Karen Scott ’98 is by all measures a leader in her field. A board-certified OB-GYN and public health scholar, she has dedicated herself to exploring and helping to eliminate race- and gender-based disparities and inequities in health care settings. Still, her expert credentials did not protect her from experiencing these inequities firsthand when she became ill with COVID-19 symptoms in the spring.

“I wasn’t heard. I was ridiculed. I was degraded. I was treated the way Black women and people are treated in America, the way they’re treated in the health care system — even though I said I was a physician. They actually didn’t believe me,” Scott said. “As a Black woman with the highest degree in medicine, when I walk into an emergency room, I am what they think a Black woman is.”

She ended up appointing two friends who are also in the nursing field, a midwife and doula, to be her “COVID doulas” and help her advocate for herself. Now recovered, she cites her own experience as an example of how the health care system often treats Black people.

Scott often refers to the SACRED Birth Study, for which she serves as principal investigator, as her “life’s work.” What she means by that is twofold. The study, which examines obstetric racism through the patient-reported experiences of Black women and people in hospitals, is the culmination of her work for the last 24 years. Her journey to becoming one of the leading voices in reproductive justice started when she was a student at Kenyon and continues today in her role as an OB-GYN hospitalist and an associate professor at the University of California, San Francisco School of Medicine.

But Scott also has a personal attachment to the SACRED Birth Study in the time of COVID-19
(SACRED stands for “Examining Safety, Autonomy, Communication, Racism, Empathy and Dignity”). Growing up poor in Nashville, the daughter of a single Black mom, Scott became aware at an early age that many systems were stacked against people like her mother and herself.

At Kenyon, Scott wanted to figure out how to make an impact on the world, and she found the answer, or at least the first clues, in Kathryn Edwards’ “Biology of Female Sexuality” class, where she first learned about reproductive health and reproductive rights. She also learned about “living legend Billye Avery,” founder of the National Black Women’s Health Project (and now known as the Black Women’s Health Imperative). Edwards’ class and Avery’s work inspired her to abandon her original plan of pursuing a doctorate in microbiology and apply to medical school instead.

“Pretty much everything about Karen is impressive,” said Edwards, professor emerita of biology. “As a student, she was very inquisitive. She was never afraid to ask questions in the classroom. Part of that, I think, was her passion for wanting to get a good education at Kenyon, and while overcoming the stress of being only one of a few Black students at Kenyon at the time.”

In the mid-1990s, Scott started the first informal chapter of the National Black Women’s Health Project at Kenyon. “The meeting was open to Black women on campus and our goal was to advance the health and wellness of Black women as students, staff and faculty,” Scott recalled. “We met at Snowden Multicultural Center.”

Scott completed a senior year independent study on Black women’s health with Professor of Sociology and Legal Studies Ric Sheffield and Professor of Sociology Jan Thomas as her advisors. The best way to change our health care system, she figured, was to be a person of authority in the system.

“I felt that pursuing a doctorate in molecular biology would not give me the authority, expertise or experience to address the atrocities I learned about through the health care system,” Scott said. “I was like, ‘I’m going to change the way health care systems treat Black women and girls, but the only way I can do that is if I have the degree that has the highest authority in health care.’”

According to a 2019 report from the Centers for Disease Control and Prevention, around 700 women die every year in the U.S. from pregnancy-related complications, and Black women have a pregnancy-related mortality ratio that is approximately three times higher than that of white women. And at least 60 percent of those deaths could have been prevented with appropriate interventions.

Last April, Scott and her team began work on the SACRED Birth Study, for which they are developing a patient-reported experience measure (PREM) of obstetric racism. This scale will allow them to capture the experiences of Black mothers and birthing people who are seeking care — whether, prenatal, labor and birth, or postpartum — in a hospital. The PREM would be the first of its kind in the country to measure racism and discrimination among Black birthing communities.

The community-based organizing partner, or CBO, of the SACRED Birth Study is the California Black Women’s Health Project. The nonprofit organization aims to empower Black women to become active participants in improving their health through policy work, collaborations with community organizations and training and education. As the CBO, the group assists in bringing together other community-based organizations across the state. It also helps with operational matters, such as coordinating communication among participants, promoting the study to a wider audience and handling marketing materials and the study’s website.

