The Mississippi Appendectomy

This chapter begins with a discussion of the historical antecedents of reproductive healthcare for Black women in America, including an overview of the overuse of hysterectomies among Black women, sometimes referred to as the “Mississippi Appendectomy.” The chapter outlines a theoretical framework, including racial essentialism in medicine, from which to understand contemporary reproductive health issues—particularly in the treatment of fibroids and hysterectomy. The chapter also illustrates contemporary practice patterns in which healthcare providers seemed to vacillate between dismissing women’s healthcare concerns to recommending intensive interventions, like major surgeries, to address common gynecological problems that may be treated with less invasive procedures.

Invisible Visits

This chapter presents the first key finding of the book. In it, women describe their perceptions of healthcare providers including the challenges they face trying to avoid race, gender, and other forms of discrimination. The chapter also analyzes how the specific stereotypes levied against Black American women negatively affect their relationships with healthcare providers. Furthermore, the chapter presents specific strategies Black women use to mitigate discrimination including emphasizing their cultural health capital (e.g., facility with medical terminology) and socioeconomic resources. However, these data suggest that the strategies women use to resist discrimination may still be experienced as a form of stress that negatively affects their health.

The Black Middle Class in White Space

This chapter describes and analyzes the Black middle class in the United States with a particular focus on how this group fares in healthcare settings. The author defines the term “Black middle class,” including data on the group’s economic well-being. The chapter argues that American healthcare institutions are best characterized as predominantly White institutions in which Black people are vulnerable to stereotyping and structural discrimination. The author describes the concept of stereotype threat and health-related stereotype threat, applies it to the study of health disparities among the Black middle class, and emphasizes implications for Black women. The chapter also presents empirical research on how racial stereotyping, allostatic load, and stress negatively affect Black people’s health.

Conclusion

This chapter summarizes the book’s main points including the idea that stereotype threat negatively affects Black women during the healthcare encounter and that women feel they must adjust their behavior to mitigate pervasive stereotypes. It also critiques the prevailing framework in health disparities research as being ahistorical and decontextualized. The chapter summarizes the women’s healthcare experiences, pointing to prevailing negative stereotypes about Black women that follow them into the doctor’s visit despite their class or educational status. Women tried to emphasize certain elements of their persona particularly vis-à-vis their cultural health capital. In other words, to be visible to their providers, they tried to leverage certain skills that are valued in the contemporary healthcare space, such as the ability to convey health information in a rational and efficient manner or take an instrumental approach to one’s body. The chapter closes with a discussion of structural interventions to address differences in treatment.

Patient Preferences

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.

Introduction

Invisible Visits tells the story of middle class Black women whose experiences of race and gender discrimination in healthcare settings are all but overlooked in social science research. The book uses interviews and focus groups to analyze how the perception of bias and stereotyping affect healthcare for Black women who are not poor but remain socially and economically vulnerable nonetheless. The introduction argues that these women anticipate being stereotyped and often feel they have to emphasize hard won skills, like their education or careers, to push back against their physician’s biased or discriminatory views. This chapter also presents data on healthcare and health outcome disparities among Black middle class women. In so doing, it lays the groundwork for the remainder of the book.