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Black Women’s Maternal Health:
A Multifaceted Approach to Addressing Persistent and Dire Health Disparities
April 2018
- Problem: iPhone shuts down on its own, or awful battery life. In 2016, Apple started a free battery.
- The Jena Six were six black teenagers in Jena, Louisiana, convicted in the 2006 beating of Justin Barker, a white student at the local Jena High School, which they also attended.Barker was injured on December 4, 2006, by the members of the Jena Six, and received treatment at an emergency room. While the case was pending, it was often cited by some media commentators as an example of racial.
Black women in the United States experience unacceptably poor maternal health outcomes, including disproportionately high rates of death related to pregnancy or childbirth. Both societal and health system factors contribute to high rates of poor health outcomes and maternal mortality for Black women, who are more likely to experience barriers to obtaining quality care and often face racial Black women are three to four times more likely to experience a pregnancy-related death than white women.discrimination throughout their lives.
Due to racism, sexism and other systemic barriers that have contributed to income inequality, Black women are typically paid just 63 cents for every dollar paid to white, non-Hispanic men. Median wages for Black women in the United States are $36,227 per year, which is $21,698 less than the median wages for white, non-Hispanic men.National Partnership for Women & Families. (2017, September). Quantifying America’s Gender Wage Gap by Race. Retrieved 4 April 2018, available here. These lost wages mean Black women and their families have less money to support themselves and their families, and may have to choose between essential resources like housing, child care, food and health care.
And since they’re literally spawned from problem #2, the black community protects them. Proliferation of Baby Mamas. The disintegration of the nuclear family has led to an astronomical increase of single-mother households. According to the Moynihan Report, in 1965, nearly 25 percent of black children were born to unwed mothers. Black people believe institutional racism is a critical problem while more white people say individual instances of discrimination are a bigger concern. An overwhelming number of white people, 66 percent, say that individual instances of discrimination in America are a bigger problem than institutional racism while only 19 percent of white. Black women in the United States experience unacceptably poor maternal health outcomes, including disproportionately high rates of death related to pregnancy or childbirth. Both societal and health system factors contribute to high rates of poor health outcomes and maternal mortality for Black women, who are more likely to experience barriers to obtaining quality care and often face racial.
These trade-offs are evident in Black women’s health outcomes and use of medical care. Compared to white women, Black women are more likely to be uninsured,National Partnership for Women & Families. (2017, October). Women’s Health Coverage: Sources and Rates of Insurance. Retrieved 4 April 2018, available here. face greater financial barriers to care when they need itThe Commonwealth Fund. (2017, February). Biennial Health Insurance Survey, 2003-2016. Retrieved 4 April 2018, available here. and are less likely to access prenatal care.Agency for Healthcare Research and Quality. (2012, October). Disparities in Health Care Quality Among Minority Women Selected Findings From the 2011 National Healthcare Quality and Disparities Reports. U.S. Department of Health and Human Services. Retrieved 4 April 2018, available here. Indeed, Black women experience higher rates of many preventable diseases and chronic health conditions including diabetes, hypertension and cardiovascular disease.Office of Minority Health. (2017, May). Profile: Black/African Americans. Retrieved on October 30, 2017, available here. When, or if, Black women choose to become pregnant, these health conditions influence both maternal and infant health outcomes.
To improve Black women’s maternal health, we need a multi-faceted approach that addresses Black women’s health across the lifespan, improves access to quality care, addresses social determinants of health and provides greater economic security.
Background: Black maternal health disparities
Too many Black women are dying in pregnancy and childbirth. Black women in the United States are more likely to die from pregnancy or childbirth than women in any other race group.Tucker, M. J., Berg, C. J., Callaghan, W. M., & Hsia, J. (2007). The Black–White disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. American Journal of Public Health, 97(2), 247-251. Retrieved 4 April 2018, available here.
- Black women are three to four times more likely to experience a pregnancy-related death than white women.Creanga, A.A., Syverson, C., Seek, K., & Callaghan, W.M. (2017). Pregnancy-Related Mortality in the United States, 2011-2013. Obstetrics & Gynecology, 130(2), 366-373. Retrieved 4 April 2018, available here.
