Ebbie A. Stewart, MD, outlines how COEQUaL targets multilevel drivers of fibroid disparities

Uterine fibroids remain one of the most common gynecologic conditions and a leading cause of hysterectomy, with a disproportionate burden borne by Black individuals. The National Institutes of Health–funded COllaboration for EQuity in Uterine Leiomyomas (COEQUaL) Specialized Center for Health Disparities and Uterine Fibroids was established to address these persistent inequities by applying the National Institute on Minority Health and Health Disparities (NIMHD) research framework to fibroid care.¹

“When the Request for Applications came out, it was clear we needed to use this framework,” said Ebbie A. Stewart, MD, one of the COEQUaL investigators and a professor in the Department of Obstetrics and Gynecology with joint appointments in Department of Physiology and Biomedical Engineering, Division of Endocrinology, Department of Medicine and Department of Surgery at Mayo Clinic, Rochester, Minnesota. “We started by getting it out and saying, ‘Well, we're doing things in this domain, and we're doing things in that domain.’ ”

COEQUaL integrates 3 interrelated research projects that collectively address multiple NIMHD domains and levels of influence. “The 3 projects that we brought together covered all of the domains except the biologic,” Stewart said.

The collaborative builds on long-standing partnerships. “This was a group that has been working together, some of us for up to 20 years,” Dr. Stewart noted. “And we said, ‘These are great frames for the kind of questions we want to answer.’ ”

A central focus is understanding and reducing patient-level barriers to timely, values-congruent fibroid care. “The 3 projects really map to, first of all, what are patient barriers? And that's where most of these domains of influence come into play,” Stewart said. In parallel, the group is examining clinician and system-level contributors to disparities. “We are also looking at providers and health care system factors,” she added.

The third pillar of the initiative centers on earlier identification and more efficient pathways to care. “Finally, we're looking at new technology and saying, ‘Can we find better ways to identify individuals early and expedite their care?’ ” Stewart said. “So it really helped us take the work we've been doing and frame it into projects that was responsive to this application.”

COEQUaL’s approach is explicitly informed by the historical and ongoing legacy of nonconsensual gynecologic procedures in Black patients. Stewart cautioned against viewing these issues as solely historical. “Health care providers often think about concerns about non consent being in the past and citing studies such as the Tuskegee syphilis study,” she said. “But if you look at the news today, there in the past year have been several instances that have made the national news where women appear to have undergone course surgeries related to gynecologic care.”

From her perspective, mistrust is grounded in contemporary experiences. “This isn't a historic issue. This is a present-day issue where individuals feel like they're not being given good information, and sometimes even undergoing surgeries that they didn't consent to,” Stewart said.

She acknowledged that unexpected intraoperative changes can occur but emphasized they should be rare. “From an ob/gyn point of view, there are rare instances where you start out to do one kind of surgery, and because of a medical emergency, you end up doing another,” she said. “But there are clear instances, even in the present day, where it looks like in particular practices, there was a systematic effort to have women go through treatments that they didn't consent to.”

For practicing ob/gyns, the message is straightforward. “We really need to go the extra mile to make sure we're listening to our patients and we're responsive to their needs,” Stewart said.

COEQUaL investigators hope that embedding equity-focused frameworks into fibroid research and care delivery will lead to measurable improvements in outcomes and, ultimately, the reduction or elimination of racial disparities.

Reference:

Stewart EA, Venable S, Borah BJ, et al. Fibroids and Health Disparities: The COllaboration for EQuity in Uterine Leiomyomas (COEQUaL) Specialized Center. Am J Obstet Gynecol. 2026 Jan 12:S0002-9378(26)00009-8. doi:10.1016/j.ajog.2025.12.068