The group’s CEO, Sonya Young Aadam, was aware of Scott’s work and was looking for a way to collaborate with her. Aadam said she was drawn to the SACRED Birth Study because it has the same “flavor” as the California Black Women’s Health Project: It’s unapologetic about getting to the root causes and the impact that racism has on the birthing experience — much like Scott herself.

“She recognizes and is not afraid to talk about the absolute seriousness of this issue. She doesn’t skirt around the truth, and she is fearless. She refuses to abide by old standards and old rules and old protocols for discussion and communication, and she takes a lot of risks,” Aadams said of Scott. “Because she works in the profession and she’s in those spaces and watching things happen, I know she has seen a lot, and she’s not afraid to call those things out and to use them as examples, and to shine a light on these issues, with a goal to giving clinical spaces an opportunity to correct a historical issue.”

Besides being the first of its kind, the SACRED Birth Study is unique in that it is a research project for, about and led by Black women. “That is huge in this field because usually it’s the other way around, where there’s a dominant presence of another group that gets funded to study us,” Scott said. “When someone else is gazing at us from this outsider perspective, we get othered, and usually in that othering, our humanity and our dignity are erased or eroded from the work.”

The fact that the SACRED Birth Study is taking place in the middle of a pandemic — a catastrophic health event that is disproportionately affecting Black communities in the U.S. — makes the work even more notable. Scott is quick to point out that obstetric racism is not a new problem or unique to COVID-19, but the pandemic has shed new light on the plight of Black people and strengthened the value of the study.

“There’s a tendency for hospitals to neglect or dismiss the concerns and needs and priorities of Black mothers and birthing people, particularly around infant bonding and attachment, as well as infant feeding. … COVID has exacerbated existing social and health inequities, because of particular policies or practices in hospital settings,” Scott said, citing rules some hospitals have enacted due to COVID-19, including limiting the number of people in a patient’s room, separating infants from their parents if a parent tests positive for COVID-19, and preventing a birthing person from breastfeeding if the person tests positive.

Outside of her own field, Scott said the pandemic is forcing all of those in health care to examine their systems and practices, and how they serve and care for the most vulnerable populations. In the case of coronavirus, the people most in need of health care are essential workers — those working in fields such as retail, dining, mass transit and nursing homes — many of whom are people of color.

The pandemic has “ripped off Band-Aids that were placed on necrotic wounds in our health care system,” she said.

Scott continues to draw upon her lived experiences as a Black woman and a COVID patient to treat her own patients with more care, understanding and empathy. “It’s scary to have things happening in your body, and you’re trying to tell people, and there’s a disconnect,” she said. “Even if things aren’t going the way I anticipated, I still want to be fully present with my patients. I find myself communicating uncertainty but with confidence. … Palliative care practitioners get it, but the rest of us, we’re not really good at sitting with people suffering, whether that’s physical, emotional or mental.”

When the SACRED Birth Study concludes in February, Scott hopes to reshape the conversation around racism and obstetrics-based hospital care and, in doing so, enact sustainable change to the health care system.

“We believe that the lived experiences, the voices, the language, the words of Black mothers and birthing people, as well as Black women community leaders, will provide us the framing of the solutions that we can then distill to hospital administrative leadership, clinical leadership, nurse leadership and physician leadership, as well as to health plans,” Scott said. “This PREM-OB scale allows for us to really see what it is like when one is birthing as a Black woman or person in the United States in a hospital setting and how the experiences are so very different than any other group.”

“When we think about who has the right to achieve and sustain a pregnancy, give birth and live through their birth all the way up until the first year of their [baby’s] life, Black mothers and birthing people do not have that privilege,” she added. “To say that living through pregnancy and childbirth is a privilege should be a daunting statement that compels people to change.”

Brittany Moseley is an editor and writer for Dispatch Magazines. She lives in Columbus, Ohio.

Nia Imara ’03 is an astrophysicist, artist and professor of astronomy at the University of California, Santa Cruz. “It was an honor for me to paint Dr. Scott, especially because of her important work concerning Black women,” she said. “When we met, I discovered she is a fellow anthophile, and so I knew I would have to feature flowers prominently in her portrait.”