Book Excerpt: "Systemic: How racism is making us ill" by Layal Liverpool

Systemic: How Racism is Making Us Ill" is a recently released book by Layal Liverpool that explores the impact of racism on minoritised communities' health around the world. Tackling topics ranging from maternal health, to mental wellbeing, racism in the health system, and epistemic injustice, Layal Liverpool provides a wealth of evidence and anecdotes that illustrates how racism is embedded in society, with a special emphasis on the health system. Systemic is a well-evidenced and story-driven piece of non-fiction that anyone curious or passionate about racial juistice could learn from. It is a particularly important read if you work in clinical, research, and/or public health settings.

Check out an excerpt from the book below, and learn more about Systemic from the publisher.

Layal Liverpool is a journalist whose work spans diverse science topics, including technology, physics, the environment and health, with a particular focus on inequalities in science, health and medicine. Her writing has appeared in Nature, New Scientist, WIRED, the Guardian and elsewhere. Before moving into journalism, Layal worked as a biomedical researcher at University College London and the University of Oxford. She has a PhD in virology and immunology from the University of Oxford. Systemic: How Racism is Making Us Ill is her first book.

Excerpt from Chapter 1: Pregnancy and childbirth

In October 2015, Londoner D’lissa Parkes was in early labour and in pain. But when she presented to hospital, her doctor insisted that what she was experiencing was normal because Black women’s pelvises were shaped differently compared with White women’s.

The following morning, D’lissa went fully into labour and was taken back to hospital where she was rushed for an emergency caesarean. She died after a blood clot in her lungs caused her heart to stop.

In a blogpost several years later, her mother Sylvia wrote: ‘I will always maintain that her death could have been prevented if she was taken seriously when she attended the hospital on the day before she died and was sent home. I’m not a medical expert ... but I’m her mum.’

The idea that Black women’s pelvises are shaped differently from White women’s – which D’lissa’s doctor referred to – is deeply problematic.

In 1933, New York-based obstetricians William Caldwell and Howard Moloy published a description of female pelvic anatomy whose legacy persists in modern medical and midwifery textbooks. Caldwell and Moloy analysed human skeletons from a collection assembled in the early 1900s and categorised female pelvic shape into four subtypes, including ‘gynecoid’, ‘platypelloid’, ‘android’ and ‘anthropoid’.

These categorisations built upon designations made by the British anatomist William Turner in the 1800s. According to Turner, the gynecoid pelvic shape was ‘characteristic of the more civilized and advanced races of mankind’ – White Europeans – while the anthropoid shape ‘was more frequently observed in the lower races of man.’

The Caldwell-Moloy classification helped transfer these racialised categorisations into the obstetrical literature in the twentieth century, just as hospital birth was becoming more common. In 1949, the anthropologist Adolph Schultz at the Johns Hopkins University School of Medicine in Maryland published a paper comparing measurements of pelvic bones between the ‘adult female Negro’ and adult female non-human apes and monkeys. Numerous studies also continued to compare pelvic shape between Black and White people.

A 2002 study which analysed eighty skeletons taken from the Hamann-Todd human osteological collection – the same collection used by Caldwell and Moloy – concluded that pelvic floor area was 5% smaller in African American women compared with European American women on average. But at the time those skeletons were collected, specimen collectors categorised them as ‘Black’ or ‘White’ in part based on racialised assumptions about pelvic anatomy, introducing a clear bias.

A more recent analysis of pelvic CT scans from 64 female volunteers in Australia found no obvious clustering into the four pelvic types in the Caldwell-Moloy classification. That study recommended that teachers and authors of midwifery, obstetrics and gynaecological texts be more cautious about continuing to promote the Caldwell-Moloy classification.

Human pelvises come in all shapes and sizes, and that has nothing to do with race. D’lissa’s doctor was mistaken – and, unfortunately, he isn’t alone. Racist ideas about pelvic anatomy are part of a wider history of racism in obstetrics and gynaecology. Raising awareness of this is a crucial first step towards tackling the problem.

Layal Liverpool is a science journalist and the author of Systemic: How Racism Is Making Us Ill.

Check out the book: https://www.penguinrandomhouse.com/books/739907/systemic-by-layal-liverpool/