Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area

This article examines the cumulative effects of multiple stressors on women's health, by race and area of residence. Specifically, we examine socioeconomic status, experiences of unfair treatment and acute life events by race and residential location, and their cumulative effects on the health status of African American and white women living within the city of Detroit and in the surrounding metropolitan area. African American women, regardless of whether they live inside or outside the city, report more frequent encounters with everyday unfair treatment than white women. African American women who live in the city report a greater number of acute life events than white women who live outside the city. Regression analyses used to examine the cumulative effects of exposure to these stressors by race and area of residence show that: (1) socioeconomic status, everyday experiences with unfair treatment and acute life events each make a significant contribution to differences in health status; and (2) the contribution of each of these variables to explaining variations in health status varies by area of residence. We suggest that differences in socioeconomic status, exposure to unfair treatment or discrimination and experiences of acute life events make significant contributions to racial differences in women's health status.     

Racial differences in Norplant use in the United States

The introduction of the contraceptive implant Norplant has focused attention on how social factors may affect contraceptive use. In the United States, race is a central category of social organization which may impact Norplant use. I use data from the 1995 National Survey of Family Growth to answer three main questions. (1) Are women of color more likely to use Norplant? (2) To what extent can racial differences in Norplant use be explained by a structural bias in the provision of medical care? (3) To what extent can racial differences in Norplant use be explained by life circumstances which may affect individual women's contraceptive decisions? I find that African American and Native American women are more likely than white or Asian American women to be recent Norplant users. There are no differences in recent use by Hispanic origin. Both a structural bias in the provision of care and differences in life circumstances account for the disparity in Norplant use between African Americans and whites. However, none of the factors examined here explain Native American women's high rate of use. Concerns about health risks for Norplant use are also discussed. These findings point out the importance of examining structural, individual and health status factors in studies of the use of health services.     

Examining the Burdens of Gendered Racism: Implications for Pregnancy Outcomes Among College-Educated African American Women

Objectives: As investigators increasingly identify racism as a risk factor for poor health outcomes (with implications for adverse birth outcomes), research efforts must explore individual experiences with and responses to racism. In this study, our aim was to determine how African American college-educated women experience racism that is linked to their identities and roles as African American women (gendered racism). Methods: Four hundred seventy-four (474) African American women collaborated in an iterative research process that included focus groups, interviews, and the administration of a pilot stress instrument developed from the qualitative data. Analysis of the qualitative and quantitative data from the responses of a subsample of 167 college-educated women was conducted to determine how the women experienced racism as a stressor. Results: The responses of the women and the results from correlational analysis revealed that a felt sense of obligations for protecting children from racism and the racism that African American women encountered in the workplace were significant stressors. Strong associations were found between pilot scale items where the women acknowledged concerns for their abilities to provide for their children's needs and to the women's specific experiences with racism in the workplace (r = 0.408, p < .001). Conclusions: We hypothesize that the stressors of gendered racism that precede and accompany pregnancy may be risk factors for adverse birth outcomes.     

African American women's perspectives on 'down low/DL' men: implications for HIV prevention

African American women are disproportionately affected by HIV. Some research has explored if non-disclosing men who have sex with men and women contribute to women's HIV risk. Popular media discourse tends to refer to these men as 'down low' or 'DL'. Six focus groups were conducted with 36 African American women in Washington, DC, to examine their knowledge, attitudes, beliefs and behaviours regarding DL men. Three of the focus groups were composed of HIV-positive women and three groups were composed of HIV-negative women. Data analysis reveals six central subcategories related to women's perspectives on the DL: awareness, suspicion, coping with partner infidelity (male versus female), sexual health communication, empathy and religion. No major differences were identified between the HIV-positive and HIV-negative focus groups. Findings from this study provide insight into African American women's perceptions of African American male sexuality and how these perceptions serve to influence interpersonal relationship factors and women's exposure to HIV risk.     