- Black women are more likely to experience preventable maternal death compared with white women.Louis, J. M., Menard, M. K., & Gee, R. E. (2015). Racial and ethnic disparities in maternal morbidity and mortality. Obstetrics & Gynecology, 125(3), 690-694.
- Black women’s heightened risk of pregnancy-related death spans income and education levels.Black Mamas Matter Alliance & Center for Reproductive Rights. (2016). Research Overview of Maternal Mortality and Morbidity in the United States. Retrieved 2 April 2018, available here.
Black women experience more maternal health complications than white women. Black women are more likely to experience complications throughout the course of their pregnancies than white women.
- Black women are three times more likely to have fibroids (benign tumors that grow in the uterus and can cause postpartum hemorrhaging) than white women, and the fibroids occur at younger ages and grow more quickly for Black women.Eltoukhi, H. M., Modi, M. N., Weston, M., Armstrong, A. Y., & Stewart, E. A. (2014). The health disparities of uterine fibroid tumors for African American women: a public health issue. American Journal of Obstetrics & Gynecology, 210(3), 194-199. Retrieved 30 March 2018, available here.
- Black women display signs of preeclampsia earlier in pregnancy than white women. This condition, which involves high blood pressure during pregnancy, can lead to severe complications including death if improperly treated.Shahul, S., Tung, A., Minhaj, M., Nizamuddin, J., Wenger, J., Mahmood, E., & Talmor, D. (2015). Racial disparities in comorbidities, complications, and maternal and fetal outcomes in women with preeclampsia/eclampsia. Hypertension in Pregnancy, 34(4), 506-515. Retrieved 30 March 2018, available here.
- Black women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, thus making pregnancy riskier at an earlier age.Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethnicity & Disease, 2(3), 207-221.
Black-serving hospitals provide lower quality maternity care. Seventy-five percent of Black women give birth at hospitals that serve predominantly Black populations.Howell, E. A., Egorova, N., Balbierz, A., Zeitlin, J., & Hebert, P. L. (2016). Black-white differences in severe maternal morbidity and site of care. American Journal of Obstetrics & Gynecology, 214(1), 122-e1. Retrieved 30 March 2018, available here.
- Black-serving hospitals have higher rates of maternal complications than other hospitals. They also perform worse on 12 of 15 birth outcomes, including elective deliveries, non-elective cesarean births and maternal mortality.Creanga, A. A., Bateman, B. T., Mhyre, J. M., Kuklina, E., Shilkrut, A., & Callaghan, W. M. (2014). Performance of racial and ethnic minority-serving hospitals on delivery-related indicators. American Journal of Obstetrics & Gynecology, 211(6), 647-e1. Retrieved 30 March 2018, available here.
Many Black women have a difficult time accessing the reproductive health care that meets their needs. Access to reproductive health care, which helps women plan their families, improves health outcomes for women and children.
- Black women experience higher rates of unintended pregnancies than all other racial groups,Finer, L. B. & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006 (p. 480). Contraception, 84, 478–485. in part because of disparities in access to quality contraceptive care and counseling.See, e.g., Dehlendorf, C., Park, S. Y., Emeremni, C. A., Comer, D., Vincett, K., & Borrero, S. (2014). Racial/ethnic disparities in contraceptive use: Variation by age and women’s reproductive experiences (p. 526.e1). American Journal of Obstetrics & Gynecology, 210(6), 526.e1–526.e9.
- Many Black women lack access to quality contraceptive care and counseling.See, e.g., Dehlendorf, C., Park, S. Y., Emeremni, C. A., Comer, D., Vincett, K., & Borrero, S. (2014). Racial/ethnic disparities in contraceptive use: Variation by age and women’s reproductive experiences (p. 526.e1). American Journal of Obstetrics & Gynecology, 210(6), 526.e1–526.e9. For example, in a recent analysis of California women enrolled in Medicaid, Black women were less likely than white or Latina women to receive postpartum contraception, and when they did receive it, they were less likely to receive a highly effective method.deBocanegra, H. T., Braughton, M., Bradsberry, M., Howell, M., Logan, J., & Shwarz, E.B. (2017). Racial and ethnic disparities in postpartum care and contraception in California’s Medicaid program (pp. e3–e4 ). American Journal of Obstetrics & Gynecology, 217(47), e1–e7.
