A Proposal for Black women’s Reproductive Health

The Problem

Over 40% of individuals who have human immunodeficiency virus (HIV) in the United States are African American, women specifically being among those most affected. In 2016 the Center for Disease Control and Prevention (CDC) reported that 60% of new HIV infections among the female population were Black women, although Black women only make up 13% of the female population (CDC 2016). HIV is not the only sexually transmitted disease that disproportionately affects Black women. In 2018 the National Association of County and City Health Officials (in collaboration with the CDC) reported that “the rate of reported chlamydia cases among black females was five times the rate among white females” (Spinner 2019). 

Black women’s exposure to STDs is an example of one of the many reproductive health disparities they face in the United States. This disparity may be linked to a number of causes, among them being conditions known as the social determinants of health. The social determinants of health are factors that influence an individual’s health outcomes such as race, gender, class, sexual orientation, education level, and immigration status. There is another factor that may contribute to the high rates of sexually transmitted infections that Black women experience: socialization.

Black women have been fetishized and exploited throughout American history. From the forced sterilizations of Black women during the eugenics era to the adultification of young Black girls in the 21st century, Black women in the United States have faced several violations of their right to bodily autonomy─the ability for individuals to make fully informed and sovereign decisions about their health. The socialization of Black women as sexually promiscusous has also contributed to this idea. Instead of being able to define their sexuality for themselves, Black women have been hypersexualized through harmful tropes such as the “Jezebel” stereotype. 

Theory

I posit there is a connection to be made between Black women’s history of exploitation and disparities in reproductive health care, such as that found in the sexual transmission of infections. This is not to say that the normalization of the objectification and hypersexualization of the Black female body directly causes the increased likelihood of obtaining an STI/STD. Essentially, Black women have not been encouraged in the United States’ history to take control of their sexual and reproductive health, as that right has often been stripped from them before they are able to. Black women have been socialized to believe they lack power in sexual relationships, and I hypothesize that this socialization has lead their being less likely to negotiate contraceptive use and seek adequate reproductive health care. 

Solution

To address such health disparities it is of the utmost importance that Black women and health care providers alike are aware of the sociohistorical context in which they are impacted. The first step to assessing this issue is increasing opportunities for cultural competency in health care, as well as encouraging Black women to take command of their unique history. Given that most consensual sexual experiences begin in adolescence, young Black women also must be prepared to discuss their sexual health and how it has been threatened in the context of American history. Having a better grasp on this information will allow Black girls and women to see a full picture of the way their bodily autonomy has been threatened in the past, and how that may impact their future.

It is important to consider the emotional implications this may have for Black women and girls. A history of exploitation may prove to be very triggering for some, which is why it is necessary to include mental and emotional wellness as part of sexual education. I propose the implementation of programs in high schools and universities across the United States that address the full spectrum of sexual health for Black girls and women: historical references, access to emotional support through therapy and group sessions, and presentations by well trained and culturally competent health officials that are prepared with lessons in sex education designed specifically for Black girls and women.

These programs will be funded and supported by established public health organizations such as the Black Women’s Health Initiative, Planned Parenthood, and the SisterSong Women of Color Reproductive Justice Collective. Given the individual missions of each of these organizations, I am confident that our new programs would be of interest. Partnering with these organizations will allow for goal-oriented program development and will assist us in training health professionals to be culturally competent. This training will include educational sessions for health care providers about health disparities unique to Black women, as well as sensitivity training for emotional support. 

