Fact: Receiving a timely diagnosis for endometriosis remains a significant challenge for many women. However, the burden of delayed diagnosis falls disproportionately on Black women, who face systemic barriers that are deeply rooted in both historical and ongoing racial bias within the medical field.
On average, individuals with endometriosis wait between 8 to 12 years—or longer—for a proper diagnosis. For Black women, this delay is even more profound. Research shows that Black women are 50% less likely to be diagnosed with endometriosis compared to white women, despite reporting similar or more severe symptoms.
This disparity is not due to biology but rather to structural inequities, including limited access to quality gynecological care, underrepresentation in research, and the persistence of racial stereotypes in medicine. Institutional racism continues to shape clinical decisions, leading to the dismissal of Black women’s pain and the misdiagnosis of their symptoms.
A Legacy of Neglect
The roots of this inequity can be traced back to the racist origins of gynaecology itself. A report from the Nuffield Department of Women’s Reproductive Health underscores how historical exploitation has translated into poorer care for Black women today. During slavery, Black women were not only denied bodily autonomy but were routinely used as experimental subjects without consent or anaesthesia.
This legacy is epitomised by 19th-century physician J. Marion Sims, often called the "father of modern gynaecology," who developed surgical techniques by operating on enslaved Black women without anaesthesia. His work fuelled the enduring myth that Black women have a higher pain threshold—a dangerous misconception that still influences medical treatment and decision-making today.
As Harriet Jacobs wrote, “Slavery is terrible for men, but far more terrible for women.” The violence inflicted on Black women’s bodies during slavery did not end with emancipation—it evolved into systemic medical neglect.
Racial Disparities in Reproductive Health
In the U.S., reproductive healthcare policies and practices have long marginalised Black women. Black women are frequently subjected to biased assumptions, including being unfairly held responsible for societal problems or viewed as leading deviant lifestyles. These harmful narratives contribute to delays in diagnosis and substandard care.
As early as 1881, Black intellectuals like Alexander Crummell recognized and condemned this injustice. In his pamphlet The Black Women of the South: Her Neglects and Her Needs, he wrote:
“In her girlhood, all the delicate tenderness of her sex has been rudely outraged… No chance was given her for delicate reserve or tender modesty… When she reached maturity, all her tender instincts of womanhood were ruthlessly violated.”[1]
Today, echoes of that violence persist in how Black women are treated in healthcare systems around the world. In the UK, Black women’s pelvic pain is often dismissed or misdiagnosed as pelvic inflammatory disease. They are less likely to be offered appropriate treatment or follow-up care, and their pain continues to be underestimated by healthcare providers—many of whom still harbour the unfounded belief that Black patients experience less pain.
Conclusion
Endometriosis does not discriminate, but healthcare often does. Addressing the racial disparity in diagnosis and treatment means confronting the medical field’s historical racism, challenging ongoing bias, and ensuring that Black women are heard, believed, and treated with dignity. Only then can we begin to close the gap in care and justice.
[1] Quoted in Beverly Guy-Sheftall, Daughters of Sorry: Attitudes Toward Black Women 1880 -1920