- Black women’s access to abortion is limited,See note 15; see, e.g., Dehlendorf, C., Harris, L. H., & Weitz, T. A. (2013). Disparities in abortion rates: A public health approach. American Journal of Public Health, 103(10), 1772–1779. and they may be more likely to experience the ill effects of abortion restrictions — such as delayed care, increased costs or lack of access to care.See, e.g., Dehlendorf, C., Harris, L. H., & Weitz, T. A. (2013). Disparities in abortion rates: A public health approach (p. 1776). American Journal of Public Health, 103(10), 1772–1779 (describing that “studies have found that restricted access to abortion services can limit women’s ability to abort a pregnancy when they wish to do so, and that these effects may be particularly pronounced for Black women and women with lower educational attainment”); Henshaw, S. K., Joyce, T. J., Dennis, A., Finer, L. B., & Blanchard, K. (2009). Restrictions on Medicaid funding for abortions: A literature review. Guttmacher Institute. Retrieved 27 March 2018, available here.
Policymakers, health care professionals and communities can improve Black women’s maternal health.
Expand and maintain access to health coverage.
Only 87 percent of Black women of reproductive age have health insurance, and many more experience gaps in coverage during their lives. To improve Black women’s health outcomes, policies should focus on expanding and maintaining access to care and coverage.
Women need health coverage throughout their lifespan including access to preventive health care, such as birth control, to maintain their health and to choose when and whether to become a parent. For women who choose to become a parent or expand their families, good prenatal and maternity care are critically important for healthy pregnancies and healthy children. Pregnant women who lack insurance coverage often delay or forgo prenatal care in the first trimester,Egerter, S., Braveman, P., & Marchi, K. (2002). Timing of insurance coverage and use of prenatal care among low-income women. American Journal of Public Health, 92(3), 423-427. Retrieved 27 March 2018, available here. and inadequate prenatal care is associated with higher rates of maternal mortality.U.S. Centers for Disease Control and Prevention. Prenatal Care. Retrieved 4 April 2018, available here.
Black women are more likely to live in the South, where women generally experience poorer health outcomes and where many states have chosen not to expand Medicaid coverage,America’s Health Rankings. (2018). 2018 Health of Women and Children Report. Retrieved 4 April 2018, available here. which leaves many Black women in the “coverage gap.” Women fall into the coverage gap because they earn too much to qualify for traditional Medicaid, but not enough to purchase insurance on the Affordable Care Act (ACA) marketplace; as a result, they lack access to health coverage. Expanding Medicaid coverage would improve maternal outcomes for Black women by providing better access to care and reducing financial instability.
Provide patient-centered care that is responsive to the needs of Black women.
6 Black Problems Song
Black women should receive health care that is respectful, culturally competent, safe and of the highest quality. Unfortunately, research shows that Black women receive a lower quality of care than white women.Black Mamas Matter Alliance & Center for Reproductive Rights. (2016). Research Overview of Maternal Mortality and Morbidity in the United States. Retrieved 2 April 2018, available here. Much too often, Black women are subject to discrimination in the health care field — 22 percent report discrimination when going to the doctor or clinic.Robert Wood Johnson Foundation. (2017, December). Discrimination in America: Experiences and Views of American Women. Retrieved 4 April 2018, available here.
Public policies and medical practice should incentivize providing patient-centered care that focuses on Black women’s individualized needs, including non-clinical, social needs. Moreover, policies should endeavor to eradicate cultural biases and discrimination in medical practice and medical education, increase provider diversity in maternity care and hold individual providers and hospital systems accountable if they fail to provide unbiased, high-quality, evidence-based care.
Address the social determinants of health.
Social determinants of health are the conditions under which people live, work and play. Social determinants have consequential and varying effects on health outcomes across race and ethnicities. For Black women who are affected by structural inequality and discrimination, the chronic stress of poverty and racism has been shown to have a deleterious effect on health outcomes and is linked to their persistent maternal health disparities.Prather, C., Fuller, T. R., Marshall, K. J., & Jeffries IV, W. L. (2016). The impact of racism on the sexual and reproductive health of African American women. Journal of Women's Health, 25(7), 664-671. Retrieved 4 April 2018, available here.
