Divided written by Annabel Sowemimo – a vital call to decolonise healthcare.
Book Review written by Doula Aimee McKenzie
In her book Dr Sowemimo covers the racist history of medicine and how healthcare institutions have a massive role in how we live our lives. She acknowledges the power that medical professionals have, particularly in the poorest parts of the world and that there is a power imbalance when it comes to doctors and patients. Race science underpins all medicine and Dr Sowemimo highlights that because of this science isn’t objective and is widely influenced by current social context.
So how is this connected to birth, might you ask? Well, everyone’s health is connected to the current structure of healthcare and maternity systems. Moreover, the historical context of medicine reveals its racist origins which continue to shape policies and the existing maternity system, impacting our perceptions of childbirth.
Impact on First Nation Women
For example, in Australia before the invasion of the Europeans, Indigenous cultures were safely birthing together as a community and birth was supported collectively by Grandmothers and Aunties as Women’s business. Currently, First Nations women in Australia have poorer outcomes than their Caucasian counterparts, “Preterm birth, stillbirth and neonatal death rates are 2-3 times higher for infants with First Nations mothers than those with non-Indigenous mothers” (Common Ground, 2024). There are many elements that influence this such as remoteness, poverty, intergenerational trauma and lastly the existence of systemic racism. History and politics continue to shape the lives of our First Nations people, and in particular birth practices. This is where Divided comes in and explains how decolonising the medical system (and in turn the maternity system) is a step towards self-determination for all of us.
Women of Colour in healthcare
As the book continues Dr Sowemimo writes about how women of colour are four times more likely to die in childbirth and how it has been suggested that women of colour be offered inductions to help with maternal death rates. She walks us through how the contraceptive pill was developed using poor Puerto Rican women as unknowing test subjects and as a result, some died and suffered adverse side effects. Now 150 million people worldwide use the contraceptive pill today.
During the 19th century Obstetrics and Gynaecology was an advancing field, and today the field that birth is associated with “is littered with eponymous syndromes and techniques named after doctors who honed their craft on enslaved and colonised populations”. The advancement of American gynaecology was made possible by the examinations on enslaved and poor working-class women. An example of how this is still prevalent today is the curved speculum, an implement utilised for dilation and examination of the vagina, was invented by a man
J. Marion Sims who performed abhorrent experiments on enslaved women. The intentions of the earliest colonial physicians is vital to understand how the current medical system works as it has left a lasting influence on how medicine and white people view Black and Indigenous populations.
Research and Bias
Dr Sowemimo highlights that research is being funded that still perpetuates racist stereotypes with most of the research coming from wealthy, predominately white northern countries.
Building on this idea of research being flawed, particularly within the birth space is the Arrive Trial. Despite being widely criticised for a number of different reasons many obstetricians and other care providers are still recommending standard 39-week inductions for all women. This is also prevalent in the use of BMI in pregnancy and birth management. BMI is a concept that was developed by a European man, Adolphe Quetelet, and was furthered by Ancel Keys, that is utilised within the birth space despite there being no scientific evidence to support its use.
The lasting impacts of this biased and racist standardisation are particularly evident in the experiences of larger-bodied women. They face assumptions that their weight restricts them from accessing water immersion as a form of pain management. Additionally, they are subjected to more stringent requirements, such as earlier testing for Gestational diabetes, compared to thinner pregnant people. Failure to meet these requirements can result in being deemed high risk and excluded from midwifery group programs, birth centres, and publicly funded home births. Prior to Quetelet coming up with the premise that weight is relative to height, being fuller bodied was considered to be a sign of wealth and prosperity. The culture around weight shifted and now obesity is seen as a moral failure and reflects the socio-political climate and highlights society’s issue with fatness. The reliance on standardised approaches in the birth world, often based on outdated or biased research, further perpetuates inequities in care. Standardisation can overlook the diverse needs and experiences of women, particularly those from diverse and non-white communities, leading to inadequate or inappropriate care practices.
While this book isn’t directly related to birth, it speaks to a deeper disparity that occurs within the medical space, a space which birth is now considered a part of. Having a deep understanding of how women of colour can experience microaggressions and bias within the medical system not only from care providers themselves but also the technology used is important for doulas and birth support. I would recommend any woman to read this book because decolonising healthcare would require us to rethink our approach to birth, which means reimagining the structure and the fabric of our society. Understanding the concept that the system you are entrusting your care into, the hospital system, has been built on the premise that some groups matter more than others is an important one to grasp when utilising the services offered.
My name is Aimee McKenzie, and I am an emerging doula and Birthkeeper through the Doula Training Academy. If you would like to know more about my offerings, reach out:
Website:
https://www.lifelaidbare.com.au/doula-offerings/
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https://www.instagram.com/lifelaidbarephotos/
Email:
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