Adia Harvey Wingfield | Vox

Abortion bans criminalize doctors. For black physicians, the risks are even higher.

2020-03-03T12:36:13-05:00

Police stand guard between a group of anti-abortion protesters and a group of abortion rights activists outside a clinic in Little Rock, Arkansas. | Greg Smith/CORBIS/Corbis via Getty Images

On Wednesday, the Supreme Court will hear oral arguments in June Medical Services v. Gee, which will focus on whether doctors performing abortions must have admitting privileges, or permission to admit patients for treatment, at nearby hospitals.

These laws are being used to undermine Roe v. Wade. In Louisiana, where this case was originally filed, the law would shut down all of the state’s abortion clinics. But similar laws were long used to maintain divides not just in who has access to care, but who provides it.

Historically, hospitals used admitting privileges to maintain racial segregation. By refusing to allow black doctors to admit patients to hospitals that served whites, hospitals could ensure that black doctors (and patients) were relegated to segregated facilities. This gatekeeping practice left black practitioners without the same opportunities, facilities, and resources as their white counterparts.

Today, admitting privileges rules and other legislation, such as “heartbeat bills” that outlaw abortion after fetal pole cardiac activity can be detected, make it harder for patients seeking abortions to do so safely by limiting access. These laws stand to disproportionately affect pregnant people who are low-income and/or of color. But left out of the conversation is that they put black health care providers in danger, too, by risking criminal prosecution for those who perform these abortions.

When it comes to the medical field, black practitioners are significantly underrepresented. Black workers are only about 4 percent of practicing physicians and 9 percent of nurses. And like underrepresented professionals in other fields, black health care providers face some common challenges: assumptions of incompetence, racial stereotyping, and subtle suggestions that they are not qualified for their jobs. Laws that erode medical practitioners’ authority have the potential to worsen existing obstacles for black health care professionals who already occupy a tenuous position in the field.

For the past 15 years, I’ve been conducting research on black professionals working in the health care industry. My findings suggest that widespread racial stereotypes of black people as less intelligent, capable, and hardworking than white people create workplace environments that are unwelcoming and stressful for black health care practitioners.

In one interview, Dante, a doctor, identified here by a pseudonym to protect his privacy, told me he has always been watched more closely and had his work second-guessed by colleagues and even subordinates: “I’ve been accused of not practicing medicine correctly by a nurse, [one time] by a respiratory therapist. And they would never think to say this to a white doctor. [They would think,] ‘He did it different than we’re used to.’”

Dante went on to say that as a result of the nurse’s accusations, the hospital decided — in a violation of its written policy — to open up an investigation into his work. For Dante, this additional level of scrutiny was a source of frustration and anger. It also had material costs, as he kept a lawyer on retainer to protect him from unjust retaliation.

Other black doctors described the challenge of getting patients to trust them. Max, an emergency medicine doctor, reported, “I’ve taken care of patients [who] made it very clear—‘I’ll sue you if you don’t get me a white doctor.’” These patients did not bother to conceal their suspicion and distrust, nor the fact that their concerns were racially motivated.

Let’s also not forget how rampant stereotypes of criminality disproportionately affect black workers, even when they’ve done nothing wrong. Even black doctors from elite schools who practiced in the nation’s best hospitals were still not immune from the reach of these tropes. One doctor, Yusef, recalled an incident when he and his colleagues learned that someone had been impersonating a doctor and stealing supplies. The administrative assistant publicly accused Yusef of the theft. Despite having worked at his hospital for three years in a highly visible role, Yusef found himself a suspect.

Some doctors have already noted that legislative bans will make their jobs significantly more difficult by obstructing the doctor-patient relationship, curtailing their autonomy, and causing them to weigh providing care with the threat of prosecution. But my research indicates that these bans may have a chilling effect for black doctors in particular.

Black physicians already encounter environments where patients, colleagues, and subordinates may be more likely to undermine their authority, question their judgment, and openly doubt their capabilities. What happens when these doctors — who already deal with heightened visibility — do this work knowing that they could potentially be charged with crimes for exercising their best medical judgment?