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6 Black Problems
To improve Black maternal health outcomes, social determinants of health must be addressed through policies that raise incomes and build wealth; provide access to clean, safe and affordable housing; improve the quality of education; prioritize reliable public transportation and transport for medical appointments; and increase the availability of healthy, affordable food.
Expand paid family and medical leave.
Black women need paid leave to take care of their own health needs and to have time to care for their children. More than one in four Black workers report that there was a time in the last two years that they needed or wanted to take time away from work for parental, family or medical reasons but could not.Horowitz, J.M., Parker, K., Graf, N., & Livingston, G. (2017, March 23). Americans Widely Support Paid Family and Medical Leave, but Differ Over Specific Policies. Pew Research Center. Slots empire no deposit. Retrieved 18 March 2018, available here. Only 30 percent of Black mothers are both eligible for and able to afford to take unpaid leave under the federal Family and Medical Leave Act.diversitydatakids.org. (2015). Policy Rankings: The Family and Medical Leave Act. Brandeis University, The Heller School, Institute for Child, Youth and Family Policy Publication. Retrieved 18 March 2018, available here.
Only 15 percent of all workers have access to paid family leave through their employers. Paid family and medical leave allows workers to earn a portion of their pay while taking time off from work to care for themselves or their families. But current inadequate leave polices mean that Black mothers are more likely to quit and/or be fired from their jobs after giving birth than white women,Laughlin, L. (2011, October). Maternity Leave and Employment Patterns of First-Time Mothers: 1961-2008. U.S. Census Bureau Publication. Retrieved 28 March 2018, available here. or return to work before they are healthy enough to do so. Lawmakers should pursue robust, comprehensive paid leave policies that are accessible and affordable for all working people.
Expand access to quality, patient-centered and comprehensive reproductive health care.
Quality, patient-centered reproductive health care is critical to improving maternal health and addressing the reproductive health disparities that Black women face including higher rates of unintended pregnancies and restricted access to abortion. Researchers attribute these disparities to a number of factors, including disparities in access to high-quality health care generally, and family planning services specifically.Finer, L. B. & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006 (p. 480). Contraception, 84, 478–485. Henshaw, S. K., Joyce, T. J., Dennis, A., Finer, L. B., & Blanchard, K. (2009). Restrictions on Medicaid funding for abortions: A literature review. Guttmacher Institute. Retrieved 27 March 2018, available here. See, e.g., Dehlendorf, C., Park, S. Y., Emeremni, C. A., Comer, D., Vincett, K., & Borrero, S. (2014). Racial/ethnic disparities in contraceptive use: Variation by age and women’s reproductive experiences (pp. 526.e7). American Journal of Obstetrics & Gynecology, 210(6), 526.e1–526.e9 (citations omitted). A number of studies have demonstrated that there is not a significant disparity in knowledge about contraception between Black women and white women. See, e.g., Craig, A. D., Dehlendorf, C., Borrero, S., Harper, C. C., & Rocca, C. H. (2014). Exploring young adults’ contraceptive knowledge and attitudes: Disparities by race/ethnicity and age. Women’s Health Issues, 24(3), e281–e289; Rocca, C. H. & Harper, C. C. (2012). Do racial and ethnic differences in contraceptive attitudes and knowledge explain disparities in method use? Perspectives on Sexual and Reproductive Health, 44(3), 150–158. See also, e.g., Dehlendorf, C., Harris, L. H., & Weitz, T. A. (2013). Disparities in abortion rates: A public health approach (p. 1776). American Journal of Public Health, 103(10), 1772–1779. Indeed, women with unintended pregnancies are at increased risk for maternal mortality and morbidity, maternal depression, experiencing physical violence during pregnancy,See, e.g., generally Tsui, A. O., McDonald-Mosley, R., & Burke, A. E. (2010). Family planning and the burden of unintended pregnancies. Epidemiologic Reviews, 32, 152–174. infant mortality, birth defects, low birth weight and preterm birth.See, e.g., generally Conde-Aguedelo, A., Rosas-Bermúdez, A, & Kafury-Goeta, A. C. (2006). Birth spacing and risk of adverse perinatal outcomes: A meta-analysis. JAMA, 295(15), 1809–1823.
