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Black Women's Burden: An Analysis and Collection of Black Women's Health Experiences in the South

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Black Women's Burden: An Analysis and Collection of Black Women's Health Experiences in the South
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Howard, Chanice A.
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English

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Black women's intersectional experience as both Black and woman creates a unique health experience and medical history for the population. Historically, as well as currently, Black women encounter discrimination for their racial and gender identities. The racist and sexist othering and objectification of the Black woman have resulted in mass discrimination and exploitation of Black women's bodies by health professionals and the institution of medicine. This paper reviews African American women's relationship with medicine and health providers from the Antebellum period to today, by analyzing existing literature and semi-formal interviewers with Black women who have received health care in the Southern U.S. Additional research should be conducted to preserve the medical histories of Black women. In addition, Black feminist Health Studies should receive further recognition as a field, for its work could assist researchers understanding and rectifying health disparities among Black women in the U.S. ( en )
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Awarded Bachelor of Arts, summa cum laude, Major: Women's Studies, and Bachelor of Arts, cum laude, Major: Anthropology on May 2, 2018.
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College or School: College of Liberal Arts and Sciences
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Advisor: Alyssa Zucker. Advisor Department or School: Women's Studies

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University of Florida
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University of Florida
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Copyright Chanice A. Howard. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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1 Black An Analysis and Collection of Black Chanice Howard Un der graduate Honor Thesis Advisor: Dr. Alyssa Zucker Second Reader: Dr. Manoucheka Celeste Working Final Draft

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2 Abstract Black health experience and medical history for the population. Historically, as well as currently, Black women encounter discrimination for their racial and gender identities. The racist and sexist othering and objectification of the Black woman have resulted in mass discrimination and medicine and health providers from the Antebellum period to today, by analyzing existing literature and semi formal interviewers with Black women who have received health care in the Southern U.S. Additional research should be conducted to preserve the me dical histories of Black women. In addition, Black feminist Health Studies should receive further recognition as a field, for its work could assist researchers understanding and rectifying health disparities among Black women in the U.S. Introduction Currently, Black women in the U.S suffer from significant health disparities due to economic, social, access, political, historical, and cultural barriers and discrimination. According to the Centers for Disease Control Black women are at the highest risk for singleton preterm births at 11.1% compared whites 6.9%, and American Indians or Alaska Native 9%; hypertension (44.0%) compared to Asian or Pacific Islander women who has the lowest rate (25.0%) In addition, from 1999 2013 Black women experienced the highest rates of infant mortality with 11.11 infant deaths per 1,000 live births in 2013 compared to the lowest rate of 3.90 among non Hispanic Asian or Pacific Islanders (2015) The reasons for these poor health conditions are multifaceted, but cultural memory and systematic oppression are significant contributors.

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3 This paper defines cultural memory as an embodied historical experience that accumulate s and produces population recognized actions beliefs, and thoughts. Cultural memory is significant. (Rodriguez & Fortier, 2007). Historical trauma i s similar to cultural memory they are not the same. The concept of historical trauma is used in public health to understand the multigenerational effects of forced migration/relocation, genocide, slavery, war, and colonialism on a population St udies have shown that populations who have endured long term mass trauma, such as the traumas mention ed above, have a higher prevalence of disease and these effects can be observed several generations after the trauma (Sotero, 2006). Public health recognizing the influence of historical trauma among Black women are vital to understanding the health disparities they face According to Michelle Sotero with the experiences and explanatory models of affected populations and recognizes issues of populations because it recogniz es past inflictions forced on their bodies, rights, and health and do es not blame the individual (Sotero, 2009). This paper attempts to tell an overall health story based on the cultural memory to address how this concept functions and how the past continues to be woven into our present. R ecent research stresse s the need for cultural competency and sensitivity in the healthcare Cohen, Gabriel, Terrell 2002 ). Promoting I argue the solution does not lie in post racial and post feminist ideologies Instead, the recognizing historical discrimination exploitation, systematic oppression, an d racist and sexist ideologies continue to impact Black women I t is not solely the

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4 responsibility t o transcend cultural barriers to health care and health access. The historical and systematic roots of health disparities among Black women must be rectified, and Bla relationship with healthcare systems and definition of health must be considered The rise of the professionalization of medicine has led to a continual decrease in Black abuse Due to a long history of medical abuse in the Black community Black women and men have developed resentment and mistrust of health care workers ( Musa, Harris, & Thomas, 2009) In a study by Musa, Harris, and informal health information sources than did w Musa, Harris, and Thomas 2009) These poor relationships only widen the health care gap in the U.S. For physicians and researchers to create culturally competent and sensitive environments and interventions there must be both a and current exploitation in the Black community. The purpose of this pap told and prioritized by breathing life into the stories of Black elders, rethinking what Black current po sition in society. As a Black woman, I know what it means to grow up with the cultural knowledge of medical oppression and exploitation. When I first arrived at college, I enrolled in a Health Disparities course. During the first day of class, my professor reviewed common health to myself, I perceived my thought as a simple snarky

