A Black Woman's Guide to Navigating and Reclaiming Health
The feeling of being dismissed by a doctor, the sense that your pain is not taken seriously, the quiet fear that you are not receiving the same quality of care as others—these experiences are not figments of your imagination. They are not isolated incidents of miscommunication or personal sensitivity. They are the lived reality for millions of Black women in the United States, a reality born from a healthcare system with deep, systemic inequities. This is not a failure on your part; it is a failure of the system to see, hear, and care for you fully.
Discover the TruthUnderstanding the systemic nature of healthcare disparities for Black women in America
Black women face staggering disparities across a spectrum of health outcomes, from maternal mortality to chronic disease. These are not simply statistics; they are the quantifiable results of centuries of structural racism, implicit bias within clinical settings, and social determinants that place health further out of reach.
The chronic stress of navigating a world that questions your credibility and devalues your well-being takes a physical and psychological toll. This phenomenon, known as "weathering," leads to premature health decline and explains why health disparities persist regardless of socioeconomic status.
unapologeticwellness.org is founded on a single, powerful premise: to speak truth to power. It is a space for unvarnished truth-telling, strategic action, and the profound act of reclaiming authority over your own health narrative. This platform rejects the notion that you must be quiet, agreeable, or accommodating to receive the care you deserve.
"This is not a journey of 'empowerment,' a term often used to suggest a deficit in the individual. Rather, it is a journey of activation—of mobilizing the inherent power, knowledge, and resilience you already possess with the strategic tools necessary to dismantle the barriers before you. This is the foundation of unapologetic wellness."
To advocate effectively, one must be armed with facts. The data presented here provides an undeniable, factual foundation for your advocacy. When a provider dismisses your concern, these numbers are the silent witnesses standing with you, affirming that the problem is real, systemic, and urgent.
| Health Metric | Black Women | White Women | Source |
|---|---|---|---|
| Maternal Mortality Rate (per 100,000 live births, 2023) | 50.3 | 14.5 | CDC |
| Prevalence of Cardiovascular Disease (Age 20+) | 59% | N/A | American Heart Association |
| Breast Cancer Mortality | 40% more likely to die | Baseline | National Cancer Institute |
| Diabetes Prevalence (Age-adjusted, 2019-2021) | 12.5% | 6.1% | CDC |
| Unfair Treatment by Healthcare Provider (due to race/ethnicity) | 21% | 3% | KFF Survey |
The chasm in maternal health outcomes is one of the most glaring indictments of the U.S. healthcare system. For Black women, pregnancy and childbirth carry a level of risk that is unconscionable in a high-income nation.
These statistics are sourced from the CDC's National Center for Health Statistics, the Center on Budget and Policy Priorities, and research from institutions like Kaiser Permanente.
The disparities are not confined to the perinatal period. Across the lifespan, Black women bear a disproportionate burden of chronic illness, often diagnosed later and managed less effectively.
Cardiovascular disease is the number one killer of all women, but its impact on Black women is exceptionally severe. An alarming 59% of Black women aged 20 and over are living with some form of cardiovascular disease. They have the highest prevalence of high blood pressure, a critical risk factor, yet only 25% have their blood pressure under control. Furthermore, the prevalence of stroke for Black women is twice that of White women.
The disparities in cancer outcomes are a story of unequal survival. Despite having slightly lower incidence rates of breast cancer, Black women are 40% more likely to die from the disease than White women. This is linked to being diagnosed at later stages, with more aggressive and harder-to-treat tumor subtypes (like triple-negative breast cancer), and receiving lower quality care. For cervical cancer, Black women have the highest rates of death from the disease.
The prevalence of diabetes among Black women has reached epidemic levels. According to 2019–2021 data, the age-adjusted prevalence of diagnosed diabetes for Black women was 12.5%, more than double the 6.1% rate for White women. Among women over the age of 55, approximately one in four Black women has diabetes, a rate nearly twice that of their white counterparts.
Black women continue to be disproportionately affected by the HIV epidemic. In 2018, they accounted for 11% of all new HIV diagnoses in the U.S. and its dependent areas. They also face significantly higher rates of sexually transmitted infections; for example, the rate of reported chlamydia cases among Black women is five times the rate among White women.
These findings are corroborated by leading health organizations such as the American Heart Association, the National Cancer Institute, the CDC, and the U.S. Department of Health and Human Services (HHS) Office of Minority Health.
Individual health behaviors do not occur in a vacuum. They are profoundly shaped by the conditions in which people are born, live, work, and age—the Social Determinants of Health (SDOH). The health disparities faced by Black women are the direct result of systemic inequities across these domains.
