In this episode, host Gwyneth Shaw talks with Berkeley Law Earl Warren Professor of Public Law Khiara M. Bridges, whose new book, Expecting Inequity: How the Maternal Health Crisis Affects Even the Wealthiest Black Americans, has just been published by the MIT Press. She’s currently on a book tour that includes an event at Book Passage in San Francisco on April 12.
The book begins with the observation that not only are Black people three to four times more likely to die from a pregnancy-related cause, but racial disparities in maternal mortality persist across income levels. Bridges spent two years observing a San Francisco obstetrics clinic that caters to the wealthy to analyze the choices class-privileged, pregnant Black people are making to survive. She interviewed over two hundred pregnant or recently postpartum people, often documenting harrowing tales of patients who felt their symptoms and input were ignored by clinicians.
Bridges joined the Berkeley Law faculty in 2019 and is the author of three other books — Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization, The Poverty of Privacy Rights, and Critical Race Theory: A Primer — and a coeditor of a reproductive justice book series from the University of California Press.
She has a J.D. and a Ph.D. in anthropology from Columbia and has published in a range of top law reviews, including Harvard Law Review, Stanford Law Review, the Columbia Law Review, the California Law Review, the NYU Law Review, and the Virginia Law Review.
Here are some other examples of Bridges’ recent work:
Race in the Machine: Racial Disparities in Health and Medical AI
The Dysgenic State: Environmental Injustice and Disability-Selective Abortion Bans
About:
“Berkeley Law Voices Carry” is a podcast hosted by Gwyneth Shaw about how the school’s faculty, students, and staff are making an impact — in California, across the country, and around the world — through pathbreaking scholarship, hands-on legal training, and advocacy.
Production by Yellow Armadillo Studios
Episode Transcript
[music playing]
GWYNETH SHAW: Hi, listeners. I’m Gwyneth Shaw, and this is Berkeley Law Voices Carry, a podcast about how our faculty, students, and staff are making an impact through path-breaking scholarship, hands-on legal training, and advocacy.
My guest for this episode is Professor Khiara M. Bridges, whose new book, Expecting Inequity: How the Maternal Health Crisis Affects Even the Wealthiest Black Americans, has just been published by the MIT Press. Building on her previous work about how race and racism are intertwined with maternal healthcare for Black women, Bridges spent two years observing a San Francisco obstetrics clinic that caters to the wealthy, to analyze the choices class-privileged pregnant Black people are making to survive. She interviewed over 200 pregnant or recently postpartum people, often documenting harrowing tales of patients who felt their symptoms and input were ignored by clinicians.
Bridges finds that not only are Black people three to four times more likely to die from a pregnancy-related cause, but racial disparities in maternal mortality persist across income levels.
Bridges joined the Berkeley Law faculty in 2019 and is the author of three other books, Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization, The Poverty of Privacy Rights, and Critical Race Theory: A Primer. She’s also a co-editor of a reproductive justice book series from the University of California Press.
She has a JD and a PhD in anthropology from Columbia, and is published in a range of top law reviews, including Harvard Law Review, Stanford Law Review, the Columbia Law Review, the California Law Review, the NYU Law Review, and the Virginia Law Review. Thanks for joining me, Khiara.
KHIARA M. BRIDGES: Thanks for having me.
GWYNETH SHAW: Where did the seed for this book come from, and how does it relate to the work that comes before it?
KHIARA M. BRIDGES: I started thinking about this book maybe months after I published my first book, which is called Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. That book was based on eighteen months of ethnographic fieldwork research that I conducted in a public hospital in New York City. I call it Alpha Hospital.
And the sort of point of that book was just to document how difficult it was for low-income pregnant folks who received Medicaid as their health insurance during their pregnancies, how hard it was for them to maintain their dignity and their autonomy and their agency and humanity, while navigating these healthcare bureaucracies, you know, as low-income people who depended on the state for assistance, essentially. And so the title of the book is Reproducing Race. And so the, uh, my goal in that book was to kind of I, I document and, and identify how race and racism makes a mess of our best intentions.
You know, the thing is that, you know, Medicaid and the provision of health insurance for low-income people is actually a wonderful thing, but then racism comes along and makes a mess of it. So again, the book was focused on how race and racism perverts the best of intentions. And you know, I would be presenting the book and talking about racism and racial discourses, as well as, you know, xenophobia and sexism and classism and all those things.
