Racial Disparities in Women’s Health
August 1, 2022
On June 24, 2022, the Supreme Court made a decision that disproportionately affects the lives of Black and minority women in Dobbs v. Jackson Women’s Health Organization: specifically, access to abortion is not a fundamental right guaranteed by the Constitution. As a result of this decision, 26 states have already, or will soon, ban abortion with little or no exceptions, leaving approximately 33 million U.S. women lacking abortion access in their home states. Twenty-two states whose laws impose strict abortion restrictions collectively are home to 45 percent of Black women under the age of 55.
On June 24, 2022, the Supreme Court made a decision that disproportionately affects the lives of Black and minority women in Dobbs v. Jackson Women’s Health Organization: specifically, access to abortion is not a fundamental right guaranteed by the Constitution.
As a result of this decision, 26 states have already, or will soon, ban abortion with little or no exceptions, leaving approximately 33 million U.S. women lacking abortion access in their home states. Twenty-two states whose laws impose strict abortion restrictions collectively are home to 45 percent of Black women under the age of 55.
These drastic changes are not the first jab to Black women’s health. A system that historically and presently discriminates against Black women has led to worsened health outcomes, including increased mortality, decreased sexual and reproductive health, and increased health-related debt compared to other populations. For example, compared to 34 percent of men, 48percent of women say they have debt due to health-related bills. Across race and ethnic groups, 56 percent of Black adults say they have debt due to health-related bills, compared to only 37 percent of White adults.
Women born in traditional “Jim Crow” states were exposed to laws that codified racial segregation and discrimination, which are associated with increases in premature mortality rates for Black individuals and a heightened risk for Black women of being diagnosed with aggressive breast cancer. Explanations for these inequitable health outcomes are many, including lack of access to basic health care, increased environmental hazards, economic insecurity, and the “psychological toll of dealing with racism as part of daily life.” Such factors may derive from transgenerational poverty which originated in slavery and still affects Black people today. Historic examples of medical experimentation (e.g., Tuskegee) further exacerbate Black women’s distrust of the health care system.
Current trends show the lasting and dreadful effects racism has on the lives of Black women. They are three to four times more likely to die in pregnancy and five times more likely to die from pregnancy-related cardiomyopathy and blood pressure disorders than White women. Black women reach menopause 8.5 months earlier than White women and experience worse symptoms. Black women die from breast cancer at a 40 percent higher rate than White women, and are three times more likely to die from COVID-19 than White men.
Despite devastating historic and current impacts on Black women’s health, law and policymakers have attempted to address health care disparities. In December 1999, Congress mandated the federal Department of Health and Human Services (HHS) to create the National Healthcare Disparities Report, last published in 2021. In November 2000, Congress created the National Center on Minority Health and Health Disparities at the National Institutes of Health. The HHS circulated its action plan to reduce racial and ethnic health disparities in October 2015. Many states have enacted legislation addressing health disparities in 2020-2021.
In 2020, U.S. Senator Elizabeth Warren (D-MA), Congresswoman Ayanna Pressley (MA-07), and Congresswoman Barbara Lee (CA-13) introduced the Anti-Racism in Public Health Act to help expand research into the health impacts of racism and to require the federal government to develop anti-racist health policy. This bill was introduced in the Senate on February 2, 2021, and then referred to the Committee on Health, Education, Labor, and Pensions. It is still undecided.
Continued efforts to address these issues require close examinations of long-standing health impacts with a historical lens. Health law needs to address structural inequality and biases that run deep through medical care delivery and public health services. Addressing structural racism that perpetuates health disparities should be an essential objective of the Biden administration, especially in the throes of COVID-19 and the Dobbs decision via the Supreme Court. Specific government actions that may help address these issues include:
- The express recognition that racism is affecting women’s health;
- expanding access to health insurance and care, including reproductive health care;
- addressing social determinants and other factors directly impacting health care access and outcomes; and
- dedicating more funding to improving conditions disproportionately affecting Black women.
This post was written by Summer Ghaith, Legal Researcher, and Erica N. White, J.D., Staff Attorney, Network for Public Health Law – Western Region Office, at ASU’s Sandra Day O’Connor College of Law.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.