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Black women remain deeply impacted by structural and systemic inequity that affects every area of their lives. Despite this, Black women are one of the most under-researched and under-recognized populations in the country. A new report from the Institute for Women’s Policy Research (IWPR), commissioned by the National Domestic Workers Alliance, aims to address this.

The Status of Black Women in the United States looks at the conditions that Black women face and provides recommendations for how to support and improve their well-being.

IWPR has released reports on the status of women in the U.S. since the mid-1990s. But this is the first one focused squarely on Black women in the country. As the authors explain:

Whether one examines Black women’s access to health care, Black women’s earnings, or Black women’s access to much needed social supports like childcare and eldercare, Black women are getting the short end of the stick — despite having contributed so much to the building of this nation.

The heart of the report lies in its message that in a changing political landscape, Black women must be at the center of policies that strive to create a more just world.

The report is meant to make visible some of what Black women face; to lift up a slice of the lived experiences of this marginalized group from health to employment, safety to political participation. The intention is that the report becomes a door to further (desperately needed) research and data collection in all of these areas.

One of these important areas is health. We know that Black women face unacceptable disparities related to health status, mortality, and access to care. The report outlines many of these problems — and examines the wide range of reasons they exist:

For example, one study found that Black women and Black men are less likely than others to have an annual visit to a primary care clinician due to a variety of structural factors. These include variations in availability of clinicians and quality of health care services in different areas of the country, as well as differences in access to transportation and knowledge of health topics among patients.

That’s just the tip of the iceberg. Black women are more likely to die from heart disease, breast cancer, and complications related to pregnancy and childbirth than any other ethnic or racial group of women, and they have much higher incidences of HIV/AIDS as well.

One study of women with heart disease, cited in the report, showed that “Black women are less likely to receive appropriate preventive therapy than White women are.” Studies have shown that there is a racial gap when it comes to new technologies, like pacemakers — fewer Black people get them. And don’t forget, women (and especially women of color) are underrepresented in clinical studies related to heart disease. Groups like the Black Women’s Health Imperative are monitoring and sharing information on the heart health of Black women and have even created a health index specifically for Black women in the United States.

Black women are still contracting and dying from AIDS at higher rates than any other group of women. The number of Black women who contracted AIDS decreased between 2000 and 2013, but Black women’s incidence of the disease is still an astounding five times higher than for any other group of women. In fact, Black women represent almost two-thirds of all new HIV infections among women.

There is evidence, notes the report, that HIV prevention strategies typically focus on men and don’t adequately address Black women’s needs and lives. Organizations like Sisterlove are working to address these high rates of AIDS and HIV through prevention and outreach strategies that are deeply rooted in community, specifically communities of Black women.

Reproductive and sexual health care, for Black women, is also critical. Black women are three times more likely to die from pregnancy and childbirth-related complications than White women are — and are more likely to have low birth weight babies. Black Mamas Matter was born from a collaboration between Sistersong and the Center for Reproductive Rights after their joint report on reproductive injustice revealed startling maternal health disparities between Black women and White women.

A traumatic history of reproductive injustice shadows Black women in the United States.

According to The Status of Black Women in the United States,

Black women’s reproductive health has been threatened by racialized and gendered policies and programs throughout United States history, including the forced or coerced sterilization of low-income Black women through the 1960’s and 70’s, and recent restrictions on low-income women’s access to contraception, safe abortions, and other family planning services, which disproportionately harm Black women.

Access to care, specifically reproductive health care, is a critical piece of the puzzle. Andy Kopsa, writing in The Development Set about the high rates of HIV among Black women, puts it plainly:

Access to reproductive healthcare is evaporating for women in the United States — and with it goes a viable and vital clearinghouse for information on HIV/AIDS.

Without access to care, including prenatal care, these disparities will remain. When we have national debates about defunding Planned Parenthood or repealing the health care law that has expanded Medicaid and extended coverage to millions of low-income women, we’re actually threatening to dismantle the systems that are helping to improve the health and well-being of Black women and their babies in the U.S.

It’s not the only way we need to address the status of Black women’s health and well-being. We also need more research focused on Black women’s health and lives, and a greater understanding of the ways in which stress from racial discrimination impacts Black women’s health, for example. But without greater access to care, we surely won’t see progress.