Abstract
Introduction
Black women are more likely to undergo surgery for uterine fibroids compared with
non-Black women. However, few studies have characterized the psychosocial experiences
of Black women seeking fibroid treatment. We aimed to identify factors that shape
Black women's fibroid management decisions; explore how discrimination based on race,
class, and gender feature in treatment-seeking experiences, and compare experiences
across age and socioeconomic status.
Methods
We conducted semistructured interviews with 37 Black women undergoing surgery for
fibroid management. We used a thematic analysis to code transcripts and identify themes.
Results
Participants were predominately single, college educated, and insured. Respondents
reported that patient–doctor interactions, support from social networks, fertility
consequences, and fear of fibroid malignancy influenced their fibroid management decisions.
Knowledge and perceptions of fibroids were also influenced by community norms and
differed by socioeconomic status; women of higher socioeconomic status had greater
fibroid awareness than women of lower socioeconomic status. Discrimination was discussed
in the context of historical inequity against Black women, with one participant questioning
whether Black women were valued less in clinical settings compared with non-Black
women. Although several women discussed positive experiences seeking fibroids care,
others expressed medical mistrust or said that alternative management options were
not offered by clinicians.
Conclusions
Fibroid management decisions were influenced not only by interactions with clinicians
and social networks, and concerns about fertility and fibroid malignancy, but also
by broader social and historical conditions. These findings suggest that clinicians
should deliver intersectional gynecologic care that centers the voices of Black women
seeking fibroid treatment.
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Biography
Brianna N. VanNoy, MPH, is a rising public health scholar interested in advancing environmental health equity for marginalized communities. She holds a BS in Environmental Public Health (Ohio State University) and an MPH in Environmental Health Science and Policy (George Washington University).
Biography
Lisa Bowleg, PhD, MA, Professor of Psychology, George Washington University, is a leading scholar of intersectionality, focusing on the effects of social context on Black men's sexual HIV risk and protective behaviors, and stress and resilience among Black lesbian, gay, and bisexual people.
Biography
Cherie Q. Marfori, MD, is a board-certified surgical gynecologist and Assistant Professor with the George Washington University. She specializes in minimally invasive gynecologic surgery and cares for patients with problems across the entire surgical gynecologic spectrum, including fibroids, endometriosis, and gender dysphoria.
Biography
Gaby Moawad, MD, board-certified surgical gynecologist and Associate Professor (George Washington University), specializes in minimally invasive gynecologic surgery, providing a wide range of gynecologic services, including treatment of menstrual disorders and fibroids, endometriosis and pelvic pain, and pelvic organ prolapse.
Biography
Ami R. Zota, ScD, MS, Associate Professor (Department of Environmental & Occupational Health, George Washington University Milken Institute School of Public Health) seeks to secure environmental justice and improve health equity through advancements in science, policy, and clinical practice. Her research identifies novel pathways linking social disparities, environmental exposures, and reproductive and children's health.
Article info
Publication history
Published online: February 18, 2021
Accepted:
January 8,
2021
Received in revised form:
December 23,
2020
Received:
July 12,
2020
Footnotes
Supported by the National Institutes of Child Health and Development, United States (R21HD096248), National Center for Advancing Translational Sciences, United States (UL1TR001876, KL2TR001877), The George Washington University Milken Institute School of Public Health, and The George Washington University Office of the Vice President for Research (Cross-disciplinary Research Fund). The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding agencies.
Dr. Moawad is a speaker for Intuitive Surgical. All other authors report no conflicts of interest.
To preserve the anonymity of study participants, the data (e.g., interview transcripts) that support the findings of this study are not publicly available.
Identification
Copyright
© 2021 Jacobs Institute of Women's Health. Published by Elsevier Inc.