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5 a valid response base d on my cultural experience. Throughout college numerous instance continued to remind me of the significance of my cultural history. During my sophomore year I shared information I learned concerning the untested Ebola vaccinations distributed in Sierra Leone with my eighty year old grandmother. I remember, before I could conclude the story, my grandmother interrupted with a stern warnin aspir ations as a researcher. I chose to write this paper to honor my experience as a Black woman and honor the Black women who have come before me through the art of story telling. I have chosen to write this paper honoring Black Feminist Scholarship and s cholars (e.g., Collins, Bowleg, and Crenshaw), by using the literature and drawing upon qualitative inte rviews to complement this paper I conducted three semi structured interviews with three women over the age of 80. I used their narrative s to inform my arguments below. A traditional, empirical social science format would not allow for the intentional interweaving of past and present, nor the significance of cultural memories to be explicitly created through the back and forth of int erviews and references to medical history. A marching through time approach was chosen for this paper because it honors the power of stories and validates it as a source of knowledge and scholarship In this paper, I will health experiences from the Middle Passage and slavery and compare how these experiences may have affected the perceptions and attitudes

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6 towards physicians, and healthcare of Black women today. I utilize h istory and storytelling to 1930s 1960s through literature and semi formal interviews to validate an d call attention to Black have a unique health experience. As such, it should be further studied and recognized as a growing field of study. To Be Black and Woman To be Black and woman is to live in a complex system of political, economic, and social those around her as well as herself. Society relates ce to the existence of others whether it of whites or her children. The Black woman is reduced to fit in to understanding of womanhood and simplified categories that do not adequately depict the wealth of Black womanhood (Crenshaw, 1991 ) To understand Black wom e s one must recognize her intersectional experience as both Black and woman sexualized, and classed According to Kimberle compounded effects of naming and contending with oppressions linked to one's multiple identities [and] ; 1246 ). Black women occupy a unique position in society, T hey experience both gender class, and racial and it is essential to recognize these realities health providers seek to treat their bodies and mental health,

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7 Health providers understanding and acknowledging intersectional experiences and identities allows for the rectification of systematic discrimination and the improvement of h 12). We all have intersectional including ethnicity, sexuality, socio economic status, and ability. Recognizing the complexity of the human experience, of not being solely white and ma le, and valuing these complexities and differences are to the benefit of the medical establishment and ultimately improve the U.S. health care model. systems of priv 2012). Figure 1, depicts the intersectional space Black women occupy. Black women live in a unique space where they must battle with being both a racial and gender minority. Many studi es attempt to group women and Blacks as a monolithic group without mention of how one can be both Black and woman. To be Black and woman in the United States is to not be real

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8 Figure 1 Living between oppressed identities Black wom e n become displaced in the U.S consciousness. They become unreal. Black women are expected to be strong but not too strong, motherly but not too sensitive, sexual but not hypersexual. These unrealistic expectations and stereotypes are constantly reinforced by media, language, and social behavior. These expectations have been adopted within the schema of the U.S. In this schema Black women only exist within the roles of the Jezebel, Mamm y, and Mule (Collins, 2002). These images of the Black woman in U.S ideology are problematic and diminish culture. When Black women are depicted in a positive light, they are often deemed as highly resilient figures, but this image also silences the emotions of Black women and expects them to deal with whatever hardships may occur instead of critiquing and altering systems that create these barriers The strong Black woman figure is a tool used to perpetuate oppression and to justify blaming those who are not To be a strong Black woman is not to be entirely free to feel and express all human emotion. To be a Black woman is to not be human but an image forever evolving in the Western Gaze. According to Western thought, to be women is to be and to be Black is to be male, but where do these strict lines leave Black women? Black women are certainly not white. Their skin, experiences, and culture are unlike the white woman nor will they ever be. Like white women Black women are susceptible to sexual violence, low wages compared to men, economic dependence, and silencing. White women and Black women do share some common gender realities, but they are manifested in different ways. Furthermore, although Black men and women undergo racial oppression, their experiences diff er. Black women do not only live amongst white

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9 patriarchy but Black patriarchy. Black women are often spoken of in relation to others but not as a subject in their own right. Black women are consistently juxtaposed to the experiences of others, thus m aking them the object rather than the subject. Objectification is the result of binary thinking. Collins defines thinking include white/black, black/female subject/object/ mind/body. These binary examples are only related because they are oppositional of one another (Collins, 2002). With this Western framework of thinking there is no middle group nor room for inter pretation. If Black and white are opposites and so are male/female where do Black women fit? This thinking excludes Black women. As a result, Black women have been ignored in media, in social service initiatives, research, and in health care. In order to dispel the myths of the Black woman, it is essential to have holistic depictions of their lives, feelings, and reflections. Semi structured interviews were used in this study to encourage these holistic images Knowledg e and the Spoken Word In this study, s emi structured interviews were utilized to collect data in a culturally sensitive and competent manner, encourage story telling from participants, and pay homage to the African tradition of storytelling. in the African American community storytelling is a recognized knowledge form This oral tradition can be traced back to Africa where the most respected person in society was the person who kept t heir sacred stories (Banks Wallace, 2002). Storytelling is not only a culturally relevant way to conduct research with elderly Black women, but also a culturally sensitive research and oppression are routine parts of life for multitudes of African Americans. The sharing of stories provides a means for women to