Talking "among us": how women from different racial-ethnic groups define and discuss menopause

Against a backdrop of scant literature on commonalities and differences among diverse groups of menopausal women within the United States, and little attempt by scholars in any country to study the ways in which both privilege and oppression can shape women's ideas and experiences of menopause, in this study, 61 menopausal women of varied racial-ethnic and class locations in a Midwestern state were asked about the different meanings and experiences of menopause. African American women and Chicanas, particularly working-class women, viewed menopause as a positive experience, whereas many middle-class European American women discussed more negative feelings. Women of color were more likely than European Americans to report talking about menopause with same-race, same-sex friends only. While women of color discussed their knowledge of European American women's menopause, the latter lacked knowledge of other women's experiences. Women's lived experiences with privilege and oppression also surfaced in the interviews. The authors argue that when scholars listen to how women discuss menopause experiences, commonalities among women by gender, and differences among women by race, and class are exposed. The presence of racial-ethnic differences in these pilot data suggests the importance of more comparative studies on reproductive aging both in the United States and abroad.     

Disparities in women's health and health care experiences in the United States and Israel: findings from 1998 National Women's Health Surveys

OBJECTIVE AND METHODS: Using data from bi-national 1998 surveys of adult women in the U.S. and in Israel, this article examines health, access, and care experiences among women in two countries with very different health care systems. We examine how well each country's system serves those vulnerable due to lower socio-economic status. The Israeli health care system-characterized by universal coverage for all its residents-relies on a system of competing health funds that employ many features typical of U.S. managed care plans. The analysis explores the extent to which such a system helps to equalize access experiences with contrasts to the experiences of U.S. women. FINDINGS: We find that U.S. and Israeli women report similar rates of disability and chronic conditions with prevalence of health problems sharply higher for low income and less educated women. We also find disparities in access: women in both countries reported unequal access experiences by education and income. In Israel, these experiences appear to be linked to health plan structural features rather than cost barriers. CONCLUSION: The findings indicate that achieving more equitable access to health care requires attention to non-financial as well as financial barriers to care. Despite the lack of financial barriers to care in Israel, administrative controls typical of managed care organizations appear to make health care systems difficult to navigate for low income and less educated women. The finding that disparities in health persist in a country with universal coverage indicates that improving women's health will require attention to broader social influences on health as well as improving access to health care.     

The sexual concerns of african american, asian american, and white women seeking routine gynecological care

PURPOSE: Because of limited knowledge regarding the sexual health of minority women, we described the types and frequency of sexual concerns among African American, Asian American, and white women. METHODS: The sexual concerns of eligible women who received their health care at a large military health care facility in Washington State were determined from December 1992 through January 1993 through the use of a questionnaire on women's sexual health that was developed by one of the authors. RESULTS: A high and similar prevalence of sexual concerns was reported among these women. The prevalence of certain sexual concerns among white, African American, and Asian American women differed significantly. A history of sexual coercion or physical/emotional abuse was strongly associated with a high prevalence of sexual concerns for each racial and ethnic group. CONCLUSION: Although women of different racial/ethnic backgrounds reported a high and similar prevalence of sexual concerns, there were significant differences in the prevalence of certain sexual concerns that may have differential health importance. Health-care providers should exercise caution when generalizing the sexual concerns of women from different racial/ethnic backgrounds.     

Dating violence and the health of young women: a feminist narrative study

Dating violence is a significant public health problem in the lives of young women. Their age, in conjunction with perceived pressures to engage in intimate relationships, makes these women particularly vulnerable to dating violence. The pressures to be in relationships can be intense and therefore may add to young women's willingness to overlook, forgive, or excuse the violence that is occurring. The authors' purposes in this feminist study were to examine the experience of dating violence from young women's perspectives; investigate how contextual factors shape their experiences; examine how health is shaped by these experiences; and explore ways that dating violence is perpetuated and normalized in young women's lives. Findings revealed that family environment and gender are critical in shaping young women's experiences. The participants described a range of physical and emotional health problems and perceived few sources of support. Their efforts to obtain support were often met with skeptical and dismissive attitudes on the part of health care providers and other trusted adults. Recommendations for health care practice, education, and research are presented.     

