Why Racism Black Women Face is Stranger Than Fiction

A brief historical analysis of medical racism that Black women endure

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Racism in American society is stranger than fiction. At least that’s what Black women keep telling White women about The Handmaid's Tale. While it's a meaningful narrative about the dangers of religious extremism and patriarchy, it fails to address the threat of racism. That's why efforts to compare the series to this moment, in which women find themselves, fall a bit short. In the real world, racism and sexism are co-villains wreaking havoc in the lives of Black women. Overlooking that nuance creates a simpler narrative, but it does so at the cost of authenticity. Some of the injustices characters endure throughout the series, such as sexual violence, are more than fictional horror; they're eerily reminiscent of the nation's legacy of forced breeding during chattel slavery. A more well-rounded narrative would address how race shapes women's experiences. But since it doesn't, and remains a popular reference, we're left with this irony — the racism Black women endure is often stranger than fiction.

In Gilead, officials force fertile women to wear a uniform comprising a red dress, a white bonnet, and a red hood, symbolizing their role in society. This marks them as Handmaidens, in contrast to Marthas, who wear gray, and Wives, who wear teal. Wit's it's certainly cruel to force anyone to wear a uniform every day of their lives, and strip them of any personal expression, enslaved Black women were often denied the simple dignity of well-made clothes. Field workers typically wore plain, usually coarse clothing made from inferior fabrics. Some were deprived of shoes to wear. Domestic workers in Virginia found their “clothes to be constricting and uncomfortable,” despite being made from slightly better materials. Some were restricted from showing their hair. In 1786, a Louisiana law required Black women to wear a tignon to cover their hair in public spaces. And enslaved women who worked in the fields didn't receive a coat to protect them through the winter months, to discourage them from venturing outdoors. Indeed, this is stranger than the fictional narrative in which an oppressed group of women was given laundered cloaks to wear to market.

Another difference would be that enslaved Black women were often forced to labor throughout their pregnancies. "Planters saw pregnancy and young children as hindrances in female slaves' productivity, so they felt no incentive to improve conditions," according to a Duke University exhibit. On one hand, enslavers wanted Black women to reproduce to increase their wealth, but they did not want pregnancy and motherhood to interfere with their ability to labor. This meant that little support was provided for the challenges that naturally arose during pregnancy. While women in Gilead were provided with government-funded medical care and protection throughout their pregnancies, enslaved Black women were deprived of access to trained medical professionals. They were expected to complete domestic chores and work in the fields throughout the duration of their pregnancy. As O.G. McClinton III wrote in Black Perspectives, from every corner of the plantation, they arose at dawn, prepared to work until dusk. By the nature of the institution of slavery, enslaved women were exploited commodities that provided a free labor force, enabling the Southern economy to thrive."

If you have ever enrolled in a creative writing class, you likely heard of the term "verisimilitude." While fictional stories provide details about characters who never existed and events that never happened, authors are expected to make their story as authentic as possible for their audience. Perhaps, if Margaret Atwood, the writer of the series, had a more diverse editorial staff, they would have nudged her to include references to the experiences of enslaved Black women. They may have asked whether she feels a responsibility to verisimilitude in her story. The odd part is, some of the narrative, while horrific, isn't quite as torturous as what Black women actually endure in this country.

Consider, for instance, the cruelty of Dr. J. Marion Sims, the so-called "father of gynecology," who experimented on enslaved Black women from 1845 to 1849. The system of slavery dehumanized them, leaving them vulnerable to being harmed, without access to legal recourse. He performed numerous surgical procedures on them without using anesthesia. To justify this gross miscarriage of justice, Sims relied upon a stereotype that portrayed Black people as less susceptible to pain. As the Equal Justice Initiative wrote, “unable to refuse treatment or withhold consent, Lucy, Anarcha, and Sim's other enslaved patients were powerless to protect themselves from medical exploitation." The torture they endured sounds like it could have been written in the script of a horror film. And it's an all-too-real history of this nation. Today, any research that involves human participants requires obtaining informed consent. But by Sims carrying out these awful procedures, Black women were deprived of this basic human dignity.