And one of the most common questions that I would get, and I wouldn’t call it a challenge necessarily, but it was a question. And the question was, you know, “Is this about race and racism? Isn’t this really about class?”
And the challenge was this sense that any kind of dignity-denying or humanity-denying experiences that I documented in the book were not a function of the pregnant patient’s race, but rather was a function of their class disadvantage. And so the question was premised on this assumption that once one escaped poverty, and once one achieved some degree of class privilege, then, like, racism would go away. And so what I wanted to do was, I sort of immediately began dreaming up this project, Expecting Inequity, where I would document and describe how racism shows up in the lives of Black people who have wealth and status.
And the stat, you know, the stat that kind of forms the drumbeat behind Expecting Inequity is the stat describing the U.S.’s racial disparity in maternal and infant mortality? And so, you know, this stat is often repeated: that three to four times as many Black women die from pregnancy-related causes as their white counterparts. But what is hidden in that statistic is that racial disparity persists across income levels.
So, that stat is not a result of the fact that Black people disproportionately bear the burdens of poverty. And so that is why three to four times as many Black people in the US die from pregnancy-related cause. Instead, that stat is hiding, I think, that even wealthier Black people are dying at higher rates than their white counterparts.
In order to make it tactile and real to people, I tell people that, you know, my office in Berkeley Law, right next door to me is, you know, one of my white colleagues. And we are equivalent. You know, we have tenure, and we have, and we have, um, high incomes, and we have status and privilege, yet I am three times as likely to die from a pregnancy-related cause, um, as she is.
Um, and so that stat reveals to me that racism persists across income levels, and that stat reveals to me that class privilege it does not, um, give Black people an escape from racism. Racism certainly looks different. It looks different at higher income levels, but it nevertheless persists.
And so that is the goal of this book, is to document that persistence.
GWYNETH SHAW: Early in the book, you talk about that previous work with the healthcare situation in New York, comparing it to Golden Health in San Francisco, where you worked on for this book. Can you talk about what surprised you about the contrast and similarities for patients between those two clinical environments? And that comparison is really at the heart of your thesis here.
KHIARA M. BRIDGES: So Reproducing Race, you know, my first book is very much present in Expecting Inequity. And what I try to do in the book is to document my surprise at the differences between this hospital where I performed or where I conducted ethnographic research for my first book, and this hospital that I conducted ethnographic research in for Expecting Inequity. And again, like the hospital for my first book, we’re talking about a public hospital in New York.
We’re talking about over, you know, burdened, underfunded. It’s the consummate poor person’s hospital. Like, this is the hospital where, homeless people are taken when they have a medical emergency.
This is the hospital that, you know, sees all of the city’s most disadvantaged. And I, you know, and I compare that to gold- I call the hospital Golden Health and Expecting Inequity, which is a hospital for well-resourced people.
This is a hospital that caters to San Francisco’s moneyed class. So it’s, we have, you know, beautiful lighting, and there’s a tea station where you can get black tea and green tea and chamomile tea while you wait for your appointment. And so there’s this visceral contrast between, I call it Alpha Hospital, where I conducted research for my first book, and then Golden Health.
And there is a chaos that just, you know, that is part and parcel of healthcare delivery in Alpha Hospital. There are long wait times, and because of the long wait times, there are conflicts between patients and staff, And it’s just, you know, it’s a, it’s a place where I don’t know where, if one has delicate sensibilities, one would be uncomfortable. Meanwhile, Golden Health is just, you know, I wouldn’t call it luxurious, but it’s really nice.
And so there were these contrasts, right? This place for poor people, essentially, and this place that is designing itself and orienting itself towards wealthier people. That being said, the Black maternal health crisis is present in both of those places.
In both of those places, Black people are dying at higher rates than their white counterparts. Black babies are dying at higher rates than non-Black babies. So although there are physical and aesthetic differences, neither place has managed to escape the effect of racism in the US.
And one of the, I would think or hope, more insightful, perhaps, aspects of the book or rather, an aspect of the book that people might not know before picking it up is that racial disparities in maternal and infant deaths are actually lower at the lower end of the socioeconomic spectrum. And so that’s to say that poor Black babies and poor white babies sort of die at similar rates, whereas when you get to the higher income levels, wealthier Black babies and wealthier white babies, there’s a greater discrepancy there. I mean, the same is true for maternal deaths.
