GRAD 219 Course – The Black Experience in American Medicine – Week 1

This is a guest post by Mariko Foecke, Ph.D. Candidate, UCSF Biomedical Sciences (BMS) Program & Eliza Gaylord, Ph.D. Candidate, UCSF Developmental and Stem Cell Biology (DSCB) Program

Despite the profound advancements achieved by modern medicine, people with ovaries in the United States were at a 10% greater risk of dying from a pregnancy-related death (PRD) in 2017 than they were in 19871. Strikingly, this risk is even greater for the BIPOC community, as Black people with ovaries account for 41.7% of PRDs. This statistic is three times higher than PRD rates for White people with ovaries1. The Centers for Disease Control defines a PRD as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy”2.

Recent research highlights variables that may contribute to disparities in PRDs for people of color, such as quality of and access to care, implicit bias, and psychological stress induced by structural racism1. Examination of disparities in PRDs across socioeconomic and educational backgrounds identified that African Americans with ovaries with at least a college degree were 5.2 times more likely to suffer a PRD than White people with ovaries with the same level of education. Furthermore, the mortality rate of infants of college-educated African American people with ovaries was 3.1 times higher than infants of high school or less-educated White people with ovaries3. Thus, as disparities in PRD and infant mortality rates continue to rise, there is a critical need to understand the physiological impact of social determinants of health during pregnancy and their potentially multigenerational effects.

African Americans with ovaries experience high levels of physiological stress due to social discrimination and systemic racism4. Additionally, racial discrimination is directly correlated with higher levels of depression14, a known consequence of stress15. For decades, it has been appreciated anecdotally that both pre-pregnancy and maternal stress contribute to adverse health and infant birth outcomes5. Maternal stress during pregnancy may lead to high blood pressure and changes in dietary intake, increasing the risk for gestational diabetes, preterm labor, and preeclampsia16. Additionally, exposure to physiological stress after pregnancy may lead to postpartum depression or substance abuse17, accounting for an estimated 14% – 30% of reported maternal deaths18

Concurrently, recent research has gleaned insights into the mechanisms underlying how the negative effects of maternal stress may persist for up to three generations6-8. In response to stress, fertility is known to decline as a consequence of a diminished ovarian reserve, which encompasses the quantity and quality of ovarian egg cells, or oocytes9,10. The incidence of oocyte aneuploidy, referring to an abnormal number of chromosomes, increases in response to maternal stress and is a known cause of infertility and disease11. Importantly, of the 10% of individuals with ovaries who struggle with fertility in the United States, 15% of them are affected by oocyte aneuploidy12. In fact, aneuploidy occurs in 5% of all clinically recognized pregnancies and is causal in 1 in 3 miscarriages13

As the connection between physiological stress and poor health and infant outcomes, particularly for Black women, become increasingly clear, there is a dire need for immediate and effective action to close the persistent PRD and infant mortality gaps. In addition to implementing policy designed to protect vulnerable populations from stressful, discriminatory experiences in professional and higher education environments3, implicit bias training for healthcare professionals should be required to decrease disparities in prenatal and postpartum care19. Finally, legislation to provide federal support that increases access to mental health care and social services specifically to people of color with ovaries before, during, and after pregnancy19 is necessary to reduce this devastating maternal health crisis. 


  1. Pregnancy Mortality Surveillance System. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2019).
  2. Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. Centers for Disease Control and Prevention. (2019).
  3. Fishman SH, Hummer RA, Sierra G, Hargrove T, Powers DA, Rogers RG. Race/ethnicity, maternal educational attainment, and infant mortality in the United States. Biodemography Soc Biol. (2020).
  4. Howard JT, Sparks PJ. The role of education in explaining racial/ethnic allostatic load differentials in the United States. Biodemography Soc Biol. (2015).
  5. Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P. Maternal stress and preterm birth. Am J Epidemiol. (2003).
  6. Crews D, Gillette R, Scarpino SV, Manikkam M, Savenkova MI, Skinner MK. Epigenetic transgenerational inheritance of altered stress responses. Proc Natl Acad Sci U S A. (2012).
  7. Ward ID, Zucchi FC, Robbins JC, et al. Transgenerational programming of maternal behaviour by prenatal stress. BMC Pregnancy Childbirth. (2013).
  8. Kiss D, Ambeskovic M, Montina T. et al. Stress transgenerationally programs metabolic pathways linked to altered mental health. Cell. Mol. Life Sci. (2016).
  9. De Felici M, Klinger FG, Farini D, Scaldaferri ML, Iona S, Lobascio M. Establishment of oocyte population in the fetal ovary: primordial germ cell proliferation and oocyte programmed cell death. Reprod Biomed Online. (2005).
  10. Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: mechanisms and clinical consequences. Endocr Rev. (2009).
  11. Mikwar M, MacFarlane AJ, Marchetti F. Mechanisms of oocyte aneuploidy associated with advanced maternal age. Mutat Res. (2020).
  12. Eisenberg E, Brumbaugh K, Brown-Bryant R, Warner L. Health topics: infertility. Office on Women’s Health in the U.S. Department of Health and Human Services. (2019).
  13. Hassold T, Hunt P. To err (meiotically) is human: the genesis of human aneuploidy. Nat Rev Genet. (2001).
  14. Hudson DL, Puterman E, Bibbins-Domingo K, Matthews KA, Adler NE. Race, life course socioeconomic position, racial discrimination, depressive symptoms and self-rated health. Soc Sci Med. (2013).
  15. van Praag HM. Can stress cause depression? World J Biol Psychiatry. (2005).
  16. Stress and Pregnancy. March of Dimes. (2019).
  17. Postpartum Depression. Office on Women’s Health in the U.S. Department of Health and Human Services. (2019).
  18. Maternal Mortality May Be Even Higher Than We Thought. Columbia University Irving Medical Center. (2019).
  19. Bailey SR. Our Black maternal health crisis is an American tragedy. American Medical Association. (2021).

