Ashana Bigard
Executive Director, Amplify Justice / Liberation Collective · Fifth-generation New Orleans native · Author · Advocate · Trainer
Section 02
There are formulas being used on Black patients right now that were built on racist science. You have the right to know what they are — and what to say.
The rules were written before you sat down — knowing how the game is played is how you protect your family
These are not historical artifacts. They are being used in hospitals right now — on you, on your family, on your children. Every one of them was built on the assumption that Black bodies are biologically different from white bodies. That assumption has no scientific basis. What it has is a long history of causing harm.
Since 1999, doctors have used a formula that automatically adjusts kidney function scores upward for Black patients — based on the racist assumption that Black people have higher muscle mass due to their race. This made Black patients appear healthier than they were.
Lung function tests have been racially adjusted since the era of slavery, when a plantation physician adapted the spirometer to compare enslaved Black people to free white people. That legacy became standard practice. Today, the race correction artificially boosts lung function scores for Black patients by up to 15%.
Created in 2007 to determine who could have a vaginal birth after a prior C-section, this calculator included race as a variable — rating Black and Hispanic patients as having 5 to 15 percentage points lower chances of a successful vaginal birth than white patients, with no scientific justification.
The pulse oximeter — that clip placed on your finger to measure oxygen levels — has been known since 1990 to be less accurate on darker skin. Studies in 2005, 2007, and 2020 confirmed this. Nothing changed for decades.
Studies of Pennsylvania hospitals found that Black women were tested for drugs during labor at significantly higher rates than white women — despite being less likely to test positive. This is not medicine. It is racial profiling embedded in hospital policy.
"These are not mistakes.
They are systems. And you have the right to name them."
You have legal rights in every medical setting. Most people are never told what they are. Here they are — plain and clear.
You have the right to know what formula, calculator, or diagnostic tool is being used to make any decision about your care. You can ask this directly and in writing.
You have the right to request that race not be used as a variable in any diagnostic tool applied to you. Ask your provider to use race-neutral versions of any formula.
You have the right to have anything documented in your medical chart — including that you declined a recommendation and why. Ask for this in writing.
Before any surgical procedure, you have the right to a second opinion. You cannot be penalized for requesting one.
You have the right to walk during labor. You have the right to refuse continuous fetal monitoring if you are low-risk. You have the right to a doula. You have the right to refuse a C-section. You have the right to know what calculator is being used to make decisions about your birth.
No procedure can be performed on you without your informed consent. Informed means you understand what is being done, why, what the alternatives are, and what the risks are. If you do not understand, ask until you do.
Write these down. Save them in your phone. Say them out loud if you need to. You are allowed to advocate for yourself in any room.
"I want to see the formula or calculator being used to make this decision about my care. Does it include race as a variable?"
"I am requesting that race not be used as a variable in any diagnostic tool applied to me. Please use the race-neutral version of any formula."
"I want this documented in my chart that I am declining this recommendation and the reason why. I want a copy of that documentation."
"I am invoking my right to a second opinion before any surgical procedure. I would like a referral."
"Please explain what evidence base this recommendation is drawn from. What studies support this decision, and what was the racial makeup of the study population?"
"I am declining a drug test. I want documented in my chart that this test was requested and that I declined. I want to know what triggered this request."
"I am aware that pulse oximeters are less accurate on darker skin tones. I am requesting that my oxygen levels be confirmed with an arterial blood gas test rather than relying solely on the pulse oximeter."
"I have the right to walk during labor. I have the right to decline continuous fetal monitoring. I have the right to know what calculator was used to make any recommendation about my birth plan. I am exercising those rights now."
Movement during labor is healthy and supported by evidence. You cannot be required to stay in bed unless there is a specific documented medical reason.
You have the right to have a doula present. Studies show having a doula reduces C-section rates, reduces pain, and improves outcomes — especially for Black women.
A C-section cannot be performed without your consent. If one is recommended, you have the right to ask why, to hear the alternatives, and to say no.
If a VBAC calculator is used to make decisions about your birth, ask to see it. Ask if race is a variable. Ask for the race-neutral version to be used instead.
If you are low-risk, you have the right to intermittent rather than continuous fetal monitoring. This allows you to move freely during labor.
Every intervention — every medication, every procedure, every test — requires your informed consent. You have the right to say no to any of them.
Print this and bring it to any medical appointment or hospital visit. It lists the racist formulas, what to use instead, and your legal rights as a patient.
⬇ Download Printable HandoutThis handout is free. Share it with anyone who needs it — including the nurses and doctors who may not know these tools have a racist history.
Executive Director, Amplify Justice / Liberation Collective · Fifth-generation New Orleans native · Author · Advocate · Trainer