Black Women and Healthcare Inequality
by Palma Black, CEO
Pregnancy is an experience that is supposed to be a joyous one; but for expectant Black women, it can be filled with anxiety, fear and trepidation. Black women are at an increased risk of experiencing worse outcomes when it comes to their reproductive health with an almost three-fold higher risk of dying in pregnancy in comparison to a white woman. But even before a Black woman can successfully conceive, they are faced with more obstacles than white women.
Research highlights that Black women are up to three times more likely to experience uterine fibroids - non-cancerous tumours causing irregular, severe menstrual bleeding and a multitude of health issues such as pelvic pain, pelvic pressure and infertility and more likely to undergo a hysterectomy due to fibroids. Black women are 43% more likely to miscarry. The issues begin in childhood with Black girls being hypersexualised at a young age and perceived to be more sexually active than white girls at a younger age. Outdated and harmful beliefs that ‘Black women are highly fertile’ leads to GP’s delaying referrals for fertility treatment.
It is well reported that Black women’s pain and health concerns are oftentimes minimised or dismissed, leading to mistrust and inadequate care. The origins of the notion that Black women don’t feel pain or have higher pain thresholds than white women can be traced back to colonial times, when African women’s bodies were used to pioneer gynaecological instrument developments and procedures. These bodies used to experiment on, were not afforded pain relief or anaesthesia and had to stifle their pain for fear of further punishment or even death. This was seen as proof that African women were immune to or had higher pain thresholds than white women. Unfortunately, these outdated perception of African heritage women persists, resulting in alarming health disparities.
This health disparity doesn’t stop at womb health.
According to Cancer Research UK Black women in England are almost twice as likely to be diagnosed with advanced breast cancer as white women. Late-stage cancers such as triple negative breast cancer is found in about 25% of Black African and 22% of Black Caribbean women. In white women, the figure is 13%. Experts say there are many reasons for this including low awareness of symptoms and screening. According to Cancer Research UK, Black women are less likely than white women to go for a mammogram when invited by the NHS. A 2022 report by the Black Equity Organisation found that most Black people living in the UK have experienced prejudice from healthcare professionals because of their ethnicity, with younger people feeling especially discriminated against. Almost two thirds (65%) of Black people who responded to a survey said that they had experienced prejudice from doctors and other staff in healthcare settings. This rose to three quarters (75%) among Black people aged 18 to 34. Participants felt that due to the misguided stereotype of ‘strong Black women,’ practitioners were dismissive of their pain,” the report said.
The British Heart Foundation funded research has shown that Black Africans, African Caribbeans and South Asians in the UK are at higher risk of developing high blood pressure or type 2 Diabetes compared with White Europeans. A study in the journal Heart in 2024 showed that women, Black people and people from low-income households are less likely to have access to heart surgery in England, and when they do have heart surgery, the results are not as good. Women are more likely to die in the year after heart surgery.
With all these challenges facing Black women, it is no wonder that they are more likely to experience common mental health problems (29%) compared with white British women (21%) and non-British white women (16%). But the picture is more sinister than appears…
Soul Purpose 360 was founded in the aftermath of my sister’s suffering and passing from stress-related cancer, and my desire to help other Black women to live fulfilled lives free from stress. Whilst researching this topic for the blog series on the challenges Black women face due to societal perceptions, I learned a new term: ‘Allostatic load’. Coined by Bruce McEwen and Eliot Stellar in 1993, it refers to "the wear and tear on the body" which accumulates as an individual is exposed to repeated or chronic stress measured through combined indicators on several organs and tissues associated with the neuroendocrine, cardiovascular, immune, and metabolic systems.
Scientific evidence has proved that ‘every day individual discrimination brought about and exacerbated by exposure to institutional and systemic or structural discrimination’ can increase our exposure to ‘the wear and tear on the body’. Examples of every day individual discrimination includes unfair treatment based on characteristics such as race, ethnicity, sexual orientation, weight, language, gender, age, or socioeconomic status. For all the talk about generational trauma that Black communities know so well, Allostatic load is something closer to home.
There is sufficient scientific evidence to prove that discrimination is associated with Allostatic load and that women of African and Caribbean descent are at a higher risk, due to repeated activation of the stress response through actions including daily hassles and microaggressions related to race and ethnicity. Furthermore, ‘internalised discrimination’, can alter a person’s self-perception due to discriminatory experiences. In coaching talk, we refer to a lack of self-esteem, personal confidence, personal agency, imposter syndrome, limiting beliefs and more. In any coaching scenario, Black women talk of the external factors that negatively impact their lives, things they have no control over that permeate their psyche and lead them to limit their own potential, leading to increased stress and inevitable illness.
In summary, social and economic factors including long-term gender and racial discrimination that cause chronic stress can lead to long term health implications and early death due to Allostatic load. Research by The Kings Fund further reinforced the fact that among ethnic minority groups, structural racism can reinforce inequalities, for example, in housing, employment and the criminal justice system, which in turn can have a negative impact on health. This describes accurately why, what, and how my sister succumbed to cancer.
Addressing these issues requires comprehensive, systematic and systemic changes that prioritise culturally competent healthcare and patient advocacy. Training healthcare providers to recognise and challenge their biases is essential. Additionally, increasing representation of Black women in healthcare professions and leadership positions with real power, can help ensure that their perspectives are integral to decision-making processes.
As a community, we also need to take responsibility for our health and that comes with raising awareness of how the external environment impacts our health as a people. We need to be active participants in research, civic society, taking up spaces in rooms and seats at table of influence. The need to shift our mindsets by raising our individual and collective awareness is crucial, because the current negative perceptions and narratives about Black women, are literally killing us. Shedding the ‘strong Black woman trope’, valuing rest as crucial to health-creation and being kinder to ourselves and others is a step in the right direction.
Soul Purpose 360 believes that it is time for this issue to form part of a bigger conversation about how the negative narratives about Black women and girls continue to impact our life chances and is calling for a National Commission on Black Women and Girls. Join the conversation by attending the #DefinitionRedefined Conference on 8th March in London. Registration and more information can be found here: bit.ly/SP360IWD25
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