GRAD 219 Course – The Black Experience in American Medicine – Week 1

This is a guest post by Jackie Roger, Ph.D. Candidate, UCSF Program in Bioinformatics (BI)

Towards the end of this past week, several of the readings and videos discussed the intersection of racism and OB-GYN. We learned about the medical experimentation on black women’s bodies (Linda Villarosa’s article in NYT), the mutilation and subsequent museum display of Sara Baartman’s genitalia (Dr. Deirdre Cooper Owens’s talk on Youtube), and the black maternal health crisis (Dr. Susan R. Bailey article on the AMA site). These examples illustrate how the historical legacies of anti-black racism are embedded in present-day OB-GYN research and medicine. One component of this is disparities in the maternal mortality rate, which was the focus of Dr. Bailey’s piece.

She described two initiatives to reduce this disparity: the MOMMA Act to extend coverage for post-partum care and the Release the Pressure campaign to promote heart health and healthy blood pressure. The MOMMA Act seems like a good start, and could reduce both overall maternal mortalities and the racial disparities in maternal mortalities. The Release the Pressure campaign calls upon black people to take steps in their own lives to improve their heart health (since heart disease is one of the leading causes of pregnancy-related death). There are so many aspects of systemic anti-black racism within the medical system and beyond that directly contribute to increased risk of heart disease. A campaign that asks them to offset these things by “taking a few more steps a day” etc seems insulting. I think that truly addressing disparities in OB-GYN will require structural changes in the healthcare system.

GRAD 219 Course – The Black Experience in American Medicine – Week 1

This is a guest post by Aris Tay, PhD Candidate, Bruce Wang and Diana Laird Labs, Developmental and Stem Cell Biology (DSCB), UCSF

In session 3 of UCSF’s racism and race: the use of race in medicine and implications for health equity discussion, as well as many other works centered around race in medicine, it was mentioned that race, as we use it colloquially, is a social construct. Due to my own identity, I often think about how gender is a social construct and how scientists often use the two terms sex and gender to separate out what is and is not scientifically and empirically biological and hard-wired. However, until this course I had not made the connection that race and racial identity is a social construct just like how gender is.

In many large scale observational genetic studies, specific genetic signatures (typically single nucleotide polymorphisms) are often found to be associated and even predicative for certain diseases. These genetic signatures are often correlated with self-identified racial groups. Thus, the field has often incorrectly assumed that race causes these genetic signatures which leads to a predisposition for disease, and that this is why I often hear statements such as “Tay-Sachs is most common is Ashkenazi Jews” or “Sickle cell anemia is more common in black people”. However, it is difficult, in these large observational studies, to separate lifestyle, family history, etc from the check box self-identified categories that patients are asked to bin themselves into. Self-identified categories of gender and race are much easier to draw correlations from; however, it is now coming to light that detailed family history and lifestyle is much more accurate. Social constructs of gender and race often make up core aspects of someone’s identify. This will definitely affect one’s choices and lifestyle which could then affect which diseases one is predisposed to. However, jumping directly from A to C eliminates a large majority of people that did not follow the most common path, thus disenfranchising them from receiving accurate medical care. Eliminating social constructs from medical treatment and diagnosis is an endeavor that the entire field should embark on.

On the other hand, when it comes to recruiting participants for large scale observational studies, clinical trials, etc. whether or not social constructs such as gender and racial identity should be accounted for is an outstanding question. Using clinical trials as an example, ensuring that the proposed experimental treatment works well on all races and genders is of utmost importance and has often been overlooked in historical trials. However, would using lifestyle in order to recruit not serve the same purpose? And be more accurate? Would taking detailed history and lifestyle cause too much strain during recruitment and completely offset its advantages? Would statistics be too difficult to run on family history and lifestyle when we know it’s possible and established using gender and racial identity. I leave you with some food for thought.

GRAD 219 Course – The Black Experience in American Medicine

This is a guest post by Antoine S. Johnson, Ph.D. Candidate, UCSF History of Health Sciences.

The 2020 police killings of Breonna Taylor and George Floyd facilitated important dialogue about racism being a public health issue. It also led to myriad student demands at college campuses throughout the nation, including at UCSF. Students demanded course curriculum addressing racism in science and medicine, with the hopes that such information and classes would be integrated in their field. One of the results were Grad 202: Racism in Science, which was taught in the Fall 2020 quarter by Dr. Aimee Medeiros and me. Almost 200 students enrolled in the course, causing us to create two sections. As a Ph.D. candidate in UCSF’s History of Health Sciences program, this was an invaluable experience that allowed me to build community with several students in the class who are now working on an article on the importance of such classes in science programs.

Demand remained high after the class, culminating in mini courses, including this one, that would continue such conversations and answer student requests. Grad 219: The Black Experience in American Medicine, examines ways Black people have not only been the victims of medical racism, but also how they contributed to the creation and expansion of medicine and science; how they have operated in their respected fields; and the harm caused by biological deterministic arguments of so-called racial differences. Although only three weeks long, students will leave this class with an understanding of the medical community’s relationship with African Americans from the antebellum period to the present. From an analytical perspective, this class will foster honest and open conversations about the assigned material. Additionally, students will have the opportunity to share their thoughts on any conversation, reading, video, or observation through weekly blog posts that will be published here, on the UCSF Archives & Special Collection, Brought to Light blog. These are not polished submissions but are rather their takeaways on things that stood out to them. In doing so, they will be able to offer one another constructive feedback by commenting on each other’s posts to continue pertinent conversations.

Thank you, and welcome to Grad 219 Course: The Black Experience in American Medicine.