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10 Wallace, 2002). Storytelling i s used as a form of knowledge sharing and healing in the Black community. Story telling was promoted through open sick and/or hurt who took care of you? Can you tell me about a time this person/ people too k ended questions allowed for participants to share multiple stories and created necessary space for participants to have full control over their responses versus an answer led question. The significance of this p aper is not solely the women who volunteered to share their lives with me, but the awakening and sharing of cultural memories. Interviews were used as a research method because there is power in the voice and the women who participated represent Black wom en throughout history who were never given a platform to share or have power over their health story. The interviewees participation allowed for us to bring to life silenced voices which is what Grace Hong refers to as bring [ing] out [our] dead (2008). is to remember what must be forgotten, to a fallacy, that life is not protected if you are raced and gendere d, and that you are raced and gendered if your life is not protected (2008). The mission of this project is to breathe life into the voices of Black women who have been and continue to be silenced and overlooked in the U.S. Black Women and the W estern Gaze: Creating the Premises of Exploitation The manifestation of mistrust of health professionals by the Black community has its beginnings in the Transatlantic Slave Trade. African

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11 vastly different African women were not only judged for their skin color but their sex as well. During the Middle Passage, African men were shackled at the bottom of slave ships, but African women were not, instead they were permitted to roam o n the quarterdeck. Having African women roam on the deck made them easily accessible to the criminal whims them (White 1999, p. 63). Black women were victims o f rape while traveling to the colonies and their children were forced to watch this take place before their eyes. The exploitation of their labor and bodies began before they ever reached land. During the late 1700s to early1800s scientists and health providers played a major role in the justification of the institutionalization of slavery. Duri ng the Enlightenment, scientists were inspired by taxonomy systems and Charles Darwin s Origins of the Species which sought to classify the world (Schiebinger, 1990) Scientists and theorists were classifying plants, animals, Christian entities, and men. Racial scientists used this same classification system in order to justified slavery by deeming Black individuals as incompetent and less than human. Anthropology and racial science viewed Bla ck women as incompetent, feeble minded, and at the very bottom of the racial hierarchy (Schiebinger 1990). Racial taxonomies created the blueprint for the justification of geno cide and enslavement. Racial theory was, and continues to be, the foundation of racist ideologies and was further employed by slave physicians. Black After the international slave trade ended in 1807, physicians began to play a major role on Southern plantations. The United States Southern economy was significan tly dependent on slave labor, so once the transatlantic slave trade ended slaveholders became hyperfocused on

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12 rtz, 2006). As white slaveholders began to own more land, they needed more laborers and the only way they could do so was through natural increase. Slaveholders began pressuring women to have more children closer together, thus using their bodies as means of mass production. Slaveholders denied Black women bodily autonomy and most importantly their health. Maternal and infant mortality rates were extremely high among slave women, and many slaveholders believed Black women were aborting babies on purpose ( Schwartz 2006). This argument further perpetuated the image of the animalistic Black woma n and became yet another rationalization for their enslavement. High rates of maternal and infant mortality, were damaging to the business of the South, for if there were no healthy children being born amongst slaves there was no stead y supply of new workers. Slave owners were frustrated. Eventually, th and ensure they were healthy enough so they would not lose profit. Physicians were not visiting plantations in the name of medicine, nor were slaveholders calling upon physicians for the wellbeing of their slaves but to maximize profit. How physic ians treated slaves were under the discretion of the slaveholder. When slaveholders called physicians to determine why maternal and infant mortality rates were so high among their slaves, physicians would exclude the clear relation of extensive labor durin g pregnancy, poor housing, and malnutrition to their poor health outcomes (Schwartz, 2006). Black slave women were living in harsh environments while completing extensive labor. Giving birth was a health risk and having babies back to back did not improve their health status. They wanted control of their lives and bodies. While sl aveholders and physicians were attempting to increase fertility among Black women, Black women were pursuing control of their health through birth control methods

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13 Physicians on ly treated slaves for profit, and slaveholders only began offering health care to ensure a healthy labor force, and what slave women wanted was of no concern to either party. What Black slave women actually wanted was intervals between pregnancy suffic ient for ensuring that mother and infant were both healthy (Schwartz, 2006). Differing goals and approaches created tension between medical men and enslaved women, each of whom thought ient wanted was not the concern to the physician, for they did not treat the body but served whom provided monetary perhaps most notably by J. Marion Sims. The field of Gynecology early beginnings was forged on the slave population during the development of a surgical repair of vesicovaginal fistulas by J. Marion Sims. From 1845 to 1849, Sims conducted experiments on numerous slave women, and even purchased slaves for the solely for experimentation, but the three most notable women were Anarcha, Betsey, and Luc y (Schwartz, 2006). Sims experimented on his participants without anes thesia, thus exposing the slave go al of operating on white women for profit Once Sims discovered how to repair the fistulas, using Black women as his testing subjects he lied claiming he conducted his experiments on not do so if it was common knowledge although he used anesthesia when operating on white women and not on Black women Sims was only one of many the benefited from the pain of Black women (Schwartz, 2006). White males and white medical professionals and researchers continuously used Black women for their personal gain, dismissing Black women as human beings and th eir right to their