Challenges 

Black women and girls must learn about the sexual exploitation of their community so they can contextualize their experiences. Equally important is the ability for health care providers to practice cultural competency when treating Black women. With regard to stereotyping, discouraging the enforcement of stereotypes both within and outside of the Black community will reaffirm the idea that Black women can take control of their own sexuality. As a part of sexual wellness, Black women and girls need to have individualized spaces in which they can express thoughts, concerns or beliefs about themselves sexually, emotionally, and mentally. Providing such an intentional space counters the narrative that has been imposed upon the Black female community for centuries. They can have the ability to explore their sexuality and define it for themselves.
There are several potential challenges that must be considered while assessing this issue. The first is that health care providers are not sociologically trained, they are medically trained. It may prove to be difficult to convince non-Black health care providers in particular that they must participate in intensive cultural competency training in order to treat their patients. It is likely that instead of seeing the sociohistorical and cultural impacts Black women’s history has on their reproductive health, they may attribute these health disparities to Black women’s individual choices. The fact that Black women are less likely to use contraception may be viewed as their problem. 

In the same vein, another potential challenge related to my theory is that to some extent Black women have to take accountability for their choice to have unprotected sex. While there are several factors that influence this decision─less formal sex education or pressures from a partner to abstain from using a condom, for example─at the end of the day Black women and girls have to take their sexual health into their own hands. It may be argued that implementing a program that requires cultural competency training for healthcare providers and the support of many non-profit organizations for what ultimately is the “responsibility” of one person is extreme.

A third potential challenge is that given that the theory I have proposed involves reproductive healthcare outcomes, investors and program leaders may be inclined to request scientific, factual evidence that lack of protection during sex is a result of a sociohistorical context, socialization and stereotyping. Of course, to my knowledge, there is no concrete evidence that the hypersexualization and exploitation of the Black female body is directly correlated to a higher chance of contracting an STI/STD. These challenges are all related to the assumption that the theory will be accepted with sociological evidence instead of tangible numbers and graphs (at this stage in development).

Despite the challenges that may arise while implementing this program, I propose that with the right resources, support and dedication such a program may be executed properly and have powerful impacts. Short term, this program will be able to better prepare Black women and girls to take control of their sexual identities with sex education, historical context, and qualified physicians. Long term, this program may initiate a ripple effect not only in the United States but also potentially around the world in which Black women and girls can define their own narratives in other aspects of their lives, such as employment, education, and in their social lives. 

One of the primary ways in which the above concerns may be addressed is through the sociological literature that already exists and that can support the proposed programs and theory. Particular work by sociologists Anna Julia Cooper, Patricia Hill Collins, and Kimberlé Crenshaw are helpful in reinforcing this theory.

These women─all educated Black sociologists─contributed to what has become known as standpoint theory, which argues that given the social positionality of Black women they are experts in their marginalization. These sociologists would support the notion that Black women know what other Black women need because they are armed with their own socio historical context. The very fact that I am proposing this theory as a Black woman about other Black women would be supported by Cooper, Collins and Crenshaw in the theoretical perspectives of standpoint theory and intersectionality.

Collins in particular has advocated for safe spaces in which Black women can freely express themselves. She has argued that “in order for an oppressed group to continue to exist as a viable social group, the members must have spaces where they can express themselves apart from the hegemonic or ruling ideology” (Collins 2006:5). Thus, Collins would likely support the safe space provided through these programs that strengthen the relationship between Black women and their sexuality.

A theorist that may not support this theory is Charlotte Perkins Gillman, primarily due to her identity as a white woman who advocated for children’s and voting rights in the first wave of the feminist movement. This is an assumption, but I imagine that given her lack of inclusive activism for Black women during her life's work she would find a theory that solely focuses on Black women and their treatment problematic. Further, functional theorists such as Herbert Spencer and Emile Durkheim may argue that health disparities are simply operational for the entire health care system. Without them─they may argue─we would not have an effective model for what constitutes adequate healthcare or where we are lacking in individualized health care. 

Luckily, these theorists are no longer alive and it does not matter whether or not they agree. This is a necessary program that I hypothesize would positively impact Black women and girls and would support their bodily autonomy. 

References

CDC. 2016. “HIV Among African Americans.”

Collins, Patricia Hill. 2006. “Patricia Hill Collins: Intersecting Oppressions.”

Theresa, Spinner. 2019. “African-American Syphilis Rates Four Times Higher Than Whites

According to New CDC Study.”