Sexual health services are failing Black women. It’s time to finally face up to healthcare’s colonial roots

A strange and troubling thing was happening on social media in 2015. It was called the #KylieJennerChallenge, in which participants encased their mouths in small cups or bottles and sucked out the air, causing their lips to swell. The viral trend was fuelled by an obsession with achieving Kylie’s full lips, which she later admitted were cosmetically-enhanced. 

But long before our social feeds were populated with dramatically plump pouts – before social media even existed – Dr Yvonne Abimbola, a general practitioner based in Kent, remembers when full lips were mocked, not celebrated. It was a time when drawing attention to her own naturally fuller lips as a Black woman meant being perceived as uncouth and uneducated. A time where such a trait was equated with sexual promiscuity. A time before non-Black people decided big lips were desirable.

“When I was growing up in the UK in the ’90s, having large lips was not fun, it was not cool. ‘Rubber lips’ was a common term of denigration,” Dr Abimbola recalls, adding that this wasn’t the only Afrocentric feature that was, and continues to be, fetishised and used to objectify Black women. “If you had a big bum when you were younger, it wasn’t good, but now it’s all the rage. Everybody wants to have a big bum, everyone wants to have large lips.”

Dr Abimbola points out how the same physical attributes non-Black individuals adopt and benefit from both socially and financially (also known as blackfishing) — like Kylie’s lips, for example, or Jesy Nelson in her recent Boyz music video with equally full lips, heavily-tanned skin and big, curly hair — are routinely weaponised against Black people who instead face negative attitudes, discrimination, and even violence. It’s a contradiction that has had a ripple effect across many facets of the Black experience, particularly in sexual and reproductive health (SRH) where communities of colour are still gravely underserved.

As a GP, Dr Abimbola often consults with patients on contraceptive issues and sexual health problems. The hypersexualisation of Black bodies, she says, is just one way that damaging assumptions about the Black community widen the divide in healthcare inequalities. The association between related stereotypes and sexuality stems from centuries-old racial narratives, which portrayed Africans as primitive and animalistic in order to justify their oppression by white colonisers. By reconciling with how this hierarchy has shaped our existing medical systems, we can better understand why historically disadvantaged groups hesitate to get the help they need, contributing to poorer sexual health outcomes. 

Dr Annabel Sowemimo, a community SRH doctor at a clinic in Leicester, agrees that the racial tropes derived from physical characteristics like larger lips and curvy body shapes is one of several factors hindering equal access to sexual health services. As the founder of the grassroots activist collective Decolonising Contraception and co-host of its podcast, The Sex Agenda, she has set out to challenge these dominant narratives through public conversations on sex, sexuality, and reproductive health that center the stories of Black, Indigenous and people of colour in the UK. 

“A lot of assumptions are made about Black people being disproportionately affected by sexually transmitted infections (STIs) because they’re ‘having loads of sex’, when actually nobody really looks at the other structures around that [such as systemic racism and poverty],” Dr Sowemimo says. “There’s a lot of looking at these statistics in isolation, but we need to go deeper. The surface-level analysis that we’ve had for so many decades needs to stop.”

To boil down the causation of these issues to sexual behaviour alone is not only reductive, it ignores the larger systemic frameworks standing in the way of change. Consider, for instance, that 4 out of every 5 women living with diagnosed human immunodeficiency virus (HIV) in the UK are migrants, and that 3 in 4 are from minority ethnic communities. It is not a coincidence that someone from a Black Caribbean community is up to twelve times more likely to be diagnosed with a gonorrhea infection compared to a white person, or that increasing rates of late diagnosis of HIV are occurring amongst South Asian people. When looked at in a wider social context, these statistics are reflective of the fact that ethnic minority groups are disproportionately affected by socioeconomic deprivation — a key determinant of health status.