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14 own bodies. Serving as a plantation physician was main source income such as Sims during the time Many physicians were acting upon their personal will not according to the will of the patient. The patients, enslaved women, were ignored and their bodies surrendered in the sake of science and the institution of slavery. This cruelty exerted a gainst Black women has led to Black women not trusting the intentions of medical professionals and researchers. Ethics in the 20 th Century The U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee, commonly known as the Tuskegee Syphilis Study is considered the hallmark event that led to the distrust between Blacks and medical professionals. The study took place from 1932 to 1972, and 399 Black men were denied effective treatment for their syphilis and were not made aware of their status (Gamble 1997). The purpose of the study was to evaluate the long term effects of syphilis on African American males. As a result of the study, over 100 men died from advance d syphilis legions (Gamble, 1997). The medical abuse case captured public at tention when Jean Heller of the Associated Press reported the story in an article for the Washington Star on July 25, 1972. Her article quickly reached the African American community and created a critical dialogue ing Black bodies (McCallum et al., 2006). Although the Tuskegee Syphilis Study did not focus on Black women, it is a notable event in medical history, because it is continuously referred to by researchers, the African American community, and pu blic health professionals. Although Black women were not the subjects of the study, there were still affected. Participants in the study were not made aware they could spread the life threatening disease to their sexual partners, nor how syphilis could affect an infected s lost economic security due to their death or the death of their partner whom they may have infected. The effects of the study

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15 are both personal and cultural. The Tuskegee Syphilis Study continues to live on in the memories of African Americans. Eighty six years later, the Tuskegee Syphilis Study continues to impact communities. The Tuskegee Syphilis study although a terrible act, is often mis interpreted due to word of mouth and a cultural memory of numerous poor bioethics and cruel experimentation throughout the 19th and 20 th centuries. Birth Control, Black Power, and Eugenics Throughout history, racists and patriarchal powers have attempted to control African slavery, but within national initiatives, second wave feminism, medicine, and t heir communities well into today. In the late 19th century, the eugenic s movement, inspired by Darwinism, gained momentum and sought to limit the reproduction of non whites to ensure the continuation of the white race. During the Progressive Era, Soci al Darwinism swept across the nation popularizing the belief that personality traits are genetic. Progressivists believed that the genetically unfit should not be allowed to reproduce for the sake of improving society. As a result, many began to promote th e procreation of the superior birth control within their communities. Scientists and medical professionals justified the idea of a fit race. The widespread belief was non whites were wild, unintelligent, and incapable of caring for themselves. Scientists believed these inferior traits and skills were inheritable for the negro, and it eventually sparked the eugenics movements, which resulted in many women of color being sterilized against th eir will or without their knowledge (Roberts, 1999). Many argued that sterilization is an aspect of public health, for it was important to have a fit race for the country to continue to strive. The mission to decrease non white populations was encouraged t hrough the

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16 encouragement of the use of birth control by feminist and federally funded Planned Parenthood (Roberts, 1999). feminism, but this liberation wa s only for white women. The Birth Control Movement began to take height around the time of the eugenics movement in the United States. Simultaneously, choice to or to not bear children. Eugenic beliefs were held by man y Americans that the poor and diseased are not worthy of producing offspring for they will corrupt the stock. The idea did not only include the poor and diseased but Black Americans in general (Roberts, 1999). In the 1970s, birth control was a liberating tool for white women but began a new discourse for Black women in relation to who gets to control and regulate their reproduction Although, birth control presented freedom for some women and even some Black women, it was yet another tool us ed to control Black women White medical professionals, researchers, and scientists were not the only groups who class Black male intellectuals called for Black upper c lass women to cease utilizing birth control at high rates. These upper class intellectuals and religious leaders believed upper possess the skills needed to survive in a racist society and if they did not procreate the A frican American population would be of lesser quality (Hart 1994). This idea is an extension of the same racial science that believed personality traits and ability were genetic. Black intellectuals believed wealthy Black families possessed satisfactory tr aits of perseverance and knowledge that needed to be spread throughout the race so that they could initiate a racial uplifting. eologies, and actions that make the exploitation and silencing

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17 and exploit Black people during slavery and continue to use to oppress marginalized group in and outside the U.S (Lorde, 2012). Black men have used, and continue to use, the same ideologies or tools, lands and bodies The belief that Black women should have numerous offspring continued well into the century with the Black Panther Party. In the 1960s and 1970s, the Black Panther Party and other Black Nationalists sought to improve the living conditions, health, and social capital of Black Americans. They supplied lunches to impoverished children and offered health care to the poor (Nelson, 2003). While the onstraining. According to the movement was to bear multiple children (Nelson, 2003). Black Nationalists believed it was children and overshadowed their work. These Black nationals also pressured Black women not to accept birth control and to continue to bear children despite their desires. This reliance o n women for a sustainable labor force during slavery. The only difference between the two dependencies is one is controlled by white men and the other by Black men, but both employ autonomy. In an effort to break their shackles, men of the Black Panther Party and Nationalist movem ent exploit ed and silence d Black women.

