Centuries of racism, along with the harmful strong Black woman stereotype — that Black women are more resilient and inherently stronger than white women — have had catastrophic effects on the health outcomes of Black women, from the cradle to the grave.
For more than 91 days, Danielle Bridges cared for her two children while dealing with excruciating knee pain after her doctor failed to treat her injury. Her knee was swollen and hot to the touch, an injury from taekwondo. She had gone to her in-network doctor, noticing her knee appeared filled with fluid and was unable to bend, but he minimized her pain. “The doctor even slapped me on the injured knee to prove it wasn’t so bad,” she said. Ultimately, she went home with crutches, no pain medication, no further tests and advice not to put too much weight on it. It wasn’t until about 3 months later that he finally did an MRI, she said. “Then, he called me sheepishly stating there was quite a bit of damage, including a torn ACL.”
Bridges already had anxiety regarding doctors and hospitals. When she was pregnant with her first child, the OB-GYN she was seeing never looked her directly in her face, she said, and he insisted she must have known who the father of her child was even after she explained she used a sperm donor. She asked that a different doctor in the practice attend her child’s birth, and, ultimately, that doctor ignored her birth plan and all of her wishes. “She pushed me into induction and insisted I could not give birth naturally,” said Bridges. “It made me feel depressed and like I am not strong or capable. I am Black and pregnant with no father. Everything I wanted was pushed aside.”
It starts at birth
Her story, unfortunately, is not uncommon among Black women. The dismissal of Black women’s health concerns is just one factor in a set of racial health disparities that begin at birth. Babies born to Black mothers are more than twice as likely to die before their first birthday. Before they even leave the hospital, Black newborns — who are more likely than white babies to be born prematurely — receive less nursing care in the NICUs of our nation’s hospitals. Black infants are also almost four times more likely than white infants to die from health complications caused by low birth weight, which is the leading cause of infant death. Across all socioeconomic statuses, Black women are about three times more likely than white women to die from preventable birth-related complications.
"It’s racism — not race — that affects Black women’s health."
“It's really important that people understand the historical context behind why racism affects medicine,” Dr. Kiarra King, a board-certified obstetrician-gynecologist, told TODAY. Citing J. Marion Sims, known as the father of gynecology, King explained that modern women’s health care was developed, without consent, on the bodies of Black women. Sims experimented on enslaved Black women without pain medication, and the idea that Black people feel less pain persists today. It’s racism, not race, that affects Black women’s health, she said.
The physical and mental health effects are unavoidable
All racist experiences, whether medical, interpersonal or institutional, add up and equal a life full of frequent, persistent stress for Black women. Studies show this toxic stress promotes an inflammatory response in the body at the cellular level — the same inflammation at the root of preeclampsia, hypertension, dementia and other chronic conditions that Black women are at higher risk of having or dying from. Premature death, before the age of 75, is more common in Black people than Hispanic and white people. The health inequities are startling, and the mental health effects of stress causted by racism are unavoidable.
“This country was founded on racist practices. “It should be no surprise that medicine also has racist practices — racism was built into the institution of medicine."
When police violence and racism claim the lives of Black people, Black women grieve and take the front lines in the fight for equality. The harmful strong Black woman stereotype, that Black women are resilient and inherently stronger than other women, leaves Black women unprotected. Exerting energy fighting the very things putting their own mental health at risk, Black women often become sacrificial lambs to racism. The chronic stress of racism is trying and leaves Black women prone to depression and other mental illnesses.
Due to stigma, distrust of the health care system and lack of access to culturally competent care, Black women are half as likely to seek mental health treatment as white women. The videos of George Floyd and other Black people being murdered and brutalized by police officers is a major source of stress. Just a single exposure to real-life police violence against a Black person, whether on social media or TV, can cause stress, anxiety and post-traumatic symptoms like hypervigilance in Black Americans — and studies are just beginning to crack the surface on the way these experiences affect the health of Black people. One thing is clear: centuries of racism have weathered the bodies of Black women.
A double whammy in the doctor’s office: Gender and racial bias
Of course, gender bias influences the care and pain management women are given, but Black women face both gender and racial bias. “There have been studies that have revealed that medical students and doctors believe Black people have a higher pain tolerance than non-Black people, which has over time led to them thinking Black people presenting with pain were drug-seeking,” said King. Myths that Black people have thicker skin and feel less pain drive inadequate pain management where Black people reporting pain tend to be 22% less likely to be prescribed pain medications.
Bridges’ story is echoed in the stories of Black women across America who have spent too many days in pain — dismissed, disempowered and denied the care they thought the health care system was there to give.
These experiences are traumatic, but more importantly, they’re often fatal. One very shocking example of this disparity is breast cancer. Black women are less likely to be diagnosed with breast cancer but more likely to die from it. According to the Centers for Disease Control and Prevention (CDC), Black women die from breast cancer at a rate 40% higher than white women. The CDC explains that doctors are more likely to find breast cancer at an earlier stage among white women than they do for Black women.
The list of racial health disparities is long, and systemic racism is at the root of them. “This country was founded on racist practices,” said King. “It should be no surprise that medicine also has racist practices — racism was built into the institution of medicine.”
For Black people, racism continues to result in unequal access to economic opportunities and ultimately unequal access to high-quality health care and insurance. The effects of racism and gender bias on mental and physical health cannot be ignored, and the importance of listening to and taking care of Black women when it comes to their health cannot be denied.
Kelly Glass is a writer and editor whose interests focus on the intersections of health, parenting and race.