So poor Black mothers and poor white mothers have similar rates of maternal deaths, whereas even when you get to the higher income levels, there’s a greater discrepancy between the rate of death between, uh, wealthier Black mothers and wealthier white mothers. And so that was a shocking kind of unexpected fact to discover. And what I theorize in the book is that it’s an effect of Medicaid.
Like, so Medicaid is this system of healthcare delivery and health insurance that removes a lot of discretion from providers, and I critique that in Reproducing Race. I critique the lack of discretion that providers have. It’s very regulatory in that sense.
But it’s that discretion, um, or the absence of that discretion that is producing this equalization amongst maternal and infant mortality and morbidity rates. And so, essentially, when one has a degree of class privilege, one exits this system that is humanity-denying, and dignity-denying and autonomy-denying and agency-denying. But then you enter into this system in which there is choice and discretion, um, and that system has deleterious health consequences.
So there’s a great irony there.
GWYNETH SHAW: The anecdote that you, you talk about where the, the, the pregnant person was begging for a C-section, but the place where she was giving birth was kind of prided itself on a low rate of C-sections, which to me is kind of a signifier of, oh, we’ve got a higher level of care. We’ve got a higher standard. We’re not gonna take you into the operating room at the drop of a hat.
But in her case, it was really a problem that she needed a C-section. She was well beyond the time when she should have been taken into the operating room, and I was really struck by those stories where these signifiers or these signs of a wealthier, more luxurious, or better serviced healthcare system seem to actually start to create problems.
KHIARA M. BRIDGES: Yeah, no, and I mean, I hope that’s the contribution of the book is to show that it is actually incredibly complicated. Um, because, you know, one of the critiques of the U.S.’s healthcare system is that we are very high intervention over here. Like, we will induce the labor.
We will give you Pitocin to, to speed up that labor. We will conduct, perform a C-section if there’s any sign that the labor is not progressing, you know, fast enough or, um, without complication. And when we compare our C-section rates to the countries we like to compare ourselves to, the C-section rates, you know, our C-section rates are astronomical.
And so then the response to that from very well-meaning institutions is to reduce C-section rates at the institution. But that creates its own problems because a patient might want a C-section.
The story that you’re talking about, this patient was in the hospital, she was in the hospital for over a week. Um, and like, And there were all sorts of signs that her labor was, um, getting more and more problematic, right? Um, and she desperately wanted a C-section because she was worried about her health, she was worried about the health of her baby. Um, but then she was also tired.
And so there’s this anxiety, this worry, this, you know… And she’s also, she says, “I was so full of medication, I was so full of medicine at that point.” And she was worried about the effect of the medicine on her baby.
And so she desperately wanted a C-section, that the hospital was unwilling to provide her, because of its commitment to, you know, quote unquote, natural childbirth. And so the question that I pose in the book is like, okay, so why did that happen to this woman, right? Like, what role did her race play in denying her, or I describe it as the hospital’s and the healthcare provider’s refusal to, like, listen to her.
What role did her race play? What role did the hospital’s own commitment play? And what exactly does justice look like in that particular scenario?
And that’s what I mean, like, by race and racism, um, making a mess of the best of intentions. I think that the hospital’s commitment is worthy. I think that the U.S.’s C-section rates, you know, ought to be reduced dramatically.
But the question I pose in the book is, like, how does race and racism, um, pervert those, those commitments? Um, a contrafact— a counterfactual that we’ll never be able to prove, what a white person in that same scenario who was begging for a C-section, with the hospital being willing to compromise on its own commitments to make sure that that white patient’s, um, birth and labor proceeded in the way that she wanted? Um, so this is the mess of racism in maternal healthcare in the US.
GWYNETH SHAW: Yeah. Um, and you spent a lot of time talking to pregnant and postpartum people for this book. Why was it important to you to hear those stories for yourself and be able to include those narratives in the book, to put, if not faces to a situation, put a real person behind some of these stories?
KHIARA M. BRIDGES: Yeah, so that’s my insistence upon talking to pregnant folks and recently postpartum folks. I mean, so first it’s selfish. Um, it’s purely selfish.
I just find it so fascinating to talk to people about their experiences. It’s probably the most enjoyable part of the research, I think, I think. But then secondly, you know, I’m trained as an anthropologist, so I have a JD, but I also have a PhD in anthropology, sociocultural anthropology, and ethnography is our methodology.Fieldwork is our methodology. And so that is where we get our data. And so ethnography and fieldwork, we call it thick description.