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18 Although, Black women were submerged in a world of ideas of what they should do with their bodies they persisted and called for their own requirements to be met. Black women fought to be included in dis cussions surrounding abortion and birth control rights, arguing for white women to consider the social determinants that may lead a Black woman to desire to end a pregnancy, such as lack of social services and unequal pay (Nelson, 2003). Black women were f ar from silent despite racist and sexist forces. They continued to progress in order to care for their communities, children, and themselves. Since the 1700s Black women have been the target of Western misogyny and exploitive health professional but they s ought to revolutionize the system. Black Women in Medicine Black women were not always at the mercy of medical exploitation but the trailblazers, caregivers, and voluntaries of medical systems and services. Throughout U.S. history, they have served as healers, caretakers, nurses, physicians, community health workers, and more. Black health care began as soon as they arrived on American soil. During early slavery, the institution of medicine was not established, and Western medicine was not well developed. West African traditional medicine was more effective than U.S. medicine. Black medicine women were sought out by her fellow slaves, slaveholders, and the broader community. They possessed much power as hea ler s In the context of ineffective Western medicine, Black medicine women possessed social capital This power was a threat to the racial taxonomies and the slave plantation hierarchal system. Slaveholders would control who and when she would heal t o limit the social capital she may gain from healing, ( Fett 2002 ) After emancipation, white health professions refused to treat Black bodies. Their lives were considered not important. Racial animosit y reduced the number of white physicians willing to

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19 see black patients. Once gaining freedom, Black people had no place to go for medical care, for hospital and clinic staff risked alienating white clients by opening their doors to Blacks (Schwartz, 2006, p institutions willing to 1995, p.17 18). Black women continued to provide and advocate for health care for their communities after emancipation through nursing and lay health work despite pushback. Before nurse registration laws, B lack nurses were active participants of nursing associations along with white women; lay providers were even welcomed in associations such as the National Organization f o r Public Health Nursing (Hine, 1989 ). Black nurses supported the effort to establish nursing as a regulated profession, not knowing they would be cast aside based on their skin color (Hine, 1989). Medicine restricted its opportunities to Blacks by elevati ng their standards for education and requiring permits in order to practice when many Black women were not educated and could not afford the permit fine. In Southern states where nursing permits were available, Black nurses were barred from taking registra tion exams or administered a separate examination, despite their demand to receive the same exam white nurses received (Hine 1989 ). Black nurses were thought to be incompetent and less qualified compared to white nurses. These racist ideologies diminished them appear as inferior members of the profession, thus an inferior hire (Hine 93). Despite many obstacles, Black women did not allow for discrimination to discourage their efforts. Along with Black community, these women formed their own associations and organizations in addition to schools to continue their mission.

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20 With the poor health status of the B lack community and the mass discriminat ion of the medical profession, B lack women managed to exert control o health. nursing schools of their own, such as Spellman College. In addition, Black nurses went on to found the National Association of Colored Graduate Nurses and the Blue Circle for Negro Relief Hine, (1989) ; ( 94&108). Like other associations, the NACGN also took measures to professionalize their field by urging 1989 ). These nurse training programs provided B lack women an opportunity to gain financial independence, education, and further professional possibilities for their children. For nursing was viewed as a form of self help for African Americans and many argued that B lack nurses w ere essential to racial uplift. The Black community was used to assisting one another in order to endure the harsh natural reaction to the dire health conditions being experienced ( Schwartz 2006; Smith 1995 ). Black nurses were far form the only group of women who made sustai nable contributions to improve the health status of African American s: so were Black community clubs, lay health providers, and community member s The Mississippi Health project is a notable example of In 1935 the Mississippi Health Project was developed, facilitated, and partly funded by the first Black Greek lettered sorority, Alpha Kappa Alpha Sorority Incorporated (AKA). The Mississippi offered alterative health services to African American sharecroppers and children in Holms County, Mississippi (Carlton LaNey, 1997). During the period, Mississippi was suffering

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21 from significant rates of preventive care and medical assistance to the area as possible. All doctors, nurses, and other staff were volunteers, and the sorority women would volunteer their time to drive up Mississi ppi to open the clinic. Clinic would sometime s be hosted out churches and old hospitals and other a venues (Cobbs, 1941 ). Eventually the Mississippi Health Project attained funding from th e United States Health Service to target smallpox and diphtheria am ong children and syphilis among adults (Cobbs, 1941). From the summer of 1 935 to 1942 AKA and the Mississippi Health Project managed to serve over 15,000 patients (Cobbs, 1941). This substantial impact was possible because of volunteerism. The Mississippi Health Project is one example of how Black women have worked to improve the lives of the Black community through grassroots activism Community work has been essential in opening doors for Black women to practice professionally and improvin g the health status of the Black community. Today, there is a growing number of Black women in medicine but Black women remain underrepresented compared to the percentage of the general population According to the Association of American Medical Colleges ( AAMC ) Blacks comprise of 4 % of the physician workforce in the United States. Among Black or African Americans physicians, 55% are women and are the only racial or ethnic group currently comprising a greater percentage of women than men. This difference is even more apparent among medical school applicants where women comprise roughly two thirds of black or African Res earchers have found that diversifying the healthcare workforce will help narrow the healthcare gap among racial minorities (Cohen, Gabriel, & Terrell, 2002). As a result, it has revolutionized the health care model. Researchers argue that adding more health care workers of

