This is an account of how the forgotten Black women of gynaecological history opened my eyes to structural racism. As a white woman I can confidently say that I have never experienced racism and to tell the truth, I have only just recently recognised this fact. I have also come to recognise that the Black and Brown people I love and call my friends and family will have experienced some level of racism at some point in their lives and that I have never acknowledged or discussed this fact with them.
I was born and raised in south London and I consider myself a well-rounded people person. Growing up on a council estate in Wandsworth and attending a mixed school gave me a wide group of friends from all different backgrounds and I loved the community feel that brought. It is personal experience of a diverse culture like this that has led me to ask the question, “Why?” Why at the age of 43 have I only just recognised that this has been an extraordinary privilege? Not only recognised it, but appreciated it.
I am aware that over the years others will have judged me, perhaps harshly, which is a natural human response and part of growing up. I was an overly opinionated, independent young woman finding her way and I would often act the fool and appear fearless, without a care in the world. But on reflection, I have never applied for a job and wondered whether I didn’t get it because of the colour of my skin; or been mistaken for the ward cleaner when working as a midwife on a labour ward. To be deemed inadequate before you’ve even said a word, or to be treated according to the racial bias of an individual, is a whole other level of judgement. It is racism.
Reflecting on my past, standing back from the comfortable bubble of white privilege, I realise racism has always been present. I just never noticed it as it didn’t affect me on a personal level. I left school at 16 with an unimpressive collection of letters that I called my GCSE results. Among other jobs, I worked as a retail assistant, an apprentice hairdresser and a postwoman. But it was not until I became a student midwife in 2009 that I recall witnessing blatant racism and its repercussions.
I was working in a London NHS hospital and an Asian couple had been assigned a lovely, very experienced Black midwife. However, earlier on in the shift it was reported to the senior midwife that the couple had requested to be cared for by a midwife who was not Black.
It seemed that this was not an informed opinion about the black midwife's lack of skills. Nor was it an ill-judged comment blurted out by a woman in the throes of labour.
This was an unashamed and openly racist request. But to my amazement, the family got their wish and were allocated a white midwife. When I approached the senior midwife about the situation, the senior midwife had clearly dealt with this type of situation before and had experienced similars circumstances. She went on to explain that although this behaviour was unacceptable, she was thinking of the midwife concerned because she felt it would have been an awful experience for the black midwife to spend the next 12 hours in a room with people who judged her purely in terms of her skin colour.
I understood that the midwife in charge was in a difficult position and dealt with it as best she could while trying to run a busy labour ward. But where was the solidarity among our black midwifery sisters? Why was there not a guideline in place to stamp this out at the core? Or a pathway whereby the senior midwife, on being informed, told the family in no uncertain terms that this disgusting racist behaviour was not acceptable? Even if this was not an appropriate time, then the problem needed to be tackled post-delivery.
With the benefit of hindsight, I can now see that not dealing with this situation head on allowed the family to think that a UK hospital had condoned their racist behaviour; while the black midwife at the centre of the situation was made to feel as though we, her colleagues, did not support her.
I qualified as a midwife in 2013 and became more confident in my skill set and my own educated opinion. Over time I slowly found myself being able to speak out if I witnessed discriminatory behaviour; and I can honestly say I thought that was enough. But I can see now that I was wrong. As much as my heart was in the right place, I was still sitting comfortable and not taking a stand.
Then, in early 2019, a conversation between friends impacted my outlook forever.
A friend and colleague had attended a midwifery-related study day where the consultant obstetrician and medical educator Dr Amali Lokugamage was presenting on the subject of the “Father of Gynaecology” Dr Marion J Sims. She described how Sims had used Black enslaved women in the 1800s to help perfect his gynaecological techniques, which are still in use today here in the UK and across the globe.