"Eyes Wide Shut": narratives of women living with hepatitis C in Australia

Hepatitis C is the leading notifiable infectious disease in Australia and in the last few years, the number of new diagnoses among young women is beginning to outnumber men. For many, infection with hepatitis C virus (HCV) results in a chronic condition, which, in addition to a range of symptoms, carries with it the stigma attached to injecting drug use. Despite the growing prevalence of HCV, women's health has barely begun to address the gender specific impact of this illness on women. We report the results of a qualitative study of young women's experiences of living with HCV with a specific focus on the meaning of this condition and its impact on their lives. In 1999--2000, twenty-five in-depth interviews were conducted with women between the ages of 18 and 43 years, who were current or past injecting drug users and who had been diagnosed with HCV. One focus group discussion was held with health workers who provide treatment and care to this population. A number of key issues were identified that women believed impacted negatively on their lived experiences of HCV. Of most concern was the meaning of HCV and the social stigma attached. Stigma coupled with the lack of knowledge and awareness among health professionals and the high cost of treatment contributed to women's reluctance to seek support and care. HCV has yet to be taken up by the women's health movement as a key issue, especially for young women and we argue that this trend needs to be reversed.     

Breast cancer knowledge and beliefs in subpopulations of African American and Caribbean women

OBJECTIVE: To examine breast cancer belief and knowledge deficits among previously unstudied African and Caribbean subpopulations and to consider the particular knowledge and belief components that are most lacking in each group. METHODS: 1,364 African American, US-born white, English-speaking Caribbean, Haitian, Dominican, and Eastern European women were recruiting via stratified-cluster sampling. Participants provided demographics and measures of beliefs and knowledge. RESULTS: There were between-group differences in cancer knowledge and beliefs and within-group variation in terms of which particular knowledge and belief items varied. CONCLUSIONS: Studying how cognitive factors relate to screening in well-defined minority groups will capacitate interventions suited to the knowledge and belief deficits that characterize populations of diverse women.     

"We wanted a birth experience, not a medical experience": exploring Canadian women's use of midwifery

In this study I explore Canadian women's use of midwifery to examine whether their choice represents a resistance to the medicalization of pregnancy/childbirth. Through my analysis of the data I identified eight ways the women's deliberate decision to pursue midwifery care represented resistance to medicalization. In so doing, I demonstrate how women actively assert their agency over reproduction thus shaping their own reproductive health experiences. The outcome of their resistance and resultant use of midwifery was empowerment. Theoretically the research contributes to understanding the intentionality of resistance and a continuum of resistant behavior.     

A qualitative study of women's hysterectomy experience

The purpose of this qualitative study was to elicit women's perceptions of their experiences with hysterectomy, oophorectomy, and surgical menopause. Focus group and individual interviews were used to obtain data from a sample of southern urban women who had had hysterectomies for benign reasons. Of the 38 women who participated, 22 were African American and 16 were Caucasian, the mean age was 48 years, and most were low to middle income. Findings revealed that biophysical, psychosocial, and spiritual domains were important in the decision to have a hysterectomy. For many, the choice to have a hysterectomy was a last resort and was viewed as a technique that could relieve a myriad of symptoms. Although most participants described the hysterectomy experience as positive, they expressed a variety of concerns from diagnosis through recovery. Participants expressed a need for information about women's gynecological health for themselves and their male partners. African American women expressed a need for change in attitudes and beliefs in the black community about women undergoing hysterectomy. Many spouses, brothers, uncles, and other African American male friends were nonsupportive, and a few women revealed that they had not told a new partner about the surgery. The findings have implications for women's healthcare providers. Provider training and education are needed that integrate biophysical care of women with the psychological, sociological, and spiritual domains. Efforts must be directed to the community to enlighten men and families about hysterectomy by dispelling myths and providing current health information related to women's gynecological health and alternatives to, indications for, and types of hysterectomy.     

A qualitative analysis of women's satisfaction with primary care from a panel of focus groups in the National Centers of Excellence in Women's Health

Health issues unique to women and differences in healthcare experiences have recently gained attention as health plans and systems seek to extend and improve health promotion and disease prevention in the population. Successful efforts focused on enhancing quality of care will require information from the patient's perspective on how to improve such services to best support women's attempts to lead healthy and productive lives. The National Centers of Excellence in Women's Health program (CoE), sponsored by the Office on Women's Health within the Department of Health and Human Services, is based on an integrated model uniting research, training, healthcare, and community education and outreach. To examine women's concept and definitions of healthcare quality, 18 focus groups comprising 137 women were conducted nationwide on experiences and attributes of healthcare that women value in primary care. Following the focus groups, a woman-focused healthcare satisfaction instrument was developed for the purpose of assessing and improving healthcare delivery. We describe the qualitative results of the focus group study.     

