Cancer in a box: How popular hair relaxers are killing black women

It was just before Christmas. A family tradition, the first for eight-year-old Gloria Moraa. She sat holding a broken mirror in her hands, watching her aunt paint her coily hair with chemicals that would straighten every strand. 

“All the young girls would get matching hairstyles for the holidays, and relaxers were fashionable back then,’’ said Moraa, who lived in Mombasa, Kenya at the time. 

With each application of the relaxer, the chemicals began to irritate her scalp, and Moraa started to cry. But she said it was worth the pain when she had straight, shoulder-length hair for the first time, like the little girls on the relaxer box. 

“Everyone was admiring our hair, and that encouraged us to keep it relaxed,” she said.

Today, Moraa, 28, lives in Nairobi and alternates between faux locs and natural hair styles. Over the years, she said she used almost every relaxer on the market. When she relaxed her hair, she had one goal: The product had to make her coily hair silky. The ingredients didn’t matter.

“I did not have the time or the expertise to discern the effects of listed ingredients,” Moraa said. “I am a consumer, not a chemist.”

She said she quit straightening her hair only recently because it seemed relaxers caused it to thin. 

Growing evidence suggests the products might have far more serious consequences.

In October 2022, the US National Institutes of Health (NIH) found women who used hair relaxers more than four times a year were at higher risk of developing uterine cancer.

The study became a tipping point in the conversation in the United States, building onmore than a decade of scientific research linking chemicals known as endocrine disruptors in hair relaxers to uterine and breast cancer. Endocrine disruptors are chemicals that interfere with hormones that regulate a range of functions such as mood, appetite, cognitive development, puberty and reproductive health.  

While many Black women in the United States are rejecting chemical straighteners — and filing thousands of lawsuits against manufacturers in the wake of the study — sales of the products in some African countries continue to climb.  

Tunisia, Kenya and Cameroon were among the top five countries in sales growth for perms and relaxers from 2017 to 2022, according to Euromonitor, a global market research firm. Sales in Tunisia and Kenya jumped as much as 10 per cent over the five-year span.  South Africa and Nigeria also saw growth.

“People still use hair relaxers as much as they did in the past,” said Joseph Kiemo, who runs Kiemo Hair and Beauty Studio in Nairobi. 

Africa is a lucrative business market for many industries, including cosmetics. It has the youngest and fastest growing population of any continent, with an expanding middle class and a flourishing community of millionaires. With an eye on the future, companies are developing more hair and skin products to meet the needs of the continent’s primarily Black consumers.  

The global hair relaxer market is expected to grow to $854 million annually by 2028, and the companies at the centre of the US lawsuits produce some of Africa’s most popular relaxers.

For many Black women, chemically straightening their hair is a rite of passage informed by unspoken Eurocentric definitions of beauty that favour long, straight hair and are rooted in colonialism and racism. But women also say manageability, flexibility and social acceptance drive the decision to straighten their hair. 

It’s a shared experience throughout the African diaspora.

“We understand that Black women use hair relaxers for a range of reasons, some within their control, some not,” said Seyi Falodun-Liburd, co-director of  Level Up, a gender justice organization in London. “And so, for us, it’s not about shaming any Black woman about making whatever choices she makes.”

Instead, it’s about government and corporate accountability, said Falodun-Liburd, who led a campaign to get L’Oreal, the world’s largest beauty and cosmetics company, to remove lye from its hair relaxers.  Lye can cause scalp burns and has been linked to an increase in breast cancer in some studies. 

Governments should do a better job of banning dangerous ingredients, she said, and they should require companies to disclose their products’ potential health effects.

In May 2022, before the National Institutes of Health study, Level Up released the findings of what it says is the first research about Black women’s experience with relaxers in the United Kingdom, surveying more than 1,000 women. The research was done in conjunction with Treasure Tress, a subscription service offering products for naturally curly and kinky hair.

Falodun-Liburd wasn’t surprised by the survey results: 95 per cent of the women weren’t aware of the connection between hair relaxers and cancers, she said. 

“I think most black women would not consciously decide to put something on their head that would harm them, and the issue is that most black women don’t know (what’s in the products),” she told The Examination in an interview. 

Ikamara Larasi, a campaigner with Level Up, said the study confirmed why the producers of hair care relaxers should be transparent about their ingredients. 

“The price of black women’s beauty should never be black women’s health,” Larasi said. 