While Americans living in the modern era often envision themselves far removed from these injustices, one study suggested nearly sixty percent of physicians believed Black people's skin was thicker than White people's (Hoffman et al., 2016). Their findings illustrate the same myths used as justification to harm Black women and deprive them of quality healthcare during their enslavement persist. Indeed, “false beliefs about biological differences between blacks and whites continue to shape the way medical professionals perceive and treat black people (Hoffman & Trawalter, 2016)." So, when Black women report pain, they are more likely to be doubted and deprived of the care extended to White women.

Another example would be the nation's legacy of forced sterilization. During chattel slavery, Black women were expected to reproduce for the enrichment of their enslavers. But once free, society treated its children as a burden. Doctors would often perform a hysterectomy on Black women patients without their consent. The practice was so common in the Magnolia State that civil rights leader Fannie Lou Hamer coined the phrase "Mississippi Appendectomy" to describe the procedure. After going to the doctor to have a tumor removed, they sterilized her without her consent. This experience contributed to her becoming a vocal activist. She believed, “You don’t run away from problems. You just face them." As an important caveat, Black women were not the only group to endure forced sterilization in the United States. As author and journalist Erin Blakemore wrote, "the experiences of Native women who were sterilized against their will are much like those of other women of color, like the African-American women who were sterilized under North Carolina laws until the early 1970s." Gilead does not promote sterilization, as it wants women to reproduce. But in America, racism complicates discussions about population increase.

For example, research shows that one-third of Americans and two-thirds of Republicans endorse the Great Replacement theory, which posits that Brown immigrants entering America contribute to the nation losing its white cultural identity. As a result, many see the increase in Latino immigrants as a threat. This has contributed to increased violence against Black and Brown people. In 2022, a self-declared white supremacist, Payton Gendron, killed ten Black people in a supermarket in Buffalo, New York. In his manifesto, he cited the theory and bemoaned the low birth rate among White women. But it was his reference to Black people as "replacers" that was more shocking. The same person who was concerned that White women were not having enough babies was willing to kill Black people, because of their high rate of fertility. This upends the narrative of The Handmaid's Tale, where the only social ill we have to face is sexism. Clearly, in the real world, racism shapes the attitudes and beliefs of violent domestic terrorists.

In America, there is no universal healthcare, in part because of the prevalence of racist attitudes. One example of this is the Medicaid expansion gap. This government-funded insurance program provides access to low-income individuals and families. Indeed, "Medicaid expansion has helped to narrow racial disparities in health coverage and access to care." Yet, many oppose the program's expansion for that very reason — they do not want Black people, and other groups, to benefit from it. "Early funding and policy decisions shaped by racism helped embed inequity in Medicare and Medicaid (Yearby et al., 2 "22)." And Haeder and Moynihan (2023) found that race and racial perceptions shape burden tolerance for Medicaid, as well as the Supplemental Nutrition Assistance Program, also known as food stamps.

Perhaps if the nation did more to mitigate these racist attitudes, debates about health policy wouldn't be so mired in controversy. However, as it stands, “who benefits” is often a primary concern in assessing support. Under this context, Black women continue to endure racial discrimination in the modern-day healthcare system. One sign of this would be the high rates of maternal mortality for Black women relative to White women. Experts at the CDC suggest that four out of five pregnancy-related deaths in the United States were preventable. This indicates that many of those Black women who died from pregnancy-related complications could still be alive today if they were shown more care and concern and provided quality preventive healthcare.

State-wide abortion bans that passed within the last few years have exacerbated an already serious social problem of medical misogynoir. It's not a coincidence that a Black woman, 33-year-old Brittany Watts, became the first to be legally punished following a miscarriage, which she had in Ohio. Prosecutors claimed she improperly disposed of the remains, overlooking that the hospital sent her home. While pro-life activists claim these new restrictions are designed to encourage women to carry pregnancies to term, what they've done is punish women, even those who want to give birth but endure complications. In doing so, they've added a layer of terror to the experience. If their concern were really the health of any mother and child, then conservatives wouldn't have fought to dismantle the Abundant Birth Project, which provided a monthly stipend for Black expectant mothers. Likewise, they wouldn't block the Black Maternal Health Momnibus Act, which could allocate funding and resources to making pregnancy safer. There's not enough care for Black mothers in our country.

