African American Health

Disparity on African American Women’s Health According to Reskin (2012), “As a structured system, racism interacts with other social institutions, shaping them and being reshaped by them, to reinforce, justify, and perpetuate a racial hierarchy. Racism has created a set of dynamic, interdependent, components or subsystems that reinforce each other, creating and sustaining reciprocal causality of racial inequities across various sectors of society.” Throughout the world there has been a troubling trend that is neither new nor surprising to African American women. That is, racism in healthcare. This problem is ongoing, and despite some advances, the issue remains an issue and has troubling outcomes for black females. From unequal medical care in the mental healthcare system to black women suffering higher rates of miscarriage and death in pregnancy, racism is not only worrisome but also deadly in some cases. Historically, the sexual and reproductive health of African American women has been compromised due to multiple experiences of racism, including discriminatory healthcare practices from slavery through the post-Civil Rights era (Prather, Fuller, Jefferies IV, Marshall, Howell, Belyue-Umole, & King, 2018). Throughout the times of colonialism and slavery through the Civil Rights era, black women have suffered greatly and, often times, in silence. For black women, eugenic programs emerged after slavery to try and control the size of the black population (Davis, A., 1982; Ross, L.J. 1992, Ross, L.J., 1992). These programs coerced African American women to undergo sterilizations without their full knowledge that these procedures were not reversible (Gould, K.H., 1984; Schoen, 2005). Although the eugenic thesis was refuted by scientists, several state-supported eugenic sterilization programs remained active (Akpan, 2013; Kaelber, L., 2013). Thirty states supported formal eugenic programs that enforced compulsory sterilization from the early 1900s to the 1970s (Kluchen, 2009). The healthcare that was provided to many African Americans during the Black Codes/Jim Crow era was eventually replaced with limited, poor-quality, or no health services for many black people. This was especially true for those people who were living in poverty during the Civil Rights era (Byrd & Clayton, 2000). Despite gains in healthcare accessibility and assistance for African Americans, the Civil Rights and post-Civil Rights eras have been characterized by overt and subtle forms of racism in the U.S. healthcare system. Legal segregation, which continued in the United States healthcare system continued through the mid-1960s until Congress passed the Civil Rights Act of 1964 (Smith, 2013). Shortly thereafter, the Medicaid program forced many hospitals to adhere to the Civil Rights Act and to hire doctors who would treat patients of all races, although the practice of treating patients continued unequally (Smith, 2013). Federal funding supported coerced sterilization, and some African American women were threatened with denial of medical care or termination of welfare benefits if they did not undergo sterilization (Randall, 2013). Also, in 1972, 20 women, mostly young, African American and poor, suffered unintentional abortions as a result of the super coil. The super coil was a device that caused uncontrollable bleeding and, in some cases, led to hysterectomies, abdominal pain, and anemia (Bernier, 1994). Another tragic and horrible issue that occurred was that many poor African American women underwent unnecessary hysterectomies as practice for medical students at select teaching hospitals (Roberts, 1997). This exploitation of African American women became routine and perpetuated the eugenic movement during this time period (Kluchen, 2009). Although long-acting reversible contraceptives (i.e., implants) are now recommended as the most effective contraception option for many women, including adolescents regardless of race/ethnicity, debates about reproductive justice and the use of these contraceptives among African American women persist. (Higgins, 2014; Gomez, 2014). African American women also report experiences of racial discrimination when seeking family planning services and are more likely than white women to be advised to restrict childbearing, which might engender feelings of mistrust (Flores, Cutler, Geckeler, et. al. 2013; Office of National AIDS Policy, 2010; Thorburn, 2005). Likewise, black women of low socioeconomic status (SES) were more likely than white women of low SES to be recommended by their healthcare provider for intrauterine contraception (Dehlendorf, Ruskin, Grumbach, et al., 2010). The CDC has stated that African American women experience a high burden of STIs, including HIV (In 2012, compared with white women, African American women were more likely to be diagnosed with (primary or secondary syphilis, gonorrhea, or chlamydia (16.3, 13.8, and 6.2 times, respectively), (Dehlendorf , Ruskin, Grumbach, et al., 2010). African American women were also two to three times as likely as white women to have pelvic inflammatory disease (Centers for Disease Control, 2012). If left undiagnosed or untreated, these conditions can lead to pregnancy complications and infertility (CDC, 2012). In addition, CDC reported that African American women had an HIV incidence rate that was 20.1 times greater than that of white women in 2010 (Centers for Disease Control and Prevention, 2010). African American women are also more likely to have delayed HIV treatment compared with women of other races (Aziz & Smith, 2011). Pregnancy-related morbidity and mortality also disproportionately affect African American women (Alio, 2011; Dominguez, 2011). In 2013, CDC reported that the preterm rate for black infants was 60% higher than for white infants (17.1% and 10.8% respectively), (Centers for Disease Control and Prevention, 2013). In addition, the low-birth-weight rate for African Americans was 10.13% and 6.97% for whites (Martin, Hamilton, Osterman, et al., 2012). During 1998–2005, African American women had a three to four times higher risk of pregnancy-related death at every age interval compared with women of other races (Berg, Callaghan, Syverson, et al., 2010). African American women also have increased risk for pregnancy-related hypertension and chronic hypertension (Martin, Hamilton, Ventura, et al., 2011). Importantly, this increased risk of mortality suggests that African American women are less likely to receive quality prenatal care and other preventive services (e.g., preconception health counseling and quality care for pre-existing medical conditions such as hypertension), (Tucker, Berg, Callaghan, et al, 2007). African American women undergo more hysterectomies due to conditions (e.g., uterine fibroids) that are potentially treatable by less aggressive procedures than other women. Becker, Spalding, DuChane. Kjerulff et al.,2005; Bower, Schreiner, Sternfeld, et al., 2009; Kjerulff, Guzinski, Langenberg, et al., 1993), also found that black women were more likely than other women to have longer hospital stays and three times the in-hospital mortalities, as well as other complications (i.e., respiratory, postoperative infection, gastrointestinal, hemorrhage, hematoma, accidental puncture, or laceration), (Kjerulff, Guzinski, Langenberg, et al., 1993). What Can Be Done Differently? 1) ensure strategies focus on culturally and contextually appropriate research and prevention, (2) ensure equal access to effective sexual health information and quality healthcare services, (3) support quality education and training for public health professionals, and (4) support policies that promote sexual and reproductive health equity. The bottom line is African American women have been victimized long enough and suffered at the hands of a system that has historically neither cared nor sought to change to accommodate their needs. It is hoped that this brief article will lead to some other research or at least open the conversation to helping African American women and change the healthcare system in their favor. References Akpan (2013). Dark medicine: how the national research act has failed to address racist practices in biomedical experiments targeting the African American community. Seattle Journal of Social Justice. 11, 1123–1181. Alio , Richman, Clayton, et al. (2010). An ecological approach to understanding black-white disparities in perinatal mortality. Maternity Child Health Journal. 14.557–566. Aziz & Smith. (2011). Challenges and successes in HIV-infected women to care in the United States. Clinical Infectious Disease. 52(Suppl 2) S231–S237. Becker, Spalding, & DuChane, (2005). 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