The Melanin Memo
What They Should Have Told You Before 35: Reproductive Health Info Black Women Deserve
The conversation about Black women and maternal health usually starts with a mortality statistic. Black women are three times more likely to die from a pregnancy-related cause than white women. More than 80% of those deaths are considered preventable. These numbers are real and they are urgent and they deserve to be said out loud every time someone tries to look away.
But there is a different conversation that needs to happen alongside that one not instead of it. It is the conversation about what Black women are never told before something goes wrong.
Because the system’s failure is not only in the delivery room. It starts years earlier, in the OB visits where no one mentioned ovarian reserve testing, in the appointments where fibroids were noted and filed away without a conversation about what that meant for future pregnancies, in the referrals that never happened, in the options that were never named.
This is that conversation.
Our community deserves to be informed not summarized, not softened, not filtered through someone else’s lens.
Your Ovarian Reserve and Why You Should Know Your Number
Anti-Müllerian hormone AMH is a hormone produced by follicles in your ovaries. A blood test measuring your AMH level gives your provider a rough picture of how many eggs you have remaining: your ovarian reserve. It is not a fertility sentence. It is information. And it is information that most Black women in their late 20s and 30s have never been offered or told exists.
Ovarian reserve declines with age for all women, but individual variation is significant. Some women at 38 have reserves typical of a 30-year-old. Others at 32 have reserves that signal a faster-than-expected decline. You cannot know which category you are in without the test. And you cannot make informed decisions about timing, egg freezing, or fertility treatment without knowing where you stand.
The question is not: why don’t Black women get this test? The question is: who decides which patients get this information proactively, and which patients have to ask for it themselves? Research on provider-patient communication patterns consistently shows that Black patients receive less information, are asked fewer questions, and have providers who spend less time in patient-directed conversation during appointments. The information gap is not a coincidence. It is a pattern. And the cost of that pattern is measured in time time that matters enormously in reproductive health.
→ What you can do: Ask your OB or gynecologist directly for an AMH test at your next annual visit. It is a simple blood draw. If you are between 28 and 38 and not currently planning pregnancy but want to preserve options, knowing your number is worth knowing.
Egg Freezing Is Not Just for the Wealthy or the Uncertain
The cultural image of egg freezing in American media is almost exclusively white, professional, and affluent a woman in her late 30s who has not found the right partner yet, buying herself time. That image has done significant damage to who feels like egg freezing is for them.
But there is another group of women for whom egg freezing is not about uncertainty it is about family history.
If early menopause runs in your family, and in many Black families it does, the window for egg freezing is not a vague concept. It is a real and finite timeline that can be anticipated and planned for. Premature ovarian insufficiency (POI), or early menopause before age 40 is a diagnosis that ends natural conception options and one that many women do not know is in their genetic history until they are already experiencing it.
Black women make up only 7% of egg freezing patients in cities where they represent nearly a third of the population even in areas with insurance coverage available. The two barriers most commonly identified are cultural beliefs and simply not knowing the option existed. That is an information failure with a direct reproductive consequence.
Egg freezing is not a guarantee. Success rates vary by age at the time of freezing, number of eggs retrieved, and fertility clinic quality. But the conversation the one where a provider explains what it is, what it costs, what it can and cannot do, and whether your personal or family history makes it worth considering is a conversation Black women deserve to be offered, not one they should have to stumble into on their own.
Fibroids: The Diagnosis That Often Comes Without a Full Conversation
Black women are two to three times more likely to develop uterine fibroids than white women, develop them earlier, and experience more severe symptoms. This is widely reported. What is less reported is what happens after the diagnosis.
Many Black women are told they have fibroids and handed a pamphlet. What they are not always told: whether the location, number, or size of their fibroids is likely to affect their ability to conceive. Whether watchful waiting is appropriate for their specific situation. What the difference is between a myomectomy, embolization, and other treatment options and which preserves fertility and which may compromise it. Whether they should be followed by a specialist, and what timeline is appropriate for reassessment.
