You may have heard the troubling statistics about the health disparities facing Black women in the U.S., like the fact that they are 4 times more likely than white women to die during childbirth, but may not know much about why these inequities exist and persist and what we all can do to end them. To help us all understand more, we spoke with Zsanai Epps, Program Director of My Sister’s Keeper, a program of Black Women’s Health Imperative.
What are some health issues that disproportionately impact Black women in the U.S.?
BWHI: Black women disproportionately experience maternal morbidity and mortality, cardiovascular disease and hypertension, diabetes, HIV and AIDS, mental health conditions, and certain cancers including breast, colorectal and cervical. They are more likely to be diagnosed and/or more likely to have poor outcomes in comparison to white women.
What are the reasons for these disparities?
BWHI: The biggest driver of this inequity is gaps in access to quality and innovative care. Black women of reproductive age, 15-44, have some of the lowest levels of insurance coverage. Not having insurance hinders access to quality preventive care, and the screenings that are needed to catch problems early and prevent negative outcomes. Bias shows up in all sorts of ways you wouldn’t even consider. Research done last year found that medical scheduling software is more likely to double-book Black patients for doctor appointments, leading them to spend more time in waiting rooms, which makes seeing a doctor more inconvenient and stressful.
Some studies have found that Black women consistently receive lower-quality care regardless of age, social status and education. So even if a woman has insurance and access, racism and implicit biases on the part of healthcare providers may contribute to Black women not getting equal quality of care. One possible example of this that made headlines was when Serena Williams gave birth to her daughter, she had life-threatening complications afterward and shared that the medical providers wouldn’t listen to her when she told them that she knew, based on prior experience, that she was experiencing an embolism. That’s just one example obviously, but it drew attention to how pregnancy and childbirth are especially dangerous for Black women, even when they have access to high-quality care. The tragic story of a Black doctor who died after childbirth is another recent example of maternal mortality that can’t be explained by lack of access to care.
When it comes to Black members of the LGBTQ+ community these issues have extra elements, because of their lived experiences they may avoid seeking healthcare, or withhold information from a provider if it’s not a safe space. Racism, stigma, and lack of culturally competent care can result in very real negative health outcomes for members of this community.
How have current events affected Black women’s health in America?
BWHI: The Covid pandemic has exacerbated many existing disparities. For women who have struggled to access care before, there are new logistical or financial barriers. Telemedicine is suggested as a way to get remote care, but what does that look like in rural communities that don’t have good internet connections?
The murders of Breonna Taylor, George Floyd, and other Black Americans that have, deservedly, received so much attention this year have been traumatic. Racism, internalized stress and trauma increases cortisol levels in the body, which can have negative impacts in terms weight management, cardiovascular disease and diabetes, and of course stress leads to or exacerbates mental health issues as well.
And Black and brown folks appear to be more vulnerable to Covid, which relates to the fact that there isn’t sufficient data or research on people of color and how health issues and treatments affect them differently.
What can healthcare providers and the medical community do to make change?
BWHI: We need more implicit bias training for healthcare providers, so they can be conscious of how they’re evaluating and treating Black women, because that bias can impact care in a whole list of ways — just as one example, there’s research finding that healthcare providers don’t take Black people’s pain as seriously. BWHI is working with groups including the Association of Women’s Health, Obstetric, and Neonatal Nurses on implicit bias training aimed at improving maternal mortality.
In general, folks in positions of power and the medical establishment need to center the lived experience of Black women, as well as think through how policies could do disproportionate harm to the most vulnerable. When the American Cancer Society recently changed its recommendations for cervical cancer screening to stop recommending Pap tests and raise the age when screening starts, our organization spoke up. Black women in the US die from cervical cancer at more than two times the rate of white women, are diagnosed at younger ages, and tend to be diagnosed with disease that is more advanced. A recommendation to reduce screenings is likely to have a greater impact on Black women and result in more deaths. It makes an unfair system substantially less fair. Similarly, the recommendation is to start mammograms at 45, but Black women are being diagnosed with breast cancer in their 20s. Black women still need to advocate for themselves beyond what the medical establishment recommends.
What can be done to close the gaps at the societal level?
BWHI: BWHI just released our national health policy agenda for Black women. It was created to help inform policymakers and other stakeholders, and centers all of those health areas that disproportionately impact black women. We encourage people to use these recommendations to engage in substantial discussions and to help hold their elected officials accountable. It contains specific policy proposals related to healthcare coverage and reimbursement, public health and emergency response management, clinical research improvements, and more support for the sustainability of HBCUs, where a lot of Black women attend school.
Are there any positive signs — things that may be improving?
BWHI: The most positive thing is growing awareness of the racial disparities in healthcare, and the life-or-death consequences they can have for Black women. You see this in ways that range from the FDA mandating that clinical trials be more inclusive to Megan Thee Stallion on stage on SNL declaring that we need to take better care of our country’s Black women. Racism, sexism, classism, all these -isms continue to exacerbate these disparities but awareness is an important first step.
What can individual Black women and the people who love them do to protect their personal health?
BWHI: Black women need to prioritize themselves. We have to save ourselves first and fill our own cups before we pour into others. The people who love us should respect and support our self-care process. Also, as Black women we need not feel guilty about taking time for ourselves, relaxing our shoulders, and decompressing. Us, Black women need to work on centering our joy and being proactive about it and protective with it, especially when it is threatened by those around us deliberately or unintentionally.
When you interact with any institution, be it the family, education, religion, the economy and work, government, and health care, you need to be your own advocate. Especially, when interacting with health care institutions, know your medical history, be armed with your own medical records if possible — if the provider or your insurance plan has changed all of the information may not be there. Know your family health history. Speak up if you feel like you aren’t being listened to or heard. You can always look for another medical provider if you aren’t comfortable with the treatment you’re receiving. You can always file a complaint, even in a resource-weak situation you have a right to share your experience and expect that a provider will listen to you. You have a right to demand the highest quality of care!
About Black Women’s Health Imperative’s Program for Young Black Women
My Sister’s Keeper (MSK), is one of BWHI’s signature programs created to empower young Black women on college campuses, with special emphasis on HBCUs, through skills training and leadership development to advocate for and contribute to their own health and well-being as well as that of other Black women.
To learn more about the MSK program and how to get involved, please contact Zsanai Epps, Program Director of My Sister’s Keeper at firstname.lastname@example.org.
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