For years, one of the most well‐known responses to the question of why Black women's birth outcomes were adverse was race. Race, an erroneous belief in the biological difference between people as the explanatory factor, reigned supreme among scholars, policymakers, health‐care workers, and the general public. Race has also been a proxy for culture or lifestyle paradigms, as Leith Mullings (2002) noted, and is often viewed as operating independently from social and historical processes.¹1 This commentary is written in honor of Dr. Leith Mullings. Mullings profound work on “The Sojourner Syndrome,” developed with Dr. Alaka Wali, closes a theoretical gap in understanding what Black women live through, with, and around as they engage in both biological and social reproduction. This commentary was inspired by Mullings’s 2002 article “The Sojourner Syndrome: Race, Class, and Gender in Health and Illness” and was written the day after she passed on December 13, 2020.

More recently, several Black feminist scholars, researchers, and activists have pointed to the historical, social, and political record to challenge that race is a risk factor for birth outcomes. Indeed, they maintain, as several have noted, that it is not race but racism that culminates on Black women's bodies and influences maternal and birth outcomes and medical experiences (Crear‐Perry 2018; Harmon, 2018; McLemore et al. 2019; Mullings and Wali 2001; Novoa and Taylor, 2018; Wynn 2020).

We know, for instance, that the disciplines of obstetrics and gynecology were developed using harmful exploration and experimentation on enslaved Black women's bodies (Cooper Owens 2017; Washington 2007). We also know that the structures of care provided by Black grand midwives and the knowledge they possessed from the time of enslavement through the 1950s was decimated by white male physicians and white female certified nurse midwives (Goode 2014; Oparah and Bonaparte 2016. The societal circumstances in which Black women's reproductive health exists offers a deep look into the pathological oversight that medicine used to control, govern, and monetize their reproduction at every turn in history. We know this governance is asserted in many ways, including that racial capitalism forced and constrained Black women's reproduction. Moreover, the racial capitalism and racialized medical procedures (such as sterilization, contraceptives, and assisted reproductive technologies) control and stratify fecundity. Consequently, the state's pathological obstruction and eradication of Black life depends on medical institutions to support such policies that remove Black children from the home and compromise Black women's ability to mother. Such policies include criminalizing the medical problem of addiction, which is just as much an economic and social problem of exclusion. Policies that “kill the black [reproducing] body,” as Dorothy Roberts (1997) stunningly documents, have existed since the 1800s. Yet we want to point out that the killing also attempts to reduce the engagement of the Black body as a part of the body politic.

In studies of reproductive injustices that shape birth outcomes, including infant mortality, several scholars have pointed out that such outcomes among Blacks are not caused by any particular biological tendencies but rather by the racism that is inherent in the provision of medical care and the ways that we conduct research (Hardeman and Karbeah 2020; Mullings 2002). We must be attuned to assessments of racism when, for example, a Black woman in a 2019 focus group in California comments, “You push out the baby, and then you go back on the fields, and you keep picking the cotton” (Scott 2020). Clearly this comment falls within the historical context of enslavement and not feeling cared for and takes on complex meaning. Her comment demonstrates a knowing of how the Black female pregnant body was viewed and treated as an incubator requiring control, surveillance, and regulation—reminiscent of US chattel slavery, when the business of birthing enslaved Black children sustained the US economy and workforce. How do we shift the quality of care, for example, based on the story shared by a laboring Black woman who in March 2020 said that a medical provider made her “feel like a pin cushion” due to multiple attempts to insert an A‐line when she was in labor, not stopping even after the unsuccessful attempts? This woman categorized that encounter as racism because little to no attention was paid to her pain, reminiscent of the high pain quotient that some medical professionals believe that Black women possess (Davis 2020a).

We have taken up a three‐part approach. First, we deploy the framework of obstetric racism, an elaboration of research on middle‐stratum Black women's interpretations of their medical encounters during preconception, prenatal care, labor, birthing, and postpartum (Davis 2018). The framework has subsequently been translated in the scale that measures Black women's experiences of obstetric racism in hospital settings, and, finally, the scale is poised to be instrumental in rethinking the quality‐improvement strategies that would now take into account Black women's experiences.

