From higher rates of unintended pregnancy to increased risk of pregnancy complications, Black women bear a disproportionate burden of reproductive health disparities. However, few studies have illustrated how racism impacts reproductive health services among Black women, so Ibis Reproductive Health researchers conducted a study to understand racism’s role better. Here, we break down the findings, the impact that structural racism has on Black women’s reproductive health, and the policy implications.
“Our hope was that the findings from our study would spark energy around creating policies and practices that benefit those most impacted (or removing policies and practices that don’t benefit those most impacted),” Terri-Ann Thompson, Ph.D., a senior research scientist at Ibis Reproductive Health, tells Austin Women’s Health Center.
The paper amplifies one set of findings from a more extensive study, known as the Trust Black Women study, and centers on the Trust Black Women Partnership work, which aims to eradicate stereotypes about Black women.
“We wanted to call attention to the experiences of Black women that never get aired, such as their concerns about preventative care or about how society portrays Black family formation,” she says.
Barriers to Reproductive Health Care
The researchers conducted six focus-group discussions and 26 in-depth interviews with 49 Black women living in Georgia and North Carolina. They found experiences of racism across a range of reproductive health services, including abortion, contraception, prenatal care, maternal care, and preventive care. The researchers also found that racism impacted participants’ access to care, use of care, and care experience.
“Black women living in the south face many challenges to getting sexual and reproductive health care that respects their autonomy and that feels patient-centered and comprehensive,” Thompson said.
Impact of Structural Racism on Reproductive Health Care
Quality of Care
This study found that health facilities in predominantly Black communities are facilities that serve a higher proportion of people on governmental assistance or with no insurance. “These same facilities were described as providing lower-quality care compared to more expensive hospitals or facilities,” Thompson adds.
In the focus group discussion, participants noted that the color of your skin and the type of insurance a person had influenced how hospitals treated you. Therefore, lower quality of care can lead patients to become sicker, have more disabilities, have higher healthcare costs, and lower confidence in the health care industry’s ability to improve health.
Racism can also hamper doctor and patient relationships. For example, participants in the study reported being dismissed for their health concerns by doctors.
One participant in the study said:
“So, one time I had gone to the hospital because I was like overtly bleeding, really hard, and I shouldn’t have been. …I feel like nothing happened. I feel like I got an $800 bill to be looked at, asked if I was assaulted, repeatedly have to tell people I wasn’t assaulted, and then be like, ‘Oh, OK, go home.’ And after that, I just stopped going to the doctor altogether because I felt like I didn’t get any help at all,” said a study participant. Ultimately, these experiences fuel mistrust in the system, making it less likely that people take medical advice, follow up on appointments, or fill prescriptions.
Structural racism also impacts the quality of care that Black women receive. For example, many Black women did not receive information on their reproductive health conditions, Doctors ignored their experiences, and fewer resources were offered.
Housing Policy
Structural racism manifests in institutions and policies that can impact Black women’s ability to access and obtain care. For example, Thompson notes that in the 1930s, President Roosevelt signed the Home Owners Loan Act and the National Housing Act to prevent foreclosures and make housing rentals and ownership affordable.
Despite President Roosevelt’s intentions, the policy resulted in maps being created that assessed risks of mortgage financing based on a neighborhood’s racial composition, with Black communities being deemed hazardous and too risky for mortgage lending. This policy ultimately led to only 2% of Federal Housing Administration loans being distributed to non-white families from the 1930s to 60s.
“We have much evidence that people living in lower-income communities have less access to public transportation, high-quality schools, high-quality care, and evidence that they are exposed to greater health and safety hazards (diminishing their overall well-being),” Thompson says. A lack of access to transportation and high-quality care can prevent Black women from seeing the doctor and lead to poorer health outcomes than other racial groups.
Medicaid
Because Black communities tend to be overrepresented in Medicaid, the experience of structural racism may be more salient for Black women living in states without Medicaid expansion.
“While research has shown that expanding federally funded Medicaid coverage allows more women to gain access to reproductive health care services, such as cancer screenings, contraceptives, and maternity care, neither North Carolina nor Georgia has adopted Medicaid expansion,” Thompson explains.
Improving Reproductive Health Care for Black Women
Racism undermines the patient-doctor relationship and decreases the quality of care for Black women. That’s why it’s important to have Black medical professionals and more diverse medical staff. According to the study, Black medical professionals are perceived as more trustworthy and knowledgeable about Black women’s circumstances, reproductive health concerns, and more empathic.
Thompson says that policies can also improve reproductive health access. “These include expanding federally funded Medicaid coverage and enacting policies, such as the Equal Access to Abortion Coverage in Health Insurance (EACH) Act, which would restore or otherwise require coverage of abortion for people receiving health coverage or care through federal programs and plans.”
Coupled with more inclusive policies, Thompson notes that cultural competency training and a mandate for funding to increase the representation of underrepresented populations in the health professions could also make a big difference.
While these solutions are not an end-all, they are a start to addressing institutional racism that prevents Black women from getting the care they need and deserve.
“Our paper helps illustrate how racism creates inequities across social determinants of health, but it also calls into focus gaps in resources and policy efforts to improve reproductive health outcomes,” Thompson says.