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Black women also live with a legacy of reproductive oppression, and continue to experience reproductive coercion, sometimes leading to a distrust of the health care system that further exacerbates disparities. For instance, Black women are more likely to report having been pressured by a clinician to use a contraceptive method.Becker, D. & Tsui, A. O. (2008). Reproductive health service preferences and perceptions of quality among low-income women: Racial, ethnic and language group differences (p. 208). Perspectives on Sexual and Reproductive Health, 40(4), 202–211. Moreover, some Black women may be forced to continue pregnancies because onerous restrictions and a lack of insurance coverage have pushed abortion out of reach.
This experience falls short of the level of high-quality, patient-centered care that all women should be able to expect. Policymakers must work to ensure that Black women are able to plan their families in the way that feels best for them, which includes access to counseling on the contraception method of their choice, access to abortion care without restrictions and access to prenatal and maternity care from providers they trust.
Expand and protect access to trusted community providers.
Community health care providers play an essential role in providing Black women with basic, reproductive and maternal health care services. Without these vital resources, many Black women would not have information about or access to birth control, annual exams, Pap tests and other essential preventive care.See, e.g., Stevenson, A. J., Flores-Vazquez, I. M., Allgeyer, R. L., Schenkkan, P., & Potter, J. E. (2016). Effect of removal of Planned Parenthood from the Texas Women’s Health Program. New England Journal of Medicine, 374, 853–860 (describing the negative impact of cuts to family-planning services on women’s access to contraception). Recent studies have also shown that, in Texas, deep funding cuts to family planning services correlated with dramatic increases in the maternal mortality rate. See generally MacDorman, M. F., Declercq, E., & Thoma, M. E. (2018). Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006–2015. Birth, 1–9; MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Is the United States maternal mortality rate increasing? Disentangling trends from measurement issues. Obstetrics & Gynecology, 128(3), 447–455 (describing how the reported maternal mortality rate in Texas doubled within a two-year period); see also Bassett, L. (2016, August 18). Pregnancy-Related Deaths Nearly Doubled in Texas After Cuts to Women’s Health. Huffington Post. Retrieved 27 March 2018, available here. Policymakers should expand funding for trusted, community-based providers including Planned Parenthood. Community-based providers can help Black women get and stay healthy throughout their lifespan, including when, or if, they choose to become a parent.
Expand protections for pregnant workers.
Women report pregnancy discrimination across races and ethnicities, but Black women are disproportionately affected. Nearly three in 10 charges of pregnancy discrimination (28.6 percent) were filed by Black women from 2011-2015, yet Black women comprise only 14 percent of women ages 16 to 54 in the workforce.National Partnership for Women & Families. (October 2016.) By the Numbers: Women Continue to Face Pregnancy Discrimination in the Workplace. Retrieved 6 April 2018 available here. Pregnancy discrimination has serious consequences for women and their families. Women who are demoted, not promoted or discharged because they are, or might become, pregnant can lose critical income.National Partnership for Women & Families. (October 2016.) By the Numbers: Women Continue to Face Pregnancy Discrimination in the Workplace. Retrieved 6 April 2018 available here. If they are discharged or have their hours cut, they may lose their health insurance and other workplace supports at a time when their families’ budgets are already stretched. Because Black women are also at a higher risk for pregnancy-related complications like preterm labor, preeclampsia and hypertensive disorders,Creanga, A. A., Bateman, B. T., Mhyre, J. M., Kuklina, E., Shilkrut, A., & Callaghan, W. M. (2014). Performance of racial and ethnic minority-serving hospitals on delivery-related indicators. American Journal of Obstetrics & Gynecology, 211(6), 647-e1. Retrieved 30 March 2018, available here. the loss of wages and health insurance due to pregnancy discrimination is especially challenging.
Stronger protections for pregnant workers, including federal and state laws that ensure that employers provide reasonable accommodations to pregnant women, robust enforcement of the Pregnancy Discrimination Act and continued education about existing legal rights are critical to combatting and, ultimately, eliminating pregnancy discrimination in this country.
Invest in health care safety and quality improvement initiatives.
Maternal mortality is three to four times higher for Black women than it is for white women, and Black women are more likely to experience complications during pregnancy and childbirth. There are existing, proven safety and quality improvement initiatives that need greater uptake to meaningfully improve health care outcomes for Black women.
