The Blues That Bind: Black Women's Centuries-Old Struggle

Annie Lee's Blue Monday self-portrait tells a story familiar to many African American women. In shades of blue, Lee's painting transcends decades, etching the pain, strength, and labor that Black women embody simply by being born. Painted in 1985 in Chicago, Blue Monday resonates deeply.

There is something achingly relatable about it. The stress weighing on the woman's shoulders, her neck hung low as if mourning the day before it's began.

Her disheveled clothes draped loosely, unable to bear the weight of her blues. It all feels too familiar, which is likely why it became Lee's most popular work. The faceless self-portrait displays her vulnerability, the sad, weary, defeated expression leaving room for viewers to see themselves sitting at the edge of the bed before or after a long, hard day.

I stare at the painting and see glimpses of my mother. Of myself.

The struggle Black women carry is profound and unending. Century after century, day after day, we live and fight to see another sunrise in a world not made for us. Yet we persevere, but at what cost?

History shows Black women are consistently an afterthought, regarded as less than our White and male counterparts. We sit at a unique intersection of marginalization where neither our womanhood nor our race is widely valued or accepted. For years, we've endured compounded discrimination, centuries of pain, abuse, struggle, and fighting. From girlhood to womanhood, that pain seeps in, leaving lasting impacts.

Professor Parker Dominguez, a social worker and Health care systems expert at USC, describes the experiences of many Black girls and how simply being Black creates a unique process to being socialized.

"It's designed to help your child understand social roles, expectations, culture - how to function within a social system. For parents of color, especially Black parents, racial socialization is extremely important. It means preparing kids to understand racism exists. You are a person of color, you are going to be subjected to this...you have to have a certain level of suspicion or mistrust when engaging with different systems, people, contexts, and situations because they can be potential sources of isms."

Even from a young age, Black girls must carry the burden of their race and what it means to be Black in America before truly living, facing higher barriers than their White peers. A level of hyper-vigilance must be instilled for their safety in a way unmatched for White children. Not only must they know they're Black, they must remember they're girls. This awareness robs them of the innocence most kids cling to longer. It manifests physically and mentally.

Dominguez states, "From a stress perspective, that physiological stress response chronically engaged can lead to wear and tear, premature aging through allostatic load - the degrading of your stress response over time because it's constantly activated. There's research on how that impacts you at a cellular, epigenetic level."

From their earliest days forming sentences, Black girls are hyper-aware of how their identity may shape how they're viewed. Thoughts of anticipated racism - knowing any situation could bring discrimination and prejudice - start young.

This framework many Black girls adopt only worsens in adulthood. Many Black women are underdiagnosed and undertreated for painful symptoms when seeking medical care.

A Georgetown Law study found that as young as 5, Black girls are viewed by adults as needing less nurturing, protection, and support, and as more sexually mature than their White peers. This adultification bias stems from deeply rooted racist stereotypes.

The perception takes two forms: situational contexts where children mature faster and take on responsibilities earlier, such as in disenfranchised communities, or adults perceiving a child's behavior as older. This framework many Black girls grow up adopting only worsens in adulthood.

Pew Research found that 71% of Black women ages 18-49 reported at least one negative interaction with a healthcare provider. Black women also have worse pregnancy and postpartum outcomes, are more likely to die of breast cancer than White women, and have higher rates of heart disease at younger ages.

When race and gender intersect, the healthcare system's shortcomings are stark.

The dismissal of pain and identity at a young age follows Black girls into adulthood, often manifesting in the health care system historically unequipped for women or Black people, much less Black women.

"I realized at 15 that my body wasn't functioning normally, and my journey for answers started," said Kylie Foster, 23, first diagnosed with polycystic ovary syndrome (PCOS) at 16 after severe stomach pains from ovarian cysts.

It took over a year for Foster's male gynecologist to take her painful, excessive periods seriously instead of writing her symptoms off as nothing more than a bad period. Even after diagnosis, Foster’s care remained lackluster.

"The process was very blunt: diagnosis, prescription, dismissal," she said. "As a teenager, I didn't have the tools to ask follow-up questions. There was no referral to a therapist to help with PCOS' mental health effects. In a way, the experience of being diagnosed with PCOS as a whole deterred me from visiting providers in the future.”

Dr. Burrs is one of the few Black OB/GYNs in her town after completing her residency at Stanford University.

"Black women would seek me out because there are no Black physicians, and they want somebody who they don't have to explain everything to or somebody who might make me and my family feel more comfortable," she said. "My practice was as Black as it could get because people would come find me from far far away."

Black women are better suited seeking other Black female medical providers due to shared cultural competency that White providers cannot provide, research shows. Providers who share sociocultural contexts with Black women have been linked to better patient outcomes. They tend to communicate more effectively, build trust and create satisfaction, which may contribute to improved health.

However many Black patients do not have the luxury to choose their doctor. Only 5.4% of U.S. doctors identified as Black, and various insurance inequities further limit doctor selection.

Dr. Burrs' insights extend beyond the surface level. She recognizes the reluctant patients—the ones who check in and out, seemingly disengaged. It's easy to label them as non-compliant patience, but Dr. Burrs looks deeper. "Why do people behave that way?" she asks. Implicit bias, historical trauma, systemic mistrust—they all play a role. Patients carry burdens beyond symptoms. Their reluctance is a survival strategy against a flawed system.

She vividly recalls when a colleague dismissed a patient's pain level, stating, "She said she's in a lot of pain, but I don't think so." While such statements may be commonplace when doctors are frustrated or fatigued, Dr. Burrs emphasizes questioning assumptions. "When she says that, if everybody nods in agreement, assuming the patient is exaggerating, that becomes the mindset," she explains. "But if someone challenges that—asks, 'Are you sure?'—it changes the dynamic. We're considering other perspectives."

Having physicians who share patients' cultural backgrounds can bridge this divide, Dr. Burrs says. They bring firsthand knowledge of cultural norms, historical context and socioeconomic factors. They understand why a patient might hesitate to follow advice or express mistrust.

"People often fail to step outside their own lens. They don't actively try to see situations differently," she explains. When providers can't fully comprehend patients' lives, gaps emerge.

Dr. Burrs firmly believes diversifying the healthcare workforce can revolutionize these conversations around patient care and health outcomes. Providers from different backgrounds bring a nuanced understanding of the factors influencing patient behavior—whether cultural norms, socioeconomic challenges or historical mistrust.

"A lot of patients harbor mistrust toward the healthcare system," she observes. "They don't necessarily believe their doctor has their best interests at heart...having a diverse team helps bridge that gap."

Many issues were linked to racism and Black women's fear of medical professionals due to a long history of abuse and dismissal.

Dr. Sims, widely known as the "father of gynecology," performed surgical experiments on enslaved Black women without anesthesia or consent, Dr. Burrs notes.

"The 'grandfathers' of OB/GYN were horrible misogynists," she says. "They did ridiculously terrible things...figuring out how to do surgery, and they did it on women who were not anesthetized and who could not consent, and this happened over and over...some of our primary instruments are even named after these people. Most physicians have no concept of how horrible our history is."

A dark history of medical racism persists in the U.S. Despite Sims' misconduct, his statue still stands at the Alabama state capitol in Montgomery.

The Black woman's experience is unmatched. In attempting to care for their bodies, an opportunity many lack, Black women face immense hurdles in getting their pain addressed. An NIH study found 94% of Black women patients had poor experiences with medical professionals, especially OB/GYNs.