Intersectional Identity and Racial Inequality During the COVID-19 Pandemic: Perspectives of Black Physician Mothers

Introduction

Black physicians. Black mothers. Each role is challenging and together they make life strikingly more complex as one toggles between worlds, one filled with privilege and the other with oppression.

Now in the era of the COVID-19 pandemic, these identities seem to be in battle with each other—while we serve in the battle against the virus.

Society may not see us by our profession but by the color of our skin. We are reminded of this in subtle ways within and outside of the health care setting. From the microaggressions of being called anything but “doctor” despite the white coat and identification badge; to the passersby who fails to step aside when seeing a Black mother pushing her stroller in the era of social distancing.

So, this leads us to question our duty to serve as physicians while putting our own health at risk, because we do not feel valued in the very society we serve.

To understand the inner turmoil, one must first understand what is being asked of us.

As Physicians

As a physician, this pandemic may require one to work outside of the scope of our practice. Doctors skilled in outpatient practice now treat patients inside the hospital. Physicians trained to treat children are now treating adults.

We are asked to alleviate anxiety and fears of others while we struggle with our own. There is the need to rapidly adapt in a fast-moving system—which just increased in speed.

Very quickly during the COVID-19 pandemic, tremendous racial disparities have been revealed as it disproportionately affected Black and Latinx communities. Instead of COVID-19 being the great “equalizer,” it has become the great “magnifier” of our country's underlying structural racism.²

As we traverse between communities, we interact through phone, video, or in-person with people who are recovering from COVID-19. As the pandemic and the disparities statistics progressed, we have continued to get intimate exposure to this virus' unequal destruction. We have counseled family members and friends on symptom management, indications for seeking care, disease progression, and strategies to isolate safely when living with someone with COVID-19. We have spoken with clinical team members to be the “medical translators” for our families and to also serve as advocates for their medical care. We also have to console those who have experienced loss of a loved one.

As Mothers

As mothers, we are caretakers of not only our children but also our parents, and for some—also the primary economic provider. In nonpandemic times, our caretaking roles are in a constant juggle with our professional and personal goals. But now this conflict has intensified.

For many physicians, children come later in life as we have spent our 20s obtaining credentials to join the medical field. If you are in a stage wherein your kids are young, picking up arms to fight COVID-19 and accepting a redeployment are not an easy decision. In a recent letter to the editor in the British Medical Journal, the authors suggested health care worker risk-exposure stratification be done. They wrote, “this should be logical, evidence-based and not misinformed by differing experiences with other infectious diseases.”³ This suggestion was in response to data showing increased fatality rates for men >50 years of age. If health care professionals relied on the aforementioned data, then they infer that a 30-year-old pregnant physician should be considered for deployment before a 50-year-old male physician. Is this logical or fair?

As mothers we will naturally ask, “What will happen to my kids if something happens to me?” Particularly for Black mothers, we know we live in a world that can be so unkind to Black children. This internal discussion can be further compounded if we are pregnant. Black maternal mortality rates are higher than those of whites, regardless of education, insurance, or income.⁴ At baseline the odds are not in our favor, and in the setting of a pandemic—now what?

As Black physician mothers, we weigh our multiple identities and consider what is more important in life. In our futures, we see the need to be present for our children, to build a legacy in terms of not just our professional roles but also our roles as mothers. Also for many of us, we are the first to build the foundation for generational wealth. With all of this in mind, our motherly instincts kick in and we conclude that in prioritizing between the battle against COVID-19 and our obligations toward the children, the children win. Our identity as physician takes a backseat.

Self-Care and Coping

How must one survive and practice self-care among all of these constraints? First acknowledging the pace and output of work will be different. Your institution's culture would be a large driver in the expectations set during this time, and for some women it may be difficult to have a candid conversation with a direct supervisor. One may consider having a virtual meeting to discuss your work–life balance constraints. Alternatively, consider consulting human resources or an ombudsman to aide with brokering a compromise.

Second, consider the many avenues one can use to cope and find an outlet for your emotions. Writing a commentary can be therapeutic. It can provide something to look forward to in all the disruption.

Besides writing, you could be a “translator” in your local community by relaying accurate, evidence-based information. You can provide information through social media, online group chats, or virtual town halls. This strategy can serve as an outlet but also allows us to make larger contributions to underserved groups. Lastly, consider advocating to your current institution expand outreach to minority communities by: accessible testing at federally qualified health centers and/or community centers; translation of COVID-19 educational materials; and ensuring accessible information and telemedicine services to patients with limited Internet.

As Black physicians who are mothers, it is an honor and a privilege to use our role in society's response to the COVID-19 pandemic. This perspective allows us to share concerns for our families, serve as connectors for our communities, and create a vision for greater inclusion in our institutions.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This study was conducted with the support of grants of BWH H. Richard Nesson Fellowship NHLBI (L30 HL143781) and Grant No. 3R01LM012836-03S1.