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22 color healthcare personal will be able to better identify and offer culturally competently and culturally sensitive care to their patients ( Betancourt, Green, Carrillo, & Park, 2005) T here continues to be a shortage of Black physicians and culturally sensitive physicians overall, states and health programming are employing community health workers. The use of community health workers can be seen in hospitals, clinics, and churches. What is problematic about this work is that Black women are once again responsible for the health of others as well as herself, low pay, and a lack of job and salary growth. Black women are being utilized to bridge health gaps health professionals and systems have created. Black women talents continue to be overlooked and exploited in order to do the work of a capitalistic system, the U.S health care system. Method s This project was approved by the University of Florida Institutional Review Board in April 2018. For participants to enroll in the study, they were required to be at least 60 years of during their lifetime. Participants were recruited through snow ball sampling from a pool of Black elder women who all knew each other from church and neighborhood networks and were acquaintances of my grandmother. The three participants were all 80 years old or older and grew up in working class families in the Southe rn United States. Interviews were conducted either in person or via phone and lasted an average of 56 minutes, with a range of 39 to 82 minutes. All interviews were recorded, transcribed, and analyzed to identify themes. The information below has been altered to protect the identities and health information of our participants. The Interviews

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23 Participant #1: Angela Roberson Angela Roberson is an 89 year old Words with Friends enthusiast with nine children 20 grandchildren, 44 great grandchildren, and ten great great grandchildren. Roberson was born in rural Georgia and was delivered and raised mo ther by her grandmother. Roberson mother passed when she was twelve years old, so her grandmother was her caretaker when she had minute illnesses. He r grandmother would give her remedies, but she never went to see a primary care doctor at the time. When asked about going to the doctor when she was a child Roberson replied that no one went t o the doctor as a child during those times. Roberson first he alth experience was going to the eye doctor. Roberson described the experience as pretty normal consisted of four seats for Black patients as white patients waited in the large waiting room Wh en asked how this clear racial divide made her feel hard headed and tal ked too much and would do what [she] want t eye doctor visit she grew thirsty, but there was no Black water fountain in the waiting room. With her daring spirit but knowing better than to drink directly from the water fountain, Roberson disobeyed her not to get up a nd proceeded to fill her soda can from the whites only water fountain. While filling her soda can with water, the nurse caught her and was frazzled at the sight above. The nurse urged Roberson to stop, but she did not care and s and went back to the Black sitting ar ea. caretaker with the support of her aunt until she married.

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24 Roberson married at the age of 15. According to Roberson, back then people did not marry just to marry but t he purpose of a wife was to take a child every year from most of her children in the hospital, except for her fifth child. Roberson had her fifth child at home with the assistance of a nurse aid. Roberson would have preferred to have her fifth child in the hospital, for women would stay in the hospital for a wee k and would have health personnel to help mom and baby. Unfortunately, Roberson could not leave her four children, who were all under the age of four, at home. Someone needed to care for them, so Roberson settled with a homebirth and assisted b y a nurse midwife. Roberson birthed children from age 17 to 26, which made her Black male doctor worried. When became Roberson had immense pride in her many children and enjoyed raising them, but her doctor believed her body was strained and would not stop having children unless there was an intervention. Roberson Black male physician wanted to have her tubes tied, but in order to do so he had to request s permission was necessary, she replied she did not know why and do not only consist of her large family. Having returned to the hospital every year for check ups and delivery, she got to know the nurses and hospital staff well and was inspired to pursue nursing. Since Roberson married at the age of 15, she did not finish grade school so a t the age of 28, when her children were more independent she attained her GED and later progressed to an all Black nursing school in 1964.

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25 Roberson enrolled in a n all Black LPN school in 1964. White nursing students and Black nursing students went to nursing school on opposite sides of town. Roberson began her early nursing program was integrated. Rob erson began her work as a nurse in a segregated health care model ; feel like all patients were treated fairly (at the hospital) personal work rather than the institutional work. After working at the hosp ital for a short period, until she could not be legally promoted anymore because she did not have a college degree. The hospital was willing to send Roberson to college, but she declined the offer stating that she was not far from retiring. ook care of my mama when she wa Until this day Roberson is stopped and thanked by her patients and the children of her patients. One day, she even received a letter from a young woman thanking her for caring for her mother when she was deathly ill. Participant #2 : Patricia Edwards Patricia Edwards is an 81 year old happily divorced woman who lives in a highly decorated African esthetic home. Edwards was born in rural Florida to a working class family, where her father was a chauffeur, and her mother was a domestic worker. She was ra ised by her

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26 me so many When Edwards condition required more than to the local pharmacist. During her childhood, people did not go to the doctor but would go to the local pharmacist and tell him what was wrong, and he would sell the customer a medication to treat the condition. Overall, Edwards had a simple childhood and jumped at the first opportunity to leave the state and live wit h her Aunt at the age of 18. In New York, Edwards married and had two daughters with her then husband. She was pretty progressive in raising her children especially since she did not talk to her friends about A lthough she denied utilizing any clinical resources at Planned Parenthood, Edwards collected their educational materials for her two daughters when they were 15 and 16. Edwards did not see anything wrong with women going to Planned Parenthood and believes the institution was a great community resource. Edwards did not have a very medicalized childhood or young adulthood but she was she believed to be an experimen t station in her hometown. Edwards believed that the medical center across from the main hospital was referring Black patients there for research purposes. According to Edwards, the hospital assumed all Black patients who came into the Emergency Room were suffering from syphilis, thus they were misdiagnosing them. She believed the mysterious building was a research hub and fueled by the ER patients from the main hospital. This experiment station alludes to those associated with Tuskegee Syphilis Study. Participant #3 Barbara Allen:

