It’s time for an intersectional women’s health agenda

“Sisters are more than the sum of their relative disadvantages: they are active agents who craft meaning out of their circumstances and do so in complicated and diverse ways.”

– Melissa Harris-Perry (2011), Sister Citizen

Far too often Black women’s health is defined by one of two extremes – disease and disability or extreme resilience. In reality, a comprehensive picture of Black women, health and wellness is necessarily complicated. It defies neat labels and categories, allowing for multiple narratives to describe what it means to be a Black woman in the 21st century. The time has come to explore the current landscape of Black women’s health within the realms of both health disparities and women’s health research, examine critical policies that have shaped Black women’s health and wellness over the past two decades, and highlight the many ways in which Black women articulate health and wellness for themselves.

The health of African American families depends largely on the health of Black women. Yet research focused on either ‘minority health’ or ‘women’s health’ agendas fail to fully address the needs of Black women who comprise an essential element in both groups. When Black women are left behind or become invisible intersections, our communities are left behind as well.

As such, we must review Black women’s health over the last 20 years – what do we know and what have we learned? What disease and behavioral trends – both risk and protective – contour the state of Black women’s health today? In tackling these questions, researchers take a holistic approach to understanding what has changed over time to facilitate transitions in health status. Perhaps even more importantly, what can the past teach us about how to reclaim our health moving forward?

Are Black women at risk?


When we think of the most pressing health concern facing Black women over the past 20 years, a recurring theme arises: obesity. Granted, the relationship between Black women and weight is complicated. It is often reported that Black women don’t perceive themselves as obese or overweight because they have higher body image ideals compared to other ethnic groups of women. Black women also seem to prize additional weight on the body frame as an enhancement, rather than a negative feature, which may lead to skewed ideals about weight and health concerns.

The fact that despite a generally higher body mass, Black women are more satisfied with their bodies than White women may be part of the reason why rates of obesity have increased more among Black women than other groups. The question you might be asking is, “why?” Some research supports what conventional wisdoms only allude: that Black women are less susceptible to body dissatisfaction compared to other racial groups because of their cultural ideals that promote a heavier body type and discourage stringent weight loss strategies.

Regardless of the reason for maintaining a higher weight, health researchers are concerned that tolerance for heavier body types may contribute to high obesity prevalence in the Black community, particularly among Black women. Obesity related health issues disproportionally affect Black women, and weight gain is a strong risk factor for a variety of other chronic conditions found in the African American community – hypertension, diabetes and heart disease.

Istand 1
While several explanations can help us to understand causes for obesity, one thing is sure: to make a difference, we may need to fully understand to what extent body size presents a real issue for Black women, and whether obesity is the sole driver of health-related complications. In fact, recent studies question the notion that simply being overweight is unhealthy. The health education program Health At Every Size (HAES), for example, challenges popular misconceptions about the health effects of being overweight.

One study comparing obese women on a typical diet with another group who were following a HAES program found that while the diet group was successful in limiting calorie intake, the HAES program supported women in accepting their bodies and listening to internal cues of hunger and fullness. After two years, the HAES group had improved blood pressure, total cholesterol, LDL, and depression, among other health benefits. Innovative approaches to healthy lifestyles may combine the high body ideals of Black women with newer, improved ways of living healthier lives.

What is your take? Is the “obesity epidemic” real or fabricated?

Women’s Health and ACA: Where are we now?

ACA White House

As we enter into the third quarter of 2014, it seems like a good time to review the changes enacted by the Affordable Care Act (ACA) and what good/bad impacts these changes have had for women’s health and underserved groups. It’s a larger discussion than to be had here for sure, but engaging in the conversation is important in ensuring that we continue to push for not only accessibility, but equity in health care as well.

infographic-how-aca-affects-women-e1368557320211The passing of the ACA signals a significant advancement in women’s health and public policy in general, ensuring that millions of women now have access to affordable health coverage. Women no longer pay more than men just for being women (e.g., gender rating). Unbelievably, for the first time in history – this overt gender discrimination is now prohibited in federally funded health care. Women will also not be denied coverage for pre-existing conditions, such as a Caesarean section or having received medical treatment for domestic violence. Lifetime dollar-value caps are no more, maternity coverage is now considered an essential health benefit and preventive services have been expanded to include contraceptives, mammograms and cervical cancer screenings with no deductibles or co-pays. Although the contraceptive mandate has stirred controversy in public discourse, the fact that birth control is available on both public insurance and private plans without out-of-pockets costs represents progress. Employers (non-religious) are not only required to provide birth control as part of insurance plans offered to employees, companies must also – and this is a big one for anyone who has ever breastfed – offer hourly employees a clean, safe space in which to pump (e.g., not an office closet or restroom).

And what about older women? One of our fastest growing demographics? They benefit too through a host of programs to support caregivers (typically women). Dual-eligibles will also maintain a more integrated balance between Medicare/Medicaid and will be able cover more prescription drug costs.

With these benefits, its hard to imagine that the ACA is anything but a resounding success. Still, coverage gaps remain. Of the currently uninsured, approximately 20% are women. Furthermore, the failure of some states to expand Medicaid eligibility benefits will undoubtedly affect women’s health in profound ways. All in all, the report card is not yet conclusive as to whether individual mandates and state expansions fully address the needs of women in this country. There is a sizable proportion of women who will be excluded from receiving any benefits due to immigration status or costs associated with buying insurance on the individual marketplace.

minority woman21 Many women fall between a space where they fail to meet eligibility criteria for Medicaid and can’t afford to purchase private insurance on the exchange, even with tax credits and subsidies. And while primary care at federally qualified health centers is available, access and quality depend on geographic location. Its possible for women with limited options to continue to receive clinic and inpatient care at the remaining public hospitals and some non-profit hospitals that provide charity care, yet this is far from ideal and free clinics are few and far between. In addition to that, abortion is still not federally supported and accessibility and affordability varies on the health exchange. Drug coverage continues to be a priced at a premium and even though certain medications are subsidized by pharmaceutical companies, ultimately, mandating insurance coverage for the poor and underserved – many of whom are struggling to meet ends – is a difficult imperative. Ironically enough, the two ways in which the ACA was close to gaps – provide access and expanded benefits (at reduced cost) – are precisely the areas in which the most marginalized still find themselves lacking, with Medicaid expansions in many states (26) at a standstill.

Of course, its not simple to overhaul a national system that historically, was never intended to provide universal access to care. And the ACA shouldn’t be blamed for the complicated and dysfunctional system it took centuries to create. Some parts of the ACA are working; but others still need tweaking. For those of us working in the community and serving underserved populations, its important to not only understand these shortcomings, but also to advocate on behalf of women, children and the un(under)insured who may be navigating a complicated system or shut out altogether.