Slavery proliferated the profitability of early medicine. The 1820 Amendment, in letter only, made it a capital offense for U.S. citizens to engage in the slave trade abroad or detain Black people with the intent to enslave them. However, it’s no secret that the ink on this Amendment dried and dissipated as Black bodies were trafficked well into the 1860s, and perhaps beyond, for the purposes of chattel slavery.
Entrepreneurial physicians were profiting as endowed slave owners saw providing some semblance of healthcare as a fiscal responsibility to mitigate illness and death, which equated to losses in slave labor and productivity. J. Marion Sims, M.D., who received the ill-gotten title of “father of modern surgical gynecology,” was among the physicians who capitalized on this new, burgeoning demographic—so much so that he built an eight-bed hospital in the back of his Montgomery, Alabama home.
“…doctoring in the South was deeply dependent on the economy of slavery and also intimately connected to the region’s domestic trade slave system,” said Stephen C. Kenny, PhD FHEA, a UK professor and historian of slavery in the United States.
Straight, no chaser.
Sims’ invention of the vaginal speculum ultimately led to him trying for years to treat vesicovaginal fistula, an abnormal opening or hole between the bladder and the vagina wall. It causes constant urinary leakage, discharge, irritation, and agonizing pain. Surgery is the predominant procedure, one that Sims performed from 1845 to 1849 through unanesthetized, nonconsensual experimentation on three Black enslaved women: Anarcha, Lucy, and Betsey. Anarcha endured roughly 30 surgeries over a four- or five-year period; Lucy, the first to undergo Sims’ experimental procedure, nearly died from sepsis; and Betsey also endured horrendous medical experimentation while Sims attempted to perfect his surgical technique.
“The first patient I operated on was Lucy…That was before the days of anesthetics and the poor girl, on her knees, bore the operation with great heroism and bravery. I had about a dozen doctors there to witness the series of experiments that I expect to perform…The operations were tedious and difficult…I got three or four more to experiment on, and there was never a time that I could not, on any day, have had a subject for operation. But my operations all failed, so far as a positive cure was concerned. This went on, not for one year, but for two, and three, and even four years. I kept all these negroes at my own expense all the time…,” an excerpt from Sims’ book, “The Story of My Life.”
While medical associations, physicians, and others applaud his work and give him cover for tortuous methods under the guise of advancing modern gynecology, his legacy helped shape a system of obstetric violence and racial bias that takes root in medical school and permeates doctors’ offices and labor and delivery rooms.
Anarcha, Lucy, and Betsey, the true mothers of modern gynecology, never received credit or recognition for the violent harm they endured, and for how their suffering built the foundation for modern gynecology. Instead, they were stripped of bodily autonomy and deemed legally nonpersons, ostracized, isolated, and shamed for their medical condition.
Old system, same outcomes.
Today, one in three Black pregnant women and birthing people report mistreatment (being shouted at, ignored, and denied help) while receiving maternity care, according to the Centers for Disease Control and Prevention (CDC). Another 40% report discrimination during maternity care due to race and ethnicity. Other forms of commonly reported mistreatment include feeling dismissed or having medical concerns ignored by physicians and nurses, and loss of personal autonomy when pushed to accept unwanted medical treatment.
A Kaiser Family Foundation (KFF) survey found that 21% of Black women report mistreatment by health providers and staff because of race, and 22% of those who gave birth or were pregnant in the last decade report being refused pain medication when they needed it.
Sims’ 19th century experiments on enslaved Black women laid a racialized foundation that too often reinforces a system void of humanity in reproductive healthcare settings today. A popular 2016 study published in the Proceedings of the National Academy of Sciences (PNAS) found that nearly 50% of white medical students and residents endorsed false biology that suggests Black people have thicker skin or less sensitive nerve endings, which correlated with higher pain thresholds and a decreased need for pain management.
The PNAS study surveyed 222 medical students and residents to evaluate beliefs about biological differences between Black and white people. Half endorsed at least one false biological belief, and in hypothetical instances rated a Black person’s pain lower than a white person’s, although the hypothetical instance was identical. Race is a social construct and not a biological marker. Yet in these medical institutions of higher learning, often revered as the country’s premier centers of intellectual depth, flagrant untruths and belief systems about Black bodies are planted, nurtured, and reinforced.
“Mistrust among Black women toward the medical system is evident across many eras of reproductive history, and the generational mistreatment of their reproductive health continues to harm their mental well-being and family health in the 21st century. Even with the advancement of modern medicine, Black women and babies are dying at a higher rate than other ethnic groups. Medicine has long been used to stereotype Black women’s physical and emotional resilience, sexuality, and capacity for motherhood. The interplay of race, socioeconomic power, and institutional knowledge has worked to preserve an inequitable and oppressive framework governing Black women’s reproductive rights.” (NIH: Historical Claims Literature Review Paper)
By all accounts, Sims’ legacy lives on. Today, Black women have at least a 3x higher mortality rate than their white counterparts, and Black babies have a nearly 11% mortality rate. States like Texas, Oklahoma, Arkansas, Tennessee, Mississippi, Georgia, Florida, and Alabama, where Anarcha, Lucy, Betsey, and others suffered horrific medical experimentation, remain bottom-performing when it comes to maternal health outcomes. Missouri ranks 44th in the nation right alongside these southern states.
The power of Sankofa.
So where do we go from here? Up. Nonprofits, birth workers, community-based organizations, philanthropy, federally qualified health centers, and health systems are working collaboratively to improve maternal health outcomes in the region. Although the work is just starting, the promise of creating systems where all women prosper throughout prenatal and postpartum is both inspiring and urgently necessary. Stakeholders are gathering to identify gaps in perinatal care, address systemic barriers, and co-create a future where birth equity is no longer an aspiration, but a reality. By reaching back to reclaim the wisdom of community-led care, we are finally building the protective, thriving ecosystem that families deserve.
As we weave historical lessons into modern solutions, we honor the spirit of Anarcha, Lucy, and Betsey. We look backward to heal, not to indict, because what’s ahead is far more enduring than the past: a future built on collective repair and unadulterated health and racial equity. By transforming our shared inheritance of pain into a blueprint for systemic justice, we turn the memory of their legacy into the foundation of our collective liberation.