The fibroid diagnosis is often delivered as if it is the end of the conversation, when it is actually the beginning of several conversations that directly shape reproductive outcomes. Black women deserve providers who have all of those conversations, not just the one that ends with a brochure.
Pregnancy Over 40: The Full Picture
The rise in pregnancies among women over 40 is real and it represents something meaningful women making intentional decisions about their bodies and their timelines on their own terms. That deserves to be celebrated without qualification.
It also deserves to be entered with complete information.
Pregnancy after 40 carries increased risks for all women: higher rates of gestational diabetes, preeclampsia, preterm birth, and chromosomal differences. For Black women, those risks are compounded by preexisting disparities. Black women already experience higher rates of hypertension, heart failure, and peripartum cardiomyopathy than white women. Preeclampsia is significantly more common among U.S.-born Black women, and a history of preeclampsia is associated with a 66% increased long-term risk of stroke a link that is especially pronounced in Black women.
Black women 40 and older face severe maternal morbidity rates 104% higher than white women in the same age group. That is not a reason not to pursue pregnancy. It is a reason to pursue it with a provider who takes those risks seriously, monitors accordingly, and does not dismiss symptoms that warrant attention.
The medical term for pregnancy after 35 is “advanced maternal age.” It has also been called, colloquially, a “geriatric pregnancy” a term that is both clinically useless and culturally harmful, particularly for Black women who have spent years being told their biological clock was running out. What the term should signal is: this patient may benefit from additional monitoring and specialist involvement. What it should never mean is: this patient’s concerns about her body are less credible.
→ What you can do: If you are over 35 and pregnant or planning to be, ask specifically about being referred to a maternal-fetal medicine specialist for a consultation, regardless of whether you have been labeled high-risk. Ask about your blood pressure baseline and preeclampsia monitoring protocol. Ask what the follow-up plan is if you develop any symptoms during or after pregnancy. Ask these questions before you need to.
Mental Health Is Not a Side Note
Nearly 60% of Black mothers receive no mental health support during prenatal or postnatal care. This is not because Black women do not experience prenatal depression, postpartum depression, or pregnancy-related anxiety they do, at significant rates. It is because the screening, the referral, and the follow-through are not being applied equally.
Black women who experience racism in the year before delivery have significantly higher odds of depression during pregnancy. Women who experienced dismissal, skepticism, or loss of autonomy during hospital births a pattern documented disproportionately in Black women’s accounts are carrying that experience into their postpartum recovery. The mental health story is not separate from the maternal health story. It is the same story with a different entry point.
A provider asking once on a screening form whether you feel sad is not mental health care. A referral to a therapist who has experience with pregnancy-related grief, fertility treatment, or postpartum adjustment preferably someone who is Black or has demonstrated cultural competency with Black patients is a different thing entirely. Black women deserve the second version, not just the form.
What Informed Care Actually Looks Like
The reproductive information Black women deserve is not complicated. It does not require a revolution. It requires providers who have full conversations instead of partial ones, who offer proactive screening instead of reactive responses, and who treat Black women as the primary experts on their own bodies.
It requires a healthcare system that understands that when a Black woman says something is wrong, the correct response is to investigate not to document her concern with skeptical language and send her home.
It requires community spaces like this one where the full picture gets spoken out loud, where egg freezing and AMH testing and fibroid treatment options and preeclampsia risk are discussed not as medical jargon but as information that belongs to the women whose lives they shape and it requires Black women to know, going into every appointment, that they are allowed to ask every question on this page. That they do not need permission to request a referral, a test, a follow-up call, a second opinion, or a provider who will listen.
You do not have to be a medical professional to advocate for yourself in a medical system. You just have to know that the information exists and that you are entitled to it.
Black and Brown communities have always been the last to receive information and the first to feel the consequences. We are changing that