Written by Sureshi Jayawardene
In 2010, several media outlets like Essence and Time as well as mainstream news sources like the Associated Press reported that C-section (cesarean section) births in the United States were on the rise.Between 1996 and 2007, the cesarean rate in the US increased by 53% and the pace of this increase accelerated from 2000 to 2007. In 2013, the C-section rate for the US was 32.7%, well above the “medically necessary” target stipulated by the WHO.
In 1985, the World Health Organization (WHO) set the ideal rate for cesarean section births between 10-15%. Accordingly, healthy outcomes for infants and mothers are best accounted for within this “ideal” range. Anything beyond 15% is considered dangerous as healthcare facilities and postnatal treatment may not be of the requisite quality to meet the needs of the greater volume.
The Obesity Thesis
This 53% increase in the US was reflected across all states, age groups, and ethnic and racial designations. The same news sources also highlighted that Black mothers were most likely to deliver their babies this way, even in the case of low-risk pregnancies. In 2008, the cesarean rate for Black women was 34.5%, higher than for any other group of women. In 2013, it had risen to 36% (Ani, 2015). The burning question remains, what causes Black women to have more C-sections than any other racial group? Researchers at the CDC and the National Center for Health Statistics appear unable to definitively answer this question. However, they, as well as other researchers have relied on an obesity thesis to explain the discrepancy since Black women are more likely to be obese than White or Hispanic women. They argue that women giving birth are older and heavier and as such are faced with greater health risks to themselves and their infants. While this may be true for some women, there is little evidence to support this thesis in regards to the disproportionate number of Black women having C-sections. Even if obstetricians find Black women’s weight a concern, Sutherland’s (2013) research on obesity in Africana communities demonstrates a more fundamental problem in the matrices and mechanisms used to rate and compare Black women’s physicalities. She notes that these formulas are culturally incongruent and preferentially normed along White women’s physical attributes, which are often different (not necessarily better) than those of ethnically diverse women.
C-Section as Existential Violence
In a recent publication, Dr. Amanishakete Ani unveils the insidious and deep contours of social regulation associated with this practice of “cutting” inherent to the longstanding practice of regulating Black women’s reproductive capacities. Given the glaringly uneven rates of C-sections among Black women, Ani (2015) explains the importance of knowing all the risks associated with this method of birthing, gaining knowledge of traditional and ancient African birthing practices, and recognizing the intrinsic racism in the elemental levels of our lives. In her assessment, cesarean section is akin to other forms of “existential violence” such as police brutality, fraternal murder, and mass incarceration directed at Africana people. She characterizes these phenomena as “tentacles” of a larger political entity (i.e. the state) whereby they function to consistently contain Africana life and impede the endurance of Africana communities. Ani (2015) argues that the dramatic increase and ongoing overuse of cesarean section as a method of delivery among Black women is “driven by a continuing history of commoditized oppression and exploitation on physical terms.” These contentions are not misplaced. In fact, private hospitals are poised for making money (approximately $22,000 for a C-section vs. $11,500 for vaginal delivery) with C-sections than with vaginal deliveries. Additionally, C-sections are also cheaper for the hospital than vaginal birth after C-section, or VBAC, which requires additional medical staff and pre and postnatal care.
A History of Commoditized Oppression
Unsurprisingly and yet, disturbingly, today’s reproductive struggles resemble Black women’s circumstances during slavery. Ani (2015) contends that C-sections today are a disciplining activity necessary to sustaining the ‘system,’ similar to procreation under slavery. At the heart of colonial slavery was White masters’ ability to exert control over Black women’s reproductive labor. In 1662, when Virginia enacted a law differentiating enslavement from indentured servitude, the status of mulatto offspring was determined based upon the condition of the mother, marking a dramatic departure from English common law wherein the condition of the father determined the legal status of children (Plant, 2010). This law transformed Black women’s reproductive capacity into the means through which slave property was sustained and produced (Morgan, 2004). Later, following the ban on slave importation in 1808, the enslaved labor force was more concretely replenished through Black women’s childbearing capacities, which effectively became “subject to social regulation rather than their own will” (Roberts, 1997, pp. 22-23). The use of legal means to legitimize and standardize racist practices comes as no surprise even in the case of Black women’s reproductive labor.
Under slavery, not only did the Black family offer a sound and dependable source of new laborers, Black women reproduced the cheap labor while they labored in the fields and nurtured and fed their own kin (Jones, 2010). To secure Black women’s reproductive labor, slave owners adopted varying degrees of coercive strategies. Some offered incentives like a lighter workload or extra rations to pregnant slaves (Flavin, 2007). And some pregnant slaves were spared harsh disciplinary action (Flavin, 2007). During a pregnancy, while some women were allowed easier working conditions, many accounts indicate they were expected to continue performing strenuous fieldwork (Flavin, 2007). In more rare instances, masters would grant permanent freedom from fieldwork to women who had already birthed a required number of children (Flavin, 2007). All of the slave masters’ strategies remain consistent with what Ani (2015) terms “commoditized oppression” and persisting existential violence in the contemporary birthing contexts of Africana women.