And in states that bring criminal cases against doctors who perform abortions, bans may put black physicians at higher risk of prosecution. In 2012, a black Baltimore doctor, Nicola Riley, was charged with murder under Maryland’s fetal homicide law after an abortion she performed resulted in serious complications for the pregnant patient. Riley’s case was the first time this fetal homicide law was applied to a doctor attempting to provide an abortion in the state. It underscores the risks for doctors when abortions are criminalized, and the potential for black doctors to face higher scrutiny and possibility of prosecution.

Of course, pregnant patients who are low-income and/or people of color will likely be affected the most by these bans. But it is important to highlight that these patients are also the ones who are most likely to be seen by black providers — who are themselves uniquely impacted by these proposed laws.

Abortion bans ask black doctors, who already often face hostile environments, to surmount these barriers in an environment where they could face criminal prosecution simply for doing the work they were trained to do.

Adia Harvey Wingfield is the Mary Tileston Hemenway professor of arts and sciences and associate dean for faculty development at Washington University in St. Louis. Her most recent book is Flatlining: Race, Work, and Health Care in the New Economy.

Abandoning public education will be considered unthinkable 50 years from now

2019-05-06T14:34:21-04:00

Part of Hindsight 2070: We asked 15 experts, “What do we do now that will be considered unthinkable in 50 years?” Here’s what they told us.

Adia Harvey Wingfield is a professor of sociology at Washington University in St. Louis. She is the author of Flatlining: Race, Work, and Health Care in the New Economy.

For many parents, when it comes to their children’s educational opportunities, they want only the best. American parents are often driven by the belief that educational advantages will allow children to accomplish ambitious goals. Thus, parents’ educational decisions are deceptively simple — do whatever it takes to get children into the best school available.

But in 50 years, we’ll look back at how a declining public sector has led to a dizzying array of increasingly out-of-reach options — whether that’s private schools, charter schools, or “good” public schools in inaccessible expensive areas — and consider it unthinkable. We’ll be living in a much more demographically diverse country, likely reconsidering what choosing “the best” looks like and thinking more about how all too often, uncritical definitions of what’s best reproduce racial and economic inequality. In this light, it will be necessary to reinvest in public education so that it becomes more of a democratizing force and less a mechanism for maintaining inequality.

Prior to Brown v. Board of Education, most US students attended local public schools. Of course, these were also strictly racially segregated. It wasn’t until the Supreme Court struck down legal segregation that a demand for private (and eventually charter and religious parochial) schools really began to grow, frequently as a backlash to integrated public institutions. In 2012, for instance, a study done by the Southern Education Foundation showed that in Mississippi, white students comprised 51 percent of all school-age students but an overwhelming 87 percent of all private school students. This pattern holds across Southern states that demonstrated resistance to school integration.

Today, proponents of our current educational system of unfettered school choice argue that diverting local, state, and federal funding to these varied types of schools creates necessary options and gives parents more control over their children’s education. But this narrow, individualized focus maintains the racial and economic disparities that desegregation was supposed to eradicate. School is viewed less as a public good and more and more as something we buy access to, and thus driven by income and wealth.

Those with more money can afford to live in areas with top public schools or pay to send children to private school. Study after study has shown that all children are not exposed to the same educational opportunities, but that those in high-income families have a significantly easier time accessing high-quality education. Additionally, as intergenerational mobility has stalled, higher-income parents have become even more devoted to hoarding educational opportunities for their children. In a changing world with less social mobility, parents often believe that education will give their children elusive tools necessary to advance in an increasingly competitive society.

This individualist attitude toward picking the “best” school for kids also reproduces racial inequality. Sociologists have shown that for white families, “best” is often shorthand for “white,” even if the school in question does not necessarily evince better educational outcomes than its more multiracial peers. White families often use cash gifts and inheritances passed down from family members as a way to purchase homes in predominantly white neighborhoods or send their children to predominantly white schools. Doing so serves to reproduce residential racial segregation, while maintaining the wealth gap that leaves black Americans with approximately one-tenth of the wealth held by whites.

No one is suggesting that in the future, parents will (or should) solve this problem by finding the worst possible schools in which to educate their children. But as people of color are an increasing segment of the US population, educational barriers that disproportionately affect a growing majority of our citizens are counterproductive. Instead, we’ll need to recognize that investing in the public sector (including but not limited to schools) helps a wide segment of Americans. If not, we’ll look back and realize that sacrificing the public sector on the altar of “school choice” and individualism has left us unprepared for an increasingly multiracial society.