Black Health Matters: Defining Radical Care with Karen A. Scott, MD

A 2019 WPI Alum and OBGYN at UCSF, Karen A. Scott, MD, MPH, FACOG has worked on Black maternal health for nearly 20 years. Disrupting the erasure and erosion of the scholarship of Black cis, queer, and trans women and non-binary people in reproductive health services and research, Karen works everyday to provide radical care and redesign research methods. For too long, Black health, especially reproductive health, has been ignored, Karen’s work is grounded in creating a health care system that finally trusts and authentically cares for Black women.

Can you tell us what first inspired you to be an OBGYN? 

I actually never wanted to be an OBGYN or a physician. Originally, I wanted to become a lawyer or a scientist. I’ve always been curious about the many factors that shape women’s health, wellness, mood, joy, pleasure, and wealth. I wanted to understand what influenced each woman’s health decision, the processes they used, and their power. 

Originally, I entered college to pursue a major in Molecular Biology with the goal of obtaining a PhD. However, I realized that career, while rooted in science, wouldn’t satisfy my desire to explore culture, racism, sexism, and classism as well.

After taking a class entitled Biology of Female Sexuality from my mentor, feminist, humanist, lesbian, plant physiologist, Ryn Edwards, PhD, I decided to change my career and obtain an MD. I am very grateful to sociologists at Kenyon College, Ric Sheffield, JD, and Jan Thomas, PhD, who acted as my advisors for senior year independent study entitled Black Women’s Health, that I developed and completed prior to my matriculation into medical school.

For two reasons:
1) I wanted my voice to matter as a southern Black woman
2) I wanted to transform health care delivery models for Black women, girls, and people.

Because I wanted to continue my liberal arts education, I chose to attend Case Western Reserve University (CWRU) School of Medicine where half-way through my third year, I was introduced to OBGYN at Henry Ford Health System (HFHS) in Detroit, Michigan. I loved everything about it, especially because I was able to see myself reflected throughout the department. We had a Black man who was the Chair, a Black woman who was the Maternal Fetal Medicine Specialist, these Black men and women OBGYNs were proud Black physicians who wanted the best FOR and FROM us. During this rotation, I was also introduced to the Midwifery practice at HFHS. Midwives supported the learning of medical students rotating through the L&D. The first pregnant teen mother I supported in pregnancy was at CWRU, the first birth I supported was at HFHS with a Midwife, and my first O.R. experience in L&D was with a Black woman OBGYN. I have been a proud Black Midwiferized Obstetrician since January 2001.

Can you talk about the importance of disrupting the erasure and erosion of scholarship of Black cis, queer, and trans women and non-binary person in reproductive justice health services?

If we are to address this crisis [specifically Black perinatal and reproductive health] with radical curiosity and courage, the philanthropic sector should re-examine its role in promoting a status quo at the exclusion and erasure of Black community members, activists, artists, and scholars.

The unfortunate reality of the health services’ industry, education, policy, and funders is that these domains are primarily white-governed institutions who use ahistorical and atheoretucals approaches to address racism and racial disparities in reproductive health. Investigations into reproductive health systems demonstrate how current structures exacerbate health inequities and community harm. Health care is a privilege in this country. Our systems and structures provide access to health, wellness, health care, and technology based on preexisting individual privileges. This leaves one dominant group continuously experiences overall better health and life, with little to no effort.

The truth is structural racism directly threatens reproductive healthcare access, utilization, experience, and outcomes through inequitable practices and policies.

Reproductive justice (RJ) provides clear standards for transforming power structures and dynamics in care provision toward the expertise of Black birthing communities and challenges the hierarchy of medicine that prioritizes physician knowledge and specialty training over community wisdom, power, and experiential knowledge in sexual, reproductive, and perinatal health (SRPH) services provision. Therefore, RJ-rooted models of SRPH directly dismantle structural and obstetric racism in service provision and improve patient-centered access toward equity.

To me radical care, at its core, is grounded in trusting Black women and people to be the architects, engineers, and providers of care that Black mothers and birthing people deserve, as defined through the theories and praxes of Black Feminism and Reproductive Justice.

How did your experience with The Women’s Foundation of California and specifically the Women’s Policy Institute shape your work? 

As a WPI Graduate of the 2019 class, I have remained in relationship with the 2019 RJ Team, Martha Gonzalez and Lorena Zermeño,  as we continue the legislative work of getting AB 732 Reproductive Dignity for Incarcerated People Act to the Governor’s Desk, with WPI and our co-sponsors the ACLU, California Latinas for Reproductive Justice, and Young Women’s Freedom Center. 

AB 732 would improve the quality of reproductive health care services and support that incarcerated people need while experiencing menstruation, pregnancy, abortion, miscarriage, postpartum, and lactation in county jails and state prisons.

It successfully made it out of Appropriations and the Assembly early in 2020. The co-sponsors and our alumni team are working together now to prepare for the bill to be introduced to the Public Safety Committee hearing in the Senate. I am really grateful that WPI allows me to activate my quadruple superpowers of participatory research, epidemiological research, health services provision, and policy, all grounded in cultural rigor, reproductive justice, and Black feminism.

During this pandemic, how important is it to understand the problems that Black mothers and pregnant people face and the disproportionate impact of COVID-19 on communities of color?

The pandemic has laid bare the necrotic wounds of the healthcare system. The U.S. health care system is not designed to facilitate healing and wholeness. Instead, the U.S. healthcare is composed of individuals and groups from society, who organize and form systems with written and unwritten rules and enact acts of violence, harm, and neglect – in the form of obstetric racism – upon the most marginalized: Black mothers and birthing people, with unchecked power and authority. Health care providers and law enforcement officers disregard Black people, particularly Black bodies, Black births, and Black lives, in very similar ways. 

We’ve seen how the U.S. health care structures capacity to care for folks with grace and dignity based on a hierarchy of skin color, rooted in racism and other oppressive ideologies and practices. We need to honor the traumas and triumphs of Black mothers and pregnant people. We also need to activate the innate power and potential Black mothers and birthing people have have to shift the narrative and reimagine their own future. It’s time to listen to the voices and experiences of Black mothers and birthing people when redesigning and evaluating U.S. health services.

I advocate for keeping doulas, partners, and newborns WITH their Black mothers and birthing people, AND for supporting body feeding with breasts/chests to provide their own milk or human donor milk to their newborns. I also advocate for hospitals increasing access to human donor milk, particularly during pandemic when folks are living with food insecurity, housing instability, and other stressors.

Right now these are unprecedented times, can you tell us while we’re celebrating the “independence” of our country what is the role of interdependence and collectivism in this moment, and what does that mean to you as a healthcare practitioner?

I can’t comment on celebrating the independence of this country. The fact is in 1776, Black people were considered enslaved people. The revolution did not outlaw slavery. As a southern Black woman, I reflect on The Three-Fifths Compromise in the U.S. Constitution, where enslaved Black people were considered 3/5ths of a human being. 

As a physician-social scientist and activist, I will do what I do every day – leverage my power, voice, and resources to disrupt and dismantle white patriarchal supremacy in policies, practices, and procedures in health care and hospital systems. I will continue to cultivate relationships with Black, Indigenous, POC, and Queer people in the fight for our humanity. I will continue to be a bridge across and within sectors to amplify the voices and efforts of folks who are bold enough to radically imagine and demand a future where we are unapologetically FREE and unbothered!

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