Documented evidence reports that slave owners in america gave up some of their female slaves who had suffered irreparable damage during childbirth. These women were less desirable and deemed to be unable to work to their full potential. These slave women were given to Dr Sims to experiment on and practise his techniques. Their very painful condition, known as vesico-vaginal fistula (VVF), was where a hole develops in the birth canal. The hole can be between the vagina and rectum, ureter or bladder and can result in incontinence of urine or faeces
One of these women, known only as Anarcha, was only 17 years old. It was documented that Anarcha alone was subjected to 30 operations. Two other known enslaved women were referred to as Lucy and Betsy but there were undoubtedly many more. These women were brutalised, degraded, and “operated” on without consent and, unbelievably, no pain relief as it was widely believed at the time that “Black women did not feel pain in the same way as their White counterparts. Enslaved women endured agonising procedures time after time so that techniques and tools used by today’s doctors, nurses and midwives could be perfected and selected.
This information shook me to my core. I had been a trainee midwife for three years and qualified for six and yet I had never been made aware of this important midwifery history.
My immediate reaction was one of shock and disgust. I had so many questions. Why had I not been taught about these women when I was studying midwifery at university?
Why are these enslaved women not celebrated for the contribution they made to medicine in the same way as Sims? How have I used the Sims speculum and not been made aware of its origins? I could not get past this feeling and I knew I needed to do something, I was inspired to start a petition. My midwifery friends and I were desperate to raise awareness and get the story out there. However, this proved difficult and getting signatures for the petition was extremely slow. I was also left wondering, "where are the expressions of disgust from the midwifery or medical community? Why has this story not been picked up by the RCM or the NMC?
I wrote an article for the British Journal of Midwifery hoping this would get attention and increase the number of signatures, but to no avail. My friends and I utilised social media platforms and pushed the petition out but the response was minimal and nobody seemed interested. I began to feel deflated. The situation finally led me to ask some uncomfortable questions: could the public response be minimal because the women we are fighting for are Black? Could this historical truth be rejected and not sit right alongside the picture-perfect image of midwifery? I would often wonder If these had been white women, would they have been acknowledged in the history books and would they be acknowledged for example by having a ward named after them in a hospital somewhere in the UK? It was a challenging reality that needed to be addressed.
Although deflated, we didn’t give up. Our campaign continued to grow much bigger and more powerful than getting a remembrance statue for these three abused and forgotten women. Our campaign had evolved and instead of being just a fight for honour and justice for Anarcha, Lucy and Betsy our campaign became a fight for justice for all those Black and Brown women who have become used to racism and perhaps (wrongly) believe that racial abuse is normal and part and parcel of being a healthcare worker in the UK.
The Anarchy, Lucy and Betsy campaign is for Justice for all those Black women who currently live with the statistic that Black women are five times more likely to die in pregnancy, childbirth and the postpartum period than their White counterparts.
And finally, we push on for all midwives, student midwives, nurses, student nurses and doctors who have not been taught the full version of the medical history. It is our right to be taught the decolonised medical curriculum in the UK and it is a moral duty of those who produce the curriculum to include it. I honestly believe this experience has changed me for the better. I feel like it has opened my eyes. Finding out about the horrific treatment of Anarcha, Lucy and Betsy by chance and realising there are parts of the Midwifery/Medical curriculum that has been whitewashed beyond recognition has made me question what else is out there. What else is missing from the curriculum and how many other Black people have been left out of the history books and not honoured, as they deserve?
This experience has also taught me that not being racist is not enough – we have to do more, so much more. I wholeheartedly believe that it is not only the job of Black and Brown people to stand up and fight structural racism, it is everybody’s job. I know I am only at the start of my journey in learning about racism and the long-term effects it generates. Now my eyes are open I have no excuse to not stand up and be counted.
I wholeheartedly believe that it is not only the job of Black and Brown people to stand up and fight structural racism, it is everybody’s job
1. Cooper Owens D (2017) American gynaecology and Black lives. In: Medical bondage: race, gender, and the origins American gynaecology. Athens (GA) University of Georgia Press; 2017
2. MBRRACE-UK (2020) Knight M, Bunch K, Tuffnell D, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK.
Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential
Enquiries into Maternal Deaths and Morbidity 2016-18. Oxford: National Perinatal Epidemiology Unit, University of
Oxford 2020
3. Ojanuga D. (1993) The medical ethics of the ‘father of gynaecology’, Dr J Marion Sims. J Med Ethics 1993; 19 (1):28-31. https://jme.bmj.com/content/medethics/19/1/28.full.pdf
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