Race has a major impact on the reproductive health of women in terms of diagnosis, behavior and access to care. African American women experience some of the highest rates of infant mortality, maternal mortality and sexually transmitted diseases.
These disparities are especially clear in the historical health of African American women; beginning with slavery and Jim Crow Laws, systemic racism has been deeply intertwined into reproductive health today.
Reproductive health refers to the state of physical, mental and social well-being in all matters relating to the reproductive system and to its functions and processes. For women, medical diagnoses, such as cervical cancer and sexually transmitted diseases, as well as pregnancy all fall under the umbrella of reproductive health. The systemic racism African American women have experienced on an internal, individual and community basis have led to weakened overall reproductive health.
Pregnancy-related mortality ratios increased with maternal age for all women, but, within age groups, non-Hispanic black women 40 years of age and older had the highest risk of dying from pregnancy complications, according to a study led by Dr. Andreea Creanga, who is an associate professor at Johns Hopkins Bloomberg School of Public Health. The high risk stems from other health issues, including cardiovascular conditions, infection, hemorrhage and cardiomyopathy. African American women also have a pregnancy-related mortality ratio that is 3.4 times higher than that of Caucasian women.
Researchers have also confirmed that uterine fibroids are more common and severe among African American women.
Uterine fibroids are benign tumors that grow in the uterus and can cause pelvic pain and abnormal uterine bleeding. They are removed by a hysterectomy, which is the removal of all or part of the uterus. Because fibroids are larger and more numerous in black females, their risks for peri-surgical complications are much higher than women of other races. This ultimately leads to a lower quality of reproductive health.
According to the CDC, there has been a strong correlation between African American women and high exposure to sexually transmitted infections. The rate of reported chlamydia cases for African American females between 15 and 19 years old was 4.5 times the rate among Caucasian females in the same age range. Similarly, the rate that African American women reported gonorrhea cases was 7.7 times higher than in Caucasian women.
In 2016, African American women accounted for 60% of all new HIV infections in women in the USA, despite only making up 13% of the US population. Another recent study showed that both male and female African Americans diagnosed with HIV are less likely than other groups to receive proper pharmaceutical treatment to control the virus and achieve adequate viral suppression. Viral suppression refers to the actual suppressing of the function of the virus and its ability to replicate. The increased chance for sexually transmitted infections and lower quality of care has also led to higher death rates.
Many studies have linked these disparities in maternal health to the social and political determinants that have marginalized African Americans.
One large disparity in the quality of reproductive healthcare available to African American women stems from unequal access to healthcare. For example, inequality in household income and the high cost of coverage has made it more difficult for African Americans to afford health insurance.
Often, African American people who do have health insurance experience poorer quality of medical care, which has been attributed to prejudice formulated by healthcare providers. The diminished access to health insurance and poorer quality of healthcare has been said to be an underlying cause for the increased rates of HIV in African American women.
Disparities in maternal health have also been attributed to physicians’ unconscious attitudes and stereotypes. This persisting bias has affected the treatments and methods of rehabilitation provided to African American women.
Personally mediated racism has been experienced by African American women in their interaction with providers who project stereotypes of sexual promiscuity toward them and provide inferior service, according to a study led by Dr. Cynthia Prather, a behavioral scientist at the Center of Disease Control.
This prejudice has led to delayed reproductive health screenings, such as HIV treatment adherence, pap smears and mammograms, all of which are essential to diagnosing reproductive health issues.
Additionally, racism affects community settings, which can increase reproductive health risks. High rates of unemployment, poverty and under-resourced education are all factors of neighborhoods that have been persistently segregated by race. Research suggests that poverty and lack of access to health information within African American communities increases chances for contracting STIs. Similarly, under-resourced education has been associated with higher rates of preterm births and infant mortality rates.
Stress that arises from racism is another way in which the maternal health of African American women are negatively impacted. Chronic stressors that stem from racism like poverty, unemployment and discrimation are linked to behaviors such as smoking and drug use. These habits can ultimately cause adverse pregnancy outcomes including infant mortality and rates of low birthweight, which is two times higher in African American women than in caucasian women. Similarly, internalized racism can cause psychological distress, low self-worth and low self-esteem. This has also been linked to higher rates of obesity, body mass indexes (BMIs) and type 2 diabetes, all of which adversely affect pregnancy.
Despite such a large divide in terms of access and quality much rooted in systemic racism, there are some proposed methods aimed at bridging this health divide.
For example, introducing microenterprise programs could boost employment opportunities for African American women and alleviate the financial burden placed on them. These researchers say that coupling health interventions with economic programs can help address self-esteem, increase education levels and reduce stress, which would all contribute maternal health benefits.
Local, state and federal programs that help educate and provide resources to African American communities can also help minimize the impact of race on health. Condom and syringe distribution programs are effective in reducing risk among STIs and injection drug users and can act as another tool to educate black women about their maternal health and wellbeing.
Growing the network of community health centers can also provide crucial medical resources because they allow access to primary care by reducing cost and, oftentimes, not requiring insurance.
One-on-one, group and family interventions can also improve the mental and physical health of African American women. For example, interventions that involve partners of pregnant women might create a larger support network, boost self-esteem and help lower stress induced by racism.
Educating black women about the history of racism and its link to maternal health today is another way to improve outcomes by promoting self-advocacy. Additionally, cultural training for physicians and other healthcare providers could help improve their understanding of systemic racism as well as their sensitivity towards the specific needs of black women.
On a larger scheme, experts propose that reform in the health insurance industry and legislation will be the best way to combat this disparity in maternal healthcare. One study suggests that legislation that proposes federally funded universal healthcare for all Americans, could make a substantial difference in the amount of African Americans who cannot afford health insurance. This would allow greater access to essential screenings, medical education and quicker diagnoses leading to better maternal health outcomes.