For Black Women in Rural Delaware and Beyond, “the South's Got Something to Say”
Black women in rural communities face some of the most significant healthcare access barriers in the United States. In southern Delaware, these challenges are driven by geography, provider shortages, transportation limitations, and a long history of structural underinvestment in historically disadvantaged communities. These conditions have produced predictable inequities that repeatedly appear in federal, state, and community data.
The Reality Behind the Data.
For me, the structural failures were and are deeply personal. After moving back to my hometown, I encountered an unexpected and frustrating barrier: simply finding care. For primary care alone, I was placed on a ten-month waiting list for an appointment more than forty minutes away. Out of desperation, I began driving long distances just to see my former PCP, all while already traveling fifty-five minutes for OB-GYN care during and after my pregnancy. What started as inconvenient quickly became unmanageable. But I didn’t have the luxury of waiting.
After my son was born, I found myself juggling life with a newborn while unknowingly battling postpartum anxiety and managing an undiagnosed chronic illness. Even with years of experience working in healthcare, navigating the system felt like a second full-time job.
During this period, I kept asking myself why care felt so inaccessible, so disjointed, so sterile, so difficult to reach. Why did it require so much effort to meet even the most basic needs?
I kept thinking, it should not be this hard.
Healthcare should not leave women scrambling for support or feeling invisible when they finally get through the door. It should not be so disconnected from the realities of our daily lives.
The Immediate Crisis vs. The Future Investment
Delaware is preparing to open a new medical school, an important long-term investment in the healthcare workforce. But while we build for the future, thousands of families need solutions now. They need support that helps them stay healthy, connected, and well in their own homes and communities.
The need is profound and immediate:
• More than 332,000 Delawareans live in provider shortage areas
• Rural residents often travel forty minutes or more for basic care
• Women in Sussex County face major gaps in reproductive and primary care
• Delayed treatment drives higher costs and poorer outcomes statewide
The Documented Gap: Structural Neglect in Southern Delaware
The data is consistent and clear. Southern Delaware is under-resourced.
• Sussex and Kent counties include multiple designated healthcare provider shortage areas across primary care, dental, and mental health services
• Specialist access varies significantly by county, with the most limited access in rural southern Delaware
• Community assessments identify healthcare access as a top priority in Sussex County, citing transportation barriers, provider scarcity, and limited specialty options as leading contributors to fragmented care
Historically Disadvantaged Communities Carry the Greatest Burden
These gaps are not evenly distributed. They fall hardest on communities already experiencing systemic disadvantage.
• Multiple census tracts in Kent and Sussex counties qualify as historically disadvantaged under Justice40, which evaluates income, health burden, and environmental risk
• Delaware’s health equity analyses show that Black residents disproportionately live in areas with fewer healthcare resources and higher disease burden
Where racial and geographic inequity overlap, Black women in rural communities experience the highest barriers and the lowest access.
Underinvestment Is the Structural Barrier
The persistent under-resourcing of rural Black communities follows three well-documented patterns:
• Rural communities receive less philanthropic and public investment than urban areas
• The South receives disproportionately low national philanthropic funding
• Black-led organizations receive fewer, smaller, and more restricted grants than white-led organizations
This level of underinvestment results in thin staffing, minimal operating reserves, and programs that depend on short-cycle or unstable funding. These are systemic funding conditions, not reflections of community capacity or need.
Black Women & Rural Communities Are Hard to Reach. Systems Are Hard to Access.
The narrative that rural Black women are hard to reach is inaccurate. Engagement is strong when services are accessible, stable, and rooted in community leadership. The barriers reflect structural neglect rather than lack of participation or lack of culture of wellness.
Under-resourced systems create predictable negative outcomes, including:
• Delayed screenings and follow-up
• Limited reproductive and maternal health options
• Significant behavioral health gaps
• Fragmented care and inconsistent coordination
The Solution Is Already Underway: Building From Within
Across Delaware and across the country, Black women continue to lead community-rooted strategies that directly address gaps in care. These solutions, built by and for Black women, demonstrate that communities are not waiting for systems to respond.
Proven community models include:
• Care navigation programs that guide residents through complex systems
• Peer support networks that strengthen connection and shared problem solving
• Trauma-informed outreach that focuses on healing while addressing systemic barriers
Community infrastructure also includes wellness spaces, parenting circles, and storytelling. These strengthen resilience and connection. When healing begins in community, outcomes improve.
Investment and Policy Must Match the Moment
The data shows that Black women in rural southern Delaware face higher health needs and fewer public and philanthropic resources than many other groups in the state. Meaningful progress requires alignment between policy, investment, and community leadership.
Progress depends on:
• Multi-year investment in Black-led and community-rooted organizations
• Strengthened rural infrastructure, including transportation and targeted workforce recruitment
• Leadership pathways that reflect Black women’s roles in decision making
• Use of federal and state programs like Justice40 that prioritize historically disadvantaged communities
A new path forward requires co-created service models, long-term stability, and community ownership of health infrastructure. Black women have always built solutions within environments shaped by scarcity. With aligned investment and policy support, community-rooted strategies can scale and strengthen outcomes across southern Delaware.
We will keep showing up, keep building, and keep creating pathways to healing because as André 3000 said, “the South’s got something to say.”
-Brittany Taylor-Williams
Founder, The Black Girl Health Collective