And it involves like sitting in a place and becoming part of a place for long periods of time. So, you know, transforming oneself from an outsider to an insider. And it’s a way of seeing, and it’s a way of observing.
And so, that’s why I was in this hospital for, as long as I was to, you know, two years, give or take a couple of months. But part of ethnography is to, not only the ethnographer achieves a different way of seeing, but it’s also to attempt to see and understand through one’s interlocutor’s eyes. And so that involves talking to people.
And so the in-depth interviews that I conducted were part of me being the process of creating this data set that I could then interpret. And one of the most interesting things about, there are so many interesting things about anthropology and ethnography, but, um, about, like, really being in a place and talking to people. My favorite sort of moment is when I, I talk to people about things that I also observed.
So I, you know, For example, I might be allowed, I mean, if granted, they- A patient has given me permission to be present during an exam. And so I’ll be in the room, and I’ll see the physician examining the patient, and I’ll hear the conversation and I’ll describe what was being said.
But then the sort of aha moments, the moments of like, um, just joy for me is then to be able to talk to the patient afterwards and talk to the physician afterwards about what they experienced. And oftentimes those descriptions of their experiences are incompatible or inconsistent with one another, or they just… It adds a layer of the phenomenon that I, you know, that wasn’t there, that wasn’t obviously present in this like objective observation of the scene.
And so, I, you know, by by being able to, but talking to people just yields insights that, simply observing and being present in a place, doesn’t necessarily yield. So, and like I said, it’s also super fun.
GWYNETH SHAW: Well, and it’s so interesting because there were a couple of people you interviewed who said things like, “Oh, I didn’t have a particularly bad experience,” and then they tell you the story. And to read that story is to sort of have the hair on the back of your neck stand up. It’s undeniably a bad experience by anyone’s neutral definition.
And so it’s really interesting to read those stories and see the way even the patients themselves can minimize some of the things that happened to them.
KHIARA M. BRIDGES: Right. Exactly. And and, um, one of the the arguments that I make in the book is this minimization. Like, what is, what is the role of that minimization? What is the work that that minimization is doing?
Um, you know, the patient that we were talking about earlier, who was in the hospital for over a week trying to, you know, give birth to her first baby, um, she’s a Black woman. Um, she’s being cared for by pretty much all, you know, all non-Black care team. Um, and it is, it is not unreasonable to conclude that, well, perhaps her race had something to do with the willingness of the staff and the providers to disregard her reports about her symptoms, to disregard her attestations about her wishes and her desires with regard to her childbirth. So yeah, it would have, I think a lot of reasonable people would conclude that racism had something to do with the way that went down. And also, a lot of reasonable people would affirm her experience, if she were to say, “I think racism had something to do with how tragic and terrible my, my birth experience was.”
That being said, she refused to understand it in those terms herself. She attributed it, it to, um, the midwifery training of her providers, right? She said like, “Oh, it’s because they were midwives, and midwives don’t want to perform C-sections.” And so this second time around, now that I’m pregnant with my second baby, I’m gonna be sure. Yeah, I’m gonna make sure that I’m being cared for by obstetricians, because that is the way that I will have the birth experience that I want.” And her desire wasn’t, “I’m gonna make sure that I’m being cared for by providers of color.” “I’m gonna make sure that I’m gonna be, you know, cared for by Black obstetricians in order to have the birth experience that I want.”
Essentially, she engaged in sort of a denial of the meaningfulness of race and racism in her experience. And so question is, why would she do that? Why? Why would she do that? And I theorize about just how awful it is to be subjected to racism, how powerless one feels when one is kind of, I don’t know, forced to navigate, racist systems and racist experience, racist experiences. And so there might be something, a clawing back of power, that comes by saying, “Yeah, no, race had nothing to do with that.” And I’m actually going to be able to control my future experiences by pulling this lever of the, you know, controlling the training that my providers have. There is something that an insistence upon claiming the agency that remains by denying the meaningfulness of racism.
And so that’s what makes it so complicated. And as I talk about in the book, like, as you know, what my political sort of commitments and my sort of political values, I want people to own the reality of racism in this, you know, sociopolitical moment. And so I was upset initially by the fact that I’m talking to someone who denies the meaningfulness of racism in this sociopolitical moment.