Maternal mortality review committees increase understanding of the underlying and contributing causes of pregnancy-related deaths and the reasons maternal mortality affects Black women at such a high rate. A structured death review process can provide powerful data and information to facilitate change that improves the health of women before, during and after pregnancy.Association of Maternal & Child Health Programs. (n.d.). MMR Resource Portal for States: Building Capacity for Maternal Mortality Review. Retrieved 4 April 2018, available here. Review committees should include medical professionals, community stakeholders, health advocates, patients and family members. Together, they should work to identify factors that lead to complications and corresponding strategies to avoid preventable complications as well as provide recommendations aimed at reducing pregnancy-related deaths.
Hospitals and medical practices should be encouraged and supported in participating in quality improvement efforts that are known to improve maternal health. For example, the Alliance for Innovation on Maternal Health (AIM) is a national>
Overall, mental health conditions occur in Black and African American (B/AA) people in America at about the same or less frequency than in White Americans. However, the historical Black and African American experience in America has and continues to be characterized by trauma and violence more often than for their White counterparts and impacts emotional and mental health of both youth and adults. (See prevalence statistics below).
Historical dehumanization, oppression, and violence against Black and African American people has evolved into present day racism - structural, institutional, and individual – and cultivates a uniquely mistrustful and less affluent community experience, characterized by a myriad of disparities including inadequate access to and delivery of care in the health system. Processing and dealing with layers of individual trauma on top of new mass traumas from COVID-19 (uncertainty, isolation, grief from financial or human losses), police brutality and its fetishization in news media, and divisive political rhetoric adds compounding layers of complexity for individuals to responsibly manage.
Help-seeking behavior is affected by mistrust of the medical system and often begins with faith-based outreach. However, MHA screening data shows that Black and African American people who screen positive for depression self-identify as planning to seek help at higher rates than the general population says they will seek help. Unfortunately, Black and African American providers, who are known to give more appropriate and effective care to Black and African American help-seekers, make up a very small portion of the behavioral health provider workforce (see treatment statistics below). Because of these factors and more, Black and African American people are more likely to experience chronic and persistent, rather than episodic, mental health conditions. Yet, hope for recovery should remain, as light is shed on these issues - and the general public holds accountable policymakers and health systems to evolve better systems which eliminate inequities in mental health services.
Demographics/Societal Issues
- 13.4 percent of the U.S. population, or nearly 46 million people, identify themselves as Black or African American and another 2.7 percent identified as multiracial. [1]
- According to the most recent Census data available, 55 percent of all Black and African American people lived in the South, 18 percent lived in the Midwest, 17 percent in the Northeast, and 10 percent in the West. [2]
- The Black immigrant population in the U.S. increased from 816,000 in 1980 to over 4.2 million by 2016. Thirty-nine percent were from Africa and nearly half were from the Caribbean. [3]
- Overall, 24 percent of Black and African American people have a bachelor’s degree or higher as of 2017. [3]
- More than 1 in 5 Black and African American people in the U.S. lived in poverty as of 2018. [4]
- Women are the heads of household in roughly 30 percent of Black and African American homes, compared to 9 percent of white homes. [5]
- Historical adversity, which includes slavery, sharecropping, and race-based exclusion from health, educational, social, and economic resources, translates into socioeconomic disparities experienced by Black and African American people today. Socioeconomic status, in turn, is linked to mental health: people who are impoverished, homeless, incarcerated, or have substance use problems are at higher risk for poor mental health.
- Despite progress made over the years, racism continues to have an impact on the mental health of Black and African American people. Negative stereotypes and attitudes of rejection have decreased, but continue to occur with measurable, adverse consequences. Historical and contemporary instances of negative treatment have led to a mistrust of authorities, many of whom are not seen as having the best interests of Black and African Americans in mind.
Prevalence
- Black and African American people living below poverty are twice as likely to report serious psychological distress than those living over 2x the poverty level. [6]
- Adult Blacks and African Americans are more likely to have feelings of sadness, hopelessness, and worthlessness than adult whites. [7]
- Blacks and African Americans are less likely than white people to die from suicide at all ages. [8] However, Black and African American teenagers are more likely to attempt suicide than White teenagers (9.8 percent v. 6.1 percent). [9]
According to SAMHSA’s 2018 National Survey on Drug Use and Health [10]:
- Sixteen percent (4.8 million) of Black and African American people reported having a mental illness, and 22.4 percent of those (1.1 million people) reported a serious mental illness over the past year.
