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Culture

The racist and unethical origins of modern gynecology

How the past affects present day obstetrics.

by Annabel Sowemimo, MBBS, Msc, DFRH DTMH, Guest Writer Reviewed by Sarah Toler, DNP, Science Writer for Clue; and Laurie Ray, DNP, Science Writer at Clue
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This piece is intended for educational purposes and not as a product endorsement.

Some of our knowledge of gynecology was acquired through unethical and racist practices (1). For instance, in the American South, enslaved people of African descent were forced to be the subjects of painful and unethical medical experiments, both in life and after death (1). We’ll explore this in greater depth below.

The influence of such history continues to impact the access and the quality of healthcare options, for everyone. Raising awareness of these unethical origins is the first step toward addressing racial bias within our healthcare systems and empowering everyone to seek the best treatment options possible.  

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Modern gynecology’s roots in American slavery 

J. Marion Sims was a 19th century doctor who is controversially known as “the father of American gynecology.” He developed a device that preceded the modern speculum, as well as a surgical treatment to correct vesico-vaginal fistulas, an opening between the vaginal wall and the bladder that can develop following prolonged labor and vaginal birth (2, 3). 

His techniques were refined through experimentation on enslaved women of African descent. We know the names of three of the women whom he experimented on: Anarcha, Betsey, and Lucy (2). Each of these women were operated on without anesthesia — as many as 30 times in 4 years — while Sims praised their ability to withstand pain (2). Such discriminatory thinking was common — for centuries, some physicians have believed that Black people can withstand more pain than white people (2).

Some of the practices that were developed by Sims from experimentation on enslaved women are still regularly used today (4), but the truth of their racist and inhumane origins is increasingly coming to light. In April 2018, debates raged as a decision was made to remove a statue of J. Marion Sims, in Central Park, in New York City (2). 

Unethical practices in cervical cancer and HPV research

In 1951, an African American woman named Henrietta Lacks died of aggressive cervical cancer. While in treatment, samples of her cancerous tissue were given to researchers without her knowledge or her consent, a practice that was common at that time (5). Yet it was later found that these cells were unusually durable and had the capacity to reproduce prolifically, rendering them “immortal” (5).

The cell line, known as HeLa cells, was distributed widely to scientists and researchers (5). Over the years, the cells have been fundamental in making discoveries in the fields of polio eradication, virology, cancer, and genetics, among others. Between 1953 and 2018, they were used for more than 110,000 studies (6). The cells were also sold for a profit by biotechnology companies and led to many profitable discoveries (5). Yet the Lacks family received no financial reimbursement and was not acknowledged by the National Institutes of Health (7) until many years later, in 2012 (8). Lacks’s medical records and cell genome were repeatedly published without the consent of her family. Lacks’s cells continue to be used globally for medical research, based on an agreement made between her family and the NIH (7, 8), but many have called for a reduction or a termination in use of HeLa cells, given the unethical origins of their discovery (9). 

Ironically, though Lacks’s cells were used to discover the connection between the human papillomavirus (HPV) and cervical cancer (10), significant health disparities still remain when it comes to access of cervical cancer treatment by BIPOC women (11-13). For instance, Black and Hispanic women in the United States (12) are still more likely to die from cervical cancer (13) than all other races of women. And, in the U.K., Black women, Asian women, and women of other ethnic minorities still log lower uptakes of cervical screening (11), which can lead to greater incidences of cervical cancer that may progress to severe disease.

The troubling history of contraception and reproductive coercion

Puerto Rican women were the subjects of the first large-scale human trials of the modern contraceptive pill, in the 1950s (14). The Harvard- and Cornell-trained scientist Gregory Pincus chose Puerto Rico for his experiments, because the island’s residents were impoverished, following colonization by the U.S. And, residents were experiencing a population boom (14).  But many of the Puerto Rican women who agreed to take the pill did not understand the risks of taking the drug, and some weren’t aware that they were participating in a clinical trial, at all (14). Many of the women who participated in the trial also experienced side effects, like headaches, dizziness, and blood clots (14). Despite their contribution to the pill’s development, Puerto Rican women weren’t able to access the safer version of the contraceptive when it became available on the market, because it was initially prescribed only to those based in the mainland United States who were married (14).

