Understanding What Epistemic Injustice Means for the Black Community
By: The Daily Coalition
Tags: Race, Medicine, Preeclampsia, Injustice, Pregnancy

Epistemic injustice — coined by philosopher Miranda Fricker in 2007 — is defined as the phenomenon by which an individual is wronged in some capacity, and transforms into a form of injustice that may result from the censoring of knowledge or even unequal paths of obtaining knowledge. While epistemic injustice may be categorized into both testimonial and hermeneutical injustice, the latter will be used to indicate the oppressions women face. Testimonial injustice is when a patient’s testimony is denounced as non-credible by their physicians and health providers, whereas hermeneutical injustice is defined as when the patient is unable to label their social experiences due to a lack of knowledge or conceptual understanding.

As per researchers Mulligan and Felton, African American women have a much higher risk of vitamin D deficiency compared with other women due to “increased skin pigmentation and low dietary intake”. In pregnant women, while 90% of study participants reported taking prenatal vitamins, “at delivery, vitamin D deficiency occurred in 45.6 % and 46.8% of black neonates”. For this statistical reason, it is clear that while most women have the knowledge and resources to gain access to prenatal care and report having been understood by their clinicians, there is another unknown underlying factor resulting in this health disparity. Researchers deduce that “low calcium levels, perhaps through vitamin D mediation, ultimately lead to the development of preeclampsia”; however, there is no evidence to suggest that “an increase in calcium levels decrease incidence of preeclampsia”. Therefore, it is suggested that “studies that count for confounding variables […] such as ethnicity, nutritional status and sunlight exposure are needed”.

Keeping these variables in mind, it is important to understand the historical data that contributes to African American women genetically being predisposed to deficiency despite nutritional supplements. The idea of social determinants of health is increasingly important here, and offers a clear connection to hermeneutical injustice. Social determinants of health are conditions under which people live, and therefore black women who are affected by structural inequality coupled with the chronic stress of poverty and racism, having great effects on health outcomes. In addition, it is known that 75% of Black women give birth at hospices that serve black communities, which indicate having higher rates of maternal complications and providing lower quality maternal care. Therefore, black women who seemingly follow up on their gynecology appointment, take prenatal care, and guidance precautions are systematically more likely to face a vitamin D deficiency as a result of their genetic predispositions coupled with systematic oppression.

Evidence of cardiac damage present in patient suffering from post-preeclampsia damage.

In addition, African Americans with darker skin pigmentation induces lower vitamin D production levels due to higher melanin presence. According to the Economic Policy Institute, black women’s main jobs historically have “been in low-wage agriculture and domestic service […] most employers would only hire black women in domestic service work”. Therefore, the nature of women of color’s works have been restricted to mundane indoor work, furthermore preventing an environment that stimulates vitamin D production. Such forms of discrimination is often unknown to women of color, unable to piece together the link between environmental discrimination, genetic dis-favorability stemming from the era of slavery, as well as in access to reproductive care. While African American women of their inequality in each of these separate fields, it becomes increasingly more difficult to analyze the oppression that results from each of these fields on each other. Especially when analyzing maternal care, the environment, workforce, as well as medical care all impact the outcome of maternal health, and is therefore responsible for the highest mortality rates of any ethnic groups. This incidence is a clear example of hermeneutical injustice, as it takes on a form of strategy of exclusion; as employers continue to discriminate against women of color, medical professionals continue to dismiss preconditions due to a lack of screening, a pregnant woman of color is placed at an epistemic advantage when trying to understand their condition.

Some potential solutions to overcome this systemic issue is to adopt an intersectional approach to bridge gaps of discrimination women of color face in the workforce, their environment, as well as in healthcare. A study conducted on California women indicate that “Black women were less likely than white women to review postpartum contraception”. Therefore, policy makers must expand and maintain access to health coverage, provide individualized care for black women, and address “social determinants of health”.

In addition, by adopting a more intersectional approach, states must also force medical facilities to participants in alliances that are focused on improving maternal health, such as the Alliance for Innovation on Maternal Health. Furthermore, the establishment of a maternal mortality review committees at major hospitals will allow individual hospitals to understand the trends of mortality per geographic region and address best outcomes to prevent pregnancy related deaths; for example, review committees should allow the inclusion of community advocates, patients, and medical professionals to cohesively provide real outcomes. Finally, physicians and clinicians must act as advocates for their black patients in educating them about their preconditions and their causes. In addition, patient outcomes may also be improved by short waiting times at prenatal care centers, increased patient-clinician interaction time, availability of ancillary services, as well as increased number of clinical staff per medical case. A possible objection to the intersectional approach is the idea that focusing on black women may only benefit a subset of black women who are already ahead, for example, those hailing from rich affluent backgrounds will be more benefited than women of lower income. However, in rebuttal to that counterargument, the approach of intersectionality works its way from the bottom up, therefore if we were to address the obstacles for those who are most unfairly held back by our society, then those in the middle get automatically uplifted, too.

Vitamin D deficiency is a plaguing precondition that claims the lives of many women of color during pregnancy, leading to preeclampsia. Such a condition results from years of systemic oppression and a lack of knowledge of the discrimination; understanding that such a deficiency is due to the discrimination from work environment, genetic un-favorability from the time of slavery, as well as lack of medical awareness, is a form of hermeneutical injustice.To overcome such form of oppression, we must adopt community awareness programs that begins at a hospital level, increase funding for data that allows researchers to identify trends in material death, as well as approaching an intersectional angle in caring for black mothers. To improve maternal health outcomes, systemic change is at large.

Citation:

Dahlem, C., Villarruel, A., & Ronis, D. (2015, February). African American women and prenatal care: Perceptions of patient-provider interaction. Retrieved October 30, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233201/B. (2018, April). Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities. Retrieved from https:// www.nationalpartnership.org/our-work/resources/health-care/maternity/black-womens- maternal-health-issue-brief.pdf

Flanders-Stepans, M. (2000). Alarming racial differences in maternal mortality. Retrieved October 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595019

Chuck, E. (2020, January 30). The U.S. finally has better maternal mortality data. Black mothers still fare the worst. Retrieved October 30, 2020, from https://www.nbcnews.com/health/ womens-health/u-s-finally-has-better-maternal-mortality-data-black-mothers-n1125896 B. (n.d.). Epistemic injustice in healthcare encounters: Evidence from chronic fatigue syndrome’.