It’s hard to explain what it feels like to know that, just a few generations ago, my great-great-grandmother was a slave woman whose body was controlled by a slave master. The knowledge becomes harder to stomach as I reflect on the past and realize what little has changed. When I gave birth to my child, my experience recalled that legacy and confirmed my own lack of bodily autonomy, as perceived by the physicians who assisted me and determined the quality of care I received.

During labor, I was given an episiotomy without my permission. I found out after the fact when the doctor told me what she’d done, with a smile on her face. “Don’t worry, I had them with both of my children. You’ll be fine,” she assured me.

I could sense from her tone that she expected me to be grateful, but I wasn’t. It scared me that she could dismiss my consent so easily. And soon afterward, it became clear that I wasn’t fine.

The pain intensified. Yet another week later, while visiting another state, I was admitted to a hospital for an emergency dilation and curettage, a procedure to remove the placenta the attending physician and emergency room visit had missed. I could have developed an infection and died. (My loved ones encouraged me to press charges, but the entire process was so complicated that I didn’t want to go through with it.) It was all made worse months later when my insurance sent the bill to collection because my D&C was misclassified as an abortion. I felt raped by the system in every way. Had I not listened to my body, and my mom, I would have been another dead black mother headline.

As a black woman, I’m always burdened with the responsibility of informing the world around me that my body is mine. Historically, it belongs to everyone else: not just the white men who saw me as a vessel for increasing their property, but also the black men who saw me as a tool for their own pleasure.

Women with the color of my skin were legally considered incapable of being raped. Being raped came with the connotation that something had been stolen from you—your comfort, safety, ability to consent, but black women were historically not afforded these. White women were seen as innocent and virtuous and were often juxtaposed with the savage and oversexualized image of black women. We were denied our humanity and used strategically as property. It’s a theme that continues today.

Today, black women have a complicated relationship with all forms of reproductive activism. The modern reproductive movement focuses on the right to an abortion but overlooks those of us who have a history of being robbed of parenthood. In the past, it was slavery, a couple decades ago it was forced sterilization, and now it’s death during childbirth. Each generation carries a different loss as it relates to bodily autonomy. Under slavery, the loss was profound. In contemporary times, we have lost our consent and too often our lives.

Modern gynecology, like many other fields, was established using black women as lab rats to conduct life-threatening experiments. James Marion Sims, credited as the father of modern gynecology, began his career as a plantation physician who experimented on slaves. In 1845, he began practicing surgical techniques for fistulas on slave women without anesthesia of any kind. One of Sim’s recorded victims, Lucy, was undressed before an audience of 12 and then subjected to extreme agony during and after an hour-long fistula procedure, in which he used a sponge and silk string to recreate a capillary tube. She contracted blood poisoning from the sponge he used to collect her urine and took months to heal. Another victim was an enslaved woman named Anarcha, who underwent 30 operations in four years, feeling full pain. Not long after, Sims “perfected” his method and went on to perform fistula procedures on white women—with anesthesia.

At the time, medical notions about black people assumed they were unable to feel pain, but disturbingly, many physicians still believe black Americans have higher pain tolerance. This may, in part, explain my own birth experience, where the physician’s dismissal almost resulted in my death.

Black women became the targets of racist violence again after slavery, when thousands of freed black men, women and children migrated from the South to the North for the opportunity of work brought by the industrial revolution. The eugenics movement started in the early 20th century and led to the forced sterilization of thousands of black women across the United States; in North Carolina, about 7,600 women were sterilized from 1929 to 1972. Medical professionals performed these unethical procedures through misinformation, threats to withdraw government assistance like food stamps and Medicaid, and deceit. Some victims were as young as 12 and some have received reparations from the state, beginning in 2014.

By now, we’ve all heard of Henrietta Lacks, the poor tobacco farmer whose cells were collected for diagnostic purposes but continued to be used without permission after her death. Lacks’ cells were harvested at Johns Hopkins Hospital in the early 1950s, and they have been sold and used billions of times to develop vaccines. While the medical industry made strides (and billions of dollars) on her DNA, her family was unaware and living in poverty, lacking the medical insurance to use the treatments their mother made possible.

Lacks died of cervical cancer, but black women are still dying from this disease (and many others) at disproportionate rates, thanks to a combination of systemic mistreatment and delayed diagnosis. That was Henrietta Lacks’ story, too. We often discuss the “good of many over the good of one,” but what happened to create these vaccines was the continued, pervasive exploitation and dehumanization of black women.

In 2013, Johns Hopkins Hospital was again in the spotlight when Dr. Nikita Levy, a black doctor who practiced obstetrics and gynecology for 25 years at the East Baltimore Medical Center, was discovered to have secretly filmed patients during pelvic exams and other procedures and treatments. Levy’s patients were overwhelmingly poor black women. He killed himself shortly after his abuse was made public. The trauma experienced by patients like Bessie Smith will lead to long-term aversions toward medical care. “I don’t trust them. I’ll die on the streets before I go back to Johns Hopkins,” she told the Baltimore Sun.

Each instance of medical mistreatment worsens the health outcomes for black Americans, whose historical avoidance of doctors' offices is validated by the long track record of abuse.

The medical industry is run mostly by white men telling others how to manage their bodies. In the past, areas like gynecology and women’s health were dominated by men. Things are changing, but women’s voices are still being muffled. Black women’s voices like my own are still being silenced. It’s hard to overcome centuries of ongoing mistreatment. We’ve been the stepping stone for so many medical advancements, yet we reap so few of the benefits. The negligence and pain from my birth experience left me wondering whether I can ever fully heal from the trauma. For now, I am somewhat comforted knowing the dialogue is taking place.

So when I’m asked why I’m still going to the doctor despite a legacy of pain, that’s what I’ll say.