This Common Disorder Overwhelmingly Affects Women Of Color, And It's Time We Start Talking About It

by JR Thorpe

Iron deficiency anemia, in which the body lacks enough iron to create the substance hemoglobin, which carries oxygen in the blood, is a pretty common condition, particularly among women. The New York Times estimates that anemia affects up to 2 billion people worldwide, but in America there's a seriously notable disparity in anemia diagnoses not only between men and women, but between women of color and white women. 2007 data indicates that 9-12 percent of non-Hispanic white women in the U.S. have iron deficiency anemia, but that number jumps to nearly 20 percent in Black and Hispanic women. The question is: why?

A serious lack of iron can cause pregnancy complications, stress on the heart, fatigue, shortness of breath, headaches, dizziness, and a host of other unpleasant problems. Understanding the root cause of higher iron deficiency anemia levels among women of color is the key to solving a pretty serious mystery, but it's one that scientists are still trying to figure out. Is it, as with many racially disparate health outcomes, down to structural racism that means communities of color are at a health disadvantage? Or is it something else that's yet to be unravelled? Bustle talked to Dr. Tieraona Low Dog, a natural medicine specialist, about the story behind anemia in women of color. "There are many layers to the question of disparity and I don’t think there is one easy answer," she says.

Why Anemia Is So Common For Women Of Color

The difference between anemia levels in white women and women of color has been known for quite a long time in the medical community; data on it dates back at least 30 years. Figuring out why it happens, though, is an ongoing process. Women are more at risk for iron deficiency problems in general, scientists believe, because of menstruation. Humans can only get iron through absorbing it through diet, and losing some blood monthly has an impact on overall iron levels, particularly if your periods are particularly heavy. (People with heavy menstrual flows are often warned about iron deficiency by their primary care doctor and given supplements to help out.)

Researchers have been trying to pinpoint the reasons behind the racial disparity for a long time, and have often come up short. A study by the U.S. Department of Health in 1992 of 2515 people found that iron consumption itself didn't seem to offer an explanation for the hemoglobin level differences between Black and white Americans. And a massive study published in 2009 that took place over four years, looking at 19,836 Black and white Americans, found that Black Americans were 3.3 times more likely to have anemia — but there seemed to be no strong tie to socioeconomic factors, demographics, or other conditions. They found that white Americans with vascular disease, diabetes, and hypertension were more likely to have anemia, but those factors didn't seem to matter very much for Black Americans. "Ensuring quality medical care regardless of race, income, or education might reduce the racial disparity in anemia prevalence," the scientists wrote, but they weren't sure.

This discrepancy matters. "Low iron can have an enormous impact on a woman’s quality of life," Dr. Low Dog tells Bustle, "contributing to poor educational performance, decreased work capacity, low mood, and fatigue with even mild exercise. And it not only impacts women, but also their babies. If a pregnant woman does not get enough iron, her baby is at higher risk for being born prematurely with a low birth weight, lower IQ, and poorer neuro-cognitive development." It also has serious relevance for a current crisis. "Low iron levels increase the absorption of lead, a tragedy that unfolded in Flint, MI, which disproportionately impacted the Black community" in Flint, she explains.

The Age Of Your First Period Might Have Some Answers

Dr. Low Dog has a few answers for the potential causes of the disparity. "Heavy menstrual periods and low intake of iron-rich foods are two major contributors to low iron levels in the body," she says. "We know that African American women are more likely to have uterine fibroids, which cause heavier periods. Obesity is another risk factor for heavy bleeding. African American women are 60 percent more likely to be obese than non-Hispanic white women."

One potential factor that might also explain part of the issue? Early menarche — the time when you start having periods. Black girls in particular start menarche earlier in life than white girls, though we're not sure why; scientists have suggested things like childhood BMI, low birthweight, and the age of their mothers' menarche as potential factors. Hispanic girls also menstruate earlier than non-Hispanic white girls, but not by very much. Two recent studies, one in 2016 and one in 2017, looked at the relationship between menarche age and iron deficiency in American girls and women. The first found that the two big risk factors for developing iron deficiency anemia as women got older were being Black and menstruating early. The second found that, in young women who aren't actually anemic, menstruating early was the only risk factor associated with iron deficiency. It looks as if menarche may be partly to blame for the differences between iron deficiency anemia statistics in female communities.

Another issue? Pregnancy, particularly when you're not wealthy. Being pregnant seems to significantly increase the risk of iron deficiency anemia, because the body requires iron to aid the growth of the fetus and might struggle a bit without sufficient amounts. The World Health Organization has estimated that up to 42 percent of pregnant women worldwide have anemia. The 2007 study found that socioeconomic status doesn't seem to be a factor on its own for iron deficiency anemia in women, "but it is a risk factor when coupled with the increased iron demands imposed by pregnancy."

A further potential explanation may be offered by inflammation levels. There are actually two types of anemia, and the one we don't hear about as much is anemia of inflammation. This is anemia caused by chronic inflammation in the body, usually as a result of long-term infections and illnesses like rheumatoid arthritis. It's now viewed as distinct from normal iron deficiency anemia, though it can be tricky to differentiate them, particularly if the underlying chronic condition isn't clear. A 2017 study of iron deficiency anemia in Cuban women found that it seemed to be associated with higher inflammation levels, while research has found that Black women have the highest chronic inflammation levels of any racial group. It's still only a theory, but it might provide a piece of the puzzle.

If you suspect that you're anemic, the good news is that it's pretty easily treated with iron supplements and diet; it's a good idea to go to your GP and get your iron levels checked, particularly if you're having very heavy periods or are considering getting pregnant. "Women should be aware of the symptoms of low iron and ask their doctor to check their ferritin (a better way to diagnose low iron than simply measuring hemoglobin)," says Dr. Low Dog. "It is a simple blood test and correcting low iron can dramatically increase a woman’s mental and physical well-being. Once diagnosed, physicians will prescribe an iron supplement." For the moment, the higher incidence of anemia among women of color remains a matter of theory rather than concrete practice. Hopefully, we'll soon have the answers.