- Serious mental illness (SMI) rose among all ages of Black and African American people between 2008 and 2018.
- Despite rates being less than the overall U.S. population, major depressive episodes increased from 9 percent-10.3 percent in Black and African American youth ages 12-17, 6.1 percent to 9.4 percent in young adults 18-25, and 5.7 percent to 6.3 percent in the 26-49 age range between 2015 and 2018.
- Suicidal thoughts, plans, and attempts are also rising among Black and African American young adults. While still lower than the overall U.S. population aged 18-25, 9.5 percent (439,000) of Black and African American 18-25-year-olds had serious thoughts of suicide in 2018, compared to 6 percent (277,000) in 2008. 3.6 percent (166,000) made a plan in 2018, compared to 2.1 percent (96,000) in 2008, and 2.4 percent (111,000) made an attempt in 2018, compared to 1.5 percent (70,000) in 2008.
- Binge drinking, smoking (cigarettes and marijuana), illicit drug use and prescription pain reliever misuse are more frequent among Black and African American adults with mental illnesses.
Attitudes
According to a study conducted by Ward, Wiltshire, Detry, and Brown in 2013 [11]:
- Black and African American hold beliefs related to stigma, psychological openness, and help-seeking, which in turn affects their coping behaviors. The participants in this study were not very open to acknowledging psychological problems, but they were somewhat open to seek mental health services.
- Thirty percent of participants reported having a mental illness or receiving treatment for a mental illness
- Black and African American men are particularly concerned about stigma.
- Cohort effects, exposure to mental illness, and increased knowledge of mental illness are factors that could potentially change beliefs about symptoms of mental illness.
- Participants appeared apprehensive about seeking professional help for mental health issues, which is consistent with previous research. However, participants were willing to seek out some form of help.
Treatment Issues
- Black and African American people are more often diagnosed with schizophrenia and less often diagnosed with mood disorders compared to white people with the same symptoms. Additionally, they are offered medication or therapy at the lower rates than the general population. [5]
- Black and African American people are over-represented in our jails and prisons. Black and African American people make up 13 percent of the general U.S. population, but nearly 40 percent of the prison population. [12] In 2016, the imprisonment rate for Black and African American men (2,417 per 100,000 Black male residents) was more than 6 times greater than that for white men (401 per 100,000 white male residents) and the imprisonment rate for Black and African American women (97 per 100,000 Black and African American female residents) was almost double that for white women (49 per 100,000 white female residents). [13] Black and African American people with mental health conditions, specifically those involving psychosis, are more likely to be in jail or prison than people of other races. [5]
- Because less than 2 percent of American Psychological Association members are Black or African American, some may worry that mental health care practitioners are not culturally competent enough to treat their specific issues. [14]
- Stigma and judgment prevent Black and African American people from seeking treatment for their mental illnesses. Research indicates that Blacks and African Americans believe that mild depression or anxiety would be considered “crazy” in their social circles. Furthermore, many believe that discussions about mental illness would not be appropriate even among family. [15]
Access/Insurance
Disparities in access to care and treatment for Black and African American people have also persisted over time.
- While the implementation of the Affordable Care Act has helped to close the gap in uninsured individuals, 11.5 percent of Black and African Americans, versus 7.5 percent of white Americans were still uninsured in 2018. [16]
- In 2018, 58.2 percent of Black and African American young adults 18-25 and 50.1 percent of adults 26-49 with serious mental illness did NOT receive treatment. [7]
- Nearly 90 percent of Black and African American people over the age of 12 with a substance use disorder did NOT receive treatment. [7]
- In 2016, 12.3 percent of Black and African American adults who had a doctor’s office or clinic visit over the past year had difficulty getting needed care, tests or treatment compared to 6.8 percent of white adults. [17]
Fact Sheets
Mental Health Resources for Black and African American Communities
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- Black Emotional and Mental Health (BEAM): BEAM is a training, movement building and grant making organization dedicated to the healing, wellness, and liberation of Black communities. BEAM envisions a world where there are no barriers to Black Healing.