Lack of health insurance is a primary barrier to receiving timely and preventive care. In 2023, 8.5% of non-Hispanic Black Americans were uninsured, compared to 5.1% of non-Hispanic Whites. This gap is particularly pronounced in states that have not adopted Medicaid expansion under the Affordable Care Act, leaving hundreds of thousands of low-income women of color in a "coverage gap".
The economic foundation for health is weaker for many Black families. In 2023, the median household income for non-Hispanic Black households was $53,789, starkly lower than the $83,121 for non-Hispanic White households. In 2021, nearly one in five Black women (18.8%) lived in poverty. These economic realities directly impact health by limiting access to nutritious food, safe and stable housing, and reliable transportation to medical appointments.
The cumulative impact of these clinical and social disparities is a shorter life. In 2022, the average life expectancy at birth for Black females was 76.5 years. This is lower than for Hispanic women (80.0 years) and slightly lower than for White women (77.5 years), reflecting a persistent and unacceptable gap that widened during the COVID-19 pandemic.
Understanding the problem is the first step. Taking action is the next. This section provides a comprehensive, strategic roadmap for navigating the healthcare system and advocating for your well-being. The approach is grounded in the socioecological model, a foundational public health framework that recognizes that health is influenced by a dynamic interplay of factors at multiple levels.
The Individual Level
Build an unshakeable foundation of self-trust and personal authority. Dismantle internalized narratives that undermine your confidence and reclaim the expertise you hold about your own body.
The Interpersonal & Community Level
Build and leverage a powerful network of external support. Your community and family can serve as a critical buffer, a source of shared knowledge, and a team of advocates standing with you.
The Institutional & Societal Level
Transform from a passive recipient of care into an active, unapologetic partner in your health. Advocate assertively and effectively in the clinical setting.
"These levels are not independent silos; they are deeply interconnected. What happens at the systemic level (Level 3), such as institutional racism, directly fuels negative stereotypes and individual experiences of discrimination. These experiences can then lead to internalized doubt and self-silencing at the individual level (Level 1), which in turn impacts how one engages with their family and community (Level 2). By addressing each level, you build a holistic and resilient strategy for unapologetic wellness."
The most fundamental act of speaking truth to power begins internally. Before you can effectively challenge a dismissive doctor or a flawed system, you must first build an unshakeable foundation of self-trust and personal authority.
For generations, Black women have been celebrated for their strength and resilience. Yet, this cultural expectation often manifests as the "Superwoman" Schema (SWS), a set of perceived obligations that can be detrimental to health. This schema, identified by researchers, includes five core tenets:
While these traits are born from a history that demanded such fortitude for survival, they come at a cost. Adherence to the SWS is linked to higher rates of psychological distress and depression. It creates a formidable barrier to seeking help, acknowledging pain, and prioritizing one's own health needs. The first step in internal advocacy is to recognize this schema in your own life, to give yourself permission to be vulnerable, to feel your emotions without judgment, and to place your well-being at the center of your own life.
The journey from feeling a symptom to advocating for treatment is fraught with psychological landmines for many Black women. This is a direct consequence of a vicious cycle fueled by external bias and internalized doubt.
The cycle begins in the healthcare setting. A Black woman presents with a legitimate concern, but due to a provider's implicit bias, her pain is dismissed, her symptoms are downplayed, or her condition is misdiagnosed. This experience of being unheard or disbelieved is a form of medical gaslighting.
This external invalidation is profoundly damaging. It can reinforce harmful, internalized racist beliefs about one's own perceptions, intelligence, and worth. Over time, this leads to self-silencing. You begin to question your own reality, suppress your feelings, and hesitate to speak up, a coping strategy that research shows is often passed down generationally from mothers to daughters as a tool for safety and survival in a race-conscious society.
This constant state of "heightened vigilance"—the mental energy spent preparing for insults or carefully managing one's appearance and tone to be perceived as credible—is a chronic stressor in itself. Research from a 2023 KFF survey shows that 61% of Black women engage in these behaviors, which are associated with poor physical and mental health outcomes, including hypertension, depression, and sleep difficulties.
Breaking this cycle requires a conscious and deliberate effort to cultivate your own internal authority.
The first and most critical strategy is to give yourself permission to trust your body. You are the ultimate expert on your own experiences. As one resource aptly states, "You are the only one who knows your body and your experiences". This is not an emotional plea; it is a statement of fact.
