The Mississippi state and United States federal governments are failing to take steps to prevent cervical cancer deaths for Black women in the Mississippi Delta, the Southern Rural Black Women's Initiative for Economic and Social Justice (SRBWI) and Human Rights Watch said in a report released today during cervical cancer awareness month. Cervical cancer is highly preventable and highly treatable, but experts estimate that 4,360 women died from the disease in 2024 in the United States, with a disproportionately higher number of Black women than white women.
The report, "No Excuse: Inadequate Cervical Cancer Prevention and Care for Black Women in the United States Mississippi Delta," documents that state and federal policies and a lack of investment in prevention are failing to ensure Black women in the rural Mississippi Delta-a region with some of the worst health indicators and highest rates of poverty in the entire United States-have access to comprehensive, affordable, and equal reproductive healthcare services and information. Mississippi has the highest rate of cervical cancer deaths in the United States and Black women in the state are almost 1.5 times as likely to die of the disease as white women. Black women living in the largely rural Mississippi Delta area in the southern United States have an even greater risk of dying from the disease.
"Black women in the Mississippi Delta are dying at alarming rates from cervical cancer as a result of neglect and exclusion from the healthcare system," said Oleta Garrett Fitzgerald, SRBWI Regional Administrator for State Lead Mississippi and the Director for the Children's Defense Fund Southern Regional Office. "Structural racism, discrimination and entrenched inequality are driving these disparities, and our government is allowing them to thrive."
From September 2023 through November 2024, SRBWI and Human Rights Watch trained and worked alongside 10 community-based researchers and a research associate to interview 159 Black women between the ages of 19 and 81 in three counties in the Mississippi Delta: Bolivar, Humphreys, and Washington. SRBWI and Human Rights Watch also consulted or interviewed a total of 49 academics, medical providers, public officials, and members of nongovernmental health, reproductive rights, and justice groups in Mississippi, and analyzed information and data from secondary sources.
The researchers found significant barriers contributing to high rates of cervical cancer deaths for Black women in the Mississippi Delta, including a lack of access to comprehensive and affordable health care, especially inadequate access to gynecological care. Racism, discrimination, and the resulting distrust in the healthcare system are major problems as is a lack of transportation. There is also too little information on sexual and reproductive health, including information on the human papillomavirus (HPV) vaccine, which can prevent certain cancers.
Human Rights Watch's research in Alabama in 2018 and joint research with SRBWI in Georgia in 2022 documented unequal access to cervical cancer prevention and care, as well as barriers contributing to disparities in cervical cancer outcomes for Black women living in rural communities in the South. Across the United States, there are persistent and glaring disparities in cervical cancer outcomes, and Black women die at disproportionate and consistently higher rates. Black women are more likely to be diagnosed with cervical cancer at a later stage and they also face a lower five-year survival rate.
Most cervical cancer can be prevented with routine screenings and follow-up treatment, yet some women interviewed said a lack of access to affordable health care was a barrier to obtaining reproductive health care, including comprehensive cervical cancer care. Mississippi is one of 10 US states that has not expanded Medicaid to extend affordable healthcare coverage to more low-income adults, and as of January 2023, one in five Mississippi women of reproductive age (18-44) were uninsured. Women of color are more likely to be uninsured than white women but even insured women often struggle with high fees.
"Despite having Medicaid, or insurance, many of the women interviewed indicated that they were unable to afford follow-up appointments and co-pays, with the high cost of medicine and high deductibles also being problematic", said Candrese Jones, one of the community-based researchers for the report. "These are decisions no one should have to make."
More than half of Mississippi's 82 counties, including 8 of the 18 counties in the Mississippi Delta, are considered by experts to be "maternity care deserts," and only seven counties in the Mississippi Delta have any licensed ob-gyns.
Gloria Shields, a research associate on this report, said structural racism and discrimination in the medical field makes women less willing to seek out care. "Many of the women we spoke with had horrible experiences with medical providers, including gynecologists, and felt that the care they received was subpar because of their race. These experiences alienate many Black women from necessary medical care and help drive the poor health outcomes that we see in Mississippi."
Mississippi state policies have also failed to ensure that all children and young people receive comprehensive, inclusive, rights-based, and scientifically accurate information on sexual and reproductive health. As a result, many women and girls in Mississippi lack the lifesaving information they need to make informed decisions to prevent and treat cervical cancer, including information on the HPV vaccine and its role in preventing cervical cancer. The Centers for Disease Control and Prevention (CDC) recommend that all children and some unvaccinated adults receive the vaccine, which can be administered starting at age 9.
But fewer than half of the 159 women interviewed reported being knowledgeable about the HPV vaccine, including several parents of adolescents.
The Mississippi and federal governments need to expand Medicaid coverage and increase funding for cervical cancer screenings and follow-up care through all 86 county health departments, the organizations said. The governments should increase awareness of the role the HPV plays in cervical cancer and fund community-based campaigns to ensure that parents and children receive information about the HPV vaccine starting in the sixth grade, as recommended by the CDC Advisory Committee on Immunization Practices.
Mississippi should also provide health education that is age appropriate, scientifically accurate, rights-based, and inclusive in all schools. It should establish certification programs for community health workers and increase incentives for healthcare providers in rural areas to become certified. The state government should also increase the availability of public transportation and telehealth services in the Mississippi Delta to improve healthcare access in underserved communities.
"No one should die from cervical cancer, yet Black women in Mississippi face numerous barriers to staying healthy and safe," Fitzgerald said. "Expanding Medicaid to create pathways to affordable health care coverage, is one urgent and concrete step towards eliminating these preventable deaths."