- Toolkits & Education: graphics on accountability, self-control, and emotional awareness; journal prompts; articles on Black mental health
- Videos: trainings and webinars, recorded and available for free
- The Boris Lawrence Henson Foundation: changing the perception of mental illness in the African-American community by encouraging people to get the help they need; focuses on stigma/self-stigma reduction and building trust between Black people and the mental health field.
- Resource Guide: directory of mental health providers and programs that serve the Black community; includes therapists, support groups, etc, but also digital content, faith-based programs, educational programs, etc
- Therapy for Black Girls: online space encouraging the mental wellness of Black women and girls; referral tool to find a therapist in your area
- Therapist Directory: find trusted therapists that can help you navigate being a strong, Black woman; can search for in-office therapist by your location or virtual therapist
- The Yellow Couch Collective: a paid membership community ($9.99/mo), space for Black women to gather to support, encourage, and learn from each other.
- The Loveland Foundation: financial assistance to Black women & girls seeking therapy
- Therapy for Black Men: primarily a therapist directory for Black men seeking therapy; includes some resources and stories
- Dr. Ebony’s My Therapy Cards: self-exploration card deck created by a Black female psychologist for other women of color; created with the intention of helping other women of color grow and elevate in the areas of emotional and mental health.
Partnerships and Resources
The following organizations are among those that offer additional information on this subject, focusing on outreach to Black and African American communities:
Sources
[1] United States Census Bureau. (2019). Quick facts. Retrieved from https://www.census.gov/quickfacts/fact/table/US/PST120219
[2] http://www.census.gov/newsroom/releases/archives/2010_census/cb11-cn185.html
[3] Pew Research Center. (2018). Five facts about blacks in the U.S. Retrieved from https://www.pewresearch.org/fact-tank/2018/02/22/5-facts-about-blacks-in-the-u-s/
[4] United States Census Bureau. (2019). Income and Poverty in the United States: 2018. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-266.pdf
[5] American Psychiatric Association. (2017). Mental Health Disparities: African Americans. Retrieved from https://www.psychiatry.org/File percent20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-African-Americans.pdf
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[6] CDC. (2018). Health United States, 2017. Table 46. Retrieved from https://www.cdc.gov/nchs/data/hus/hus17.pdf
[7] CDC. (2019). Summary Health Statistics: National Health Interview Survey: 2017. Table A-7. Retrieved from https://www.cdc.gov/nchs/nhis/shs/tables.htm
[8] CDC. (2018). Health United States, 2017. Table 30. Retrieved from https://www.cdc.gov/nchs/data/hus/hus17.pdf
[9] CDC. (2019). High School Youth Risk Behavior Survey Data. Retrieved from https://nccd.cdc.gov/Youthonline/App/Default.aspx.
[10] SAMHSA. 2018 National Survey on Drug Use and Health (NSDUH): African Americans. https://www.samhsa.gov/data/sites/default/files/reports/rpt23247/2_AfricanAmerican_2020_01_14_508.pdf
[11] Ward, E. C., Wiltshire, J. C., Detry, M. A., & Brown, R. L. (2013). African American men and women's attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research >, 62 >(3), 185-194. doi:10.1097/NNR.0b013e31827bf533
[12] Prison Policy Initiative. United States Profile: Racial and Ethnic Disparities in Prisons and Jails. Retrieved from https://www.prisonpolicy.org/profiles/US.html#disparities.
[13] Bureau of Justice Statistics. (2018). Prisoners in 2016. Retrieved from https://www.bjs.gov/content/pub/pdf/p16.pdf
[14] American Psychological Association. (2017). Demographic characteristics of APA members by membership characteristics. Retrieved from https://www.apa.org/workforce/publications/17-member-profiles/table-1.pdf
[15] Williams, M. T. (2011). Why African Americans avoid psychotherapy. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/culturally-speaking/201111/why-african-americans-avoid-psychotherapy
[16] Kaiser Family Foundation. (2020). Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018. Retrieved from https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/
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[17] Agency for Healthcare Research and Quality. (2018). 2018 National Healthcare Quality and Disparities Report. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr.pdf