Systemic racism impacts all areas of our society, but how bad is the problem within reproductive healthcare and what can we do to address inequalities that are impacting - and in some cases costing - lives? Here we’ll explain some of the key statistics we should be concerned about and how we can make some changes. 

Key Takeaways 

• Black women are more likely to have conditions like fibroids 
• Misdiagnosis and delays in diagnosis for reproductive health conditions are more likely for women of colour  
• Black women are sadly more likely to experience miscarriage and also die in childbirth
• Lack of representation in medical research and a historical lack of trust in healthcare providers could potentially be contributing to these issues 
  
  

Delays and Misdiagnoses

Misdiagnosis is the enemy of good healthcare - it causes delays in getting the right treatment and can even send people down a completely wrong care pathway. Women of colour are more than 20% more likely to face medical misdiagnosis than white men - and when we look at specific conditions like endometriosis this issue is even worse.

Although more research needs to be done, it seems like black women are 50% less likely to be correctly diagnosed with endometriosis when compared to white women. Considering the average time for an endometriosis diagnosis is 8-10 years (way too long in our opinion) this could leave black women waiting decades to get the support they need.  

Black Women Are More Likely To Develop Fibroids

Despite systemic issues with misdiagnosis, black women are actually often more susceptible to reproductive health conditions than white women.  

Take fibroids for example. Uterine fibroids are a common reproductive health issue, in fact, 2 out of 3 of us will develop them in our lifetime. 

However, Black women are three times more likely to have fibroids than white women. This disparity is not just statistical; it has profound implications for quality of life and fertility. In fact, Black women with fibroids are also at least twice as likely as white women to remove their uterus through a hysterectomy which raises questions about the way in which these cases are being handled. 

Black Women Are At Higher Risk of Miscarriage

Miscarriage is a heartbreaking event for any woman and is more common than you may think. Around 1 in 6 pregnancies will end in a loss, and for Black women, the risk is disproportionately higher. In 2021 The Lancet, working with the miscarriage charity Tommy’s published a paper indicating that Black women had a 43% increased risk of miscarriage compared to white women. 

The reasons for this increased risk are pretty complex and we still need a lot more research into why miscarriage happens in general - let alone why certain groups are more at risk. However, it could be connected to black women being more susceptible to certain conditions (like fibroids and Type 2 diabetes) that can add a level of risk to pregnancy -  but there could also be a link to how the health system often treats Black Women when it comes to being disbelieved or misdiagnosed. 

Black Women More At Risk Of Adverse Maternal Health Outcomes

Black women are four times more likely to die during pregnancy and childbirth. Historically this figure was actually even worse at five times more likely - a shocking statistic that inspired the incredible work of the Five x More organisation. 

Once again, it’s hard to pinpoint exactly why these horrific disparities exist but Five X More and Mbrrace have worked hard to collate anecdotal evidence from the black community to build a picture of why this is happening - and once again it seems to often be connected to being misdiagnosed and disbelieved by healthcare practitioners. 

Why is this happening?

The reasons for racial disparity in reproductive health care are vast and complex, but there are a few key factors that definitely contribute. 

Historical Distrust

There has been a long history of distrust between black women and healthcare providers - and for good reason. There are various examples in history of times when black women have been mistreated by doctors, especially in the areas of reproductive healthcare. James Marion Sims - lauded as the ‘father of modern gynaecology” - routinely abused enslaved black women as part of his experiments. Even more recently, in the 50s and 60s, there were huge issues with forced sterilsation of Black Women in America. This generational trauma leaves a lasting impression on black women today as this can make them less likely to see support, screenings or treatment, contributing to poorer health outcomes. 

Unconscious bias

There is also a huge issue with unconscious bias on the side of healthcare professionals. Unconscious biases are beliefs we hold deep down that can affect our conscious decision making. We would hope that doctors are intelligent enough to not stereotype women of colour, and hold these bias (and often racist) views, but sadly that is not the case. A 2007 study found that American doctors are twice as likely to underestimate black people’s pain and a 2016 survey of white medical students found that half of them (wrongly) believe black people have a higher pain threshold than white people.  

Underrepresentation in Medical Research

One of the most pressing issues in addressing these disparities is the underrepresentation of Black women in medical research and clinical studies. Studies have found that black women are significantly underrepresented in clinical trials compared to white people, which means treatment pathways are constantly being skewed to benefit white communities more than people of colour. This gap limits the understanding of how reproductive health conditions, like endometriosis and fibroids,  specifically affect these communities and harms the development of effective treatments. 

It will take a very long time to untangle the systemic issues that impact black women in the healthcare system, and we’re grateful for organisations like Five x More for the incredible work they are doing to make change. As an individual, one of the best things you can do is to get empowered about your body and your choices and learn how to advocate for yourself in medical situations. Our learning hub is a great place for you to boost your knowledge.