A recipient of the Harvard University Maternal Health Task Force Global Visionary Award for Commitment to Advancing Women’s Health, Dr. Crear-Perry is a thought leader, advocate, and trainer in issues concerning racism as a root cause of health inequities, best known for her work to remove race as a risk factor for conditions such as premature birth. The following are some highlights from an edited transcript of the interview. Mary C. Curtis: As a leader and expert on the issue of racism in the healthcare system, tell us about how that led you to recognize a particular need, and to launch the National Birth Equity Collaborative. Joia Crear-Perry: In my training in medical school in the late 1990s, I was taught that there were three biological races. I had an embryology professor who said that there were three races. He was teaching about skin: Mongoloid, Caucasoid, and Negroid. My classmates and I organized to have him fired for teaching such antiquated and nonfactual information. The fact is, he had been teaching that for generations or for decades at my state public medical school in Louisiana. Many people still are practicing around the world believing that the reason we have inequities in health outcomes is because race is biological, because people make bad choices, that there’s a genetic basis. My son, who is now 24 years old, only weighed about a pound when he was born. I had him in medical school, and the only risk factor I had at the time was being Black. I was married. I was planning to be pregnant. I was healthy. As we evolve our understanding about the impact of racism, we know that there is no genetic or biological basis of race, that race is a social and political construct. It was not my Black skin that made my son come early, but the way that my Black skin is treated, the way that racism impacts my body. And so really undoing this belief, and ensuring that we focus on the real factors of racism, classism, and gender oppression as to why we have poor birth outcomes, that’s why we started the National Birth Equity Collaborative. Mary C. Curtis: Can you talk about how reproductive health, which is a specialty, is so linked to other unequal outcomes in the healthcare system? Joia Crear-Perry: The thing about being a Black woman is that both identities come together. Black people are twice as likely to have diabetes, twice as likely to have obesity, but when it comes to reproductive health, like maternal mortality, we’re three to four times more likely to die in childbirth, and in places like New York City, 8 to 12 times more likely. Add on the way that we have always devalued women and a culture that sets gender identity around what women’s roles are and that they should stay home and not work. You see that even play out right now during the pandemic. Women have been the social safety net for the United States of America. We’ve not invested in childcare. We’ve not invested in paid leave. So now that women have to work from home and also be the social safety net, you see that breaking, because we’ve never invested in real infrastructure they way other countries have. Day care. Childcare. It should be a requirement. Our choices around reproduction, our access to abortion, contraception, all those things have always been treated as a thing we have to fight for, fight to be seen — that we can have control of our own body. So being both Black and a woman puts both of those oppressions together to create the outcome that you see in the United States and across the globe.