But then I had to ask myself why was that upsetting to me? And I think it’s because that has been pushed on us by political actors, right? Since- Since the emancipation of the enslaved people, powerful people in this country have said that racism no longer matters, and we’re now a colorblind country. And so when that has been like a political program that has been imposed on us, it was a little unsettling to me to see an individual kind of embrace it as a personal, individualized way of navigating life.
But then that, you know, that’s the value of being able to step away from it and look at it as an academic. It’s that I ultimately came to appreciate it. Like, I critique her no longer. I think that we all have different ways of surviving, the brutality of racism, and that is one of many ways to survive it.
GWYNETH SHAW: Well, and of course, there’s a deep irony in the idea of, you know, many pregnant people reach out to midwives or other establishments that are going to try to offer a more natural or less medicalized birthing process, and that’s become sort of trendy, especially in upper-income areas. And the irony of sort of having that, still having to navigate that is interesting to me on sort of another level, which is the whole maternal healthcare industry and how that’s changed, but that’s not part of your book.
So what are some of the reasons that you see maternal outcomes being so poor for Black pregnant people, and why do you think those persist across class lines? We’ve already talked a little bit about that, but I really want to dig into sort of some of the reasons for that you think.
KHIARA M. BRIDGES: Yeah, no, so I identify many factors that contribute to racial disparities in maternal mortality and morbidity. And the factors that have received the most attention tend to focus on individuals. And so there is undeniable, I believe, the reality that there are implicit biases. They’re present all over the place, including in obstetricians and midwives and staff nurses in hospitals. And so these implicit biases compromise the care that Black people receive.
And so at least some part of the racial disparity in maternal mortality and morbidity is a result of the inferior care that Black people are receiving as a result of the implicit or explicit biases that their providers have.I don’t wanna dismiss the role of implicit and explicit biases, I just feel like so much space, like that that factor has taken up so much space in sort of political conversation, but also in like medical education.
For the most part, I would say medical education, to the extent that it addresses or thinks about racial disparities in maternal mortality, morbidity, or just racial disparities in health generally, medical education has focused on implicit biases and cultural competency trainings. And so the idea is that if we can fix the hearts and minds and souls of providers, then, we can solve the problem of racial disparities in health. And I think that is, um, inaccurate.
I think that we might reduce racial disparities in health to some, um, extent, but I don’t think we will eliminate them. I think I’m confident that structural contributors are doing most of the heavy lifting, um, when it comes to the racial disparities in health that are present across, you know, so many aspects of of life, from hypertension and diabetes and COVID and asthma, right? All of those racial disparities in health, They’re not a function of inferior care that providers are giving, or they’re not solely a function of inferior care that providers are giving. Most of that disparity comes from structural inequities.
And so the structural inequities that I found really interesting have been residential segregation. I mean, the reality is that even higher-income Black people tend to live in segregated neighborhoods. And the segregated neighborhoods that even higher-income Black people live in are those neighborhoods that have the environmental injustices that compromise health.
So we’re talking about situated close to highways and the pollution that highways produce is known to compromise fetal health, known to compromise maternal health. Um, lead in soil as well as, you know, paint in, in older, um, housing structures. Um, water, I mean, we all knew what happened in Flint. Um, so those neighborhoods that have sort of older infrastructures that are crumbling, um, those are the neighborhoods where you’re more likely to have, um, the environmental injustices that contribute to racial disparities in health and racial disparities in maternal and infant mortality and morbidity.
Um, another factor that is causing the higher rates of maternal deaths and severe injuries is epigenetics. And it’s, you know, there’s an interesting conversation happening amongst academics now about epigenetics, um, because we’re unsure. We’re debating how we should think and talk about epigenetics. And just to be sort of clear, epigenetics refers to the expression of genes.It refers to not alterations in genes, that’s mutations, but just how genes are expressed. And the environment causes different expression of genes, And some of those expressions of the genes are health-affirming, and some expressions are contrary to healthfulness. And the really interesting thing about epigenetics is that those gene expressions can be transmitted across the generations.
So, you know, the example that I give in the book is that, you know, my grandmother was a maid. And actually both my paternal and maternal grandmothers were maids in the Jim Crow South. And so one can just imagine the hatefulness and, um, and the hostility and the violence of the environments that they lived in, you know, their entire lives.
