For Black women in America, asking the right questions can result in better care from your Ob-gyn. From breast cancer screenings to prenatal care, here are some key topics to discuss with your doctor on your next visit.
According to the National Institutes of Health, only 11% of Obstetricians and Gynecologists (Ob-gyn) are Black, and the majority of those practice their speciality in major metropolitan areas. As a result, it is highly likely that the majority of Black women will have a white doctor.
“Women of color, particularly Black and Latinx women, have more difficulty accessing care. There are likely financial limitations, but it’s also cultural,” says Dr. Marcela Almeida, who served as Director of Women’s Health and Reproductive Psychiatry at the University of Illinois, and is currently on the faculty at Harvard Medical School. “Many black women are concerned that they won’t be heard or understood.”
Black women must advocate for themselves in order to receive the best possible reproductive and sexual health care.
Talk frankly about race-related bias
The American Journal of Obstetricians and Gynecologists reports that there are major disparities in healthcare for Black women; they are more likely to die from breast cancer, suffer from infertility, and have more preterm births than white women. Not only that, but Black women experience significantly higher maternal death and fetal death rates than white women.
“Every doctor sincerely wants the best for their patient or they wouldn’t join the profession,” says Dr. Gloria Elam, Associate Professor of Clinical Obstetrics and Gynecology at the University of Illinois/Chicago. “However, doctors are human and not immune to stereotypes and prejudice.”
“Fortunately, the American Association of Medical Colleges has developed training guides, podcasts, and professional development opportunities so that doctors can learn to acknowledge their biases, and make the effort to overcome them.”
Still, Black women have to take the necessary steps to get the best care they possibly can by having frank conversations with their doctors about racial bias.
Make sure you’re getting regular mammograms
According to Breastcancer.org, Black women are more than 40 percent more likely to die from the disease than white women.
“The difference in those numbers is due in part to not catching the cancer early. Early treatment can definitely extend and perhaps even save your life,” says Dr. Elam. “That’s why it’s so important to share all of your family history during intake with the nurse practitioner or doctor,” she says. “If your mother, grandmother, sister or aunt had breast cancer, the risk is higher that you may get it too.”
According to the Mayo Clinic, there is disagreement among practitioners about how early to begin exams. The American Cancer Society recommends screening beginning at age 45.The Affordable Care Act requires all new insurance plans to cover mammograms for women beginning at age 40 with no copay. And Medicare covers mammograms for women as young as 35.
Check for uterine fibroids
The University of Michigan Health Lab estimates that nearly a quarter of Black women between the ages of 18 and 30 have fibroids compared with 7 percent of white women. By age 35, that number increases to 60 percent of Black women. According to the NIH, 84 percent of Black women will be diagnosed with fibroids in their lifetime. Black women tend to have a higher number of tumors and each is relatively larger.
It’s also important to be aware of the symptoms of fibroids, which are more severe in Black women, including lower back pain, swelling of the abdomen, painful intercourse and extended heavy bleeding during menstruation.
“It used to be that the standard response to fibroids was a hysterectomy, which would eliminate the possibility of having a baby. It’s much better now,” says Dr. Elam. “We’ve seen a significant increase in positive outcomes. Not only is the pain gone [but] many women are able to conceive after surgical removal of the tumors.”
It’s OK to talk to your doctor about infertility
In 2018, Oprah Magazine and Women’s Health Magazine, in partnership with the Black Women’s Health Imperative, surveyed over 1,000 women. The results: Black women were 50 percent more likely than white women to say they are uncomfortable talking about infertility issues with their doctor.
Infertility affects at least 12 percent of women of childbearing age, and studies suggest this number doubles for Black women in the US. Only 8 percent of Black women seek IVF to get pregnant, compared to 15 percent of white women.
“This is another of those persistent culturally embedded fallacies,” says Dr. Almeida. “Latinx and Black women are mistakenly believed to be sexually active at an early age and hyper-fertile. Those stereotypes are internalized so that women who have infertility issues may feel ashamed that they are unable to conceive.”
Look into maternal mortality rates at the hospital where you plan to give birth
In the United States, the maternal mortality rate for Black women is about 37 per 100,000 live births -- more than double the overall figure of 17 per 100,000 live births.
Infant mortality rates for Black babies are also double that of white babies. Data from the CDC reveals that infant death rates of Black babies occurred for 10.8 for every 1,000 births — more than double the statistic for white babies, which was 4.6 per 1,000 births.
According to The Commonwealth Fund, daily encounters with racial discrimination is actually linked to preterm birth in Black women based on chronic stress. Studies show that women live a more stressful life can increases the stress hormones that can have an adverse effect on the development of the child and on labor.
Dr. Elam’s advice: talk to your doctor about a birth plan. “A birth plan is very helpful as a basis for a discussion between you, your doctor and your partner,” Dr. Elam explains. “Most doctors will try to respect your wishes, as long as it’s in the best interest of the health of you and your baby.”
Make sure you get checked for postpartum depression
The NIH also notes that there are significant racial and ethnic disparities in depression-related mental health care after delivery. Dr. Elam says this is due in part to cultural stigmas which prevent Black women from asking for help. “This is such an important issue,” says Dr. Almeida. “If someone was bleeding, you don’t say to them, ‘stop that.’ But when it comes to mental health in Black and Latinx communities, the response is often, ‘get over it.’”
“However, it’s also bias among mental health professionals,” she says. “For example, the same symptoms that lead to a diagnosis of bipolar disorder in a white patient are often labeled as schizophrenia in Black [patients].”
Undiagnosed postpartum depression not only can interfere with daily functioning and relationships, it also affects the critical bonding and attachment which takes place between a mother and her newborn. Untreated postpartum depression can have severe impacts on the health and well-being of the affected woman and her family, including long-term consequences for the cognitive, emotional, and behavioral development of her child.
Take advantage of sexual health resources via telemedicine during the pandemic
Long-standing systemic health and social inequities have put people of color at increased risk of getting sick and dying from COVID-19, according to the CDC. Dr. Almedia says this risk exacerbates existing disparities in mental, reproductive, and sexual health care for Black women and increases the likelihood of a problem during a pregnancy. But, she says there’s good news, too. “The use of telemedicine has boomed during the coronavirus. As the comfort level with this technology grows, Black women will be able to readily communicate with health care providers who look like them,” she says. “At the same time, better training in medical schools will produce a new generation of doctors who are culturally aware and less biased. I’m optimistic.”