Shellae

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?

Shellae

Are Black women at risk? Part II: Black Women Face Greater Risk of Exposure to Violence

IPV2Did you know that homicide is the second leading cause of death for Black women aged 20-24? The truth is that for some Black women, they feel as though they are surviving day-to-day instead of living.

“To face the realities of our lives is not a reason for despair—despair is a tool of your enemies. Facing the realities of our lives gives us motivation for action. For you are not powerless… You know why the hard questions must be asked. It is not altruism, it is self-preservation—survival.”
– Audre Lorde (1989), Oberlin College Commencement Address

We might better understand the reason behind this sentiment considering the statistics facing Black women and the exposure to violence. Black women are especially likely to be a victim of violence in America. The fact that no woman is more likely to be raped in America today than a Black woman is sobering. Black women are more than three times as likely to be murdered as are white women and are in fact, the most likely group of women in America to become a victim of homicide. Though only approximately 8% of the population, Black women comprise 29% of women who experience intimate partner violence (IPV). Yet Black women are less likely than other groups to utilize social services, such as battered women’s programs. These statistics represent a cry for action to expand public health research and public policy to reconsider protections afforded Black women.

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Unfortunately, young Black girls face similar challenges in navigating environments marked by violence and peril. Black adolescent girls are disproportionately impacted by zero tolerance school policies, and experience an increased risk of becoming involved in the criminal justice system at some point during elementary school education. #BlackGirlsMatter!

Reports also reveal that nearly 60 percent of Black girls are abused by an intimate partner before reaching the age of 18. Yet, Black women are less likely to go to the police or file a report against their attacker. Why? While complicated, we may be able to understand this paradox in the cultural and political context of systematic racism, fear and distrust in official authorities. Reports claim that Black women have the “tendency to withstand abuse, subordinate feelings and concerns with safety, and make a conscious self-sacrifice for what she perceives as the greater good of the community, but to her own physical, psychological and spiritual detriment.” (Bent-Goodley, 2001)

IPV kidWhile shedding some light on the complicated nature of disclosure and IPV, these claims only scratch the surface. Black women who don’t report IPV are often in the position of protecting their families, partners and children while averting the reality of abuse. Regardless of the rationale, the fact that partner abuse is a life-altering experience is a truism. The long-reaching effects can be traumatic for the women and their families; in some cases, cycles of violence are reproduced over generations. Victims of IPV often experience guilt, anxiety, phobias, substance and alcohol abuse, sleep issues, alienation, aggression and sexual dysfunction. They are three times more likely to suffer from depression and six times more likely to develop post-traumatic stress disorder.

Isn’t it time that we sound the alarm that domestic violence is a national priority for Black women’s health?

Shellae

Are Black women at risk?

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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.

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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?

Shellae1 Comment

Silence at the intersection

cece-mcdonaldI recently posted a link for Free CeCe (a documentary-in-progress by Laverne Cox and CeCe McDonald) to a listserv of friends and colleagues. CeCe McDonald is a Black transgender woman and activist. She was sentenced to 41 months in a male prison for stabbing a man who attacked CeCe and her friends in Minneapolis, Minnesota. CeCe’s case generated a significant amount of media attention and public discussion surrounding the victimization and harassment suffered by trans-women and particularly trans-women of color (WOC). Cece was released from prison in January 2014 after serving 19 months, and in her subsequent media appearances CeCe used her platform to discuss her life experiences as a trans-woman, her prison sentence and regaining her life.

In my e-mail post, I solicited opinions about CeCe. I was curious what a group of college-educated, middle class, African American thirty-something professionals thought about CeCe’s (and other trans-WOC) experiences that often entail violence and abuse? How do we think about the voices of Black LGBT*Q folks at the intersection? Where do we place sexuality in the politics of antiracism efforts? And how do we teach our peers and children about acceptance and the importance of being allies?

Good questions, right? I thought so too. Until a day, then 2 days passed. No response. A week. Still no response. The silence was deafening. A group of very knowledgeable people who definitely had opinions on a wide range of issues and not one. single. comment. about my post? Surprised and outraged, I followed up. “What gives? Why the silence?”

Then, someone offered this:

“For most people, until they know someone, until it affects them directly, or until it is right in their own back yard do people rarely care (or pay attention to) specific issues. Until then, it’s just an abstract thought that you may be aware of but not really motivated to do anything about.

It’s even more a problem in the Black community since we tend to suppress/ignore issues even when they do affect us (dietary behaviors, depression, sexual assault, sexuality, etc.). AND because we (compared to other groups) strongly stick to a religious dogma that teaches us to blindly accept/ignore things and to pray away our “problems” instead of talking about them.

