Medical Fragility and Epistemic Injustice in Reproductive Knowledge and Care

• In Event: Reproductive Subversion Reconsidered: Contemporary Politics of Reproductive Knowledge

Abstract

Despite decades of research on dismissal of pain and disparities in care and outcomes, inequity in reproductive care persists. This paper introduces the concept of medical fragility in order to examine how reproductive healthcare remains a site of epistemic injustice. Drawing on the concept of white fragility (DiAngelo, 2006; 2018) medical fragility describes the reluctance to assign and accept critique within medicine for the epistemic harms patients regularly incur, particularly in reproductive healthcare. The paper begins with a critical analysis of Season 2 of The Retrievals which brought substantial public attention to pain during cesarean section surgery. We then ground the concept of medical fragility in two empirical research projects, one examining experiences of birthing while Black and another which investigates endometriosis diagnosis and care. We show how enduring epistemic injustice (Fricker, 2007), both testimonial and hermeneutical, shape how and whether people consider medicine to have expertise and authority, the ways in which people feel pushed away from biomedicine, and how people develop and circulate knowledge about reproduction and reproductive practices, and engage with and sometimes reject biomedicine.

Authors

• Melanie Jeske, Baylor College of Medicine

• Jennifer Elyse James, University of California, San Francisco