The history that led to the development of such a pill is similarly fraught. The pioneers of the birth control movement, Margaret Sanger, the founder of Planned Parenthood, and Marie Stopes, the namesake of Marie Stopes International, believed that women wouldn’t truly be able to experience freedom until they were able to regulate their own pregnancies (15). Yet they also held beliefs that were aligned with the American eugenics movement, at that time. In particular, they believed that populations of “undesirable” people could be regulated by controlling their ability to reproduce (15).

While ideas of eugenics have since been denounced, modern history still offers examples of governments and institutions that abuse contraception to regulate populations of marginalized groups. Since the introduction of Depo-Provera (the birth control shot) in 1976, studies suggest that it has been targeted for use in immigrant populations. One study conducted in East London, in 1978, by the prominent obstetrician Wendy Savage showed that the majority of those offered Depo-Provera were of Asian descent (16). And, in 1979, a fourteen-year-old working-class Black girl was injected with Depo-Provera while under general anaesthesia, for an unrelated treatment (17). When the administering physician was asked about the violation, he said that he felt that as “a citizen of this country… it was his moral duty to do so” (17). Around the same time, the Organisation of Women of African and Asian Descent (OWAAD) joined forces with other groups to launch the Campaign Against Depo-Provera (CAPD) to address its disproportionate use on marginalized groups (18).

In 1981, Depo‐Provera was banned in Zimbabwe, in part (19), because it had been used on Black Zimbabwean women as a form of population control, by the ruling white government. (This concern dovetailed with the gender politics of the time—the ban also reflected a concern that the contraceptive would allow women to make decisions about reproduction, without consulting their male partners (19).)

Longer acting methods of contraception have also been misused in the criminal justice system (20). In the early 1990s, many bills were introduced in the United States that proposed that women agree to use the birth control implant in exchange for public assistance benefits or to avoid jail time (20). The American Civil Liberties Union (ACLU) has repeatedly denounced these measures as unconstitutional acts of reproductive coercion (20). In 2017, a Tennessee judge offered a 30-day reduction in jail time to those willing to undergo a vasectomy (a surgical procedure for male sterilization) or a contraceptive implant insertion (21). He was eventually reprimanded by the Tennessee Board of Judicial Conduct (21). 

In addition to abuses of contraception, marginalized communities worldwide have long fought forced sterilization efforts. Studies have found incidents of forced sterilization in 38 countries. Recently, in regions like Namibia and South Africa, where the HIV epidemic persists, women living with HIV have been sterilized without their consent. And in 2018, 60 Canadian indigenous women pursued a class-action lawsuit alleging that they were forced to undergo sterilizations. In September 2020, amid growing concerns about treatment of migrants at U.S. detention facilities, a whistleblower raised concerns that Spanish-speaking women were undergoing hysterectomies, without their consent

Racial disparities in reproductive healthcare today 

Racial disparities in reproductive healthcare are still prevalent today. In the U.K., Black women are five times more likely to die during or shortly after pregnancy, than white women (22).  In the U.S., Black and Indigenous women are two to three times more likely to die during or shortly after pregnancy, than white women (23). Additionally, non-white women in the U.S. are less likely to receive pain medication during and after birth (24, 25). 

Raising awareness of past and present atrocities in the field of gynecology helps to create a more just future in reproductive healthcare. Organizations like the Guttmacher Institute, which advocates for sexual and reproductive rights in the U.S., call for reproductive health policies that protect vulnerable populations and create ethical research. Additionally, community-led groups like Sister Song, in the U.S., and Decolonising Contraception, which I founded, in the U.K., are gaining traction, as we advocate for reproductive justice, by dismantling the structural factors that lead to inadequate access to reproductive healthcare. 

Lastly, the students and faculty members of medical schools around the world are advocating to revise their curricula, in order to address the racial and colonial context of Western medicine and pay homage to Anarcha, Betsey, Lucy, Henrietta Lacks, and the countless lives that have been compromised in pursuit of medical knowledge. 

At Clue, we are dedicated to ensuring that the content we publish online and in our app is diverse, inclusive, and scientifically accurate. We also run and support studies that help to advance the research that is desperately needed in the fields of menstrual and reproductive health. If you’d like to support our app and our research or learn more about your menstrual and reproductive health, download Clue today.

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