Expanding Black Women’s Access to Reproductive Healthcare

To commemorate Black History Month, we are exploring an issue that burdens Black women in the United States: disparities in access to reproductive healthcare. Lawmakers, healthcare providers, and concerned individuals can implement several far-reaching changes that will significantly improve Black women’s reproductive health outcomes.

Here are the basic facts:

  • Black women are 3 to 4 times more likely than White women to die due to complications related to pregnancy across all income and education levels.
  • Black women are more than twice as likely to experience the death of an infant — 11.4 out of 1,000 Black infants die each year compared to 4.9 per 1,000 White infants.
  • Black women are 3 times more likely than White women to have uterine fibroids — growths on the uterus that can lead to heavy menstrual bleeding, severe pelvic pain, miscarriage, and early onset of labor.
  • Over 12 percent of Black women of reproductive age remain uninsured compared to less than 8 percent of White women.

Perhaps the clearest evidence of the barriers that Black women face is in the physical “weathering” (premature aging) of their bodies due to chronic stress from repeated exposure to racial prejudice and/or discrimination, regardless of socioeconomic status. Dr. Arline Geronimus was the first to correlate Black maternal stress with birth outcomes — she demonstrated that Black women in their mid-20s, who have experienced more sustained exposure to racial prejudice, face higher rates of infant mortality than Black teenaged girls. For White women, on the other hand, the prevalence of infant mortality decreases between their teenage years and their mid-20s. “Weathering” of the body increases Black women’s susceptibility to chronic diseases, making pregnancy much riskier for all Black mothers and their infants.

What can lawmakers do?

At every level of government, lawmakers can improve health outcomes for Black women by expanding access to health insurance and paid family leave. The majority of the 12 percent of Black women without health insurance fall into the “coverage gap,” meaning that they earn too much to qualify for Medicaid (which finances nearly half of all births in the U.S.) but too little to afford an insurance plan through the Affordable Care Act (ACA). If a greater number of states Medicaid expansion laws, more uninsured Black women will gain access to a wider range of family planning, prenatal, and postpartum reproductive health services.

Lawmakers can also pass bills that expand paid family leave and protections for pregnant workers. Currently, only 30 percent of Black women are both eligible (through their employers) and can afford to take unpaid family leave after giving birth, compared to almost 38 percent of White women. Between 2011 and 2015, 3 out of 10 reports of pregnancy discrimination in the workplace (e.g. being demoted because of pregnancy) were filed by Black women. The lack of paid family leave protections puts Black women at a greater risk of losing their jobs due to pregnancy or being pressured to return to work post-partum before they are healthy enough to do so.

What can healthcare providers do?

Healthcare providers have the responsibility to continually work to ensure equal, quality care regardless of race or socioeconomic status. Due to a lack of diversity in clinical research and among medical professionals, doctors often do not have an understanding of the specific effects of treatments for diseases on Black women. Researchers can provide higher quality care to Black women by recruiting more diverse, representative groups of patients for clinical trials.

Doctors can also work to provide more equitable care by taking seriously the health concerns of Black female patients. Currently, about 22 percent of Black women report experiencing discrimination when going to a doctor or health clinic. Studies have shown that doctors offer Black patients less pain medication and therapeutic treatments than White patients. Doctors must be equipped to treat any patient’s needs, regardless of their race or class.

Healthcare providers can greatly improve treatment of Black patients by increasing diversity in the medical field, starting with the medical school admissions process. Black doctors currently make up only 4 percent of all physicians in the U.S. Studies have shown that Black doctors are more likely than their White counterparts to see medically underserved populations to earn higher levels of patient trust, and to spend more time meeting with Black patients.

What can you do?

Here are a couple of ways that you can contribute to expanding access to reproductive healthcare services for Black women:

  • You can lobby or call your local, state, or federal legislators to urge support for a specific bill — whether it relates to Medicaid expansion, access to family planning services (protect Title X!), or comprehensive sex education.
  • You can vote for Black female politicians at the local, state, and federal levels — to elevate voices that will undoubtedly represent the needs of Black women.
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