And so one can imagine that those environments were not conducive to health-affirming expression of their genes. So they had this, you know, phenotypic expression of their genes that might have compromised the quality of their lives and compromised their health. But that expression of their genes caused by their environment, they would have passed it on to my mother. And now my mother managed to scramble her way into the middle class when she was a young adult. She married my father. They scrambled together. In fact, they met when they were 14 and 15. Very cute story.
(laughter)
And they scrambled together into the middle class. And so by the time I was born, we were solidly middle class. I lived in the suburbs. You know, I played outside.
(laughter)
No problem. Ran down the streets without worrying about violence, without worrying about food insecurity. There’s always food. I mean, I was in ballet class when I was three years old. I mean, I’m talking about solid middle class upbringing, and now here I am today, a tenured professor at Berkeley Law. The way that, um, epigenetics works is that I have inherited the hateful environments that my maternal and paternal grandmothers survived. I’ve inherited it through the phenotypic expression of genes. And so even though I have this wonderful privileged life, I still have to deal with Jim Crow racism as it has been imprinted in the expression of my genes.
And so that can go a long way towards explaining the persistence of racial disparities in maternal and infant mortality across income levels. Class-privileged Black folks like myself, we’re just a generation or two out of, like, formal racial disenfranchisement, and so that might be showing up in the racial disparities in health that we see.
The last factor that I will mention is just segregated hospitals. You know, I already mentioned segregated neighborhoods, but I want to talk about segregated hospitals for a second. And this is, I dedicate a whole chapter in the book to segregated hospitals because it’s one of those features of American life that many people accept as just the way things are. Like, you know, we have segregated neighborhoods, we have ghettos, we have Chinatowns, we have Japan towns, we have Korean towns.In Miami, where I grew up, we have Little Havana. You know, we just have segregated neighborhoods, and of course, we’re gonna have, like, segregated hospitals. There are gonna be hospitals in the poor neighborhoods and hospitals in the suburbs, and so boom.
But it’s just… It’s actually bizarre that in a country, um, that has in its charter of government this little phrase about equal protection of the laws, it’s very bizarre to have hospitals for the haves and hospitals for the have-nots. I mean, it’s also very bizarre that the hospitals for the have-nots are providing healthcare that is inferior to the hospitals for the haves. It’s just strange. And then like, you know, it’s not a function of geographical segregation. Like San Francisco’s not that, you know, it’s not this sprawling metropolis. It’s kind of a little condensed place. It’s a condensed city, as is New York City as well, right? It’s a very, you know, it’s large in terms of population, but in terms of just like geographical ranges, we’re talking about compact, you know, dense places.
Um, in these places where, you know, various hospitals are accessible, especially in a place like New York City, where you have subways and buses, you know, you have a system of public transportation. There nevertheless are hospitals where poor people go and hospitals where wealthier people go. It’s like they— like, we manage to segregate populations in these tiny geographical regions.
And I just, you know, I would like to denaturalize that phenomenon. I would like for people to pick up this book, read it, put it down, and then say, “That’s weird.” Because wherever they’re reading it, wherever they’re reading in whatever city or suburb or, um, rural area that they’re living in, they will be able to observe healthcare segregation, Um, in their, in their, in their space, in their region. And so I think it’s weird, but that healthcare segregation is also contributing to racial disparities and maternal mortality and morbidity that persists across income levels. In these high Black-serving hospitals, like, there’s actually names for them in the literature. In high Black-serving hospitals, they just have poor health outcomes across the board.
So even white people, even non-Black people who receive their care in high Black-serving hospitals, can expect inferior outcomes versus those that receive their care in low Black-serving hospitals. So it becomes like a strategy of survival. As you know, especially amongst the class-privileged Black people that I was working with for Expecting Inequity, it becomes like a strategy for survival to make sure that one is getting one’s care from a low Black-serving hospital because it just increases the odds that you’ll be able to survive your pregnancy and maybe even have a joyful experience.
GWYNETH SHAW: So you worked on this book for more than a decade, and this is during a time of great upheaval in the healthcare system. So COVID obviously was a big part of some of the timing of your research, but also, you know, Roe is gone, and there’s all kinds of different reproductive rights things that have happened during the time you’ve been writing this. I know you propose solutions at the end of the book.
A decade from now, what changes do you hope have been made? You just mentioned one about trying to solve the problem of segregated hospitals. What else would you like to see looking forward a decade from now?
