Shirley A. Hill

Class, Race, and Gender Dimensions of Child Rearing in African American Families

African American family scholarship uniformly attests to the immense importance of children in Black families (Anderson, 1991; Billingsley, 1992; Burton, 1990; Nobles, 1985; Staples & Johnson, 1993). More than one third of the 30 to 35 million Black Americans in the United States are children younger than age 18 (Pinkney, 1993) and, as Nobles (1985) has pointed out, they are the very heart of the African American family:

Teaching and Doing Gender in African American Families

In this article, based on in-depth interviews with a nonrandom sample of 35 African American parents (25 mothers and 10 fathers), I explore the gender socialization of children in their families. Using the conceptual framework advanced by multiracial feminism, I explore how both race and class shape the gender ideologies and behaviors of parents. The findings reveal significant support for teaching children gender role equality; however, that support is mediated by social class status (defined by education) and patterns of social mobility. In this study, 21 respondents were classified as middle-class and 14 as lower-income parents. Social class status predicts religiosity, homophobia, and structural factors that may militate against full support for gender equality or foster contradictions between ideology and behavior. The results show the role of Black parents as active agents in the lives of their children and expand our knowledge about child socialization processes in Black families. The study also contributes to multiracial feminist theory and the emerging literature on the growing social class diversity among African Americans.

Managing sickle cell disease in low-income families

As many as 30,000 African Americans have sickle cell disease (SCD). Though the political activism of the 1960s and a major 1970s health campaign spurred demands for testing, treatment, and education programs, little attention has been given to how families cope with SCD. This first study to give SCD a social, economic, and cultural context documents the daily lives of families living with this threatening illness. Specifically, Shirley A. Hill examines how low-income African American mothers with children suffering from this hereditary, incurable, and chronically painful disease, react to the diagnosis and manage their familys health care.The 23 mostly single mothers Hill studies survive in an inner-city world of social inequality. Despite limited means, they actively participate, create, and define the social world they live in, their reality shaped by day-to-day caregiving. These women overcome obstacles by utilizing such viable alternatives as sharing child care with relatives within established kinship networks.Highlighting the role of class, race, and gender in the illness experience, Hill interprets how these women reject, redefine, or modify the objective scientific facts about SCD. She acknowledges and explains the relevance of child-bearing and motherhood to African American womens identity, revealing how the revelation of the SCD trait or the diagnosis of one child often does not affect a womans interpretation of her reproductive rights.

MOTHERHOOD AND THE OBFUSCATION OF MEDICAL KNOWLEDGE: The Case of Sickle Cell Disease

This study examines how low-income African American mothers of children with sickle cell disease (SCD) cope with the reproductive implications of having passed a genetic disease on to their children. Based on in-depth interviews with 29 African American mothers, I found that most mothers knew about SCD prior to having a child with the disease; many knew they were carriers of the sickle cell trait. In explaining why this knowledge did not lead them to alter their reproductive behaviors, mothers invoked a theme of medical mismanagement; that is, they said the genetic screening programs for SCD did not provide them with enough medical knowledge about the disease. The implication that adequate knowledge about SCD would have affected their childbearing choices, however, is contradicted by their subsequent reproductive behaviors. I argue that the SCD diagnosis threatened motherhood, an important cultural value among low-income African American women, and that they protected their reproductive autonomy by obfuscating SCD medical knowledge.

Reforming Gendered Health Care: An Assessment of Change

Health policy in the United States has changed dramatically over the past three decades, with the main concern shifting from expanded health care coverage to containment of health care costs. The current focus on providing cost-effective health services, reflected in the growth of managed care initiatives, has elevated concern about the quality of health care. The authors contend that quality of health care has always been the key focus in the womens health movement, which evolved in the late 1960s as the first significant challenge to modern medicine. In this article, they apply the analytic lens of gender to develop a fresh perspective on U.S. health care organizations and policies, examining the six broad demands of the feminist consumer model of health care, all of which hinge on the issue of quality care for women, to determine whether womens health needs are now being better addressed. The authors conclude that, despite some notable gains in the roles of women as consumers and providers of health care, many of the new health reforms have replicated and solidified the historical inequities in the health care system.

The effectiveness of CAHPS among women enrolling in Medicaid managed care.

