Young Adult Black Women Face Many Sexual and Reproductive Healthcare Barriers
December 1, 2025 5 minutes read
By Melinda Young
Young adult Black women in the United States face disproportionate reproductive and sexual health concerns, as well as reduced access to care, research shows.1 Strategies to reduce barriers must start with learning more about what these barriers look like to individual young adult Black women (YABW) and developing patient-centered care that is culturally responsive, a new study suggests.1
“We found that, among our participants, the perceived challenges to accessing sexual and reproductive healthcare could be thought of in two broad categories,” says Aaliyah Gray, PhD, a research assistant professor in the Center for Women’s and Gender Studies at Florida International University in Miami. Gray answered questions in writing, via email. “On one hand, our participants reported perceived logistic challenges to access, like not knowing where to go to get care or the cost of care,” Gray explains. “On the other hand, they perceived other challenges that were more stigma-related, such as having concerns about disclosure or feeling judged receiving services.”
Stigma related to women’s sexual behaviors contributes to their concerns with accessing care for sexually transmitted infections (STIs). Black women say they feel judged by others when it comes to human immunodeficiency virus (HIV) testing and disclosure of their HIV status, and they anticipate being rejected by their families and society.1,2 “We looked at these two categories of perceived barriers across three different services — accessing birth control, STI testing, and abortion care, and we did find that perceived access barriers differed slightly across the three,” Gray says. “For example, perceived logistic and stigma barriers were greatest for abortion care.”
Black women also expressed feeling judged for accessing abortion care. The stigma of having an abortion is exacerbated because of negative stereotypes about Black women and sexuality, the study says.1,3 “We investigated several psychosocial factors potentially associated with perceived barriers to care among our participants,” Gray says. “Clinicians encouraging self-efficacy in sexual communication is important, and supporting decision-making and autonomy is critical to promoting healthy sexuality in this population and care-seeking behaviors.”
Another barrier is knowledge: a lack of communication about abortion care increases barriers to accessing services when they are needed.1,4 “But we also found that one in five participants and one in four participants did not know where to get birth control or STI testing, which is very concerning for this age group,” Gray adds.
Clinicians are central to prevention, treatment, and education for any woman seeking care, she says. “They are a primary point of contact for individuals needing sexual and reproductive healthcare,” Gray says. “So, the implications of our findings for improving clinical interactions for young adult Black women is central to the overall objectives of this work.”
The study’s stated purpose is to understand YABW’s perception of barriers to accessing sexual and reproductive healthcare. The study’s authors found perceived barriers to care in the two dimensions of logistics and stigma. YABW believed they were more affected by stigma barriers than logistical barriers, and these barriers were worse for abortion care and STI testing than they were for obtaining prescription contraceptives.1
Researchers found that for this population in states with restrictive abortion policies, their perceptions of barriers to care are independent of the “larger sociopolitical context or that YABW across states may anticipate negative experiences accessing care regardless of policy context.”1 They also found that anticipated policy effects contributed to perceived barriers to care. For instance, participants perceived stigma-based barriers to STI, abortion, and contraceptive care in anticipation of negative effects of the Dobbs v. Jackson Women’s Health Organization ruling.1
“These findings reflect that legal consequences ushered in by restrictions to abortion care in many states are associated with concerns about Dobbs having further-reaching implications for other types of care and contribute to stigma related to accessing care for YABW,” the study says.1
One of the strategies for addressing the stigma and logistics barriers for this population is to provide culturally responsive patient-centered care.1 Providers can do this by acknowledging their personal biases, addressing racism, and working to eliminate stigma within their own interactions with patients. They also can avoid making assumptions about patients’ sexual histories.1
“This is crucial for providing high-quality, comprehensive care, and for young adult black women in particular, clinicians must also acknowledge, correct, and eliminate stigma in sexual and reproductive care spaces by addressing racism within their interactions with patients and avoiding harmful biases that perpetuate warranted mistrust among this population,” Gray says.
Another step is to learn more about available services for patients. “Increasing the knowledge base of available services is a critical step for improving access to STI testing and birth control for this population,” Gray notes. “However, our findings pointed to a really interesting relationship between stigmatizing experiences and logistical challenges to accessing care.”
Another barrier-reducing strategy is to include cultural competency and patient-centered care training for all healthcare providers, including interns. Another strategy is to expand insurance coverage for telehealth and direct-to-consumer access to contraceptives, STI tests, and medication abortion.1 A stigma-reducing tactic is to normalize the concept of a first OB/GYN visit for young women.1
Reducing stigma is essential for improving that knowledge base because Black women historically have faced significant challenges to receiving high-quality, adequate sexual and reproductive care, Gray says. “In the article, we discuss the importance of clinicians investing in and adopting patient-centered care approaches for this population,” Gray explains. “What that might look like in sexual and reproductive care settings is engaging in shared decision-making and prioritizing patients’ needs and values.”
Shared decision-making is a strategy that works for every patient and could help YABW meet unmet sexual and reproductive health needs so long as the process is not characterized by racism and discrimination, the study says. Investigators found that there is an interplay between stigmatizing experiences, such as anticipating racist stereotypes from others, and perceived logistical barriers to care, the study explains.
“Challenging race-based sexual stereotypes through positive and affirming interactions with young adult Black women is also beneficial for this population,” Gray says. “For example, addressing the risk behaviors that a patient presents during a clinical interaction, rather than relying on assumptions or stereotypes, is necessary for promoting healthy sexuality and building trust that can remove stigma as a barrier to care.”
Future research might evaluate targeted interventions, such as school-based and community-based programs that offer free/low-cost contraception and STI self-testing kits.1
“Young adult Black women deserve access to high-quality, comprehensive sexual and reproductive healthcare services, which requires addressing both logistic and stigma-based challenges to receiving care,” Gray says.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Gray A, Sinclair S, Trepka MJ, Nelson KM. Exploring state- and individual-level characteristics associated with perceived barriers to accessing sexual and reproductive health care among young adult Black women. J Sex Res. 2025;Sep 12:1-14. [Online ahead of print].
2. McDougall GJ Jr, Dalmida SG, Foster PP, Burrage J. Barriers and facilitators to HIV testing among women. HIV/AIDS Res Treat. 2016;2016(SE1):S9-S13.
3. Griner SB, Reeves JM, Webb NJ, et al. Consumer-based sexually transmitted infection screening among young adult women: The negative influence of the social system. Sex Transm Dis. 2022;49(9):596-600.
4. Brown K, Plummer M, Bell A, et al. Black women’s lived experiences of abortion. Qual Health Res. 2022;32(7):1099-1113.
Young adult Black women in the United States face disproportionate reproductive and sexual health concerns, as well as reduced access to care, research shows.
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