Where It Started

In the 1800s, gynecology began to emerge as its own field of medicine.

At the center of that history is J. Marion Sims, often called the “father of modern gynecology.” He developed surgical techniques to treat complications from childbirth that are still used today. But those techniques were not developed in an ethical or patient-centered system. They were built through repeated experimental surgeries on enslaved Black women, including a young woman named Anarcha.

Anarcha had endured a prolonged labor lasting days. The baby did not survive, and she was left with a devastating injury called a vesicovaginal fistula, where openings form between the vagina and bladder or rectum, causing constant leakage of urine and stool. At the time, this condition often led to isolation and social exclusion. Sims became determined to “cure” it, and over the course of several years, he performed repeated surgeries on Anarcha and other enslaved Black women—operating on her approximately 30 times before claiming success.

These procedures were performed without anesthesia, even after anesthesia had begun to emerge in medical practice. Many of his early attempts failed, leading to infection and prolonged suffering. And while these women were subjected to repeated operations, Sims later went on to build his reputation, found a hospital for women, and rise to national prominence in medicine.

These women were not patients in the way we define patients now. They were not in a position to consent, refuse, or shape their care. They were treated as a means to an outcome. And that foundation didn’t just shape the procedures that came out of this era. It shaped what the field learned to prioritize, and what it learned to overlook.

At the same time, this wasn’t a moment where reproductive care was being created from nothing. Long before gynecology became a formal medical specialty, care around pregnancy, birth, and reproductive health already existed within communities. It was led by midwives, doulas, and community healers, many of whom were Black women and Indigenous women carrying generations of knowledge. In many communities, especially in the American South, Black midwives were the primary providers of childbirth care well into the early 20th century.

This care was relational. It was continuous. It was built on knowing the person, not just the pregnancy. It drew on observation, lived experience, and generational knowledge that had been passed down, refined, and trusted within communities.

But as medicine began to professionalize in the 19th century, it didn’t simply expand on these systems. It replaced them. Physician-led care, largely dominated by white men, positioned itself as the authoritative form of knowledge, while community-based care was increasingly pushed aside. Midwives, particularly Black midwives, were discredited, restricted through licensing laws, and labeled as unsafe or untrained, despite their longstanding role in providing care.

This shift wasn’t just about safety or scientific advancement. It was also about control. Control over whose knowledge counted, who was allowed to provide care, and what kind of care was considered legitimate.

As that transition happened, reproductive healthcare moved out of homes and communities and into institutions. The relationship between patient and provider became more distant. Listening became less central. And patients became more passive in their own care, expected to trust a system that no longer knew them in the same way.

When you look at modern gynecology through this lens, the gaps we see today start to make more sense. The system didn’t just evolve. It was built by replacing community-based, relationship-centered care with a model that prioritized authority and control, while also advancing through the use of marginalized bodies without consent.