The large-scale transition of public health insurance programs to managed care has shifted much of the responsibility for selecting appropriate coverage to beneficiaries—a role for which many have had little preparation. This study evaluates the impact of a CAHPS™ (Consumer Assessment of Health Plans Study) health care report card in assisting newly enrolled Medicaid case heads in selecting a managed care plan. The major finding is that the CAHPS report card helped consumers make more informed decisions. Those who received the report cards found judging quality between plans easier, felt that they had significantly more information on which to make decisions, and recognized the importance of their decision more often than those receiving only standard enrollment packets.

Rational choice in Medicaid managed care: A critique

ABSTRACT Market-based health care policies cast patients as active decision-making consumers who are able to choose among health plans and select the highest quality and lowest priced providers. Embodied in the Consumer Assessment of Health Plans Study (CAHPS), a national policy initiative based on assumptions of rational choice, such a model has recently been extended to low income populations enrolled in the U.S. Medicaid program. This paper describes and seeks to investigate the efficacy of this policy initiative by examining three questions: (1) Are Medicaid recipients willing to take an active stance in selecting health plans? (2) Do they see the varying health plans as offering genuine choice? and (3) Does the ability to choose ones own health plan help address some of the long-standing obstacles to quality care for the poor? Analyses of these questions are informed by a review of existing knowledge about the life circumstances and health needs of low income populations (particularly low income women), and by original data from Kansas Medicaid recipients, gathered in conjunction with a state-wide version of the CAHPS. We find significant discrepancies between the assumptions of this model and the realities of low income womens lives. We conclude that the current consumer model of health care reflects class-biased assumptions about rational choice that negate the daily experiences of the poor, offers little in the way of real choice, and fails to address long-standing health needs of low income populations. Market incentives and consumerism will be effective only when the social context of poverty is taken into account and addressed by health care initiatives.

Examining Status Discrepant Marriages and Marital Quality at the Intersections of Gender, Race, and Class

Purpose – This study examined the impact of educational differences between married women and men on marital quality at the intersections of gender, race, and class.Methodology/approach – Guided by an intersectional perspective we analyzed data for 4,835 black and white married couples from the National Survey of Families and Households (NSFH; 1987–1988). Dyadic multigroup models were estimated using structural equation modeling to examine how status differences affected four latent dimensions of marital quality: happiness, stability, perceived fairness, and disagreement.Findings – Our findings highlight how multiple dimensions of marital quality vary according to intersections of gender, race, and class, and reveal how these intersections moderate the impact of status on marital quality.Research limitations/implications – To our knowledge, the NSFH is the most up-to-date, nationally representative dataset available with couple-level data; however, the data were collected in the late 1980s and are insufficient for extending our analysis to other race-ethnic groups. Our findings demonstrate a strong need for more comprehensive contemporary data collection that has adequate numbers of respondents/couples at the intersections of gender, race, and class to facilitate further quantitative studies using an intersectional perspective.Originality/value – Our study is innovative in using education, an arena where women are currently outpacing men, as an indicator of status, and in embracing an intersectional perspective. By doing so we advance literature on status discrepant marriages, and contribute to the fields of gender and family studies which seek to understand how the changing roles of women may be affecting marital quality.

An end of innocence: African-American high school protest in the 1960s and 1970s

This paper considers African-American student protests in secondary schools during the 1960s and early 1970s. Taking a national perspective, it charts a growing sense of independence and militancy among black students as they made the schools a focal point of activism. Activist students challenged established civil rights organisations on a variety of questions. They also engaged in an escalating series of protest activities to make schools change. Much of this focused on curricular change, particularly adding black history courses and hiring African-American teachers and principals. Generally, these protests proved quite successful. Black students also protested against conditions encountered in integrated schools, where they often met hostility from whites. Distinct regional patterns characterised such activities, with more protest over school issues in the North and greater conflict regarding desegregation in the South. By the mid-1970s the era of black secondary student protest concluded, although its legacy continues to live.

Ethnicity and the ethic of caring in african american families

Abstract Several important demographic and economic factors have led to the shift in medical caregiving work from health care professionals to family members, primarily women. The growth in family caregiving has spawned numerous studies on how caring for the sick affects unpaid family caregivers. While caregiving work can be gratifying, most studies have focused on the negative effects, such as its adverse impact on the health and employment of caregivers. Only recently have we begun to expand this literature by examining the impact of ethnicity, specifically culture, on family caregiving. This study argues that African American families have retained specific cultural values and developed family systems which may lessen the negative impact of caregiving on families.