This powerful concept, articulated by public health researchers, is the antidote to external invalidation. It is defined as "a guideline by which Black women's centered experiences, needs, trust, and confidence to advocate for, empower, and inform others about their lives and health become the basis for evaluating situations, making decisions, and taking action".
It is an embodied, inherent knowledge cultivated from lived experience and ancestral wisdom. Cultivating this knowledge means:
It is vital to acknowledge that repeated experiences with racial discrimination, including in medical settings, are not just "unpleasant." They can inflict psychological trauma with symptoms comparable to Post-Traumatic Stress Disorder (PTSD), such as anxiety, depression, hypervigilance, and avoidance.
Healing from this trauma is an integral part of reclaiming your wellness. This involves:
Once you begin to fortify your internal foundation, the next level of action involves building and leveraging a powerful network of external support. No one should have to navigate a hostile healthcare system alone.
Social networks are a cornerstone of resilience in the Black community, offering emotional, informational, and tangible support. Strong family and community ties are consistently linked to better coping and mental health outcomes. However, it's also important to recognize that not all support is equally effective, and sometimes these networks can be a source of stress.
Research on Black women's well-being reveals a crucial distinction: for coping with the unique stress of racial discrimination, tailored social support is significantly more effective at reducing depressive symptoms than general social support.
The love and encouragement you get from friends and family for everyday life challenges.
Specific to the experience of racism—having someone who understands the nuances of a microaggression, who can validate your anger and frustration without questioning it, and who can strategize with you on how to respond.
This distinction calls for a strategic assessment of your current support system. Who in your life provides that essential general support? And, critically, who can you turn to for tailored support that directly addresses the racialized stressors you face in healthcare and beyond? Identifying and cultivating both types of support is key.
In a powerful act of collective self-preservation, Black Americans are actively creating their own trusted health advisory networks in response to a fractured relationship with the formal healthcare system. This is not a sign of failure, but a brilliant, adaptive strategy for survival and thriving.
Decades of medical mistreatment and ongoing experiences with bias have understandably eroded trust. As a result, research shows that 61% of Black Americans—and an even higher 68% of Black mothers—have intentionally created personal networks, or "Chosen Circles," of trusted people and resources they consult for health decisions.
Most tellingly, over a third (36%) of Black Americans do not include a healthcare professional in their Chosen Circle, a stark reflection of the current state of trust. This section reframes this phenomenon as a proactive strategy and provides a guide to intentionally curating your own circle of trusted advisors.
Building a robust support network is an intentional act. It involves seeking out resources, formalizing relationships, and initiating important conversations.
You are not alone in your experiences. Connecting with community-based organizations (CBOs) can provide invaluable education, advocacy training, and the profound relief of shared experience.
This is one of the most powerful, evidence-based strategies you can employ, particularly for maternal health. These professionals are not just "nice to have"; they are a critical part of a comprehensive care team that can dramatically improve outcomes.
CHWs are trusted community members who serve as a bridge between patients and the healthcare system. Their involvement is proven to work. A study in Detroit found that pairing pregnant Black women with a CHW led to significantly better birth outcomes, including:
In the clinical setting, doulas and birth advocates act as crucial interpreters, advocates, and sources of emotional support. Their presence helps patients feel "seen and heard," which is essential for building trust and ensuring shared decision-making. Midwifery care, in particular, is associated with reduced rates of preterm birth and cesarean deliveries.
Health is often a family and community affair. Initiating conversations about health within your family is a powerful act of collective care. This includes:
Knowing which chronic illnesses run in your family (e.g., high blood pressure, diabetes, certain cancers) is critical information to share with your doctors.
Many families have unwritten rules about not discussing health problems. Gently breaking these patterns can create a more supportive environment. Michele Tracy Berger's book, Black Women's Health: Paths to Wellness for Mothers and Daughters, explores how intergenerational dialogue is key to health.
Frame health not just as an individual responsibility but as a family or household goal. This could involve:
This level provides the tactical, "in-the-trenches" guide for direct engagement with healthcare providers and the broader system. Armed with a strong sense of self-authority (Level 1) and a robust support network (Level 2), you are now prepared to advocate assertively and effectively in the clinical setting.
To effectively counter bias, you must first understand how it operates. The disparities in care that Black women receive are often driven by implicit bias—the unconscious attitudes and stereotypes that affect our understanding, actions, and decisions. A provider may not be consciously malicious, but their ingrained, unexamined biases can lead to devastatingly different treatment and outcomes.