‘Now it makes sense’

Mary Cunningham of New York City is among thousands of people suing the hair-care companies. Her daughter, Telichia Cunningham-Morris, died of uterine cancer more than two years ago after years of using relaxers. 

When Cunningham-Morris was a little girl, she wore her relaxed hair in three pigtails that skipped past her shoulders. That was her favourite hairstyle. 

Her mother started chemically straightening Cunningham-Morris and her sister’s hair when they were six or seven. Relaxing her daughters’ locs made managing their hair and a busy family life easier for her, Cunningham said. She typically straightened her daughters’ hair every six to eight weeks.

Kiddie Kit was the name of their first relaxer. The brand is long gone. But in an old photo from the 1980s, the relaxer box is decorated with drawings of an adolescent Black girl, her thick straight tresses sweeping her shoulders as she swims, bikes, and cartwheels with a young male admirer.  Also on the box, the words Mild. Gentle. Safe.

Cunningham-Morris used relaxers for decades, then about six years ago, she and her sister made a pact to go natural, influenced by growing discussions about the harms of relaxers. But her time styling her natural hair was short-lived. On June 15, 2021, she died of uterine cancer at age 50. She spent her last days in her mother’s home in Jamaica, Queens in New York City. 

Cunningham, 75, and her younger daughter, Travias Cunningham-Case, 51, believe chemicals in the relaxers caused Cunningham-Morris’s death — and their hysterectomies. Cunningham had surgery to remove fibroids nearly a decade ago; Cunningham-Case’s surgery was for endometriosis.

“It just seemed like all three of us had some kind of female problems all the time. Now, it makes sense to me that's where it came from,” said Cunningham, reflecting on the price she believes her family paid for straight hair. 

Regulations lagging

Some of the most concerning ingredients in hair relaxers, scientists say, are formaldehyde, a known carcinogen, and phthalates, parabens and Bisphenol A — chemicals known or suspected to be endocrine disruptors.

Bisphenol A, which appears under various names on relaxer boxes, is used to produce plastics.  Phthalates make plastics more durable and parabens help preserve ingredients in cosmetics.

Scientists say the cumulative effect of a combination of chemicals in hair care products, from relaxers to hair dyes, is especially concerning. 

Despite more than a decade of research about the adverse health effects of chemicals in relaxers, regulation varies across Africa and the globe.

The European Union bans some endocrine disruptors in cosmetics andhas proposed prohibiting the chemicals in other products, including toys.  The EU says it hopes to “phase out the most harmful chemicals in consumer products” by 2030.

The United States does little to regulate cosmetics as a whole, including hair relaxers. While Brazil, Canada and other countries banned or restricted formaldehyde in relaxers years ago, the  U.S. Food and Drug Administration only proposed to ban the carcinogen last fall. The agency could make a decision this month.

Some African countries, such as Nigeria, have warned consumers to avoid using hair products that contain formaldehyde. Most countries worldwide require companies to list ingredients on product boxes. Health experts, however, say listing ingredients doesn’t mean consumers understand the potential harm of relaxers. 

“The more we educate [people] about what these chemicals are and the potential adverse health effects that may be associated with them, perhaps people could make more informed decisions about whether to use these products,”  said Adana Llanos, an epidemiologist and professor at Columbia University’s Mailman School of Public Health and co-author of a 2022 article suggesting policy changes to reduce exposure to potentially harmful hair products. 

Llanos is working with investigators at the state-sponsored Kenya Medical Research Institute to study hair and personal care product use in Kenya. 

Women in the US began to sue relaxer manufacturers by the hundreds shortly after the publication of the 2022 NIH study.  The lawsuits claim the companies failed to warn consumers that relaxers could increase risks of uterine and breast cancer, fibroids and endometriosis.  

In November 2023, a federal judge in Chicago ruled that thousands of claims against L’Oreal and Revlon and other companies in a multi-jurisdictional litigation could proceed, opening the door for a massive court battle that industry observers are comparing to the Johnson & Johnson talc-based baby powder lawsuits.  More than 50,000 plaintiffs accused Johnson & Johnson of failing to inform consumers that the powder, which was heavily marketed to Black women, had been linked to risks of ovarian cancer. The company replaced the product but hasn’t settled with the plaintiffs.