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27 Barbara Allen is an 80 year old woman who enjoys her neighborhood walks, attending church, and spending time on her porch. Allen was born in urban Florida to a mother and father who spent most of their lives in rural Georgia. Allen described her childhood as not deviating from the normal Black childhood of the time. She grew up in a poor family, but in her opinion, [they] were happy. re of Like Edwards, Allen did not go to the doctor when ill but relied on the local pharmacist. When the pharmacist was not available or not sufficient for the illness there was a community physician who would visit your home named dr. Washington. Like the pharmacist, Dr. Washington the affordable white doctor, but he would mostly deliver babies, but he would do almost the pharmacist, possibly because the condition required additional care, the y would contact Dr. Washington Allen even saw Dr. Washington in her 20s during her first trimester with her oldest child Allen does not remember being n otably ill that she neede d long term care from a healthy provider, but she does remember the healthcare the cou nty and schoolboard offered to grade school children. Nurses would visit schools to vaccinate children. Allen vividly remembers her Measles vaccination that was inse rted in her back. Allen attributes this vaccination to her positive tuberculosis (TB) test results ; she cannot take a standard TB test because she always tests positive. Instead, she has to have an X ray conducted. Allen believes she was given a live

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28 versi on of Measles during her vaccination as a child, so she now has false positive TB tests. In addition, Allen suspect that her and other students were used for research when receiving vaccinations reach down and pull that fishbone ou The fish bone incident time receiving care from a physician. r health experiences as a young woman were mostly during the birth of her three children. Allen second child was born with extreme scoliosis but denied swift medical interfere because she doctors did not know what they were doing for them to touch her week old son. When I asked if she would have done it today, she said she would do it today because she thinks doctors now know what they are doing unlike back then. Allen truly did not think doctors were as efficient and knowledgeable in the 1960s as they are today. use to bringing my children home ya know She believed her use of birth control as a young woman resulted in her miscarrying at six months with her t hird child from heart problems and two types of cancer. As the sole caretaker of her husband, she spent a lot of her time in and out of doctor appointments and emergency rooms, Allen tracked complicated treatment regimens and helped her disabled husband bathe and dress,

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29 Since her husband was physically impaired, she would spend the day before his doctor appointment and the doctor woul d only spend 15 m With numerous doctor appointments for herself and her husband, Allen grew tired o f the rush of the doctor office and the n pushed against their requests to blindly oblige to their requests without explanation. like how doctors forcefully push pills and give it to y a I think they are doing trials on you ya know At the conclusion of the interview, I asked Allen tangible ways her health experience may be improved: Interviewer: Would you prefer your doctor to be a Black woman? Allen: Yes, white. At this age in my life, I would love to have a Black female doctor. She would be up Interviewer: What do you wish doctors and other health professionals knew about women?

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30 Interviewer: What d o you wish your doctor and other health professionals knew about you specifically? want for their mother, daughter, or wife. Not because I am Black or nothing like that I Results/Analysis The participants were born in the 1920s and 30s in the South. They had similar experiences with physicians growing up. Going to see the doctor was not a common occurrence, nor was it an option unless it was because the doctor was expensive -it was on ly two or three dollars -but the doctor need ed E ither your mom, grandmother, or pharmacist knew what to do. The ir childhood was not medicalized but filled with folk remedies and loving women would nurse them back to health The participants all touched upon racial segregation in different ways alluding to the culture of the time and its normalization. While race was mentioned in all interviews, only one 1950 1960s South Throughout than you [ points at me during the interview ] [ me ] a seat in the white section of the train but once the conductor saw her grandmother her proximity to whiteness w as reduce d Roberson is a light skinned Black woman with fine curly hair. She never attributed her privilege to her skin color or curly hair. Roberson compared her skin color to

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31 other nurses but attributed their anger to her promotion to jealousy. There is no doubt, Roberson was a force to be reckoned with, but colorism seemed to be an overarching theme of her interview, unlike other participants. Roberson ignoring her color privilege is an example of the highly complex intersectional space Black women navi gate, and how they too may be unaware of their privilege. All three participants perceptions of medicine differed depending on their background. Unlike Edwards and Allen, Roberson did not demonstrate any extreme disappointment or skepticism of the he alth care system. This may be because she was once part of this healthcare system and understand its culture that celebrate efficiency and meeting the bottom line. Anderson was familiar with the tools healthcare models employ, so she was not questioning of it even in here current medical care. Edwards was not extremely skeptical of medicine, except for the possible experiment hub. Allen was the most skeptical of health among the participants. Interestingly, all participants were affiliated with the same hea lth system and had differing interviews and opinions on their care. In comparison to other participants, Allen had a very medicalized life. She gave birth three times in the hospital, suffered a miscarriage, fant, and was a care taker for her husband and brother for numerous years. Both Roberson and Allen saw medicine step in with the future of their children Roberson was told she is going be sterilized although her doctor never asked her if this is she wanted but Roberson says she wanted it and when the doctor had stated she was going to be sterilized she agreed. stop having children. He may ha ve seen the stress her body was having, but it is odd that a doctor