This bias manifests in concrete, measurable ways:
This is one of the most well-documented forms of bias. A 2023 KFF survey found that 22% of Black women who were pregnant or gave birth in the past decade reported being refused pain medication they believed they needed. Academic studies confirm that Black patients are systematically undertreated for pain, a practice rooted in centuries-old, false, and racist beliefs about biological differences in pain tolerance. One study found that non-Hispanic Black patients had significantly lower odds of receiving opioid therapy for chronic pain compared to non-Hispanic White patients.
The bias extends beyond pain management. According to a 2023 assessment by the federal Agency for Healthcare Research and Quality (AHRQ), Black patients received worse care than White patients on 52% of quality measures. For example:
Recognizing these patterns is not about assigning individual blame but about understanding the systemic nature of the problem you are up against. It prepares you to be vigilant and strategic.
The most powerful tool to counter subjective bias is objective data. By systematically preparing for, documenting during, and reviewing after your medical encounters, you shift the dynamic. You are no longer making a subjective plea that can be easily dismissed; you are presenting a data-driven case that demands to be addressed. This process transforms you into the lead researcher of your own health.
Preparation is paramount. Walking into an appointment well-prepared changes the entire power dynamic.
If you have a diagnosis or a specific set of symptoms, gather credible information about it. Understand the standard diagnostic tests, treatment options, and latest research.
This is your primary data collection. Keep a detailed symptom journal. Note the symptom, its severity, frequency, duration, and any potential triggers. Use a health tracking app like Bearable (to track mood, symptoms, sleep, energy, and custom factors) or Juli (which integrates smartphone data with self-reports for conditions like depression or COPD). If your symptoms are visible (e.g., a rash, swelling), take clear, dated photographs.
Do not leave the appointment's direction to chance. Write down a prioritized list of your concerns and questions. Clearly define what you want to achieve from the visit. Using a structured worksheet can be incredibly helpful.
Compile a complete file to bring with you. This should include:
Never underestimate the power of a plus-one. Ask a trusted friend, family member, or doula to accompany you. Before the visit, brief them on your goals and how they can best support you—whether it's by taking notes, asking clarifying questions, or simply providing a supportive presence.
This is where your preparation is put into action. You are not a passive observer; you are an active participant and co-leader of the consultation.
Begin the appointment by stating your agenda clearly and confidently. For example: "Thank you for seeing me. I have three main things I need to discuss today to ensure we make the most of our time".
Your tone and language matter. Assertive communication is clear, direct, and respectful, and it is a skill that can be learned. Use "I-Statements" to express your experience without placing blame, which can reduce defensiveness. For example, instead of saying, "You're dismissing my pain," try, "I feel that my concern about this pain is not being fully heard. I need us to explore the possible causes more thoroughly because it's significantly impacting my ability to work".
The DESC model (Describe the behavior, Express your feelings, Specify the change you want, outline the Consequences) is another powerful tool.
Do not leave with ambiguity. Have a checklist of questions ready. These questions force a more thorough and transparent discussion:
Document the conversation, the doctor's responses, the proposed plan, and any instructions given. This creates your own record of the visit. You can also ask if you can record the audio of the consultation for your records.
Your advocacy work continues after you leave the office.
As soon as they are available, log into the patient portal to review the official visit notes and test results. Compare them to your own notes. If there are discrepancies, address them. You have a legal right to access your full medical records; request a complete copy for your personal files.
Getting a second opinion is a standard and respected part of medical care. It is not an insult to your doctor; it is a sign of an engaged and responsible patient. For Black patients, given the documented disparities, a second opinion can be a life-saving measure. Most insurance plans cover second opinions, and some even require them for major procedures. If possible, seek a second opinion from a racially concordant provider, as research shows this can lead to more positive interactions and better communication.
Do not ignore post-visit surveys from the hospital or clinic. Use them as a formal tool to document your experience, both positive and negative. This feedback is often tracked as a quality metric and can contribute to accountability. Consider using platforms like the Irth app to share reviews of maternal care providers specifically for other Black women.
Sometimes, despite your best efforts, you will encounter substandard care, blatant bias, or harm. In these instances, you have the right to escalate your concerns and hold the provider and the system accountable.
Your first point of contact should be the institution's patient advocate or ombudsman. These are professionals employed by the hospital specifically to mediate disputes and resolve patient complaints. They can intervene on your behalf to address the situation with the provider or department in question.
Every state has a medical board, a government agency with the legal authority to investigate complaints against physicians and take disciplinary action, which can range from requiring further education to suspending or revoking a medical license.
