Australian political scientist Carol Bacchi argues that what we propose to do about a problem reveals what we think the problem is. When U.K. public health guidance focuses on individual behaviors, such as smoking, diet, and weight loss, it’s locating risk and responsibility within individual bodies rather than systems. Across the Atlantic, similar patterns unfold. Anthropologist Khiara Bridges’ Reproducing Race describes how U.S. hospitals frame Black mothers as inherently “risky,” subjecting them to extra scrutiny and control. In this context, reproductive risk becomes less a medical evaluation than a social judgment.
Many Black women, however, know that the real dangers don’t lie within our bodies but in the systems meant to care for us. As a result, Black women often navigate clinical spaces with heightened vigilance—asking pointed questions, seeking second opinions, or enlisting family members and doulas to advocate alongside them. This work of advocating forms part of Black women’s reproductive labor—rooted in both personal experiences and collective histories of dismissal, harm, and systemic neglect.
THE LABOR OF VIGILANCE
Renay Richardson, a 41-year-old British Jamaican Trinidadian, conceived her two children through in vitro fertilization (IVF). During her first labor, Renay’s blood pressure spiked, and her baby’s heart rate dropped. Clinicians had to break her waters, and when they did, the fluid was brown: a sign the baby had passed its first bowel movement in the womb and risked inhaling it.
“I could tell that things were heading in a bad direction, so I suggested a C-section,” she says. The emergency cesarean section, luckily, resulted in a healthy baby. “But why did they let it be my decision?” she asks.
Olivia, the tech worker, also had to push for the care she needed. At her first appointment, the midwife wanted to rush through her intake questions over the phone so she could catch an early train. “I had to tell her, ‘No, you’re going to do the full hour, properly.’” Later her baby was born prematurely at 33 weeks and admitted to the neonatal unit to be fed through a tube. However, Olivia soon felt pressured to take her son home. “But I was like, what if he rips out his tube, which he was doing quite a lot. My husband and I don’t know how to put that back in.”
When staff tried to reassure Olivia she could call the team for support or bring him back into the hospital on weekends, she balked: “I have to pack up a baby, put him in the car seat, take him to the hospital? That’s crazy.”
Olivia says her complaints went unheard until her husband stepped in. “They listened to him even though I’d been saying the same thing,” she said. “And I just thought, what about women who don’t have someone to speak for them?”