In another heartbreaking case, doctors at the Emory University Hospital declared a pregnant Black woman, 31-year-old Adriana Smith, brain-dead last February after discovering blood clots in her brain. She visited another Georgia hospital the day before after experiencing headaches, but was sent home after receiving medication. The next morning, she woke up gasping for air and in need of medical attention. It was at this point that medical professionals informed her family that her status would not improve, that she would not survive. Sadly, that was only the beginning of her ordeal, as the hospital did not respect her family's wishes to remove life support. Because of the state's anti-abortion law, they claimed it would be illegal to do so.

Despite there being no hope for Adriana's life, she was forced to serve as an incubator. The very injustice feminists have long warned of has come to pass. Ms. Adriana's mother noted that her grandson would likely suffer physical disabilities as a result of her daughter's condition — he could suffer blindness, not be able to walk, and struggle to survive. Doctors performed a cesarean on Friday to deliver Chance, an infant who weighs 1 pound, 13 ounces, severely underweight for a newborn. At long last, as the state could no longer control what happened to Adriana's body, her family was able to remove life support. Her ordeal was horrific, and also reminiscent of the experience of a Black pregnant woman in Handmaidens' Tale, OfMatthew, played by Ashley LaThrop. Seemingly compliant before, she snapped and attacked a Guardian at a market, and was shot. At the hospital, doctors declared her brain dead, but they kept her on life support until the baby was delivered.

What makes our reality terrifying is that what happened to Adriana could happen to any Black woman because of the racial bias of the healthcare profession. We're deprived of the distance afforded to cinema in this case, as anti-abortion laws place an additional burden on the health of women. While the series places no importance on her race, it’s essential to consider that our society does. It may be a coincidence that in Atwood's narrative, OfMatthew, the pregnant woman forced to keep on life support to carry a pregnancy closer to term is Black. But in our society, when Black women receive a lower standard of treatment that consistently places them in danger, it does carry weight. Throughout the nation's history and even in the present, Black women have been subjected to a level of horror that is indeed stranger than fiction. So, either our popular fictional narratives must adapt and embrace their stories to become more authentic, or we must concede that some White authors who write from a colorblind perspective are ill equipped to use fiction in its full potential, not just to critique the aspects of society that impact them personally, but to paint with a broader brush, the problems we face.

References

Bardes, J. (2023, June 20). Plantation slavery in antebellum Louisiana. 64 Parishes. https://64parishes.org/entry/plantation-slavery-in-antebellum-louisiana-adaptation#:~:text=Plantation%20owners%20spent%20a%20remarkably,cornmeal%20rations%20were%20allocated%20weekly.

Blakemore, E. (2016, April 25). The little-known history of the forced sterilization of Native American women — JSTOR Daily. https://daily.jstor.org/the-little-known-history-of-the-forced-sterilization-of-native-american-women/

Burke, M. (2025, June 18). Baby of brain-dead pregnant woman kept alive under abortion law has been delivered, family says. NBCNews.com. https://www.nbcnews.com/news/us-news/baby-brain-dead-pregnant-woman-kept-alive-abortion-law-delivered-famil-rcna213558

Centers for Disease Control and Prevention. (2022, September 19). Four in 5 pregnancy-related deaths in the U.S. are preventable. Centers for Disease Control and Prevention.

https://archive.cdc.gov/#/details?url=https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html

Cohen, R. (2023, November 21). Backlash to affirmative action hits pioneering maternal health program for black women. The 19th. https://19thnews.org/2023/11/affirmative-action-backlash-maternal-health-program-black-women/

Cross-Call, J. (2020, October 21). Medicaid expansion has helped narrow racial disparities … https://www.cbpp.org/research/health/medicaid-expansion-has-helped-narrow-racial-disparities-in-health-coverage-and

Fandom, Inc. (n.d.). Natalie. Handmaid's Tale Wiki. https://the-handmaids-tale.fandom.com/wiki/Natalie

Gruber, C. K. E. (2024, August 26). Clothing and adornment of enslaved people in Virginia. Encyclopedia Virginia. https://encyclopediavirginia.org/entries/slave-clothing-and-adornment-in-virginia/

Halpert, M. (2025, June 17). Baby of brain-dead woman delivered in Georgia's mother says. BBC News. https://www.bbc.com/news/articles/c1jwl9l9yneo

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296. https://doi.org/10.1073/pnas.1516047113

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296. https://doi.org/10.1073/pnas.151604It's

It's in your hands: Fannie Lou Hamer (19It's It's In Your Hands | Fannie Lou Hamer (1971). (n.d.). https://www.historyisaweapon.com/defcon1/yourhandshamer.html#:~:text=In%20the%20North%2C%20I%20don,free%20until%20I%20am%20free.