Health care reform in New Zealand: the diversity of gender experience

Women are a heterogeneous group with varying experiences and needs of health care systems. It is important that we recognise not only differences between women, but also that individual women may have different, even contradictory, health care issues and needs. These may vary according to women's different roles, identities, contexts, and resources (financial, social, etc.). This paper explores situated ideas about identity, gender, and place and how these relate to perceptions of accessibility of health care services in the context of New Zealand's restructured health care system.     

A Preliminary Analysis of the Effects of a Stress Reduction Psychoeducational Intervention on African American Working Women

The primary purpose of this research was to provide an initial test of the effects of a six-session stress reduction psychoeducational intervention to enhance psychological well-being and reduce role conflict among two groups of African American working women. A one-group pretest–posttest design was utilized. A multimethod approach, combining both qualitative and quantitative methods, was used. Qualitative methods and analyses were used to enhance the accuracy, richness, and completeness of quantitative data. Results showed that there were significant differences among the pre-, post-, and follow-up measurements with life satisfaction and role conflict. The intervention had an effect in the predicted direction for life satisfaction and role conflict for Times 1 and 2 and for Times 1 and 3. There was a significant interaction effect for role conflict and life satisfaction between Times 1 and 2. As role conflict scores decreased, life satisfaction scores increased. The intervention helped participants verbalize strategies for reducing role conflict such as establishing priorities, partitioning and separating roles, overlooking role demands, and changing attitudes toward roles in order to maximize satisfaction in a specific role. Many mental health providers are positioned to participate in the development of the needed knowledge to support an expanded perspective of women's roles and work. Mental health care includes supporting the empowerment of women to make choices and take action on behalf of themselves and their families. These preliminary findings suggest that mental health providers can both empower African American women to choose actions benefiting self and family and successfully promote knowledge necessary for more accurate and comprehensive perspectives on the roles and work of African American women.     

Slipping through the safety net: implications for women's health

The failure of the 104th Congress to pass legislation that would have provided universal health care coverage has created gaping holes in the health care safety net for the working poor. As a result, the number of Americans without health insurance, which was 37 million in 1992, could reach 50 million in 1998. Current changes in welfare policy, centered on reform of the joint federal-state program Aid to Families with Dependent Children (AFDC), have further redefined the safety net for the poor. These changes may jeopardize the health of poor women as any change in eligibility requirements for AFDC also limits eligibility for Medicaid. Given the financial and social difficulties facing poor women, a growing number of researchers are redefining what constitutes research on women's health. Research is needed on how the high rates of health problems and few health resources of poor racial/ethnic minority women affect their quality of life.     

African American women and family planning services: perceptions of discrimination

OBJECTIVES: The purpose of this study was to examine perceived race-based discrimination in obtaining family planning or contraceptive services among African American women in the U.S. METHODS: We conducted a 30-minute telephone survey with a random sample of 500 African Americans (aged 15-44), which included questions about race-based discrimination when obtaining family planning services. The present analyses were limited to the 326 women who completed interviews. RESULTS: The majority (79%) of women reported having seen a health care provider for family planning or birth control services. Of those, 67% reported race-based discrimination when obtaining such services. Half of the women reported more general experiences of discrimination when obtaining family planning services (e.g., poorer service), and 52% reported experiences that reflect stereotypes of African American women (e.g., doctor or nurse assumed they had multiple sexual partners). Most indicated that experiences of discrimination occurred infrequently. Generally, background characteristics were not significantly associated with perceived discrimination. However, in multivariate models, stronger Black identity, younger age, and lower income were associated with reports of discrimination. CONCLUSION: African American women may be vulnerable to prejudice within reproductive health care contexts, including family planning.     

Moving experiences: a qualitative analysis of health and migration

This paper describes a qualitative analysis of the health and health care experiences of South Asian Fijian women now living in the lower mainland area of British Columbia, Canada. A particular focus is put on the health impacts of the migration experience. A thematic analysis of in-depth interviews informs the discussion of individual women's, as well as service providers', views of health meanings, physical and emotional health concerns, experiences with the health care system, and women's roles as care-givers. The findings have implications for how health and illness are conceptualized, and how health services are provided to particular groups in particular places.