The key is having an open dialogue on all of these things which, in a way, makes the world smaller and makes relating to people/issues easier even if not directly affected. I think younger generations growing up with social media exposes them to topics that older generations (all of us included) didn’t have access to.”

Finally.

Vigil Held For Transgender Woman Beaten And Killed In HarlemHowever, as on-point as the comment was, I still had questions. Are we now part of an “older generation” that is too set in traditional ways of thinking to grapple with these issues? Is not knowing an excuse for not caring? How can we begin to engage in difficult dialogues, and more importantly solutions, if we remain SILENT? I wondered what the other 99% of the listserv thought? Did they agree and if so, why didn’t they speak up? Again, why are we so SILENT?

As I consider my own research dealing with the complicated nature of intersectionality, I can’t help but notice that everyone has not come to join my party at the crossroads. In fact, many people don’t consider their identities (much less the identities of others) as intersectional. It was a sobering moment. A moment that makes me realize that beyond the academic labor, there is real work to be done on the ground in raising the consciousness of people living ‘at the intersection’ and outside of it. For instance, there is real work to help our brothers understand how to work together in helping to empower, not objectify and destroy, Black women. There is real work in getting the word out that (black) feminism is not a dirty word and yes, men, you too can join the movement. And, there is real work in paying attention to – and understanding the experiences of – the CeCe’s of the world.

The list continues to grow.

If Crenshaw really did conceptualize the term intersectionality from a schema of intersecting roadways, then it stands to reason that in all of its complexity, some people will be left in the median wondering where they fit (if at all). Isn’t it time we did something to translate and disseminate the message of what it means to be a true ally – and to “do intersectionality” – far and wide? While we debate the future of intersectionality, with the conceptual and measurement issues on one front, we also need to coordinate ways to do the work required to reach everywoman/man.

Carbado et al. (2013) explain:

“When Kimberlé Crenshaw drew upon Black feminist multiplicitous conceptions of power and identity as the analytic lens for intersectionality, she used it to demonstrate the limitations of the single-axis frameworks that dominated antidiscrimination regimes and antiracist and feminist discourses. Yet…the goal was not simply to understand social relations of power, but to bring the often hidden dynamics forward in order to transform them. Understood in this way, intersectionality, like Critical Race Theory more generally, is a concept animated by the imperative of social change.”

As we see, the very essence of intersectionality is historically steeped in centering perspectives as a tool of analytical, theoretical and social development. Our potential to be transformative depends on facilitating efforts to change structural invisibility and inequality. So what are we waiting for? Let’s get on with it.

Shellae5 Comments

Studying intersectionality quantitatively

Screen-shot-2013-05-31-at-00.15.091I came across a blog recently that details the complexity involved in studying intersectionality from a quantitative perspective. Anyone who has encountered such questions in their own work can identify with the frustrating nature of accounting for an anti-categorical approach that is already quite complicated in theory. And yes, I said anti-categorical. As a quantitative researcher, “anti-categorical” is paradoxical to what we do. We live by quantifying things!

So what is one to do if so quantitatively-inclined? How can we, as scholars, accurately represent intertwined identities in research? The very notion that social categories (e.g., race, SES, gender, sexual orientation) are not independent and unidimensional but rather multiple and mutually constitutive, is both reasonable and rational, but very difficult to measure. Over the years, I have had many conversations with people (just like me) who are overwhelmed at the idea of accounting for intersectionality from a quantitative perspective. “Oh the categories!” Or perhaps, “What size N would we need to have for something like that?!” While easily mind boggling, these questions also reflect a fundamental misunderstanding of the intersectional perspective.

Let’s review. First, as a health researcher it is important to acknowledge that the intersectionality framework did not originate from public health research, nor was it designed to specifically predict health outcomes or processes. However, its utility lies in the potential to examine and explore health disparities. The standard method of studying disparities is a comparative approach (e.g., Black/White or male/female differences). While useful to some extent, a comparative approach misses what I consider to be the most critically important questions. WHY are there mean differences between these two groups on say, chronic disease? To what extent is within-group variation shared between both groups? In other words, comparing health outcomes between two groups (A and B) can only give you half (at best) of the big picture. If we are concerned with preventative health strategies and fundamental causes, then we must also be concerned about questions that address the origins of such disparities.

researchmethodsB1Therefore, a significant challenge for intersectionality researchers is to adapt a perspective originally designed as an analytical theory into a model that might be useful to empirically examine say, social inequalities in health. Tall order, huh? Lisa Bowleg eloquently addresses this issue in a 2012 American Journal of Public Health publication:

“Thus, for public health and other social science researchers, the absence of theoretically validated constructs that can be empirically tested poses not only a major challenge but also tremendous opportunities for advancing the study of intersectionality from a public health perspective.”