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32 wishes After Allen birthed her first son she stated that doctors wanted to operate as soon as she said. Allen stillbirth was a traumatic experience and she was anxious that her pain would be profited from history of putting Black bodies on display and using Black people for the advancement of medical research. Allen did not want her child to be part of this narrative Although Allen is critical of health workers she says she trusts researcher s for she believes one day they would find a cure to an array of disease s The contingency to this statement could be that she does not intend to be part of that process, for research only hurts incorrect. Allen is reluctant to trust the pills her doctors attempt to give her. Currently, pharmacy compan ies have a major monopoly in overprescribing numerous drugs to the public and having some physicians push patients drugs they may not need. Allen even mentioned how doctors would not offer h er alternatives until she refused the first medication. One of the most significant findings was that the participants did not prefer for their physician to be a certain race necessarily, but they just wanted them to treat them correctly. All three partici pants complained about the short time doctors spend with them and the impersonal relationships they have with their current physicians. They feel like a number rather than cared for. Allen did prefer a woman over a physician who is a man. She believed a wo man would

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33 understand her more because she had been through the same things. As women, they would share a similar cultural memory. The critiques given concerning their current medical and health care are common critiques of the fast paced U.S. health care system. All participants mentioned how impersonal health professionals are, except for Roberson, this perception may be based on the comparisons of their past care givers. Growing up, these women had their mothers and grandmothers caring for them, an e asy to access pharmacist to prescribe, and figures such as Dr. Washington who was Medical care was simple. Edward s mentioned how now there is a provide an example of the increased that going to see the doctor was not common nor was it an option at most times. Now in their old age they find themselves going to numerous specialist s who rush and do not take the time to care for them as a person. Some mistrust may be amended if physicians effectively with their patients. Physicians are not sharing what they are doing with their patient s bodies and for Black women, and for many, that can result in anxiety and treatment non compliance. This neglect of the human behind the patient could be due to the pressures of the capitalistic U.S healthcare model but also stereotypes the physician may have about the patient. Allen noted how she was not told of the side effects of her medications or alternatives until she or may not be able to afford non Medic aid covered medications. Physicians are not sharing what anxiety and treatment non compliance.

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34 Black Lives Matter and Black Mamas Matter Too Black women have created avenues and spaces to address health in a holistic way that Guide to Physical Health and Emotional Well address their needs. Today, Black women are demanding for their needs to be heard and Matter Alliance Modern day social movement challenge what is hea lth and how health is proclaimed and pursued among the Black population and, more specifically, Black women. Black Lives Matter (BLM) is a social movement created by three Black women to address police violence against Black bodies and Black neighborhoods #BlackLivesMatter was Matter is an ideological and political intervention in a world where Black lives are systematically and intentionally targeted for demise Matter). condition Mass incarceration and police violence is an epidemic in the Black commun ity. Roberson has a son who has served 20 years in state prison for the murder of a rich white man. He was with the has hired numerous lawyers, each with a higher p rice tag, in order to get him justice but their efforts have failed.

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35 Like BLM, The Black Mothers Matter Alliance (BMMA) is an alliance spearheaded and culture for resources to The BMMA does not seek to gain public support for Black ba bies, for many are able to sympathize with an infant but with the mother. I had the pleasure of sitting in on a BMMA seminar at the Annual Public Health Association Conference. After their presentation, an ot called the Black Mothers and Babies for black women for every 100,000 births there are 14.7 per 100,000 ratio ( Repro ductive Health, 2017 ). This focus on mother is crucial. As stated earlier in this paper, Black women are often other named as wife, mother, caretaker By always relating Black identity to another are never recognized nor prioritized Naming and dedicating oneself to the health and wellbeing of Black women is a political move that may make some uncomfortable. Movements and alliances such as BLM and BMMA, are examples of how Black women continue to work to improve the health of their communities and continue to redefine what healthcare looks like and what health means. Black women understand that their survival extend on their willingness to revolutionize systems and ideologies and strive for political change. Conclusion

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36 Black women live in an intersectional space of both Black and woman, and society has women and Black men. Although Black women experience racial inj ustice and sexism their race and gender significantly alter these realities Since the Transatlantic Slave Trade Black women have been oppressed due to her gender ed and rac ial identities These cultural memories and historical traumas from unethical research, healthcare, and everyday oppression their health is impacted. Health is more than the biological but is the result of cultural and social realities and individual behavior. The consid cultural memories has the ability to narrow the health care gap. In order for medicine to improve they must begin listening to the stories of women such as Roberson, Edwards, and Allen In these stories is a wealth of information pertaining to complex identities complex experiences, and basic tools anyone could incorporate in order to improve patient satisfaction. It is imperative that health care systems, researchers, and physicians consider these pasts as they pursue innovative ways to reduce health disparities among the Black women and the larger Black community. In addition, it is essential for the intersectional experiences of Black women to be highlighted and celebrated. As all patients, Black women should be prioritized in the health model and given room to exercise their understanding and approach to health without being a cost effective scape goat. As initiatives such as Community Health Workers begin to gain momentum researchers and health programs must be cautious of not exploiting the labor of Black women once again. To prevent modern exploitation of Black women in healthcare the stories of Black women need to

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37 be recorded a nd analyzed in order to fully understand how the institution of medicine have developed and to improve health care services and programming for black women. This research validated and promote d non hegemonic knowledge present among Black women. The recodi rights to their voices and bodies, and will serve as an empowering force for Black women generations from now

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