Policing Mothers of Color
Reading Andrea Ritchie as a Future Pediatrician
By Livy Low
How can we advocate for children of color without inflicting undue criminalization and violence against mothers of color?
As a fourth year medical student, I am not taught to consider this question; however, it is one I have been ruminating on ever since I attended a conference at Barnard College organized around the work of Andrea Ritchie.
During medical school, I fell in love with pediatric medicine. Aside from the children themselves, part of what I love about pediatrics is the work it takes to build trusting, supportive relationships with parents and caregivers. This is not only good medicine, but also the necessary labor of justice-informed care.
One of the things that can fracture the doctor-family relationship is a medical evaluation for suspected child abuse and/or neglect. The term, “child abuse” can refer to physical, emotional, and sexual violence; it exists alongside the term, “neglect.” Neglect consists of behavior deemed potentially harmful or dangerous, such as leaving a child unattended or failing to offer adequate food.
As pediatricians, we are taught that advocating for children means preventing and treating their abuse. At a surface level, this can seem to translate to protecting kids from their own parents. This notion, however, is a misguided oversimplification of much more complicated circumstances, especially when we account for the dynamics of race, poverty, and gender.
A study published by the American Academy of Pediatrics (AAP) states that “Black children are involved in reported and substantiated cases of child abuse and neglect at approximately twice the rate of white children.” Researchers have identified underlying “risk factors” for child abuse, as well as the potential for physician reporting bias. Those studying the root causes, however, concluded that the social conditions that families of color endure — rather than individual bias — serve as a stronger explanation for this racial disparity.
The latest data from the Children’s Bureau shows that the number of children involved in child abuse reports is increasing, now totaling around 7.2 million children. To understand what is at stake for both mothers and children of color, we must look deeper.
CONSTRUCTING BLACK MATERNAL FAILURE
Understanding the modern context of child abuse requires an examination of the way American society has policed black women over time. Racial disparity in the reporting of black children to Child Protective Services (CPS) stems from historical oppression of black women, starting from the time before their children are even born.
Scholar Andrea J. Ritchie examines “policing” beyond the parameters of literal police killings and physical brutality in her book Invisible No More: Police Violence Against Black Women and Women of Color. Rather, she asserts that policing also refers to state-sponsored surveillance, criminalization, and violence in its many forms as they extend across lines of race, gender, sexuality, disability, etc.
The policing of motherhood operates through the perpetuation of certain racialized social norms and ideas, such as longstanding narratives of unfit mothering. Through time, the state has constructed black mothering as an image of inherent defectiveness, that in turn has warranted forced sterilization, punishment, and surveillance. Scholar Dorothy Roberts notes in her book Killing the Black Body: Race, Reproduction, and the Meaning of Liberty that since black women were brought to America as slaves, they have remained barred from the idealized vision of womanhood and motherhood.
As Ritchie explains, the idea of the black ‘Welfare queen’ emerged in the 1980s as a means to characterize black mothers as fraudulent, deviant, women who had children solely to gain the benefits of state funding and services (167). In the process, the Welfare queen would maltreat and neglect her child; she was lazy, uncaring, and even dangerous. Much of this was tied to the criminalization of black drug use, and associated ideas of intrinsic racial inadequacy and inherent pathology.
The archetypes of maternal failure are not limited to black women. Latinx mothers are thought to produce ‘anchor babies’ for the sake of securing immigration status. Asian mothers are seen as villainous, barbaric, and heartless women who choose to abandon and neglect their female children for the sake of sex selection. Arab mothers are thought to reproduce future extremists and terrorists (168).
SURVEILLANCE, THE STATE, AND THE HOSPITAL
Throughout history, the state has translated these ideas of “unfitness” into public policy, which in turn has served to control and criminalize the behavior of mothers of color. Even though health care facilities are intended to serve as a place of refuge, surveillance of maternal behavior occurs under the eye of the U.S. health care system.
In the past, the police themselves used to enter the hospital in dramatic, violent ways to arrest women as soon as they gave birth. In 1989, a public hospital in Charleston, South Carolina implemented a now unconstitutional program to test the umbilical cord blood of newborns without maternal consent. Hours after birth, women whose babies had cord blood positive for illegal substances would be shackled and dragged out of their recovery beds. Rather than receive the care they needed in addition to their newborns, they were sent to jail for child abuse and separated from their babies. The South Carolina program represented a cooperation between health care providers and law enforcement, a contradictory denial of health and affirmation of heavy-handed violence. Nearly all the mothers arrested were black. Today, pregnant black women are more likely to be reported for drug use, despite comparable rates of drug use among white pregnant women (172–174).
Because physicians are mandatory reporters of child abuse, they become located within current day policing systems. Doctors must document and report, with precision and supposed objectivity, the evidence for suspected abuse and neglect when they see it. Thus, physicians become implicated in the modes of surveillance enforced by the state, which may require them to cooperate with law enforcement.
