Constructions of race, reproductive health, and gender have been inextricably linked in the United States since the beginning of the nation. Today, these linkages remain evident in the marked racial and gender inequities in reproductive health outcomes that persist in the U.S. To better understand how these meanings and material outcomes are negotiated and produced by actors on the ground, this study asked: “How do reproductive healthcare providers (RHPs) communicate about the intersections of race, reproductive health, and policy?” I conducted semi- structures interviews with 24 RHPs, resulting in over 35 hours of recorded interviews. Drawing on critical-cultural communication, Reproductive Justice, Narrative Medicine, and Postcolonial theories, I developed a novel approach to narrative inquiry—Critical Narrative Analysis—to explore my data. Here, I present an in-depth analysis of 8 narratives shared by my participants. I conclude that participants communicated about race, reproductive health, and policy by engaging with dominant cultural narratives around these topics. While some participants contested dominant narratives, most upheld the foundational logics of oppressive systems in the stories they shared. To advance reproductive justice, I argue that new approaches to teaching clinicians, which engage with both narratives and sociopolitical structures affecting these narratives, are needed. By sharing my participants’ stories and contextualizing them within dominant narratives and social institutions, I aim to identify future research and practice opportunities for creating new stories about reproductive health and physician identity, stories which could suggest more equitable and just ways of doing reproductive health care.

The goals of this project are twofold. The first goal is to articulate my sense making of reproductive health for Women of color in the United States as a postcolonial condition; one that I trace back to the logics of elimination of settler colonialism (Wolfe, 2006) and frame as maintained through the colonial institutions, or racial projects (Omi & Winant, 2015), of the Prison Industrial Complex, the welfare system, and the health care system which create and perpetuate dominant cultural narratives of “the welfare queen”, “the negligent Black mother”, and “the wily patient”. I show how these narratives colonize the minds of health care providers and contribute to the current stratification of health care. My second goal with this project is to show how postcolonial interpretive ethnography can be used as a narrative medicine educational intervention for providers. Currently, Narrative Medicine asks providers to read themselves, their patients, and their interactions as literature to emphasize the personal and interpersonal tensions that are often lost in the fast paced biomedical world (Charon, 2001). With this project I aim to expand the field of Narrative Medicine to consider the ways patient-provider interactions are postcolonial, and how analyses of these interactions can be a method of decolonization. I do so by analyzing three interpretive ethnographic narratives that I have created which story my interactions with three Women of color: Tiffany, Rose, and Jane. I then analyze each of these interactions for colonizing and decolonizing sense making.

White supremacy's impact on Black bodies is well-known. Starting with the enslavement of millions of Africans and their descendants, to Reconstruction, Jim Crow laws, the race-based War on Drugs, mass incarceration, police murders--and now, through fat phobia. Fat phobia--the hatred of and discrimination against fatness--is problematic for all bodies because it limits basic opportunities and privileges. However, it becomes particularly dangerous at the intersection of structural racism and misogyny. Francis Beale argues that as both Black people and women+, Black women+ carry a "double strike" against them; consequently, they experience both racism and misogyny, termed "misogynoir" by Moya Bailey. Language in recent medical publications indicates the severity of fat phobia in America around the Black woman+'s body: fatness is something Black women+ have a "high recidivism rate" with after weight loss (Small). This rhetoric affirms the criminalization of the Black body; fatness is something a Black woman+ has "recidivism" with--a term used almost exclusively for incarcerated people. Thus, the medical community's discourse affirms the"legitimacy" of fat phobia and of fatness' adverse effects on health, inviting discrimination against Black fat bodies. Specifically, it suggests that Black women+ need supervision over their bodies--by white people. This thesis considers the work contemporary Black fat women+ (Sonya Renee Taylor, Sesali Bowen, and Tressie McMillan Cottom) are doing through essays and memoirs against fat phobia; that is, it seeks to amplify their voices as they name, critique, and suggest changes for the institutions that uniquely harm fat Black women+--namely medical racism, beauty, and capitalism. The naming, or making visible, of otherwise-invisible institutions affirms bell hooks' assertion that "groups of women who feel excluded from feminist discourse and praxis can make a place for themselves only if they first create, via critiques, an awareness of the factors that alienate them" (276). Fat phobia perpetuates the narrative that Black women+--especially in larger bodies--are undeserving of love. It posits that women+ are only as valuable as their bodies. But Taylor, Bowen, and Cottom literally rewrite that narrative; instead, these women+ write the fat Black body as inherently worthy and capable of bringing joy--deserving, as we all do, "radical self-love."

The purpose of this study was to better understand the way that intersectional identities affect one's perception of one's healthcare experience. Many previous studies focus on one facet of the minority experience, such as race or sexual orientation, and even then, limit it to a comparison between the majority population and one small subsection of the population of interest (ex: studying only African-Americans as racial minorities and disregarding other minority races). This study was more of a broad survey that sought to account for the unique intersection of different minority identities that one may possess and which ultimately affects how they are perceived and treated in society. This study surveyed 115, primarily college-aged, participants that fell into one of four categories: White/Caucasian and Cisgender/Heterosexual, White/Caucasian and LGBTQ+, Racial Minority and Cisgender/Heterosexual, and Racial Minority and LGBTQ+. Participants were asked to complete an open-ended survey and a Likert scale to rate and review their experiences with healthcare in general, and in regards to their identity. Results showed that although minority participants, especially those who were double minorities (racial minority and LGBTQ+) did not always explicitly express being discriminated against, they often showed it through other ways, such as being more likely to report distrust of their healthcare provider or an unwillingness to seek healthcare despite possessing health concerns. LGBTQ+ individuals were also much more likely to report discriminatory practices in healthcare than racial minorities or the majority group on a statistically significant level. This indicates that minority identities predispose individuals to lower quality of care and this health discrepancy manifests at different intensities based on an individual's specific minority makeup.

Indiana University-Purdue University Indianapolis (IUPUI) / At the end of the nineteenth century, the African-American population of Indianapolis increased, triggering a need for health care for the new emigrants from the South. Within the black population, some individuals pursued medical degrees to become physicians. At the same time, advances in medical treatment—especially surgical operations—shifted the most common site of care from patients’ homes to hospitals. Professionally trained nurses, mostly white, began to replace family members or untrained African-American nurses who previously delivered care to Black patients. Barriers of racial segregation kept both the Black doctors and Black nurses from practicing in the municipal City Hospital in Indianapolis. To remedy this problem, the city's African-American leaders undertook establishing healthcare institutions with nurse training schools during the first few years of the twentieth century. This thesis argues that the healthcare institution-building that occurred in the early twentieth century offered opportunities for the practice of self-help in the Black community. The institutions also created a bridge for Black-white relations because the Black hospitals attracted the support of prominent white leaders. Good health and health care for the sick or injured were necessary to achieve racial uplift, and healthcare consumption became an indicator of social status and economic success. Racially segregated institutions afforded doctors and nurses a chance to increase their expertise and prove they were capable of functioning in the public hospital system. After a decade of working in separate institutions, the Black community prepared to push for full access to the city's tax-supported City Hospital as a civil right.