So what if race is just a construct? That doesn’t stop race and racism from having real impacts on health. Let’s discuss the leading explanation for why Black women’s health deteriorates over time, and specific physiological mechanisms that break down the female reproductive system and harm pregnancy. If you want to read more how racism “get’s under the skin” and becomes biology, head over to the genetics tab.
The Weathering Hypothesis
It has been shown that Black women age prematurely, due to a lifetime of racial discrimination, social disadvantage, and economic roadblocks. Researches have looked at different biomarkers, such as levels of cortisol and cytokine production, as a proxy for measuring physiological effects of discrimination. Building on this idea, researchers coined the term “allostatic load,” which is a score that measures the cumulative impact of stress due to social, economic, and political marginalization. Between white women, white men, Black men, and Black women, Black women were shown to have the highest allosteric load at all ages, and the gap widened between ages 18 and 64 years. Black women have the highest allosteric load of all groups, in part due to the double discrimination they face for both their race and their gender.
How does the stress of discrimination hurt the health of Black women? 
Even before a woman becomes pregnant, chronic stress damages the body. In what’s known as “toxic stress,” frequent exposure to stressful events (like persistent discrimination) causes constant activation of the fight or flight response in the body. While helpful in emergencies, prolonged activation wears down the body, both physically and mentally, and has been linked to heart disease, diabetes, substance abuse, depression, and pre-term birth.
Once a woman becomes pregnant…
Chronic stress is linked to preterm labor, which puts both mother and baby at high risk and is the number one cause of infant mortality. There are three physiological pathways for how chronic stress literally breaks down the female reproductive system.
- Chronic stress increases glucocorticoid production, which inhibits the immune system (making women more susceptible to infections and complications)
- Chronic stress activates the hypothalamic-adrenal stress pathway, resulting in increased production of CRH (stress hormone). Increased CRH causes uterine contractions, which may induce labor before the mother and fetus are ready, leading to pre term birth
- Activation of stress pathway leads to pro-inflammatory state, which has been shown through elevated CRP (another stress hormone), to cause contractions and preterm birth, along with many other health issues not related to pregnancy
Black women have significantly higher levels of stress hormones (such as CRH, CRP, ACTH) present in their blood during their third trimester of pregnancy than white women do, quantifying their stress into measurable biologic differences.
What to do?
We just read all about how stress harms the body specifically during pregnancy. So, solutions need to focus on how to decrease stressors in Black women’s lives. Short of ending racism, there are steps we can take. Black women have been shown to have fewer support services in place to buffer stress. Providing resources to pregnant Black women, like this guide, explaining what all of their options are, and listening without judgement are the first steps. For more suggestions, look at our solutions tab.