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Rachel Feltman: For Scientific American’s Science Quickly, I’m Rachel Feltman.

In 2024, which is the most recent year the Centers for Disease Control and Prevention have released data for, Black women faced a maternal mortality rate of 44.8 deaths per 100,000 live births. That means they were more than three times as likely to die during childbirth than white women were.

But the Black maternal mortality crisis is just one part of a much larger problem. Black women also face disproportionately high rates of fibroids throughout their lives. They’re also more likely to have endometriosis go undiagnosed and more likely to die from endometrial cancer.

Today’s guest calls this the Black womb crisis. Dr. Kemi Doll is a professor in the University of Washington School of Medicine’s Department of Obstetrics and Gynecology and the director of the university’s Gynecologic Research and Cancer Equity Center. Her new book, A Terrible Strength, combines research data and personal stories to offer insight into this crisis and a way forward.

Thank you so much for coming on to chat with us today.

Kemi Doll: Thank you for having me.

Feltman: I think some of our listeners are, are probably familiar with the

Black maternal mortality crisis, but your book broadens its scope to what you call the Black womb crisis. Can you tell me more about what that phrase encompasses and why that distinction is important?

Doll: Yes, I use that phrase very intentionally to encompass the entire what I think of as, like, the gynecologic life course, so, like, the womb from the time that you start your period and through and past the time that people go through menopause, because, as we know, we spend most of our lives not pregnant. And there are severe gynecologic conditions, up to and including cancer, that disproportionately affect Black women. And what I have found is that when I use the language of the womb, it kind of brings everybody into what we’re talking about and allows us to expand our imagination past just the maternal mortality crisis, to recognizing that the womb itself is actually—we’re having a lot of suffering, you know, from many diseases across the life course.

Feltman: Mm. So tell me a little bit about what brought you to writing this book.

Doll: I am a clinically trained gynecologic oncologist, and I’m also a health-equity scientist, and so my research really focused on the question of why Black women had such a higher mortality rate after endometrial cancer diagnosis in this country. And I like to say that I was agnostic to method; I’m very focused on the problem, and I’ll use any method to get to a solution. And one of the things that we found early on is that endometrial cancer, for a lot of Black women, is just the end of a lifetime of suffering from fibroids and endometriosis and heavy bleeding and that even though, from a medical and biological standpoint, we think of cancer as this other entity and we’re kind of over in a different category, for the actual Black woman going through the disease, she thinks of it as yet another womb condition she’s dealing with.

And so what brought me to write the book was recognizing that we’re not going to bridge the gap of understanding about endometrial cancer, and we’re certainly not going to start to intervene on the issues with delayed diagnosis and incomplete treatment, and the things that plague Black women unless we speak to the experience Black women have over their entire lives with their womb. And so this book is really serving to create a new narrative where we unite those perspectives, and frankly, that we show Black women that from—physicians and scientists can also speak to them in a holistic manner that takes into account all of their life experiences with regard to their womb.

Feltman: Can you tell me more about what we might miss when we just focus on the data in trying to solve problems like this?

Doll: Sure, so a great example is how we diagnose endometrial cancer. So when I was in training and coming up, I learned that the way that we diagnose endometrial cancer is that when a woman has postmenopausal bleeding, she comes to the doctor, we do an ultrasound to evaluate the thickness of what we call the endometrial lining, or the endometrial echo, and if that is over a certain threshold, then her risk is higher and we do a biopsy to rule in or rule out endometrial cancer.

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