It also involves demonstrating marital status, the importance of wearing a wedding ring at all times, even when it was uncomfortable during pregnancy, because you’d want to signal that, first, you’re not a stereotype: a poor, unmarried Black person who is having babies to increase the size of their welfare check. But also you want to signal that somebody cares for you deeply. And that because somebody else cares for you, the provider should care for you as well.

But then also, one of the more surprising things that I found was that when a Black woman was married to a non-Black man, specifically a white man, they would bring their white husbands into their appointments to say, ‘Hey, a white man cares about me. So I am deserving of quality health care.’

What was surprising to me about it all was the awareness that Black women had that they were making these strategic choices. They were deliberately undertaking these efforts in order to avoid becoming yet another Black maternal death.

As I read the book, I was struck by your own exasperation, sometimes your own anger. Did I read that right?

In a lot of ways in my scholarship, I’ve become a petulant 2-year-old. Where I’m saying, ‘It’s not fair. It’s just not fair.’ And that’s the book in a nutshell: It’s just not fair that we have created these conditions.

Over the course of several generations, we have naturalized these conditions. Many people hear about the statistics describing Black people’s higher rates of maternal deaths — and they move on with their days. So it’s perceived as this natural, normal feature of American life that Black people are just dying more frequently than white folks during pregnancy and childbirth.

It’s just not fair that individuals who have no culpability, no responsibility for these systemic failures, are being asked to figure out a way to navigate them during one of the most vulnerable moments of their lives. It strikes me as an incredible injustice.

[Listen to Khiara M. Bridges on “Voices Carry,” the Berkeley Law podcast hosted by Gwyneth Shaw, at the link or below.]

Your book uses both quantitative data and human stories to illustrate the risks confronting Black people who want to have a baby. Are there one or two stories of women and their experiences that linger with you?

The story that comes back to me time and time again is the one that I tell at the beginning of the book. It’s this woman who was pregnant with her second child when I interviewed her. She was in her late 40s. She’d had her first experience with gynecological care when she was 15 years old — after she had been sexually assaulted. 

During the rape, she contracted a sexually transmitted infection, which was later identified as herpes. This was her first sexual experience. What a trauma, right? Trauma on top of trauma.

And so, as a 15-year-old girl, she seeks healthcare, and the gynecologist that she sees was horrible, like a movie villain. He tells her she’s worthless, that she’s promiscuous and that she brought this on herself, and that she’s dirty. And this is happening during her first gynecology appointment.

One reason this story stays with me is that this 15-year-old girl at the time was at the top of her class. She was the daughter of a physician. She was going to an elite private school. She had access to all of these opportunities. She actually had been sexually assaulted while she was doing a study abroad program in Italy.

So many of the Black people I interviewed are “winning”: they’re wealthy, they have high incomes, they have degrees from Yale and Harvard and Stanford and UC Berkeley. They have all of the accoutrement of success, but they still encounter neglectful and negligent healthcare. They still are not believed when they report their symptoms. They still are presumed to be undeserving of quality healthcare.

In so many of the stories that I tell in the book, the point is to demonstrate that we can’t buy an exit from racism in this country.

Your book suggests that society tends to assume that Black people are affected by these health conditions at higher levels because of genetics or culture. But you dismiss those assumptions forcefully.

Proposing that Black people have genes that predispose them to death, first of all, has no empirical basis. There is no theory of evolutionary biology that would explain why people with African ancestry evolved to have genes that predispose them to hypertension, and diabetes, and kidney disease, and lung diseases, and maternal deaths and infant deaths.

Second, in addition to having a law degree, I’m a sociocultural anthropologist by training. The object of anthropology is culture. If you look at the literature — the literature that proposes that culture has some explanatory value when it comes to racial disparities in health — they’ll say Black culture is religiosity, believing that one’s religion will heal you as opposed to medication. Black culture is not exercising. Black culture is fried foods. Black culture is feeling close to family. But it’s such a caricature of Blackness.

Blaming racial disparities in health on culture as well as genes is a way to get us to not focus on the things that are actually causing higher rates of morbidity and mortality among Black people. If we want to stop Black people from being sicker and dying earlier than others, we need to reckon with structural racism.

Blaming genetics or culture allows society to abdicate responsibility for the avoidable deaths that are happening every day.