The Health Crisis No One Talks About Enough: Disparities in Black Women's Health
Black women in the United States are sicker, dying younger, and receiving worse care than their white counterparts across nearly every measure of health. This is not a story about individual choices or personal risk factors. It is a story about a healthcare system that has consistently failed to see, study, and treat Black women with the same rigor and urgency it extends to others.
This post focuses on four areas where the disparities are particularly stark: endometrial cancer, uterine fibroids, maternal mortality, and cardiovascular disease. These are conditions that I have professional experience seeing, treating, and doing my very small part as a clinician and advocate to educate and prevent.
#1 Endometrial Cancer: A Survival Gap That Should Not Exist
Endometrial cancer, which is cancer of the uterine lining, is the most common gynecologic malignancy in the United States, and its incidence is rising across all groups. Black women are diagnosed at roughly the same rate as white women. And yet Black women are nearly twice as likely to die from the disease. This is one of the most severe racial disparities of any cancer, globally.
The reasons are layered and intersecting. First, there is a critical difference in tumor biology. Black women are two to four times more likely to be diagnosed with aggressive, non-endometrioid subtypes, including serous carcinoma, clear cell carcinoma, and carcinosarcoma, which carry significantly worse prognoses. Among all women diagnosed with high-risk endometrial cancer, serous carcinoma was found in 26% of Black women compared to about 17% of white women. These subtypes, while accounting for only 5 to 10% of uterine cancer diagnoses overall, are responsible for nearly 40% of uterine cancer deaths.
But the disparity persists even after accounting for tumor type and stage. Even when comparing Black and white women with the same histology, the same stage, and similar treatment, Black women consistently have worse outcomes - a finding so striking that it has prompted researchers to look at molecular, systemic, and structural factors simultaneously.
Even though Black women are diagnosed at roughly the same rate as white women, diagnosis comes later for Black women. One analysis found the diagnostic interval, the time between a woman's first clinical visit for symptoms and her actual diagnosis, was 30% longer for Black women than for white women. This delay could not be explained by insurance or access alone, pointing instead to failures in clinical recognition and the standard diagnostic algorithm, which has been shown to underperform in Black women. This is largely due to racial implicit bias within providers as well as institutionalized racism which exists at the healthcare institution level.
Treatment disparities compound the problem further. Black women are less likely to receive evidence-based, guideline-concordant treatment for endometrial cancer, less likely to be enrolled in clinical trials, and less likely to have access to a gynecologic oncologist - only 1 to 3% of whom are Black. Someone that I have been following, Dr. Kemi Doll, is a wonderful resource and advocate on this topic and is also a gynecologic oncologist. Research has documented that Black women with cancer receive less pain management and less patient education than their white counterparts, and that some discontinue treatment early. This is not because they don't want to be well, but because of prior mistreatment, poor provider communication, and the emotional toll of navigating a system that has historically harmed them.
The result of this disparity is a five-year survival gap of over 20 percentage points: 64% for Black women compared to 86% for white women. This makes endometrial cancer one of the most racially inequitable cancer diagnoses a woman can receive.
#2 Uterine Fibroids: Earlier, Larger, and Undertreated
I was a student at the University of Michigan in their post-graduate certificate course in Sexual Health Counseling when the opening keynote speaker shared a resource with us: Medical Apartheid by Harriet Washington. In her keynote address, she talked about uterine fibroids in Black women and how they were tied to systemic racism. My mind was blown, and this was a pivotal time for me as a profession that I began to truly understand the racial disparities in our medical system.
[side note - it is the above mentioned book why I do not use any Dr. Simm’s instruments including the metal speculum for my exams and the reason I do not use stirrups.]
Uterine fibroids are benign tumors that grow in the uterine wall and affect the majority of women by age 50. For many women they are asymptomatic. For others they cause heavy bleeding, severe pain, pelvic pressure, urinary frequency, fertility challenges, and pregnancy complications. And for Black women, the burden of fibroids is disproportionate in nearly every dimension.
Black women are diagnosed with fibroids roughly three times as frequently as white women. They develop them earlier (on average about three years younger) and with more fibroids, larger fibroids, and more severe symptoms. Nearly a quarter of Black women between ages 18 and 30 have fibroids, compared to about 6% of white women in the same age group. By age 35, that number climbs to approximately 60%.
The symptom burden is real and significant. Black women experience higher rates of anemia from chronic blood loss, more severe pelvic pain, and greater interference with daily functioning and quality of life. They are also more likely to experience fertility complications and adverse pregnancy outcomes, including higher rates of miscarriage, preterm delivery, placenta previa, and cesarean section - most of these are also risk factors for cardiovascular disease. It is all related.
When it comes to treatment, the disparities deepen. Black women are 6.8 times more likely than white women to undergo a myomectomy (surgical removal of fibroids) and 2.4 times more likely to undergo a hysterectomy for fibroid-related indications. Yet despite being more likely to have surgery, they are also more likely to have worse surgical outcomes. One systematic review found Black women had a more than 50% higher rate of perioperative complications from hysterectomy compared to white women.
Research points to multiple drivers. Black women are more likely to have their symptoms dismissed or attributed to something else. They wait longer before seeking care: partly because of prior experiences of not being believed, and partly because fibroid suffering has been so normalized in Black communities that it can seem like something to simply endure. When they do seek care, they may face barriers to minimally invasive surgery due to hospital capacity, provider implicit/explicit bias, and geographic inequities in access to surgical expertise.
Emerging research also suggests that fibroids in Black women may have distinct biological characteristics including different patterns of gene expression, extracellular matrix composition, and tumor stiffness. These distinctions may contribute to more aggressive growth. But researchers emphasize that biology does not exist in a vacuum. Chronic stress, adverse childhood experiences, perceived racism, and environmental exposures including air pollution have all been associated with fibroid risk, and Black women disproportionately carry these exposures across a lifetime.
