University School of Medicine, a community service project that supports Black women with high-risk pregnancies to help address dire racial disparities in maternal health outcomes.
We pair patients with medical student advocates trained to identify social barriers to care, provide social support, and connect them to community support programs. Studies have repeatedly shown that Black pregnant patients are three to four times more likely to experience pregnancy-related death than any other racial group. This disheartening outcome cannot only be attributed to the social drivers of health but also to structural racism within the healthcare system and in the approach to care of Black patients.
J. Marion Sims, the so-called “father of gynecology,” discovered surgical techniques by operating on enslaved Black women without anesthesia. From the story of Henrietta Lacks to the laws that enforced sterilization of “undesirable races” in the early 20th century and the Tuskegee experiments, Black people have historically been exploited and disregarded in the American medical system. The current racial disparities in maternal health outcomes today continue to buttress this point.
In my time working with pregnant Black patients, one common theme keeps surfacing – the power of listening. Every patient recruited into our program has mentioned the importance of having someone, in our case a medical student advocate, listen to them, see them, acknowledge them, and understand them.
Listening is an important communication skill with the power to build deep and meaningful human connections. It is valuable when working with marginalized communities, particularly those that have been historically excluded from adequate healthcare. I like the Merriam Webster definition of listening as an intransitive verb: “to hear something with thoughtful attention.”
To hear and understand Black patients requires listening with thoughtful attention. This allows for the building of trust and stronger relationships, which is important for a population with a high historical level of mistrust in the healthcare system. By listening thoughtfully, a healthcare worker demonstrates respect to the patient. It creates a safe space that empowers patients to share without fear of judgment or neglect.
Listening with thoughtful attention makes room for empathy and a better understanding of the context in which those words are shared. It helps us act according to the needs of our patients. It makes room for cultural humility and combats the harmful stereotypes that Black women are angry, crazy, or aggressive. Listening is at the foundation of patient-centered care.
The medical community must develop and improve strong listening skills to support Black pregnant women in ways that encourage them to share concerns and seek answers without feeling judged or having to justify their personalities or character. Our Black patients deserve to feel safe, and their health needs must be met with thoughtful attention.