Background <p>Cervical cancer remains a preventable disease, yet Black women in the United States continue to face disproportionately high rates of incidence and mortality. These persistent disparities highlight that Black women’s trust in preventive services is shaped not only by historical injustices but also by current experiences of systemic complexity, inequitable access, and provider behaviors.</p> Methods <p>This qualitative study explored how Black women perceive and navigate the U.S. healthcare system in the context of cervical cancer prevention. Seventeen African American and Black immigrant women between the ages of 21 and 65 participated in semi-structured interviews. Thematic analysis was guided by an integrated framework combining Ecological Systems Theory, the Ecosocial Theory of Embodiment, Intersectionality, and Black Feminist Thought.</p> Results <p>Three main themes emerged from the analysis: (1)systemic fragmentation that makes the healthcare system difficult to navigate and limits provider capacity; (2)&#xa0;inequitable access shaped by high costs, inadequate insurance coverage, and structural discrimination; and (3)&#xa0;the central role of healthcare providers in fostering trust, safety, and engagement. Participants emphasized that medical mistrust among Black women is rooted not only in historical injustices but also in ongoing experiences of marginalization and invisibility within clinical care.</p> Conclusions <p>To improve engagement with cervical cancer prevention services, healthcare systems must address both structural and interpersonal barriers. Culturally responsive care, institutional accountability, and acknowledgment of historical harm are essential to rebuilding trust and advancing health equity for Black women in the United States.</p>