Black Women’s Health: Paths to Wellness for Mothers and Daughters

Book Title: Black Women’s Health: Paths to Wellness for Mothers and Daughters

Author: Michele Tracy Berger

Publication Information: New York, New York University Press, 2021, 247 pp., $30.00, paperback

"The US health system is hardly immune to racism, especially within a medical community that disbelieves Black women’s pain and dismisses their experiences with their own bodies.”¹ In contrast Dr Tracy Berger, a scholar of women and gender studies with a PhD in political science, listens intently to Black women in this book. She presents findings from focus groups with 24 matched pairs of African American mothers and daughters ages 12-18 years. The mothers were divided into five groups with their daughters in five parallel groups. Each group met one time for 2-3 hours to discuss health, sexuality, and intimacy.

Dr Berger argues that the health of African American mothers and daughters is linked in that inconsistencies in mothers’ health behaviors and communication create a health barrier for daughters. Intergenerational dialogue is hampered by the contradictory and fragmented messages mothers give about health and sexual intimacy. A second barrier to health is a lack of trust in health care. Mothers and daughters report dissatisfaction with health care particularly when physicians do not listen. As one mother says, “I feel like they’re always rushing… to move on to the next person; not to fully hear your issues” (p. 88). Alarmingly, many daughters describe experiencing a lack of respect by health care professionals. Black female voices are important to attend to in order to improve equity in health care,² and Dr Berger discusses the intersectionality of race, class, and gender in health. Of interest to family physicians is that these mothers’ concerns about discriminatory practices in medicine lessened when they had a long-term relationship with a clinician.

Several topics are raised in the focus groups: how mothers and daughters define and assess their health, reasons for not following through on health goals, and information passed down through generations about health, sex, and wellness. Group discussions also include cultural influences on how girls dress and present themselves, the unfair double standard for males and females regarding sexual behaviors, the pressures to have sex, mothers’ fears of pregnancy for their daughters, and methods of deterring daughters from having sex. Dr Berger notes the absence of any discussion of sexual pleasure in conversations about sex.

One of the major themes in the book is that mothers want to have open and good communication with daughters and believe they provide such when it comes to sexual health. However, daughters do not typically view their mothers’ overtures at communication about sex as helpful and do not confide in their mothers. Daughters want and actively seek out information but often go to others; they do not trust mothers not to lecture or judge them. One teen states: “You can’t ask your parents… if you ask them questions about sex they’ll think you want to go have it” (p 194). This reminds physicians that teens benefit from adults who can talk about weighty topics in a calm manner without judgment.^3,4

Reading this book gives a “fly on the wall” perspective to important conversations. There are numerous quotes throughout the book as Dr Berger analyzes themes, content, and dynamics of each group while searching for overarching themes. The qualitative approach provides an inside look at these topics by voices not often heard. While there is some consensus across groups, Dr Berger also goes into depth about differences between the groups. She labels each group with a certain worldview. Thus, the qualitative data have variability and the reader gets a range of perspectives.

For the reader seeking systematic reviews and metadata, however, this book is a difficult read due to the limitations of these data. The findings are not easily generalizable, and significant conclusions cannot be drawn about the wide variety of topics covered. Furthermore, as a set of case studies this book is also unsatisfying because there are minimal descriptive statistics and little information about the individual participants. While there is a benefit to hearing what these mothers and daughters have to say, the book is somewhat repetitive across chapters and drawn-out for what would be considered a very small set of data in medicine. Due to the small number of participants in each group, the consensus across groups is more thought provoking than the details about specific group dynamics or “worldviews.” This book sets the stage for future research as the conversations offer interesting ideas that need further exploration. Much more data need to be collected before medicine will have specific guidelines for “the paths to wellness for [African-American] mothers and daughters.”