#3 Maternal Mortality: A Crisis in This Country
The United States has the highest maternal mortality rate of any high-income nation, which is abysmal.
According to the most recent CDC data for 2024, the maternal mortality rate for Black non-Hispanic women was 44.8 deaths per 100,000 live births - more than three times the rate for white women, which was 14.2. To put this in global terms: a Black woman in the United States faces maternal mortality odds that rival those in countries with far fewer healthcare resources.
This is not a new crisis, and it has not been improving. The disparity for Black women persists regardless of education level, income, or access to prenatal care. There was a painful reminder of this with midwife Dr. Janell Smith died after delivering her first child earlier this year. Research has shown that college-educated Black women have higher pregnancy-related mortality rates than white women who did not complete high school. This points unequivocally to the role of racism - both structural and interpersonal - as a driver of outcomes that income and education alone cannot protect against.
The causes of death are largely preventable. Hemorrhage, hypertensive disorders (including preeclampsia and eclampsia), blood clots, and cardiac complications top the list. Black women are also more likely to develop postpartum cardiomyopathy, a serious form of heart failure that can emerge in the weeks after delivery but occur anytime 12 months after delivery. Over 80% of pregnancy-related deaths in the United States are considered preventable.
Implicit bias in clinical care plays a documented role. Studies have shown that Black patients are undertreated for pain and that their reported symptoms are more likely to be minimized or dismissed. In the context of labor and delivery, this translates into delays in recognizing warning signs, inadequate response to deteriorating vital signs, and failures to escalate care in time. Reports from Black women who survived near-misses (an event that could have ended in severe harm or death but did not) describe patterns of being told their symptoms were normal, of having their concerns brushed aside, of being discharged from the hospital too quickly.
The loss extends beyond the individual. Black infant mortality rates are more than twice those of white infants. This is a disparity that is directly connected to maternal health. Children whose mothers die in or around childbirth face significantly higher risks of death themselves in the first month of life.
#4 Cardiovascular Disease: The Heaviest Burden
Heart disease is the leading cause of death for all women in the United States. I say this every day that I am seeing patients! No group of women carries a heavier cardiovascular burden than Black women. If you’re like, what even is cardiovascular disease? It is a general term for conditions that affect the heart or blood vessels such as high blood pressure, high cholesterol, coronary artery disease, peripheral artery disease, heart failure, arrhythmias, all of which can lead to heart attacks and strokes.
According to the American Heart Association, approximately 59% of Black women ages 20 and over are living with some form of cardiovascular disease. Black women have the highest prevalence of hypertension of any group, and only about 25% have their blood pressure under adequate control. The rate of stroke among Black women is nearly double that of white women. Rates of heart failure, coronary artery disease, and cardiovascular mortality are all elevated.
Particularly concerning is the trend among younger Black women. While cardiovascular mortality has declined overall for most groups over the past several decades, Black women between ages 35 and 54 are not seeing the same improvements. A 2022 JACC analysis estimated that between 2000 and 2022, there were approximately 21,000 excess cardiovascular deaths among Black women compared to white women - representing over 625,000 excess years of potential life lost.
Several cardiovascular risk factors hit Black women with particular force:
Hypertension affects Black women at higher rates and at younger ages.
Diabetes is more prevalent and more often undiagnosed.
Obesity is more common - reflecting, in large part, the food environment and chronic stress Black women disproportionately navigate, not simply individual behavior.
Preeclampsia and other hypertensive disorders of pregnancy further elevate long-term cardiovascular risk
Black women tend to reach menopause earlier than white women, and earlier menopause (defined as last menstrual period before age 45) is independently associated with higher cardiovascular risk.
Provider recognition is part of the problem. Black women are less likely to be assessed for cardiovascular risk, less likely to have their cardiac symptoms recognized and taken seriously, and less likely to receive guideline-based preventive care. Awareness of heart disease as a major health risk among women is lower in Black women compared to white women in part because cardiovascular health messaging has historically failed to reach and resonate with Black communities, and in part because the medical system has not prioritized their risk.
What Connects These Disparities - and why did I choose these 4 to focus on?
Across all four of these conditions - endometrial cancer, uterine fibroids, maternal mortality, and heart disease - certain themes repeat.
Black women are underrepresented in the research that generates clinical guidelines. They are undertreated compared to white women even when receiving care within the same systems as their white counterparts. Their symptoms are more likely to be dismissed, their pain undertreated, their risk underestimated. The diagnostic tools and thresholds used in routine clinical care were often developed and validated primarily in white populations, which means they underperform for Black women at the point when early identification matters most - which is why I stopped using the ASCVD risk calculator!
And undergirding all of it is the relentless physiological toll of navigating racism - what researchers call "weathering," the accelerated biological aging that results from chronic exposure to discrimination, poverty, and systemic stress. Weathering explains why Black women at every socioeconomic level face elevated health risks. It is not a metaphor; it is measurable in inflammatory markers, telomere length, cardiovascular reactivity, and hormonal dysregulation.
What Needs to Change
Acknowledging these disparities is necessary but not sufficient. What changes outcomes is action - in clinical practice, in research, in policy, and in how healthcare systems train and hold accountable the people within them.
Clinicians who care for Black women must ask harder questions, listen more carefully, and resist the normalizing of suffering that has allowed so many preventable deaths and complications to go unaddressed. Screening algorithms need to be validated in diverse populations. Clinical trials need to enroll Black women in numbers that make race-stratified analysis meaningful. Black women in medicine - as physicians, PAs, nurses, midwives, and researchers - need to be recruited, trained, supported, and given the authority to lead.
This article is intended for educational purposes and does not constitute medical advice.
