Alaka Wali

Qualitative methodologies and community participation in examining reproductive experiences: the Harlem Birth Right Project.

Objectives: Racial disparities in health present a challenge to public health because of the complexity of interacting social forces. The Harlem Birth Right Project sought to improve understanding of these forces by using qualitative and community participatory methods. In this paper we 1) describe the process of qualitative inquiry and community involvement, 2) evaluate the impact of community participation, and 3) present a brief summary of the findings on social context as it relates to pregnancy outcomes of women in Harlem. Methods: We operationalized the qualitative method by combining participant observation, longitudinal case studies, and focus groups. An ethnographic survey was used to verify and triangulate findings across methods of data collection. We involved the community in the design, implementation, and analysis by collaborating with community-based organizations, setting up a community advisory board, and the use of dialogue groups and community meetings. Results: The use of qualitative methods and community partnership uncovered important aspects of the social context of womens lives that may not have emerged through traditional epidemiologic research. We found that pregnancy may serve as a catalyst to increase perception of the magnitude of preexisting social stressors. Several stressors and chronic strains associated with structural forces were identified. For example, the high percentage of households headed by women is seen as one consequence of larger structural forces. While social support networks serve as an important coping mechanism to buffer against the stress caused by these structural forces, the types of support women seek differs by social strata, and some strategies were identified as being substantially more effective than others. Conclusions: Qualitative and community participatory research can be successfully conducted to support public health goals and can derive important new information on the social context of womens lives.

Race, Class, Gender, and Health

Although this study has focused on reproductive health, African American women and men die younger and have higher rates of morbidity and mortality for most diseases than whites. Mainstream literature in medicine and epidemiology traditionally has attributed these disparities to genetic or cultural differences. Critics of these approaches have pointed to the necessity of studying race, class, and gender as structural constraints on health (Cooper, 1986; Krieger and Bassett, 1986; Krieger, 1999; Mullings, 1984, 1989).

Local Assessment of Chicago: From Wild Chicago to Chicago Wilderness – Chicago’s Ecological Setting and Recent Efforts to Protect and Restore Nature in the Region

From the time of its charter in 1832 the population of the City of Chicago grew explosively and the landscapes of the region were largely transformed both by the expanding physical footprint of the city and by the extensive development of agriculture in the hinterlands. This transformation was at the expense of highly biodiverse ecosystems that had been inhabited by populations of indigenous peoples who had themselves been agents in the historical development of the region’s biota. As a consequence of both public and private community planning early in the history of the city, the region retained substantial open space in the city itself and its hinterlands. In this chapter we describe the factors that determined the structure of the biota of Chicago and review recent large-scale attempts to manage the biodiversity of the region. We discuss recent biodiversity conservation strategies mainly through the lens of Chicago Wilderness, a regional biodiversity conservation alliance that emerged over a decade ago and that now has more than 260 institutional members. These members represent federal, state, and local agencies, public land-management agencies, conservation organizations, and scientific and cultural institutions. Despite the progress we show that the footprint of the city continues to grow and that there is significant work to be done even on questions of the basic natural history of the Chicago area.

Social Support and Reproductive Health

The importance of social support in health and illness and in reproductive health (Boone, 1989; McLean et al., 1993) has been extensively explored. The literature suggests that support networks are important in recognition, compliance, and treatment during and after (cf. Helman, 1990) pregnancy (Boone, 1989). Though intervention trials to provide social support have found little evidence of increased birth weight or reduced preterm delivery, studies are needed to explore the definition, meaning, and differential effect of social support (Rowley et al., 1993).

Social Science Methods Used in the RESTORE Project

The RESTORE (Rethinking Ecological and Social Theories of Restoration Ecology) project is an interdisciplinary, multi-institutional research endeavor funded by the National Science Foundations Dynamics of Coupled Natural Human Systems program. The goal of the project is to understand the links between organizational type, decision making processes, and biodiversity outcomes in the context of ecological restoration of oak woodlands in the Chicago metropolitan area. This paper describes the procedures used to design, implement, and analyze the social data gathered for the project. Here we provide the useful details about methods that rarely fit in journal articles. We also provide appendices of all research tools. The size and interdisciplinary nature of the project make such documentation necessary. We hope this report can also serve as a guide for future large-scale interdisciplinary projects.

Where People Live: The Environmental Context of Reproduction

This chapter begins exploration of the broad social context that shapes the sources of stress and the “resistance resources” (Antonovsky, 1979) with which women confront stressful conditions. We are concerned here with the ways resource inequality, institutionalized racism, and gender discrimination mold the structure of risk, and we argue that only such a systemic view permits a comprehensive understanding of the potential sources of stressors and chronic strain. We also demonstrate that the women we studied were not passive victims but actively struggled to improve their quality of life. Ironically, both the conditions of the environment and women’s attempts to ameliorate those conditions are potential sources of stress. This discussion is divided into three parts: 1) the broader urban environmental conditions that characterize Harlem and affect women’s daily lives, 2) specific issues related to securing and maintaining safe and decent housing that appeared to be significant sources of stress and chronic strain, and 3) the impact of the delivery of social services (education and public assistance) on women across strata. In each part, we examine the interaction with and perceptions of social and environmental factors that shape exposure to stressors and sources of chronic strain and then document the types of strategies women develop to protect themselves. In each part, we look at similarities and differences in women’s experiences across social strata.

Health Care Delivery and Reproductive Health

Since the turn of the century, the health care delivery system has promoted prenatal care as the single most important way to manage pregnancy and prevent poor pregnancy outcomes (Wilcox and Marks, 1994). Extensive studies have verified a relationship between prenatal care service and birth outcome: adequate care is associated with improved outcomes and inadequate care is associated with poor outcomes, including infant mortality.

Reproductive Health, Harlem, and Research

Men and women were gathered at the local public hall for a regular meeting sponsored by the community policing unit of the local police precinct. The group was diverse in age and occupation, but it was united in its concerns for the safety and well-being of the neighborhood. They engaged the police representatives in a forceful discussion of their needs and offered many suggestions for improving police procedures. There were two special guests that evening: ethnographers from the Harlem Birth Right Project. The ethnographers described the project and its significance, and lively debate ensued about the causes of infant mortality and the best focus for research. Some argued that research that was narrowly focused on women’s bad behaviors (substance abuse and smoking, for example) was not useful because it just reinforced the negative portrait of Harlem that residents had to confront all the time. Others acknowledged that the problem of infant mortality was a grave one (one woman said, “Every week in my shop someone buys a card for a baby’s funeral.”) but wondered why the project did not examine other pressing issues such as lack of employment.

Where People Work: The Economic Context of Reproduction

As various studies have noted, African American women historically have worked outside the home; thus, occupationally related stressors and strains, as well as those arising from household work and community work, may influence their health status (Mullings, 1984; Krieger et al., 1994). African American women now constitute a slightly greater proportion of the African American workforce than men. Currently, on the national level, while approximately one-fifth of African American women in the labor force are in managerial and specialty professions, most are concentrated in service, technical, clerical, and laborer occupations. Twenty-eight percent are service workers; 12 percent hold jobs as operatives, fabricators, and laborers; and 39 percent hold jobs in technical, sales, and administrative support (Bennett, 1995). While only about 4 percent of African American women report themselves as self-employed (Devine, 1994), their increased participation in the informal sector has been widely discussed by social scientists (Sassen, 1991). Class stratification over the past 10 years has produced a concentration of African American women in low-wage, dead-end jobs and a growing middle stratum of managerial and professional workers.1 The community description figures in the appendix describe employment and income characteristics of Central Harlem residents, according to the U.S. Census Bureau and other administrative sources of data.