Illustration of a black fetus | The importance of diversity in medical imaging

The illustration of a baby in the womb of its mother, both black-skinned, has sparked strong reactions on social networks recently: it shows how little cultural diversity is represented in the world of medical illustration. And it’s time for that to change.

Maude Goyer
special collaboration

For six years, Marlee Gauthier has come across many illustrations of pregnancy and childbirth, in books, websites, her doctor’s office… And yet, this mother of two children aged 5 and 3, pregnant with twins, had never seen an illustration of her.

“When I saw this image, it touched me a lot, confides this dental surgeon of Haitian origin. She revealed to me that I had always taken it for granted that I was shown Caucasian babies and that I was used to not seeing myself…too used to it! »

Cadleen Désir, founder of Déclic, an organization that offers educational intervention services for children, and mother of three boys aged 14, 11 and 8, had the same reaction. “It moved me,” said the businesswoman with Haitian roots. I had never seen that! Throughout my pregnancies, I had little pictures on my fridge to see how my baby was developing in my womb over the weeks. But there has always been a gap between what I imagined and what was going on inside me…”

According to her, this gap is explained by the lack of diversity in the representation of pregnancies. “This image is good. It allows us to transpose and imagine our baby. The illustration was posted by Chidiebere Ibe, a young Nigerian who studies medicine and promotes inclusion in medical illustrations. He thus modified an image by the way designed in Montreal by Les Éditions Québec Amérique, which can be found in particular in the online software The virtual human body. Mr. Ibe then posted it on his Instagram account and it has been widely reported on ever since.

Obstetrician-gynecologist Anne-Maude Morency confirms that this image is beautiful… and rare. “We are in an era where we talk about the importance of inclusion, of the representativeness of all ethnic groups, explains the doctor. And yet, this type of image is not common. We have little or no access to this type of illustration for our communications, or to display in our offices. »

She brings a downside to the “veracity” of the image: the pigmentation of an unborn baby is never so well defined, she says.

“At birth, the baby does not have its final color, whether premature or full term,” says Dr.^D Morency, who practices at the McGill University Health Centre.

She adds that, as a general rule, a baby will have a more reddish-purple hue, with translucent skin in the case of premature babies. “A full-term black baby does not have dark skin as shown in the picture. It is melanin that determines the color of the skin and this will progress over time. »

Although they are represented in medical images, and can therefore identify with what is presented to them, white-skinned mothers are also “cheated”, in a way: their babies will not be born with white skin. immaculate, as seen in the books…

A strong symbolism

According to Michel Rouleau, scientific illustrator and industrial designer, there is a great lack of awareness, and a certain ignorance, surrounding the importance of representation in the world of illustration. “You have to illustrate people of different ethnicities, men and women, old and young, people with disabilities,” he says.

And if authors, researchers or publishers don’t think about it, an illustrator should have the reflex to suggest a better representation of diversity, he believes. “People need to feel challenged and not be sidelined. Moreover, an illustration is the art of suggesting, we interpret what we see as we want. »

In this sense, the fact that the image of the black baby in its mother’s womb is not glued to reality is not really important, he argues. “It’s a diagram of an anatomical cut, you understand right away and… the symbolism is there. »

And the symbolism is strong: it can help parents prepare for childbirth. “This allows parents to visualize the child to come and, in this sense, this type of illustration appeals to identity, to attachment”, underlines the D^D Anne-Maude Morency.

A broken glass ceiling

Psychologist Lory Zéphyr applauds the arrival of more varied and diverse medical images. “It’s a glass ceiling that’s been smashed,” she said. This image reveals to us that we have an unconscious bias: collectively, we are used to seeing images of people with white skin, with white bodies. It’s a reminder to be careful. »

She adds that many members of ethnic communities, she thinks of the black or indigenous community, for example, are suspicious of the medical system; being better represented could be a step towards better dialogue.

“The doctor-patient relationship could benefit from this openness,” she says. The patient will feel more at ease, will ask more questions, will feel less judged, less infantilized, more listened to… And in the end, we will all realize to what extent there is a lack of representation of diversity, in general, in society. »