The deaths of George Floyd and Breonna Taylor, the Black Lives Matter movement and the COVID-19 outbreak have highlighted long held inequities for people of color around the world. Those inequities are especially notable in health care. At The Center for Innovative GYN Care, we’re committed to improving the lives of women through the treatment of complex gynecological conditions, and we’re working every day to make the most effective treatments more accessible to African American women.
In a live discussion on Facebook, CIGC Director of Education and Community Outreach Nilofar Kazi joined Dr. Natalya Danilyants, CIGC co-founder and surgeon, and Abayomi Walker, board-certified women’s health care nurse practitioner, to address racial disparity in health care and the negative effects on women of color in receiving necessary treatment for gynecological conditions.
Watch the recorded discussion here
In the past three months, COVID-19 has disproportionately affected the African American community, and several factors contribute to the increased susceptibility of African Americans to COVID-19. It’s important to note these factors are the consequence of socio-economic, political and medical policies that were put in place by centuries of systemic racism. These policies have made health disparities common among members of the African American community.
Economic and social factors that make COVID-19 exposure more likely — such as living in densely populated areas, relying on public transportation, multigenerational living and incarceration — are also statistically more likely to be experienced by people of color, according to the Centers for Disease Control and Prevention. Black people also face the issue of lack of access to necessary care.
“Black people are two times more likely to have gone without health insurance in the last year in comparison to white Americans,” Walker said.
Many African Americans are also dealing with toxic stress that has been passed down through generations of being faced with racism, and many are distrustful of the health care system due to previous negative experiences.
Racial disparity in health care is especially present in women’s gynecological health. When we look at research related to fibroids, the evidence is clear that fibroids are more common and severe in African American women. They are three times more likely to develop fibroids and have an earlier age of onset compared to white women.
Disparities between the two races are clear at every step along the journey of experiencing symptoms and seeking treatment for fibroids. A 2013 study by Stewart et al, examining racial differences in the overall experience of fibroids shows African American women reported a higher occurrence of symptoms, were significantly more impacted by heavy bleeding and abdominal pain and were more likely to experience impairment of their relationships with friends and family. They more often reported that fibroids interfered with their daily activity and were more likely to miss days from work due to severe symptoms.
Future fertility and pregnancy were key concerns for African American women, and 71% said preserving the uterus was very important to them. Despite these fertility concerns, African American women are two to three times more likely than any other racial group to undergo a hysterectomy for fibroid treatment.
Because research shows African American women wait more than four years before seeking treatment for fibroids, researchers at CIGC sought to find out what contributes to this delay.
“We initially theorized that this was due to the ‘unintentional normalization’ of fibroids in the Black community, meaning [other female family members] all had bloating, painful periods and heavy bleeding so [they thought] ‘It must be normal, I’m going to put this off,’” Kazi said. “However, from our own focus groups, we learned that this passivity does not rest with the African American patient, but rather the physician telling the patient to either have a hysterectomy or to ‘watch and wait.’”
Even for women who elect not to have a hysterectomy, the four-year delay creates more concerns regarding complications and consequences of treatment options available — often compromising fertility and eventually leading to a hysterectomy.
It’s extremely important for physicians to do regular screening to rule out fibroids, even when no symptoms are present, according to Dr. Danilyants.
“If the physician, nurse practitioner or medical provider recognizes that a population is at higher risk for fibroids, then they need to do screening,” Dr. Danilyants said. “We screen for cervical cancer with pap smears. We talk about HPV vaccines. [Fibroids] should be part of the conversation and part of educating Black women that fibroids are a significant risk.”
Don’t wait. Contact us for a consultation.
In terms of racial disparity, we at CIGC know there is not enough research being done to find out why people of color are not able to access the same level of care as their white counterparts. One of the shortcomings in fibroid-related research is that race is omitted, a critical issue given the disproportionate impact of the disease on African American women. We see those gaps in the research and we are actively working to fill them.
At CIGC, we work to empower women to take control of their health and get the treatment they need. That includes knowing what to ask your doctor. Don’t let anyone dismiss your symptoms. Ask for an ultrasound. You know your body best, so you are the best advocate for your health.
It’s important to remember that gynecological conditions like fibroids are a surgical issue and cannot be managed medically. Many women of color are told by their physicians to watch and wait and that their pain is normal. It’s common, but it’s not normal.
CIGC is available to answer your questions!
What You Can Do Next:
- Talk to your doctor
- Get an ultrasound
- Seek a second opinion if you feel unheard
“Pain that’s unresponsive to over-the-counter medication is not normal. Pain that is debilitating is not normal,” Walker said. “If you know that, when your period comes, you are not going to be able to leave the house or you’re going to have to call out of work, that’s not normal. Pain that limits or diminishes your functionality — that’s not normal. If you have pain that’s disruptive repeatedly throughout the month, that’s not normal either.”
For those with pain and other gynecological symptoms, please know you’re not alone. If you’d like to tell us more about your health journey, please take the Women’s Health Survey.
Coronavirus Disease 2019 (COVID-19). 2020.
Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA. The health disparities of uterine fibroid tumors for African American women: A public health issue. Am J Obstet Gynecol. 2014;210(3):194-199. doi:10.1016/j.ajog.2013.08.008
Stewart EA, Nicholson WK, Bradley L, Borah BJ. The burden of uterine fibroids for African American women: Results of a national survey. J Womens Health (Larchmt). 2013;22(10):807-816. doi:10.1089/jwh.2013.4334
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