多年来，种族问题一直是最著名的回答之一，为什么黑人妇女的出生结局会受到不利影响。种族是一种错误的信念，认为人与人之间的生物学差异是解释性因素，这种现象在学者，政策制定者，卫生保健工作者和公众中占据了上风。正如Leith Mullings（2002）所指出的，种族也已经成为文化或生活方式范式的代表，并且通常被视为独立于社会和历史进程而运作。^1个1此评论是为纪念Leith Mullings博士而写的。由Alaka Wali博士开发的Mullings关于“寄居者综合症”的深入研究弥合了黑人女性在从事生物和社会生殖过程中所经历，生活和生活的理论鸿沟。这篇评论的灵感来自穆林斯（Mullings）在2002年发表的文章“寄居者综合症：健康和疾病中的种族，阶级和性别”，并于2020年12月13日过世后的第二天被撰写。

最近，一些黑人女权主义学者，研究人员和激进主义者指出历史，社会和政治记录来挑战种族是生育结果的危险因素。事实上，他们认为，几所指出的，这不是比赛，但种族主义，关于黑人女性的身体和影响孕产妇和出生结局和医疗经验的高潮（CREAR -佩里2018 ;哈蒙，2018 ; McLemore等人。2019 ;马林斯和Wali 2001； Novoa和Taylor，2018； Wynn 2020）。

例如，我们知道妇产科学科是通过对被奴役的黑人妇女的尸体进行有害的探索和实验而发展起来的（Cooper Owens 2017 ; Washington 2007）。我们还知道，黑人大助产士提供的照护结构以及从奴隶制到1950年代他们所拥有的知识是白人男性医师和白人女性认证护士助产士（Goode 2014; Oparah and Bonaparte 2016。黑人妇女生殖健康所处的社会环境使人们对病态监督有了深刻的了解，而在过去的每一个转折点，药物都被用来控制，控制和货币化其生殖。我们知道这种治理有很多主张，包括种族资本主义强迫和限制了黑人妇女的生育。此外，种族资本主义和种族化的医疗程序（例如绝育，避孕药具和辅助生殖技术）控制着生殖力并使其分层。因此，该州对黑人生活的病理性阻碍和根除取决于医疗机构的支持，以免这些政策将黑人儿童带出家园并损害黑人妇女的母亲能力。这些政策包括将成瘾的医疗问题定为刑事犯罪，这同样是排斥的经济和社会问题。多萝西·罗伯茨（Dorothy Roberts）（自1800年代以来就存在着令人震惊的文档（1997年）。然而，我们要指出的是，这场谋杀还试图减少黑人作为政治团体的一部分的参与。

在对影响包括婴儿死亡率在内的出生结局的生殖不公的研究中，几位学者指出，黑人之间的结局不是由任何特定的生物学倾向引起的，而是由提供医疗服务所固有的种族主义和我们进行研究（Hardeman和Karbeah 2020； Mullings 2002）。我们必须对种族主义进行评估，例如，加利福尼亚州2019年焦点小组中的一名黑人妇女评论道：“你推开婴儿，然后又回到田野，然后继续采摘棉花”（斯科特2020年）。显然，该评论属于奴役的历史背景，不被关注，具有复杂的含义。她的评论表明，人们了解如何将黑人女性怀孕身体视为需要控制，监视和调节的孵化器，这让人想起美国动产奴役，当时被奴役的黑人孩子的业务维持了美国的经济和劳动力。例如，根据一个正在工作的黑人妇女的故事，我们如何改变护理质量。她在2020年3月说，由于多次尝试插入A线，医疗服务提供者使她的感觉“像别针一样”当她在工作时，即使尝试失败也没有停止？这位女士将这次遭遇归为种族主义，因为几乎没有注意到她的痛苦，2020a）。

我们采用了三部分方法。首先，我们部署了产科种族主义框架，对中层黑人妇女在孕前，产前护理，分娩，分娩和产后的医疗经历进行了详尽的研究（Davis 2018）。该框架随后被转换为衡量黑人妇女在医院环境中的产科种族经历的量表，最后，该量表有望重新考虑现在将黑人妇女的经历纳入考虑的质量改进策略。