Leith Mullings

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 and Globalization

IN 1903 THE GREAT AFRICAN AMERICAN SCHOLAR AND PAN-AFRICANIST W E. B. Du Bois noted, “The problem of the twentieth century is the problem of the color line … the relation of the darker to the lighter races of men in Asia and Africa, in America and the islands of the sea.”1

African‐American women making themselves: Notes on the role of black feminist research

Afr: frican-American women continually make themselves—always assuming an active role in the creation of culture and history. In this paper, I will put forward preliminary reflections on how, as Black feminist social scientists, we might operationalize in research practices Black feminist theoretical perspectives that seek to bring African-American women to the center of analysis. In other words, how can researchers explore the substance of African-American womens lives from the central vantage point of their experiences? This necessarily involves interrogating the relationship between scholars, researchers, and writers on one hand and working-class and poor women on the other in examining how we think about and understand gender identity.

The Impact of Social Disadvantage on Preconception Health, Illness, and Well-Being: An Intersectional Analysis:

Purpose. To understand how social and structural contexts shape individual risk, vulnerability, and interconception health-related behaviors of African-American women. Approach or Design. A longitudinal ethnographic study was conducted. Setting. The study was conducted in Philadelphia, Pennsylvania. Participants. The sample included 19 African-American women who were participants in the intervention group of a randomized clinical trial of interconceptional care. Method. Data were collected through interaction with participants over a period of 6 to 12 months. Participant observation, structured and unstructured interviews, and Photovoice were used to obtain data; grounded theory was used for analysis. The analysis was guided by intersectional theory. Results. Social disadvantage influenced health and health care–seeking behaviors of African-American women, and the disadvantage centered on the experience of racism. The authors identify seven experiences grounded in the interactions among the forces of racism, class, gender, and history that may influence womens participation in and the effectiveness of preconception and interconception health care. Conclusion. African-American womens health and wellness behaviors are influenced by an experience of racism structurally embedded and made more virulent by its intersection with class, gender, and history. These intersecting forces create what may be a unique exposure that contributes significantly to the proximal determinants of health inequities for African-American women. Health promotion approaches that focus on the individual as the locus of intervention must concomitantly unravel and address the intertwining structural forces that shape individual circumstance in order to improve womens interconceptional health and to reduce disparities.

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).

Blurring boundaries: post-racialism, inequality and the anthropology of race

I thank the Anthropology Southern Africa (ASnA) Executive Board, particularly Professor Rose Boswell for organising the conference and inviting me to speak, Dr Joy Owen, Des Bekker, and Charmaine Avery for all their help, and all the volunteer labour, particularly on the part of students, that goes into making a conference run smoothly. I would also like to pay tribute to two South African anthropologists who were very influential in my life, Archie Mafeje and Bernard Magubane. I first met Archie Mafeje in the 1970s when I was a young student hoping to do field work in Tanzania. Archie was chair of the Department of Sociology at the University of Dar-es-Salaam, where he hired me to work as a tutor. Though the mostly male students – who did not expect to be taught by a young African American woman with a huge afro – gave me a hard time, Dar-es-Salaam was a wonderful place to be during those years. The university was filled with exciting scholars such as Walter Rodney, the Guyanese author of the seminal study, How Europe Underdeveloped Africa (1972), who was later assassinated at the age of 38. Dar-es-Salaam was also home to leaders and representatives of the national liberation movements of southern Africa that would soon be successful in decolonising Africa. When I returned from Africa and became a university instructor, I met Bernard Magubane, an exiled member of the African National Congress (ANC). For young African American scholars, writing against the tide of hegemonic knowledge frames could be extremely perilous. For me, Ben stood as a paragon of courage by, for example, deconstructing the revered anthropological notion of ‘tribe’ (1973). These experiences profoundly influenced how I understood the world, its many borders and boundaries, and the responsibilities of scholars to attend to them. Boundaries and borders is a particularly timely theme in the contemporary world. Though mobilities, migration, and displacements are pressing issues all over the world, since at least 15,000 BC, people, culture, language, commodities, disease, flora, and fauna have been on the move. Through our long history, human movement has taken many forms, ranging from enforced migrations as in slavery and trafficking to migrations driven by trade or labour. Migrations and displacements have resulted from expansion, colonialism, violence, and war, as well as from the production of commodities and labour needs. Borders can be understood as political, social, and cultural practices and projects that are socially constructed – reproduced, altered, and transformed. Boundaries are

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).

Race, inequality and transformation building on the work of Eleanor Leacock

Speech given at the presentation of the Eleanor Leacock Award to Stephen Gregory at the 13th International Congress of Anthropological and Ethnological Sciences, July 30, 1993.

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.