Review: “Under the Skin” by Linda Villarosa

But despite this broad influence, Villarosa felt the limits of understanding this country. Along with almost every other black woman of childbearing age I knew, I read the article and talked about it constantly. Trapped in the American narrative of individualism, I learned the same ineffectual lessons that Villarosa espoused in Essence: “to work within the medical system and get all you can out of it”, not to “challenge that system “but for” self-advocacy for fair treatment. I did all of this during my own pregnancy, with Landrum’s story in mind. I took prenatal vitamins religiously; I followed doctor’s orders even when they suggested I should lose weight during my pregnancy; I hired a doula, found a doctor who looked like me, and chose a hospital with a reputation for low C-section rates. I still found in the hospital a week before the birth of my daughter, a traumatic time marked by painful medical interventions with which I sometimes feel like I’m still coming to terms with. I was “cared enough” about everything the world that told me that black mothers didn’t care. Instead of acknowledging the external factors of my suffering, I internalized it in shame.

“Under the Skin” offers another understanding of this suffering, for which there is a long history. Black pain is not, and never has been, the fault of the individual, but the result of structural racism embedded in the practice of medicine in this country. Many physicians avoid confronting this truth. Upon hearing Villarosa’s account of Landrum’s harrowing childbirth, a group of white Midwestern doctors only wondered why Villarosa was allowed into the delivery room. “Was that your takeout?” she replied. “The denial of racial bias can be so extreme that no one believes you even when you have the evidence.”

In this eminently admirable book, there are no easy answers or platitudes. Although Villarosa meticulously describes the myriad ways black people have fought for their own health, from social workers to doulas to community organizers, she remains focused on the nature of a structural problem, one that cannot be changed by individual choices. In 1992, Villarosa asked Audre Lorde if she agreed that racism in America was “dying off”. In response, Lorde “warned me that when something dies, it doesn’t just disappear; he fights to the death, clings desperately to life, and comes out ugly. If racial bias in medicine recedes, Villarosa concludes, it’s definitely “gone bad.”


UNDER THE SKIN: The hidden toll of racism on American lives and the health of our nation, by Linda Villarosa | 269 ​​pages | Doubleday | $30


Kaitlyn Greenidge is the director of feature films at Harper’s Bazaar and the author, most recently, of the novel “Liberty.”

Patricia J. Callender