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Recently, the United Nations removed a Valentine’s Day illustration from social media after receiving criticism for its depiction of a range of couples and a single Black woman, set apart from the couples, seemingly exhibiting self-love. If you’re outraged that this kind of image could have ever been created, then your outrage comes too late.

As Black women, we live under a myriad of untrue, un-controlled, and unfair assumptions and beliefs. Racist assumptions stand between us and a life that is autonomous, safe and allows us to thrive. This is evident in the field of sexual and reproductive health, where Black women continue to experience poorer health outcomes than other racial and ethnic groups and are continually harmed by stereotypes about our sexuality, fertility and partnerships. Our recently released paper, Racism Runs Through It, highlights the impact that structural and individual racism plays in southern Black women’s experience with reproductive health care. This paper is part of our larger study, Trust Black Women.

Trust Black Women is a study by Black women for Black women that sought to understand Black women’s perspectives on reproductive health relative to their location and the factors that influence their reproductive health decision making. Through several listening sessions with Black women living in North Carolina and Georgia, we were able to get a picture of the sexual and reproductive health journey of these women, from the time they first learned about their bodies to their hopes for family, both current and in the future. What we learned was that experiences of racism are evident across the sexual and reproductive health lifespan and across a range of reproductive health services: abortion, contraception, prenatal care, maternal care and preventive care.

One area that stood out was participants’ repeated recounts of dismissal and disbelief of reproductive health concerns by medical professionals. This led many to have to engage with the medical system multiple times to receive a diagnosis or care for a persisting issue while others took on the task of finding a solution for the health issue on their own, to help speed the process of diagnosis.

“Most of the things that I am diagnosed with now like polycystic ovary syndrome, I came to my own doctor with. I showed them, […] it wasn’t until I forced them to do that that they discovered my diagnosis.”

In response, southern Black women reported seeking out same-race providers to avoid similar incidences of discrimination, and because they believed their experience and health outcomes would be better. Considering the evidence that a racially and ethnically diverse health workforce can promote better healthcare access and use among underserved populations, it is imperative that funding for federal programs dedicated to increasing the numbers of underrepresented minorities in health care professions be mandated.

The stories we heard about pregnancy and delivery underscored discrimination, stereotyping and the reality that our healthcare system is failing Black women. Participants constantly referenced high maternal mortality rates in the community and their frustration with the lack of policies and programs to address this issue.

“[…] it don’t matter how much money you make, where you live, whatever. When it comes to Black women, we’re still dying four times more than white women, two and three times more than any other woman. The only women that are neck and neck with us are natives because they discard them as well.”

This led some to recommend alternatives to hospital care, such as home births, and to form support groups to arm each other with strategies and advice to navigate and advocate for better maternal care. One strategy involved integrating doula care into the birthing experience. However, lack of reimbursement for doulas greatly reduces the ability of Black women to utilize this strategy — a strategy that has been associated with improving maternal health outcomes among low-income women and women of color.

Few studies have illustrated how racism influences Black women’s use of reproductive healthcare services, yet this is a pervasive problem. As we enter Women’s History Month, we must ensure our gaze stays focused on how negative stereotypes, racism and systematized discrimination in the education, housing and health system impacts every facet of the sexual and reproductive health experience of Black women.

We are glad to contribute to the growing body of literature on racism and its impact on health in our nation, but what we really want is to support real change. Our hope is that findings from this study will call into focus the need to address implicit and explicit biases within the medical system and to enact policies that undo structural barriers to sexual and reproductive health coverage and service availability.

We want Black women across the United States to know that we see the many things that make the reproductive road challenging, and we applaud you for navigating a system that is (all the way) broken. What we knew before we started this work, and are even more convinced of now, is that Black women deserve better. We demand better, and we will keep demanding better until it’s realized.

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Terri-Ann Thompson is Senior Research Scientist at Ibis Reproductive Health. Ibis Reproductive Health is a research organization working with partners to conduct high-quality research that positively impacts people’s sexual and reproductive health and lives.

Terri-Ann Thompson

Writing since March 2022 · 1 story contributed