Depending on the nature of the complaint, other bodies may be relevant. The Joint Commission handles reports related to patient safety concerns in accredited facilities, and your state's Attorney General office can be contacted for issues of patient abuse or neglect.
Knowledge and connection are the fuel for sustained advocacy. This resource hub is a living library, a curated collection of tools, organizations, and media designed to support you on your journey.
A powerful memoir and social commentary that connects the author's personal story as a second-generation Black woman physician to the broader history of systemic racism in American medicine. It ends with a compelling call to action for how everyone can contribute to advancing health equity.
A landmark work of investigative journalism that meticulously documents how racial bias and systemic neglect in the healthcare system have created devastating health outcomes for Black Americans.
The unforgettable story of a poor Black tobacco farmer whose cells—taken without her knowledge in 1951—became one of the most important tools in medicine, raising profound questions about race, ethics, and medical history.
A comprehensive, head-to-toe guide from a Black female OB-GYN that addresses the top medical issues for Black women, the effects of microaggressions, and practical tools for self-care and patient advocacy.
A practical and accessible guide filled with exercises designed specifically to help Black women revitalize their outlook, improve mental health, and prioritize their well-being.
From the founder of the Therapy for Black Girls podcast, this book explores how to harness the power of community and sisterhood to heal oneself and one's relationships.
An essential resource that helps readers navigate an unequal system, learn tools for emotional wellness, and get the help they deserve, written from a Black perspective.
A weekly chat about all things mental health, personal development, and the small decisions we can make to become the best possible versions of ourselves, hosted by licensed psychologist Dr. Joy Harden Bradford.
Listen Now →This biweekly podcast dissects health issues and news relevant to Black women, defining health holistically to include physical, emotional, mental, economic, and social well-being.
Listen Now →A weekly podcast that delves into topics of society, culture, and healing, creating a space for authentic conversation and connection.
Listen NowA podcast featuring Executive Director Janette Robinson Flint and Visionary Adjoa Jones, sharing insights on current events, culture, policy, and wisdom for Black women on life and joy.
Listen NowThe first nonprofit organization created by Black women to protect and advance the health and wellness of Black women and girls through advocacy, research, and leadership development.
Visit WebsiteA community-based organization committed to the health and well-being of Black women and girls through health education, empowerment, and advocacy on issues like reproductive and environmental justice.
Visit WebsiteThe nation's oldest and largest civil rights organization, which advocates for policies that dismantle systemic injustices across all sectors, including health.
Visit WebsiteA Black women-led alliance that advocates for Black maternal health, rights, and justice, working to ensure Black mothers and parents have the resources and support they need.
Visit WebsiteA global professional organization focused on the advancement of Black and African-American professionals across the healthcare and life sciences industries.
Visit WebsiteA statewide organization in California advocating for health equity for Black residents through policy analysis, research, and training.
Visit WebsiteAn online space and directory dedicated to connecting Black women and girls with culturally competent therapists.
Find a TherapistAims to make finding therapy simpler and safer for marginalized populations.
Find a TherapistConnects individuals with clinicians committed to serving the mental health needs of Black and Latinx/Hispanic communities.
Find a TherapistA healing justice organization focused on transforming mental health for queer and trans people of color.
Find a TherapistA national training, movement-building, and grant-making organization dedicated to the healing, wellness, and liberation of Black and marginalized communities.
Learn MoreSustains the mental wellness of Black women by building community, sharing information, and connecting them to quality mental wellness services.
Learn MoreProvides financial assistance to Black women and girls seeking therapy, helping to remove financial barriers to care.
Apply for SupportCrisis Text Line: Text COALITION to 741741 to connect with a crisis counselor for free, 24/7 support.
988 Suicide & Crisis Lifeline: Call or text 988 for free, confidential support for anyone in distress.
A highly customizable app that allows you to track mood, emotions, sleep, energy levels, custom symptoms, medications, and other health factors. It helps you identify correlations between your habits and your health.
DownloadThis app integrates data collected automatically from your smartphone or smartwatch (like activity, sleep, heart rate) with your own quick daily check-ins on mood and symptoms for chronic conditions like depression, bipolar disorder, or COPD.
DownloadA popular app for tracking and managing chronic pain, offering personalized education and a diary to log pain severity and symptoms.
DownloadSpecifically designed for individuals with epilepsy to track seizures, triggers, and medication adherence.
DownloadAllows users to journal their asthma activity, triggers, and medication use, creating a color-coded graph to share with clinicians.
DownloadA leading app for medication management that provides personalized reminders, tracks adherence, and warns of potential drug interactions.
Download