Though the U.S. child welfare system was theoretically created to protect vulnerable children, it also enables police to directly insert themselves into the lives of black mothers and mothers of color. Case investigation is an opportunity to regulate, judge, and assert control. Ritchie offers clear examples of police as enforcers of child welfare policy, through which they mobilize a means to invade the private home:
In July 2014, Denise Stewart, an asthmatic forty-seven-year-old grandmother in New York City, answered her door when police knocked. Responding to a complaint that a child was being harmed, they had come to the wrong apartment. Denise informed them that they had the wrong location and that she had just come out of the shower. Refusing to believe her, police officers dragged Denise, half naked, out of her towel and into a hallway as she begged for her inhaler and later collapsed…Police also dragged her four children into the hall and handcuffed them. Eventually, an officer threw a towel over Denise. (178)
For many, police violence comes as a compounding burden. Evaluating a mother’s ability to care for her child is more often an evaluation of her ability to withstand the demands of poverty and racism. National data shows that 75.3% of reported child maltreatment is due to neglect rather than physical or sexual abuse. Research has made it clear that poverty is a major risk factor for neglect. In addition, race, parental mental illness and substance use, and pediatric chronic illness contribute to increased risk. Rather than provide support, the state chooses to punish mothers. In an interview for the Nation, journalist Sarah Jaffe states, “Our public policy suggests that women shouldn’t have the audacity to parent while poor.” Emma Ketteringham, managing director for the Bronx Defenders, echoes this sentiment, saying child services “has not been equipped to address the daily manifestations of economic and racial inequality” and instead “is designed to treat structural failings as the personal flaws of low-income parents.”
In my experience, I have noticed that many pediatricians across the country appreciate this kind social complexity. While our function in state surveillance may be unintentional, it should not go unexamined. As future and current clinicians, we have an opportunity to incorporate the kind of research put forth by Andrea Ritchie into our practice of medicine.
IMAGINING JUSTICE FOR CHILDREN OF COLOR
To justify punishment as policy, the state uses the rhetoric of protecting the most innocent of all, children. This may come in direct contradiction to the distress that children themselves face as a result of child protection policy: violent police invasions into the home, the traumas of repeated CPS involvement, and psychological harm of separation from families and foster care placement. The innocence of children is used to validate the surveillance, control, and oppression of mothers of color. This is not only harmful to mothers, but also a severe disservice to children of color themselves.
According to the AAP, 70–80% of children in foster care have a history of abuse and/or neglect, and children in foster care face worse health outcomes than a child in any other group. Their traumas may accumulate with involvement in foster care itself, adding to the adversities they have already experienced. Outcomes of foster care ‘alumni’ show a high prevalence of mental health illness, homelessness, chronic medical illness, and poverty. In the last decade, the health issues of children in foster care have become increasingly complex. Thus, for a system that claims to further the well-being of children, its ability to effectively do so remains questionable.
Solutions to these problems must occur at systemic and communal levels, and could take shape in various forms. Given the influence of poverty, it makes sense to provide mothers with adequate social services, resources, and economic safety rather than punishment. Furthermore, the points of connection between physicians and the police should be critically examined. Health care workers should not remain allied with punitive systems.
Given the medical complexity of children who have experienced maltreatment,their families require more support in managing their children’s chronic illnesses and other needs. It would also be helpful to separate neglect from the physical and sexual abuse of children, for which the solutions may be different. Lessons from prison abolition and transformative justice movements offer guidance as to how to build alternative modes of accountability. Mia Mingus of Bay Area Transformative Justice Collective shares examples of a transformative justice approach to child sexual abuse.
To me, it seems that most pediatricians do not seek to punish mothers. Nevertheless, what I have seen is the harmful judgment of black mothers and mothers of color by health care providers at all levels of training. I have seen a failure to fully consider mothers of color as human beings with sociopolitical realities that wealthy, white mothers do not face. The micro-level work of undoing the thread of interpersonal racism in our profession is necessary, but not sufficient. We need structural change.
None of this is meant to disrespect or disregard the work of child abuse pediatricians, nor is it a trivialization of the very real trauma that parents may cause their children. Instead, this comes as a call to pay attention to these issues with humility, critical perspective, and an imagination of futures.
Rather than blame individual mothers for inherent failure, we should re-center our pathology onto the injustice of the systems at work in American society. If we want to advocate for children, we need to advocate for improvement in the conditions they live in — this, then, enters the realm of their caretaker. Helping children lead healthy lives means supporting families in doing so; it necessitates a nuanced understanding the contexts of their care.
Developing trust and collaboration with parents is at the heart of pediatrics. In many cases, a parent or family member — oftentimes, a mother — is a child’s greatest advocate. This should lead us to consider the power and potential in linking justice for mothers of color with justice for children of color. It should lead us to make that union real.
Livy Low is a 4th year medical student at Albert Einstein College of Medicine in the Bronx, NY. She is a femme of color and future pediatrician interested in racial justice, queer and transgender health, and the arts. Find her on Instagram.
