How Listening Closes the Racial Gap in Black Women’s Preventive Care

A recent Guardian article surfaced a truth many women recognize immediately: symptoms dismissed, pain minimized, care delayed until persistence—or decline—forces the system to respond. For Black women in particular, these experiences are not aberrations. They are patterned.

What’s striking is not that these stories exist, but how little medicine has actually studied their downstream impact. It’s a well-understood fact that BPOC women have a higher risk of preterm birth, labor and postpartum complications. It’s also well documented that BPOC women have an increased incidence of chronic condition onset like hypertension, diabetes and mental health diagnoses. And yet, research has done little to really disentangle what we can do to dramatically stave off this effect.

We See the Outcomes, But Not the Full Explanation

Across the U.S. healthcare system, Black women experience worse outcomes across a range of conditions, including maternal health, cardiovascular disease, autoimmune disorders, and certain cancers. In preventive care, the gaps are especially visible.

Black women are less likely than White women to be up to date on cervical cancer screening and more likely to be diagnosed at later stages, when treatment is more complex and survival rates are lower. These differences persist even after accounting for income, insurance status, and education.

The usual explanations—access, socioeconomic status, comorbidities—are real, but incomplete. They tell us where disparities appear, not why they persist so stubbornly even when guidelines, coverage, and clinical tools are ostensibly the same across all populations.

One hypothesis, supported by lived experience but insufficiently explored by research, is cumulative strain: the cognitive, emotional, and physiological toll of navigating a system that repeatedly signals disbelief.

• What happens to care-seeking behavior when appointments feel adversarial?
• What happens to disclosure when patients expect to be minimized?What happens over years when trust erodes slowly, visit by visit?

Today’s establishment treats these as “soft questions” but they are not – they are meaningful questions that we can see impact clinical outcomes.

Recognizing the history behind these outcomes

Modern gynecology itself was shaped through experimentation on Black women who could not consent. In the mid-19th century, physician J. Marion Sims developed and refined surgical techniques and instruments that would later become foundational to gynecological practice, including early forms of the vaginal speculum, through repeated experimental surgeries on enslaved Black women such as Anarcha, Lucy, and Betsey.

These procedures were performed without anesthesia—not because anesthesia did not exist, but because Sims believed Black women did not feel pain, a belief rooted in racist pseudoscience. And, at the time, these women had no legal ability to refuse. This history is embedded in the tools, norms, and power dynamics of women’s healthcare. For many Black women, gynecological care is not merely uncomfortable—it carries generational memory of exploitation, disregard, and harm.

That legacy extends beyond gynecology, from the Tuskegee syphilis study to other non-consensual or deceptive research practices performed on Black people that have been well documented. Research shows that awareness of these histories correlates with higher medical mistrust among Black Americans and lower engagement with preventive care.

Against that backdrop, we must take this mistrust and outsized strain Black women experience when using the medical system seriously.

What we still haven’t studied enough

Despite this history—and despite persistent outcome gaps—research into how disbelief, bias, and relational dynamics affect long-term health outcomes has been limited.

More concerning, several NIH-funded programs that supported research on health equity, patient experience, and structural drivers of disparities were recently shut down or deprioritized as part of broader efforts to defund initiatives labeled as “DEI.” The consequence is clear: fewer resources to study how trust, listening, and lived experience interact with biology over time.

This leaves medicine in an uncomfortable position. We can observe correlations between mistrust and worse outcomes, but we lack the kind of longitudinal, mechanistic evidence that healthcare systems typically demand before changing practice.

What we do know: Listening changes outcomes

Even without perfect data, one signal is consistent across care settings: when women feel listened to, they engage differently with healthcare. In environments where patients report feeling heard and respected, preventive screening rates increase. Follow-up improves. Chronic conditions are managed more consistently. Mental health needs surface earlier, before they become crises.

We believe there is no better indicator that women are going to continue to engage in their core preventive care services if (and when) they feel heard, seen, supported and most of all believed. Systems where patients spend less energy defending their credibility and more energy participating in their health mean there is more time for finding solutions that will work for them. While this issue of “not feeling believed” is prevalent across women of all colors and socieconomic backgrounds, the persistence and detriment of this effect for black women stands out to such a degree that it merits an intensive focus on adopting attentive practice to support black women in particular.

Preventive care can lead the change

Cervical cancer screening is often cited as a clear example of racial disparity in preventive care. Nationally, Black women are less likely than White women to be up to date on Pap testing and more likely to experience delayed diagnosis and higher mortality from a disease that is largely preventable with routine screening and follow-up.

These gaps are frequently framed as immutable—byproducts of access, behavior, or history. But real-world outcomes suggest something else: the gap is not fixed.

In care environments designed explicitly around listening, trust, and continuity, preventive screening rates can not only improve overall—they can equalize, and in some cases reverse, traditional racial patterns.

In 2024, Tia showed that cervical cancer screening rates among women receiving empathy-forward, integrated primary care exceeded national benchmarks across all racial and ethnic groups. Notably, Black women in our care model were screened at rates that matched—and in some cases surpassed—those of White women, a result that stands in stark contrast to national averages.

Overall, more than 80% of patients were up to date on cervical cancer screening—nearly two and a half times the national average. These outcomes were achieved not through novel technology or incentives, but through care models that reduced friction: longer visits, continuity with clinicians, trauma-informed gynecologic care, and an explicit emphasis on being heard.

This matters because screening is not a purely logistical act. It requires consent, vulnerability, and trust. For women whose historical and personal experiences with gynecologic care include dismissal or harm, avoidance is not irrational—it is protective.

When care is delivered in a way that acknowledges that history—when clinicians take time, explain procedures, and treat patient concerns as valid rather than inconvenient—engagement changes. Preventive care stops feeling like something done to patients and becomes something done with them.

The implication is not that listening alone solves inequity. But it does suggest something critical: when the emotional and relational costs of care are reduced, women who have historically been underserved do not lag behind—they show up.

Cervical cancer outcomes do not have to follow the same racial patterns they always have. The data shows they don’t—when care is built differently.

Ethics, even in the face of uncertainty

Medicine routinely acts in uncertainty—when evidence is emerging, when risks are asymmetric, when waiting would cause harm. The risk here is visible: delayed diagnoses, preventable disease, and worse outcomes concentrated among women who already bear a disproportionate burden. We may not yet be able to quantify precisely how disbelief affects physiology over decades. But we can no longer pretend that it doesn’t.

Despite the fact that conversations around structural racism and DEI have become politicized, we need to see that listening and believing are not political or idealogical. They are foundational to good clinical practice, and the absence has measurable consequence.

Until research catches up, the ethical response is simple: design care as if being heard matters—because every signal we do have suggests that it does.