Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity

Abstract

Background: 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. However, studies rarely consider how the historical underpinnings of racism negatively influence the present-day health outcomes of African American women. Although some improvements to ensure equitable healthcare have been made, these historical influences provide an unexplored context for illuminating present-day epidemiology of sexual and reproductive health disparities among African American women.Methods: To account for the unique healthcare experiences influenced by racism, including healthcare provision, we searched online databases for peer-reviewed sources and books published in English only. We explored the link between historical and current experiences of racism and sexual and reproductive health outcomes.Results: The legacy of medical experimentation and inadequate healthcare coupled with social determinants has exacerbated African American women's complex relationship with healthcare systems. The social determinants of health associated with institutionalized and interpersonal racism, including poverty, unemployment, and residential segregation, may make African American women more vulnerable to disparate sexual and reproductive health outcomes.Conclusions: The development of innovative models and strategies to improve the health of African American women may be informed by an understanding of the historical and enduring legacy of racism in the United States. Addressing sexual and reproductive health through a historical lens and ensuring the implementation of culturally appropriate programs, research, and treatment efforts will likely move public health toward achieving health equity. Furthermore, it is necessary to develop interventions that address the intersection of the social determinants of health that contribute to sexual and reproductive health inequities.

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

“…For instance, Prather et al . 's recent review of racism and African American women's health points to the need to explore health effects of racism in healthcare, criminal justice, housing, education and employment systems.…”

A Transdisciplinary Conceptual Framework of Contextualized Resilience for Reducing Adverse Birth Outcomes

“…Daily interactions of indignities with healthcare personnel add up to increased stress and worry for Black, Hispanic, and Latina women, resulting in increased adverse birth outcomes ; Author et al, reducing cumulative stress and physiological responses in the body during pregnancy. Increased access to health and preconception care, nutritional fresh foods, economic opportunities and family supports can also provide an understructure to promote healthy birth outcomes and resilient pregnancies Lu et al, 2010;Prather et al, 2018).…”

“…Embodiment of contemporary and historical trauma has been shown to influence both disease and adverse birth outcomes for Black women (Sealy-Jefferson et al, 2016;Prather et al, 2018;Prather, Fuller, Marshall & Jeffries, 2016;. Exposure to structural violence and threats in the form of discrimination and racism can be embodied as a higher allostatic load, or cumulative "wear and tear" on the body , which can result in weathering, an increased susceptibility of disease (Geronimus, Hicken positive trajectory but representing a process of "harnessing key resources to sustain well-being" (Panter-Brick, 2014) in which political economies, access to power, cultural norms and expectations are influenced by structural vulnerabilities, historical oppression and the ecological layers and environments of the individual, family and community.…”

Long‐acting reversible contraception: A route to reproductive justice or injustice

“…This distribution of unplanned pregnancies, marked by high rates among minority women, especially African Americans, likely reflect the institutionalized and interpersonal discrimination suffered by these groups for hundreds of years (Prather et al., ). Pathways from discrimination to unplanned pregnancies include limited access to affordable and effective contraception and a scarcity of reproductive healthcare providers in neighborhoods where high concentrations of minority women live and work (Bailey et al., ).…”

“…Further, limited education, residential segregation, poverty, and having few opportunities for advancement—rooted in social inequalities—also may contribute to a high rate of unplanned pregnancies by influencing decision‐making around sexual behavior, sometimes in efforts to acquire basic needs such as food and shelter (Bailey et al, ). Finally, the legacy of medical experimentation and inadequate healthcare has exacerbated a mistrust of the medical establishment, among disenfranchised women (Prather et al., ), leading to a bias against contraception that requires doctors’ intervention, and this includes LARC. The overall picture is that women of color, as well as women of other minorities in the United States, often face difficult socioeconomic circumstances which influence their reproductive strategies and choices, including those related to the use of contraception (or not) and, correspondingly, the risk of an unintentional pregnancy.…”