KHIARA M. BRIDGES: Oh, man. Um, yeah, it’s, you know, it was hard to write the conclusion of the book. Um, ’cause, you know, in the conclusion, I proposed solutions, and, um, my editor proposed that I end on a hopeful note, and I just thought that was disingenuous.
Um, you know, I’m writing this book and, you know, I was writing the conclusion at the very beginning of the second Trump administration, um, when all of the horrors were being unleashed, you know, the campaign promises were being pursued, these attacks on DEI and CRT were intensifying. And, you know, I just wanna pause and just note how critical I’ve been in the past of, like, diversity, equity, and inclusion type things because I’ve always felt that they were not structural, um, in terms of their transformation. I’ve always thought that, um, or many times they have been marketing and branding and, um, value signaling. And so I greeted the attacks on DEI first with apathy because I didn’t really think that these programs were doing anything. But then also with fear and trepidation, because if these, what appeared to me to be cosmetic programs were being eliminated, then like the actual programs that can do the work, and that can redistribute the resources, and that can really take on structural racism. Like, we have no hope for those.
And so anyway, I’m writing the conclusion at the beginning of the second Trump administration, and my editor, my um, publisher is telling me to, “What can we do to solve the problem?” And so I was like, “Well, okay, so we have to create a new world.” That is the solution.
We need to create a new world. We need to create a new system of healthcare delivery in the US, and we need to eradicate racism. And so in 10 years, I would hope that we have moved away from a healthcare delivery system that has as its engine the profit motive. The profit motive is perverting the quality of care in the US for everyone. For everyone.
As I say at the, in the conclusion of the book, like, if we were to truly move towards a healthcare delivery system that focuses on patient outcomes as opposed to generating the most wealth from the delivery of healthcare, it would really, really help people of color who suffer, you know, poorer health outcomes relative to their white counterparts. But it would actually really help white people as well. Like, this is like, this is an intervention that would be good for everyone. The only sort of actors who would not be benefited by a move to a healthcare delivery system that is not motivated by generating massive profits, the only actors who wouldn’t benefit are those that are generating massive profits from our current healthcare delivery system.
So I would like to see in the next 10 years a move towards something that is less governed by capitalist logics of wealth accumulation. I would also like to see, and I think part and parcel of that is a dismantling of our two-tiered healthcare system where poor people have to, you know, try to get healthcare through this Medicaid insurance that is not funded at all or not funded well, not funded adequately. Whereas, you know, well, people with class privilege have commercial insurance that they access through their employers. I think that’s a very bizarre system, and that is a system that’s contributing to the poor health outcomes that we just have as a general matter in the US. And then in 10 years, whoo, this is fanciful, but I would love to see the US start to take racism seriously. Like racism is killing people of color. It’s killing them, and it’s killing them in spectacular ways that make headlines, like when, you know, an unarmed Black man gets, you know, killed in the streets, or a Black woman is awakened to police kicking down her door and shooting and killing her in her bed, right? So it kills— So racism kills in those spectacular ways, but it kills in these, like, banal ways. It kills in these invisible ways.
Like, I wonder if I would still have… All of my grandparents are dead. Pa- maternal, paternal grandmothers and grandfathers are dead, and I wonder if I would still have them with me if they didn’t have to navigate anti-Blackness for their, you know, throughout their entire lives. Um, Yeah, I just— I, I— if we— the Black maternal health crisis in the U.S., like we have to take it seriously.
Like I say at the conclusion of the book, like, people of color in this country now, but also before, you know, these ICE raids—like people of color have experienced daily life as a series of hostilities. It’s like walking down the street, going into work, coming back home, turning on the internet, don’t look in the comments, right?
Because anti-Blackness is very comfortable in the comments. It’s like we have to be safe. And safety is incompatible with racism. And so I would like to see real efforts made to make race matter less, because right now race matters a lot.
GWYNETH SHAW: Well, thank you so much for this really great and important conversation, Khiara.
KHIARA M. BRIDGES: Thank you for listening.
GWYNETH SHAW: Expecting Inequity is available now, and Professor Bridges will be on a book tour this spring. Please check the show notes for more information and links to some of her other work. Thank you so much for listening.
And if you enjoyed this episode, please share it. And be sure to subscribe to Voices Carry wherever you get your podcasts. Until next time, I’m Gwyneth Shaw
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