There is a particular kind of preparation that happens before a healthcare appointment when you are a Black woman.

The questions written down. The symptoms carefully documented. The decision about whether someone should come with you. And then there is what to wear. The pressure to look put together, even when you are unwell. You cannot simply arrive however you feel. You are thinking about how you will be perceived, what assumptions might be made, and whether your appearance will influence how seriously your concerns are taken.

The preparation becomes its own quiet calculation. What to say. How to say it. How to dress. How to make sure the person in front of you sees someone worthy of their time, their attention, their care.

Before you have even explained what is happening in your body, you are already working to be believed.

In my work with Black women and mothers, I return to this often. What does it mean to enter a space meant to care for you already preparing to defend your need for that care? What happens when the effort required to be heard becomes another weight you carry while unwell?

These questions belong at the centre of conversations about healthcare quality, patient safety and the research shaping our future.

Canada now has new evidence that demands our attention. A study published in the Canadian Medical Association Journal on October 5, 2026, examined almost 1.5 million in-hospital live births between 2012 and 2023, excluding Quebec. Severe maternal morbidity occurred at a rate of 47.8 per 1,000 births among Black people, compared with 27.7 among White people. Differences persisted after researchers accounted for factors including age, income, immigration status and existing health conditions. CMAJ study announcement, North York General research summary

These are serious complications during pregnancy, childbirth and the postpartum period. Behind every number is someone whose life was interrupted. A recovery that became more complicated. A family navigating fear when they had been preparing for joy.

The study does not establish what caused the disparity. It does, however, give healthcare leaders a clear responsibility to investigate the conditions producing unequal outcomes. Blackness itself must never become a substitute for that investigation.

For Black women, the arrival of Canadian evidence carries a complicated weight. There is recognition. There is also the knowledge that women were speaking long before those experiences appeared in a journal.

That is part of why we created Voices Unheard at the Black Women’s Institute for Health. Nearly 2,000 Black women, girls and gender-diverse people shared experiences across healthcare, mental wellness, employment, education and other conditions shaping their lives. Voices Unheard

Among those answering the question about medical dismissal, 66.7% reported that their health concerns had been dismissed or not taken seriously by a healthcare provider. Participants described pain being minimized and concerns attributed to anxiety. Voices Unheard, p. 10

Sit with that for a moment.

A woman recognizes that something is wrong. She makes the appointment, arranges her responsibilities, prepares her questions and finds the words. And still, she leaves feeling unheard.

What does she do the next time?

Our survey asked that, too. More than four in ten respondents to the question reported delaying or avoiding healthcare because of concerns about how they would be treated as a Black woman. These findings describe survey participants’ experiences, rather than population estimates for all Black women in Canada. They nevertheless demand attention to the distance between having access to care and feeling safe enough to seek it. Voices Unheard, p. 10

And the conversation cannot end at physical health.

In Voices Unheard, 27.4% of respondents to the mental health question reported having struggled with thoughts of self-harm. More than one in four. Voices Unheard, p. 21

That finding deserves a serious response, with care available before distress becomes a crisis.

It also requires us to examine the expectations placed on Black women. The expectation that we will keep working, keep mothering, keep supporting everyone around us. That we will manage our pain without allowing it to interrupt what others need.

I worry about how easily functioning becomes mistaken for wellness. A woman can meet her deadlines, care for her children and arrive looking composed while struggling deeply. The ability to keep going tells us very little about how much support she needs.

The pressure to appear credible in a medical appointment and the pressure to appear strong in everyday life leave too little room to be vulnerable. Healthcare must make room for the whole person, including the distress that does not announce itself in ways a provider expects.

For research sponsors, contract research organizations and healthcare executives, these findings should influence how work is designed and evaluated.

Start before recruitment. Examine who can realistically participate in a study. Appointment schedules, transportation, childcare, language and unpaid time all deserve scrutiny. Ask whose circumstances the protocol assumes, and whose lives those assumptions leave out.

Bring Black women into decisions about research questions, meaningful outcomes and interpretation. Compensate that expertise. Give community partners the authority to identify problems and influence how they are addressed.

Build responsible race-based data collection into that work, with clear purposes, privacy protections and community involvement in governance. Report what the data reveals, including where experiences remain missing.

Then fund a response.

A report cannot carry the responsibility of implementation. Leaders must identify what will change, who is accountable and when progress will be assessed. Participants should hear what their contributions made possible. Communities should be able to see whether evidence changed practice.

We also need to measure whether care feels safe enough to return to. Whether concerns receive a response. Whether mental health referrals lead to accessible support. Whether a mother receives continuity of care after she leaves the hospital.

These are practical questions about the quality of a healthcare system.

There is reason for hope in the willingness of Black women to share their experiences, build knowledge and imagine something better. But that willingness must be met with sustained investment in Black-led care, community partnerships and institutional change.

I want a future in which a Black woman can arrive at an appointment tired, frightened, casually dressed or struggling to find the words, and still receive attentive care.

A future in which a Black mother has room for joy. In which a Black girl learns that her questions deserve answers. In which asking for mental health support is met with somewhere to turn.

Black women have already done so much of the preparation.

Healthcare leaders must now do theirs.