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This chapter first explains how the American medical establishment has never mobilized on behalf of the African American population. That the ongoing medical calamity experienced by the African American population since the Emancipation of 1865 has never provoked the public outrage or the political mobilizations associated with other forms of racial injustice and suffering, such as Jim Crow segregation and the repression of black voting rights. The discussions then turn to the medical defamation of black people by whites in positions of authority; evidence that doctors employ racially motivated thinking when dealing with patients of color; American medicine's ambivalence toward the hundreds of studies documenting racial disparities in health care; liberal analysis of physician behavior; and the creation of a racially differentiated human biology that has influenced medical thinking in significant ways.

The introduction sheds light on the crisis of premature birth among Black women. It lays out the theoretical terrain on which premature birth is generally understood and develops the rationale of linking the issue to past ideologies and practices of medical racism. Premature birth and medical racism are introduced through the birth story of a young African American woman who was a college student when she became pregnant and later gave birth to a daughter, born three months prematurely, who was admitted to a neonatal intensive care unit (NICU). Grounded in a Black feminist framework, which privileges Black women’s experiences as a site of knowledge production, the chapter describes the book’s theoretical foundation; its methodological approach; and its use of birth stories, interviews, ethnographic observations, and archival sources to understand Black women’s medical encounters.

This chapter discusses the African American medical condition as a form of “internal colonialism” and how American psychiatry has treated African Americans over the past century. It begins by considering debates over the idea that African Americans have been subjected to a form of colonial medicine. It then explains how African Americans have never been allowed to shed their involuntary role as imaginary African “natives”; American psychiatry as racial medicine; the “colonized” status of African Americans in American psychiatry for most of the twentieth century; the Task of Black Psychiatry; and the “colonial” status of African Americans within the American medical system.

Having examined the history of prematurity, Black women’s experiences of pregnancy, labor, and birthing, and their assessments of medical racism, this chapter gestures toward some approaches to address Black women’s high rates of prematurity. These approaches may also be applied to rates of infant and maternal mortality, as well as to addressing the adverse birth outcomes of other groups. Presently, much emphasis is placed on stereotyping the characteristics believed to cause prematurity. The general approach is to intervene in the problem. This chapter suggests that preventive approaches to birth outcomes must be deployed with the same commitment as is done with interventions. Transforming the model of care requires viewing pregnancy as an event, not a risk. And, unless risk is well established, pregnancy care need not be medicalized. In the event that medical interventions are necessary, a team-based model of care is preferable. Medical providers should be sharing the care with the family, a midwife, and a doula. Most important, medical professionals must acknowledge the ways that they uphold racism in their practice of medicine.

This chapter discusses racial interpretations of human types and traits. These include racial interpretations of black infants and children, black elderly, black athletes, black musical aptitude, losing consciousness, the nervous system, pain sensitivity, heart disease, human organs and disorders, the eyes, black skin, human teeth, and “white” and “black” disorders. It also considers notions about the physical and emotional hardiness of blacks. The long and influential careers of “white” diseases and folkloric ideas about black “hardiness” confirm that racial interpretations of health and disease have pervaded medical culture, even in the absence of overt efforts to promote this kind of thinking. The remainder of the chapter deals with racial folklore in medical specialties and the role of racial folklore in obstetrics and gynecology during the twentieth century.

This chapter describes the complex and sometimes contradictory nature of race and gender preferences among middle-class Black women. First, the author presents a case study of Tammy, a focus group respondent whose great-grandfather was involved in the Tuskegee Syphilis Study. Although her case illustrates underlying assumptions of the race concordance hypothesis (that Black patients want Black providers), her story also points to the persistence of structural discrimination and limits of using race concordance as a strategy to overcome it. Second, Tammy’s case is contrasted with women who complicated the underlying assumptions of the race concordance hypothesis by emphasizing the intersection of race, gender, and other identities (e.g., disability, age, sexual orientation) on the formulation of preferences and the futility of race concordance as a strategy to mitigate the effects of a rushed, impersonal, and neo-liberal healthcare environment.