Klein, A. (2024, February 23). Fannie Lou Hamer fought for Black Reproductive Rights. We continue that work today. Tacoma-Pierce County Health Department. https://tpchd.org/blog/fannie-lou-hamer-fought-for-black-reproductive-rights-we-continue-that-work-today/#:~:text=Hamer%20coined%20the%20term%20%E2%80%9CMississippi,removed%20and%20instead%20was%20sterilized.

Knight, K. (2024, March 13). The dichotomy of enslaved women's and men's work in the Antebellum South. AAIHS. https://www.aaihs.org/the-dichotomy-of-enslaved-womens-work-in-the-antebellum-south/

Lister, R. L., Drake, W., Scott, B. H., & Graves, C. (2019). Black Maternal Mortality-The Elephant in the Room. World journal of gynecology & womens health, 3(1), 10.33552/wjgwh.2019.03.000555. https://doi.org/10.33552/wjgwh.2019.03.000555

Luthra, S. (2025, June 17). A brain-dead Georgia woman is set to be taken off life support after her baby was delivered. The 19th. https://19thnews.org/2025/06/adriana-smith-georgia-brain-dead-pregnant-woman-baby/#:~:text=Adriana%20Smith%2C%20the%20pregnant%20Georgia,The%20case%20made%20national%20headlines.

Nicolaou, E. (n.d.). It almost was even worse for the" in handmaid's "ale." What Happens To Matthew's Baby Pregnant Handmaid's Tale. https://www.refinery29.com/en-us/2019/07/238080/ofmatthew-braindead-baby-boy-handmaids-tale-season-4-episode-9

McClinton, O. G. (2024, March 13). The dichotomy of enslaved women's and men's work in the Antebellum South. AAIHS. https://www.aaihs.org/the-dichotomy-of-enslaved-womens-work-in-the-antebellum-south/

Roberts, E. T., Kwon, Y., Hames, A. G., McWilliams, J. M., Ayanian, J. Z., & Tipirneni, R. (2023). Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the Federal Poverty Level. JAMA Internal Medicine, 183(6), 534. https://doi.org/10.1001/jamainternmed.2023.0512

Sharpe, J. (2022, October 25). New National UMass Amherst poll on issues finds one-third of Americans believe in "great replacement" theory. UMass Amherst. https://www.umass.edu/news/article/new-national-umass-amherst-poll-issues-finds-one-third-americans-believe-great

Smithers, Gregory D. Slave Breeding: Sex, Violence, and Memory in African American History, University Press of Florida, 2012. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1053767.

Sukumar, S., Pijush, D., & Brandes, S. (2019). Monuments celebrating the past: African slave experimentation in the development of vesico-vaginal fistula repair — J Marion Sims: Urologic Surgery Hero or villain? Journal of Urology, 201(Supplement 4). https://doi.org/10.1097/01.ju.0000555413.14028.c1

The Working Mom: Mothering While Enslaved. Omeka RSS. (n.d.). https://exhibits.library.duke.edu/exhibits/show/the-working-mom/slavemothers

Urell, A. (2022, June 3). Medical exploitation of black women. Equal Justice Initiative. https://eji.org/news/history-racial-injustice-medical-exploitation-of-black-women/

Yearby, R., Clark, B., & Figueroa, J. F. (2022, February). Structural Racism in Historical and Modern U.S. Health Care Policy. https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01466

Zellars, R. (2018, October 25). Black subjectivity and the origins of American gynecology. AAIHS. https://www.aaihs.org/black-subjectivity-and-the-origins-of-american-gynecology/

Originally published June 23, 2025 on Medium.