Nice way to take lemons and make lemonade. Did you catch that? As public health researchers, there are great opportunities to uncovering ways to study intersectionality! So, back to the original question of how to actually do that in practice. There are several possibilities. Bowleg suggests more use of qualitative or mixed-methods research in public health research (I’m a fan of this idea). Given that I research intersections, I have devoted considerable thought to the topic and one approach that has been very rewarding and fruitful for me is within-group analysis. I’m sure you might be thinking, “But how can we possibly find out anything interesting about ____ people if we don’t compare them to ____ people??!” Ah yes. I’ve encountered different variations of this question over the years, and to that I reply, “It’s simple. No one group is monolithic.”

In essence, we are all complex and if I am concerned with Black women’s health, for example, I cannot fully understand Black women if I am only comparing health outcomes between Black and White women. Within-group research (studying only one group) allows us to understand the wonderful complexity that exists within a group of people who share one social identity. For example, Black women are extremely diverse. However, that diversity can easily get lost if you don’t take into account education, class background, geographic location, and other features of the social context that shape the human experience. Furthermore, there is a tremendous amount to be learned from understanding variability between risk and resiliency. Not all Black women develop diabetes, cardiovascular disease and die young, but some do. Why? And why does upward mobility not yield the same beneficial effects in terms of infant mortality for educated Black women, as for White women? These important questions require a thoughtful and deliberate approach to not only examining disparities, but actually doing something to help prevent them.

Natalie Sabik and I will be presenting our work on intersectionality and physical functioning among older African American women at the Intersections of Race, Culture, Health and Mental Health Conference at Boston College, October 18-19th.

Note: Just ordered Evelyn Simien’s Black Feminist Voices in Politics – an intersectional analysis. Can’t wait to read!

Shellae1 Comment

Why we should be talking about hair

barbie-with-natural-hairThere is a pervasive sentiment that hair is a superficial aspect of beauty. Yet for many women of color, hair is quite the contrary. Hair is an expression of self – who I am and where I’ve been. Before I get too deep, let’s take a moment to recognize the obvious – all women, regardless of race, view hair differently. For Black women, however, this view may be shaped by historical significance (e.g., Black is Beautiful movement), family influences and social upbringing (preferences for straight and non-straight styles) or matters of convenience. Google ‘Black women and hair’ and I’m sure you’ll get more information than you could ever imagine about the complexity of Black women’s hair. Therefore, to downplay its relevance in our social conversation is insensitive and dismissive of the real way that hair matters to the lives of African American women.

Recently I came across this article, and while it saddened me, it certainly did not surprise me. Shaming anyone, much less a 7-year old child, about the way she chooses to wear her hair is unacceptable. I could deconstruct the baseless rationale given by the Deborah Brown Community School administrators regarding their harassment of Tiana Parker about her decision to wear locs. But that’s too easy. Instead, I wonder how different Millard Jones is from the rest of us. I wonder how, consciously or unconsciously, we as a society are imparting negative messaging about hair and beauty into the minds of our little girls and disempowering them in the process. Even more, I wonder what type of behavior we are modeling as Black women. When we run through the rain or avoid exercise/swimming because we don’t want to get our hair wet and ‘revert’ – are we sending a positive message? And while I overstand that economic considerations, such as salon costs and time for hair maintenance can be prohibitive, I would like to propose an alternative. Let’s shift the conversation. Let’s pen a new narrative for the mental and physical health of our children. Let’s model active behavior that can be achieved regardless of hairstyle. Let’s reaffirm that beauty comes from within. Let’s allow our girls to see reflections of themselves – in us.

I don’t claim to be wise, but if there is one thing I am certain of – children pay attention to what you do, not necessarily to what you say. So if we are telling our daughters, nieces and granddaughters that they are beautiful, but still we complain about doing their kinky hair, give them chemical relaxers at age 5, tell them to be careful not to ‘sweat their hair out’ and encourage them to wear their hair in ‘acceptable’ styles, then we are no better than the Deborah Brown Community School administrators. We are all reproducing a damaging cycle to the psyche that devalues the natural beauty of Black hair.

Perhaps if I were so inclined, I would design a public health intervention to visit cities and rural towns across the nation on a U R Enough Crusade. I don’t need tons of funding or a complicated research plan; just one bullhorn and a single message: You are enough. Your hair is enough. The way your hair grows out of your head is enough. Whatever way you choose to rock your ‘do, know that your hairstyle does not dictate your self-worth or value. That is all. Even without the bullhorn, I hope this message spreads (as it seems to be doing):

May your hair be enough to make you feel pretty, valued and empowered!

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