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Try out PMC Labs and tell us what you think. Learn More. 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 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. : 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. Racism in the United States is pervasive and is a major contributor to sexual and reproductive health disparities of African American women.
The historical narrative about racial inferiority has exacerbated discriminatory healthcare practices, in turn negatively affecting the quality and types of healthcare provided to African American women. Although legalized slavery, the most salient manifestation of race-based mistreatment for African Americans, ended inracism persists in institutions e.
The authors posit that a combination of these race-based events across eras impacts the current reproductive and sexual health status of African American women. We searched online databases Naked black women and white men. To for the unique healthcare experiences influenced by racism, including healthcare provision and research, our search was limited to the United States only.
Second, we describe contemporary sexual and reproductive health outcomes. Third, we explore the link between these historical experiences and current sexual and reproductive health outcomes. Finally, we discuss the potential benefit for public health interventions that acknowledge the historical and current health status and healthcare experiences of African American women, and interventions that promote health equity.
We argue that a careful examination of historical factors is essential to effectively address the current healthcare needs of African American women especially as they relate to chronic stress and impacts on health outcomes across a variety of conditions potentially rooted in racism, including STI e.
If past influences that have potentially shaped current outcomes are not taken into consideration, then public health efforts may neglect the impact of larger, contextual factors that affect health and contribute to inequities. Given the nature of this article, our review was considered exempt by the institutional review board and not required.
We argue that the race-based experiences of these women underlie many of their sexual and reproductive health conditions.
Race-based mistreatment that occurred during the year enslavement — of Africans and their descendants involved many sexual and reproductive acts of violence against both enslaved African American women and their sexual partners.
Enslaved women often experienced legalized sexual and reproductive exploitation.
Acts of sexual violence against African American men could also affect enslaved women. Consequently, childbearing during slavery was often intrinsically related to an economic system that benefitted white slave owners more so than a matter of personal freedom. Table 1. Furthermore, eugenic programs emerged to control the size of the black population.
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Public Health Service recruited poor and uneducated African American men in Alabama to determine the effect of untreated syphilis. Although treatment became available, the men were misled, denied treatment, and not informed of the study findings until Legal segregation in healthcare continued through the mids until Congress passed the Civil Rights Act of The super coil was a device that caused uncontrollable bleeding and, in some cases, led to hysterectomies, abdominal pain, and anemia.
In addition, many poor African American women underwent unnecessary hysterectomies as practice for medical students at select teaching hospitals. Taken together, these historical experiences of sexual violence, experimentation, and healthcare disenfranchisement support the intergenerational transmission of poor sexual and reproductive health outcomes among African American women in the United States.
Pregnancy-related morbidity and mortality also disproportionately affect African American women. African American women undergo more hysterectomies due to conditions e. Researchers are urged to examine any biases they may have about African American women before interpreting data about their sexual and reproductive health. Although focused on African American men, Leigh and Huff outline important considerations regarding reporting bias that are pertinent for African American women.
Whether racism is internalized, experienced within institutions i. These clinics typically have more stringent reporting requirements. For example, healthcare systems that emphasize teaching and research related to patient care may have a higher proportion of African American patients, which can lead to the identification of health problems believed to be more common among African Americans e.
The historical context of racism continues to shape the sexual and reproductive health of African American women. Figure 2 is a visual representation of key historical and contemporary social conditions experienced by African American women in the United States.
It demonstrates the trajectory of adverse social determinants i.
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Although improvements in the public health and the healthcare system have occurred over time, the following paragraphs discuss the continuum of racism-related experiences that began in slavery and have been found to influence sexual and reproductive health today. Time line of key historical and contemporary racial and social experiences of Africans and their American descendants in the United States. Transgenerational poverty originated in slavery and continues to disproportionately affect African Americans.
Limited education may contribute to health issues experienced by African American women. During slavery, laws prohibited enslaved women from receiving a formal education. Low educational attainment may be associated with multiple sexual and reproductive health issues.
Race-based residential segregation continues to differentially structure access to quality educational opportunities in many predominantly African American neighborhoods.
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Some researchers have discussed structural inequalities in employment opportunities in relation to sexual and reproductive health outcomes. Historically i. As slavery came to an end, they were not provided access to resources or immediate employment opportunities to sustain themselves and their families. Poverty is associated with sexual risk decisions in efforts to acquire basic needs, such as food and shelter.
A personal history of sexual violence may also influence the overall health of African American women. Some data suggest that these negative stereotypes help to further racist sentiments because they can be internalized by African Americans. Because many African American women lack access to quality healthcare, they have an increased likelihood of late-stage diagnoses of HIV and other medical conditions that increase the risk for early mortality. Enslaved women endured poor health across their life span due to insufficient diet, extreme physical work, and disease.
Although slavery was abolished in the United States inJasienska argues that there has not been enough time to eliminate the physical effects of slavery, which contributes to the disproportionately high levels of low birth weight in African American infants born in the 21st century. Additionally, the legacy of medical experimentation and inadequate healthcare has exacerbated African American women's complex relationship with healthcare systems, past and present, and laid a foundation of mistrust of the medical establishment.
The historical and contemporary racism-related health and healthcare experiences of African American women to date highlight the need to develop new models for health promotion.
Socioecological models are useful for understanding the context of both race-specific and gender-specific issues relative to sexual and reproductive healthcare experiences. Consistent with strategies outlined in the Department of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities and Healthy Peoplewe highlight the following strategies as first steps in reversing historical patterns of poor sexual and reproductive health outcomes among African American women: 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.
To ensure strategies incorporate culturally and contextually appropriate research and prevention, an understanding of cultural theories and perspectives is central to prevention efforts. This approach enables the development of programmatic systems and policy actions that are relevant and appropriate for the intended audience.
African American women must be involved in the de, implementation, and evaluation of all aspects of the research and implementation of agreed-upon programs. Such an approach is modeled by community-based participatory research. This approach further illuminates the impact of social determinants of health on African American women and expands opportunities and strategies for primary prevention. Addressing equal access to effective sexual and reproductive health information and quality healthcare services that stem from institutional racism and discrimination entails reducing barriers to access to quality care, increasing access to health insurance, and ensuring the provision of culturally appropriate and specialized care.
Moreover, to effectively and efficiently address those underlying causes of adverse sexual and reproductive health outcomes for African American women, public health agencies are encouraged to broaden their partnerships to include nontraditional partners i. Addressing the shortage of African American public health professionals and supporting quality education and training are ificant in improving the provision of high-quality healthcare. Their representation in the workforce has both educational service and relationship benefits for patients and providers.
In addition, ensuring their presence within the healthcare profession serves as an opportunity to address the discriminatory practices that may have prevented their entry into healthcare professions. In addition, public health researchers should be familiar with the histories and lived experience of their African American patients to appropriately de collaborative prevention efforts that ameliorate racism and its health-related impacts among African American women.
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Learning to be culturally competent and sensitive is essential for providers and public health practitioners providing services to populations that have traditionally been marginalized and medically underserved. Moreover, policies that promote health equity can be powerful tools for social change. Enforcing policies that promote racial and gender equality, quality education for all students, equal access to job training and employment opportunities, and equal access to quality health care for all could enhance population health.
The field of public health will be more successful addressing the root causes of health inequities when strategies are informed by rigorous social and epidemiological research. Properly framed and executed, such research can support the development of approaches that take into the unique experiences of African American women.