Erica E. Marsh, MD, MSCI, FACOG | Image credit: ihpi.umich.edu
“Who is our health care system designed for? What populations are our normative data based on?” These are questions asked by Erika E., professor of reproductive endocrinology and infertility at the University of Michigan. These are some of the questions that guided Dr. Marsh, M.A., as he came to work every day throughout his career as a physician.
Marsh is an associate professor of obstetrics and gynecology at the University of Michigan Medical School and a leader in reproductive health research. Her groundbreaking research on uterine fibroids, abnormal uterine bleeding, and health disparities has raised millions of dollars and reshaped the field.
With degrees from Harvard University and Harvard Medical School, Marsh’s expertise lies in understanding reproductive disorders through a comprehensive lens and examining their social determinants and clinical impact. Her research focuses on patient experiences and community impact.
“The David and Rosemary Adamson Excellence in Reproductive Medicine Lecture at the 2023 American Society for Reproductive Medicine (ASRM) Scientific Conference & Exposition: “The Silence of Friends”: At the Intersection of REI and Racism, Equity, and Inclusion ” Marsh, of New Orleans, Louisiana, has developed the experience and expertise to illuminate the complexities of health care inequities that impact health care today.
The broadest U.S.-centered definition of health disparities includes differences in incidence, prevalence, mortality, disease burden, and other adverse health conditions that exist among specific population groups. Health inequalities, on the other hand, are defined by the WHO as unnecessary and systematic differences in the health status of different population groups, explained Marsh.
“These are largely the result of social structure and genetics and biology,” she said.
Equity is often misunderstood as providing the same resources to everyone, but Marsh says this approach doesn’t necessarily address existing disparities. The goal in the concept of equity is to provide individuals with the specific tools they need to access opportunities.
The importance of history in medicine
Key features of Mr. Marsh’s presentation included a historical overview of dark chapters in American history, particularly focusing on slavery and its aftermath, and the subsequent fight for civil rights.
While reflecting on recent and current events such as the death of Breonna Taylor and conflicts between community school boards over critical race theory (cathode ray tube), and about the January 6, 2021 attack on the U.S. Capitol, Marsh asked: How did we get here?
Several years ago, we marked the 400th anniversary of the arrival of Africans in Jamestown, Virginia, and the beginning of slavery in what would become the United States. She spoke of how this era was characterized by the enslavement and brutal treatment of Africans caused by white supremacy and the economic benefits of free labor.
Marsh answered the question by quoting James Baldwin.
Although almost no one seems to know this, history is not just something to read. And it doesn’t just or even primarily refer to the past. On the contrary, the great power of history is that we carry it within us, that we are unconsciously dominated by history in many ways, that history is literally present in everything we do. It comes from facts. It is highly unlikely that this is not the case, as it is through history that we form our standards, identities, and aspirations.
Mr. Marsh highlighted the contradiction between the basic rhetoric of freedom and equality enshrined in the Declaration of Independence and the harsh realities faced by enslaved Africans and Native Americans. Even after the importation of slaves became illegal, inhumane treatment continued, discriminatory practices became deeply entrenched, and the rise of the Jim Crow era perpetuated racism and inequality.
She is known for the Dred Scott case, in which the Supreme Court ruled that both free and enslaved Africans were not U.S. citizens, and the Civil War, which led to the abolition of slavery with the Emancipation Proclamation and the eventual 13th Amendment. A detailed explanation of important events such as
Despite legal advances, racial discrimination persists, as evidenced by the rise of Jim Crow laws and infamous laws. Plessy v Ferguson In this case, the Supreme Court upheld racial segregation in public places.
In recounting these historical events, Marsh cited the dissenting opinion of Justice John Marshall Harlan, the lone voice against racial discrimination. Plessy v Ferguson. According to Marsh, this history is important for understanding the enduring struggle for civil rights and racial equality in the United States and the challenges faced by marginalized communities.
Taking action with counter-storytelling
Mr. Marsh referred to the persistence of racism, which has been framed in the media as a belief that all white people are racist, but in reality this is not the case. He said it is likely the most controversial doctrine.
“The persistence of racism shows that our structures are inherently racist by their historical context,” she said. “And the result is that some people are more privileged than others.”
Another tenant, counter-storytelling, serves as a tool to challenge dominant narratives and reclaim the voices and experiences of marginalized communities, Marsh explained. This stands as a response to historical and social contexts in which narratives are primarily created by individuals outside these communities, often leading to misrepresentation, erasure, and distortion of their lived realities.
She said the concept of counter-storytelling revolves around the idea that marginalized groups are in charge of their own stories, even when it is easier to ignore them. In essence, it serves as a corrective to the majoritarian narrative that has perpetuated stereotypes and prejudice.
“We can’t ignore this,” Marsh said. “There’s more at stake than our discomfort.”
standing together against racial inequality
“What do many of the things I talked about have to do with health disparities, patients, and society?” she asked. “all.”
Mr. Marsh challenged the audience to confront the uncomfortable truths about racial inequality and to actively participate in conversations about race, discrimination, and inclusion. She said her message was clear: “Silence is no longer an option; collective action is the key to achieving a more just society.”
The importance of overcoming discomfort was emphasized when Marsh asked, “Why can’t we move closer to equality?” She explained that this requires individuals to find the courage to speak up, lift others up, and admit their own biases. Unlearning and relearning is essential in this process, as it paves the way for true reflection and understanding.
“Just as we are all part of the problem, we are also all part of the solution,” she said.
Marsh took the title of his talk from a quote from Dr. Martin Luther King Jr.
In the end, we will remember not the words of our enemies, but the silence of our friends.
“Sometimes it’s more important than discomfort, sometimes it’s more important than fear. Inclusion is more important,” she said. “Care for our patients and loved ones is more important, and our existence tomorrow must outweigh the fears of today.”
Representation is critical, and Marsh explained that everyone, regardless of race or background, has a responsibility to ensure inclusive representation in every boardroom.
“I want you to think about who’s at the table. Who’s participating in this discussion? Whose voices aren’t being heard or thought about?” she asked. “Whose voice is it that cannot fill in the blanks because it has no lived experience?”
Before receiving a standing ovation, Marsh concluded with a plea to the audience, and especially those who have been working on inclusion within the ASRM leadership, to continue to do so.
“Even if I’m not in the room, I want you to know that I’m in the room. I’m not addressing anyone, I’m addressing all of us.” she said. “We have to do better, but when we know better, we can do better.”