From Slavery to Structural Inequality: Understanding the Health Disparities Faced by Black Women
Written by: Helmi Pruuki
During my time in West Harlem as an intern with Kota Alliance, I have reflected on questions of race, ethnicity, and the lasting effects of colonialism more than ever before. Having grown up in Finland, a relatively homogenous society, this experience has significantly broadened my perspective. A particularly eye-opening moment was my visit to the African American History Museum in Washington, D.C., where I gained a deeper understanding of the centuries of oppression and the enduring legacy of colonialism that continues to affect African American women today. In this blog post, I will explore how the history of slavery and the heritage of racism have contributed to the health disparities that Black women face today.
The health disparities Black women experience can be traced back to the transatlantic slave trade. Of the 15 million people forcibly taken from Africa, about one-third were women. These women endured violence, sexual and reproductive exploitation, forced prostitution, and the trauma of forced childbearing and the sale of their children. In addition to forced labor, they faced extreme discrimination due to their race and gender.
Enslaved women were subjected to experimental surgeries, such as those performed by J. Marion Sims, who notoriously operated on Black women without anesthesia. According to Harriet A. Washington, Black women were exploited in medical experiments without consent, excluded from life-saving treatments, and secretly used for medical advancements. This history laid the foundation for the ongoing dehumanization of Black women in healthcare. Even after the abolition of slavery, Black women were forced to navigate a healthcare system—and a society at large—founded on racial discrimination and exclusion.
The impacts of colonialism are still evident in healthcare today, extending far beyond the mistrust that many African American communities feel toward the healthcare system. Many current health disparities Black women face are rooted in the social determinants of health: the conditions in which people live, work, and age. Factors such as racial segregation, discrimination, and historical policies designed to oppress Black communities have led to serious disparities in education, employment, and housing. It is important to recognize that, to this day, Black women earn significantly less than their white counterparts, experience higher rates of unemployment and poverty, and are more likely to be heads of households, often supporting more dependents with fewer resources.
Residential segregation, a result of practices like redlining, has left Black women in neighborhoods with lower property values and limited access to essential resources such as quality healthcare, education, and employment opportunities. This segregation has been identified as a fundamental cause of racial disparities in health, as it limits access to services that promote well-being. Black women face a unique intersection of race- and gender-based discrimination, contributing to higher rates of chronic health conditions such as heart disease, diabetes, and obesity. Structural racism remains a major factor in limiting access to healthy foods, safe spaces to exercise, adequate health insurance, and medication, all of which directly impact health outcomes. Notably, life expectancy for Black women is three years shorter than that of white women.
One of the most alarming examples of racial disparities in healthcare is in maternal health. Black women are three to four times more likely to die from pregnancy-related causes than white women, regardless of education or income levels. Black women experience higher rates of preterm birth and are more likely to undergo medical procedures such as cesarean sections, which carry a higher risk of complications. In addition, infant mortality rates for babies born to Black mothers are twice as high as those born to white mothers.
These disparities are partly due to systemic issues, such as limited access to high-quality healthcare and implicit bias among healthcare providers. Black women are more likely to give birth in hospitals with lower standards of care, contributing to higher rates of severe maternal morbidity. In addition, many report having their symptoms ignored or dismissed by healthcare providers, a bias often rooted in racist stereotypes, such as the false belief that Black people feel less pain. These harmful stereotypes have historical roots and continue to affect Black women’s health outcomes today.
The legacy of racism also manifests through intergenerational trauma, passed down in ways that harm Black women’s health. Although race is a social construct with no biological basis, the effects of racism have effectively become biological. Stress, social inequities, and environmental factors can alter gene expression, making individuals more vulnerable to illness. The historical experiences of slavery and colonialism, combined with present-day racism, are key factors in understanding the health disparities faced by Black women. Moreover, it is important to acknowledge that much of modern medicine is based on research and practices derived from white norms and values, often excluding Black communities' experiences and healing traditions. Medical education and healthcare delivery disproportionately rely on knowledge that has historically exploited and harmed Black bodies.
During my time as an intern with the Kota Alliance, I witnessed firsthand the organization’s dedication to gender equality, women’s empowerment, and addressing the intergenerational impacts of colonialism and racism. Working with Kota has broadened my understanding of these deep-seated inequalities that persist in the U.S as well as the importance of promoting holistic healing and well-being through alternative approaches while amplifying the voices and experiences of marginalized communities. I believe that Kota’s health and wellness programs, along with arts and culture initiatives, provide meaningful ways to uplift and empower local voices and create real opportunities for change. Moving forward, I will continue learning about these critical issues and remain committed to doing my part in the fight for equality.
References:
United Nations. (2015). Observance of the International Day of Remembrance of the Victims of Slavery and the Transatlantic Slave Trade. Retrieved from https://www.un.org/en/rememberslavery/observance/2015
Saylor Foundation. (2013). The Transatlantic Slave Trade. Retrieved from https://resources.saylor.org/wwwresources/archived/site/wp-content/uploads/2013/05/HIST211-1.3.3-TransAtlanticSlaveTrade.pdf
Gamble, V. N. (2006). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 95(7), 1113–1116. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC2563360/
Kaplan University. (n.d.). Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Retrieved from http://extmedia.kaplan.edu/nursing/NU310_1504B/MedicalApartheid_Article.pdf
Yale School of Medicine. (n.d.). Blackness, Maternal Mortality, and Prenatal Birth: The Legacy of Slavery. Retrieved from https://medicine.yale.edu/news-article/blackness-maternal-mortality-and-prenatal-birth-the-legacy-of-slavery/
Harvard Gazette. (2019). Ramifications of Slavery Persist in Health Care Inequality. Retrieved from https://news.harvard.edu/gazette/story/2019/10/ramifications-of-slavery-persist-in-health-care-inequality/
Centers for Disease Control and Prevention (CDC). (2020). Racial Disparities in Maternal Mortality. Retrieved from https://www.cdc.gov/womens-health/features/maternal-mortality.html#:~:text=Racial%20Disparities%20Exist
Alang, S. M., Carter, C. R., & Blackstock, O. (2023). Past Is Prologue: Dismantling Colonial Legacies to Advance Black Health Equity in the United States. Health Equity, 7(1), 831–834. https://doi.org/10.1089/heq.2023.0226
Chinn, J. J., Martin, I. K., & Redmond, N. (2021). Health Equity Among Black Women in the United States. Journal of Women's Health, 30(2), 212–219. https://doi.org/10.1089/jwh.2020.8868