In Global Perspective
The disproportionate representation of Black women in C-section deliveries is not unique to the United States. Notorious for its high cesarean rates, Brazil currently tops the list at 52% of C-section deliveries. Eighty-two percent of babies born in Brazil’s private hospitals are C-section births. An article in The Atlantic last year exposed the reasons why high numbers of Brazilian women were delivering their babies through C-section. Prominent among these are the abuses suffered by pregnant women at the hands of their physicians who routinely coerce them to deliver by cesarean section. The woman whose experience foregrounds The Atlantic’s coverage of this issue reveals she sought psychiatric treatment after delivery due to postpartum depression. This is not uncommon with C-section births. According to a position paper issued by Lamaze International, cesarean section poses a number of both short-term and long-term health risks to mothers and newborns. For mothers these include infection, admission to intensive care, pelvic floor dysfunction, endometriosis, difficulties forming attachment with their babies, lower likelihood of skin-to-skin contact immediately following delivery, lower likelihood of breastfeeding, negative psychological consequences in the case of unplanned cesarean section, and even death. Moreover, scarring of the uterus can cause potential harm for future pregnancies as well as deliveries. Ani (2015) indicates that fathers, too, receive little to no psychological care, preparation, and support particularly in the case of emergency C-sections. The potential harm to infants includes complications from prematurity, respiratory complications, accidental surgical cuts, childhood development of asthma, and sensitivity to allergens, Type 1 diabetes, and death in the first 28 days following birth. However, even if a pregnancy progresses without high risks, an emergency C-section maybe warranted due to factors like early labor, the baby’s breech presentation, among other unforeseen issues. In such instances, C-section delivery maybe a necessary course of action when a dire or devastating outcome needs to be avoided.
Gaining Awareness of Africana Philosophies of Birthing
While it is necessary to recognize the potential harm and the underlying racist ideologies associated with the C-section birthing method, gaining knowledge of traditional and culturally relevant birthing practices is equally important. Contrasting European and Eurocentric ideologies of childbirth are African philosophies toward nature, women, children, and birthing. For instance, the ancient Egyptians viewed the womb with the same regard as the eyes (Smith, 2011). According to the Lehun papyrus, a Kemetic medical text, the womb was considered responsible for more than just procreation. Any ailment suffered by a woman was seen as linked to agitation sensed in the womb (Ani, 2015). While many portions of this ancient text are devoted to pregnancy and womb-related conditions, nowhere does it mention surgical intervention in child-birthing (Ani, 2015). The only interventions advocated are oil rubs, ingesting herbs, and smoke fumigation (Ani, 2015).
Birthing practices congruent with Africana cultural lineages include the guidance and support of doulas and midwives. Midwifery has a long history in the Black community. The first midwives came aboard slave ships from West Africa in the 17th century and for several hundred years thereafter assisted both enslaved Black women as well as their White mistresses in the birthing process. Although these practices declined in the early 1920s as a result of legislation, the movement of Black midwifery has resurfaced since the 1960s and 1970s. According to a more recent movement of Black midwives, the threat to Black life begins at the level of gestation. Not only do Black women have the highest rates of C-sections, but they are also at the greatest risk for pregnancy-related death. Likewise, Black infants are four times as likely to die of complications at birth and twice as likely to die before their first birthday, not to mention the lifelong threat of death and assault at the hands of the state thereafter. According to a study from 2008, racial disparities have been identified as a significant predictor of low birth weight for African American infants. Moreover, perceived racism and the general stress associated with discrimination are also said to have an effect on pregnancy. Given the high risks of racist and discriminatory treatment when it comes to pregnancy, Ani (2015) cautions Africana women to tread the terrain of Western and Western-derived healthcare facilities, treatments, and methods with great care. As an alternative method of birthing and care, the Black midwives at the Community Birth Center in Los Angeles believe that provision of holistic and culturally sensitive pre and postnatal care to Black women is a viable means of ending, or at the very least, ameliorating these racial disparities at birth. In addition, research indicates that babies delivered by midwives through natural procedures experience better birth outcomes.
Resources on Birth Centers and Africana Birthing Practices
The National Association of Birth Centers of Color
Black Women Birthing Justice
International Center for Traditional Childbirth
Mamas of Color Rising
Black Women Birthing Resistance
Birthing Project USA
The Birth Place, Florida
Atlanta Birthing Project
Community Birth Center, Los Angeles
Ani, A. (2015). C-section and racism: “Cutting” to the heart of the issue for Black women and families. Journal of African American Studies.
Flavin, J. (2007). Slavery’s legacy in contemporary attempts to regulate Black women’s reproduction. In M. Bosworth and J. Flavin (Eds.), Race, gender, and punishment: From colonialism to the war on terror (pp. 95-116). Rutgers University Press.
Jones, J. (2010). Labor of love, labor of sorrow: Black women, work, and the family from slavery to the present. New York, NY: Basic books.
Morgan, J.L. (2004). Laboring women: Reproduction and gender in New World slavery. Philadelphia, PA: University of Pennsylvania Press.
Plant, R.J. (2010). History of motherhood: American. In Encyclopedia of Motherhood. (Vol. 2, pp. 507-516). Thousand Oaks, CA: SAGE Publications, Inc.
Roberts, D. (1997). Killing the black body: Race, reproduction, and the meaning of liberty. New York, NY: Vintage Books.
Smith, L. (2011). The Kahun gynecological papyrus: Ancient Egyptian medicine. Journal of Family Planning and Reproductive Health Care 37: 54055.
Sutherland, M.E. (2013). Overweight and obesity among African American women: An examination of predictive and risk factors and weight-reduction recommendations. Journal of Black Studies 44(8): 846-869.