Godrej, Revlon and Namaste have been cited in some of these studies but did not respond to The Examination’s request for comments. A L’Oreal spokesperson criticized the NIH study in an email saying it was based on “a small number of uterine cancer cases” and “does not conclude that using these products causes certain health outcomes, such as uterine cancer. Tellingly, the study states that ‘more research is warranted.’”

Additionally, the spokesperson said: “Our hair relaxer products do not contain any ingredient defined as an 'endocrine disruptor' by the World Health Organisation.”

International advisory and regulatory bodies have long wrestled with product testing and identifying endocrine disruptors and other potentially harmful chemicals, according to scientists who study the hormone system.They note that parabens — contained in most hair relaxers — are widely considered endocrine disruptors.         

Kate Akpabio, a seamstress in Lagos, Nigeria, was washing her braided hair in a salon on a hot Saturday afternoon in December. Akpabio, who has been straightening her hair with Mega Growth relaxers for seven years, had read on Facebook about the study linking frequent use of straighteners with cancer. 

“It doesn’t change my attitude towards relaxing my hair,” she said. She didn’t know about the US lawsuits against hair-care manufacturers. 

Favour Godwin didn’t know about the lawsuits or the NIH study. Godwin, a former trader at Computer Village in Lagos, had experienced a burning and itchy scalp from some relaxers. But she said she hadn’t heard anyone talk about the health risks in Nigeria and that she didn’t plan to quit relaxing her hair. 

“I can’t even cope without relaxing my hair every two months,” she said.

Opting for natural look

Even before the lawsuits against hair care manufacturers, sales of relaxers in the US, the most lucrative product market, were declining as a natural hair movement began to flourish nearly a decade ago. 

In the United States, relaxer and perm sales declined by about 9 per cent between 2017 and 2022.

Sales of relaxers will probably continue to dip, according to Caro Bush, a research analyst for market research firm Euromonitor. “Consumers are apprehensive of the chemical composition of these products and their impact on health,” Bush said, adding that the lawsuits intensify mistrust of relaxers in the United States.  

She says the US demand for natural hair care products that don't chemically alter hair texture is presenting a market opportunity.  Large companies have acquired some of the small natural hair care brands in recent years. Last year, Procter & Gamble bought Mielle Organics, a Black-owned natural hair care company. And some global companies have created products.

In Africa, interest in natural hair products is growing alongside the sales of relaxers. Leshme de Bruyn, who lives in Cape Town, South Africa, sells her line of natural hair care products called Miss L - Embrace My Roots.

A bad experience with hair dyes and relaxers inspired her company motto: “My products will bring you back to the natural hair you had before it started to get chemically damaged.”

De Bruyn said in an interview with The Examination, “Nowadays, they don’t do the blow dry and curls and flat irons. Younger people are saying, ‘This is the hair I’ve been born with, and I’m going to embrace it.’’’

Julie Ouandji, raised in Cameroon and France, hopes to discourage African women from straightening their hair through her social media website, NappyFrancophones. Ouandji, 38, founded it to write about hair tips and inspire Black women from French-speaking countries to go natural after she quit relaxing her coily hair almost a decade ago.  She had read early studies questioning the health effects of chemicals in relaxers.

Today NappyFrancophones has 218,000 followers on Instagram and 85,000 on Facebook.

“I love this name because it's like being natural and happy,” Ouandji said of the word nappy.  “I want to encourage Black women to love their hair and be happy about their hair. So, that's why this name was meaningful to me.”

Ouandji, who now lives in Montreal, Canada, first relaxed her hair to copy her friends when she was 13.  Fifteen years later, she did “the big chop,” cutting her shoulder-length straight hair. She recalls being afraid of how she would look with short, natural hair. 

“I was like, ‘I’m not sure it’s going to suit me,’” she said, reflecting on how her definition of beauty was synonymous with straight, long hair. “It’s really interesting to feel that way when I think about it. It’s your natural hair. Obviously, it’s going to suit you.”

As a girl, Ouandji was influenced by the women she saw on French and American TV, none of whom had natural hair. 

“I think it's really important for our generation to have more Afros in the media so our daughters and granddaughters will want to keep their natural hair,” said Ouandji, who has a three-year-old daughter.   

“I would like all women to stop relaxing their hair,” she said. “But that’s utopia.”

Agatha Gichana is a gender reporter with Nation Media Group in Kenya. Additional reporting by Blessing Oladunjoya from Nigeria’s BONews.

This story is published in partnership with The Examination, a non-profit newsroom that investigates global health threats.