But despite this broad influence, Villarosa felt the limits of understanding this country. I, along with almost every other black woman of childbearing age I knew, read the piece and talked about it constantly. Trapped in the American narrative of individualism, I drew the same ineffective lessons that Villarosa had espoused to Essence: “work within the medical system and squeeze whatever you can” out of it, not to “challenge that system” but to “advocate of fair treatment.” I did all of this during my pregnancy, with the story of Landrum at the center of my mind. I followed the doctor’s orders even when they suggested that I lose weight during pregnancy; I took a doula, I found a doctor who looked like me and chose a hospital famous for its low rate of caesarean sections. I still ended up in the hospital for a week before my daughter was born, a traumatizing period marked by painful medical interventions that I sometimes feel with. I still had to come to terms. I had done everything, I had “cared enough” in front of everyone who told me that black mothers didn’t care. Suffering, I internalized it in shame.
“Under the Skin” offers an alternative understanding of this suffering, for which there is a long history. Black pain is not, and has never been, the fault of the individual, but the result of the structural racism embedded in the practice of medicine in this country. Many doctors shy away from facing this truth. Hearing Villarosa’s account of Landrum’s heartbreaking birth, a group of white Midwestern doctors wondered just why Villarosa was allowed into the delivery room. she answered. “Racial prejudice denial can be so extreme that no one believes you even when you have evidence.”
In this eminently admirable book, there are no easy answers or clichés. Even as Villarosa meticulously outlines the myriad ways blacks have fought for their health, from social workers to doulas to community organizers, she remains focused on the nature of a structural problem, which cannot be changed through individual choices. In 1992, Villarosa asked Audre Lorde if she agreed that racism in America was “extinction”. In response, Lorde “warned me that when something dies, it doesn’t just vanish; he fights to the death, clinging desperately to life, and comes out ugly. “If racial prejudice in medicine is fading, Villarosa concludes, it is certainly” going ugly. “
UNDER THE SKIN: Racism’s Hidden Toll on American Lives and Our Nation’s Health, by Linda Villarosa | 269 pp | Double day | $ 30
Kaitlyn Greenidge is the feature director of Harper’s Bazaar and most recently the author of the novel “Libertie”.