What Mary & Elizabeth knew

Luke’s gospel tells the beautiful and affecting story of an encounter between Mary, still trying to make sense of her stunning news from the angel, and her cousin Elizabeth, in the sixth month of her own pregnancy. There is an instant and powerful connection between the two women. Elizabeth’s very body testifies to the power of God as it registers the first movement of her own, late-life child. We imagine Mary with her hand on the bump: yes, I feel it too. 

When pregnant people meet, there can be an unspoken understanding between them, born of the shared experience of the profound changes that are unfolding inside them. Tastes change, bones loosen. Flickers of movement become full-blooded kicks from within. Neither the partners of these people nor their doctors can quite understand what they really, truly know.

For many women, the lack of doctors’ understanding has proved fatal. In the United States, death rates for the babies of African American women run at double that for those of white women. Maternal death rates are three to four times higher.

Repeated research has shown that these results cannot be explained by different educational and economic circumstances. Rather, Black women are ignored and disbelieved by medical professionals when they raise concerns about what their bodies are telling them. They are offered false reassurance, or condemned for making a nuisance of themselves. Knowing, on some level, what the response will be, these women may simply lack the confidence to ask.

The injustices faced by these women are the inheritance of centuries of male-dominated medical science.

In eighteenth-century Europe, as men took over the profession of midwifery, female practitioners were pushed out. For those who could not afford the attention of a doctor, their only source of help was lost. 

British mothers in the mid-twentieth century were routinely subjected to degrading, painful and medically unnecessary procedures by their male doctors.

White women were told that pain was the result of their anxiety. Black women were assumed not to suffer much pain at all.

Pregnant women were reduced to objects, illustrations in medical textbooks. Their experiences, their voices, were lost for many years. They no longer knew their own bodies.

Pregnancy, as a subject of medicine, became an illness.

To be sure, the medicalisation of childbirth has brought much greater safety to the process for those who have access to it. But its advantages have been distributed unevenly, and have come with hidden costs.

Rachel Zaslow, a midwife and founder of Mother Health International, had an epiphany about these inequalities. Initially, Zaslow developed a highly successful peer-based perinatal support scheme for women in Uganda. 

Later, she came to understand what the research revealed: that similar services were urgently required even in the wealthier context of the US. 

Support and advice from others who had a deeper affinity with childbirth was more effective than from institutionalised medicine. Peer assistance was the key to maternal and infant health, no matter what the setting.

And so Zaslow started up Sisters Keeper, a collective of 45 Black and Latina midwives and doulas (birth assistants) which now serves women in Virginia. In New Orleans, the independently established Birthmark Doula Collective offers a similar service to around 400 women every year, of all ethnicities and financial circumstances. 

Both projects have dramatically improved perinatal outcomes for women and infants, not least in the emotional and psychological experiences of parents.

These inspiring stories, against their backdrop of racial and gender-based wrongs, echo the great hymn to justice that Mary sings in the Magnificat. Thanks to these women and their allies, medical science is changing, slowly, to reinstate something of the embodied, peer knowledge of which Luke’s gospel speaks. 

The knowledge of women is validated and celebrated; lives are saved and dignity is restored. These emerging practitioners of medical science understand and build upon something of what Mary and Elizabeth knew.

Discussion Questions

• This story touches on how the experience of health and healthcare that people have can depend on their identity, such as ethnicity or social background. Can you think of any other examples?
• Linda Villarosa’s research shows how Black women can sometimes be disempowered by the way that medical professionals talk to them. In what situations have you felt disempowered? In what situations do you have power over others?
• Can you think of any other gospel stories where women are given more respect than one might expect from the culture at the time?

Further reading

• https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html
• Linda Villarosa, Under the Skin:The Hidden Toll of Racism on American Lives and on the Health of Our Nation (Doubleday Books, 2022)
• L. J. Jordanova, Nature Displayed: Gender, Science and Medicine 1760-1820 (Routledge, 1999)