Expectant Fears and Racialized Reproduction: African American Women’s Lived Experiences of Pregnancy and Motherhood Kaaren M. Haldeman A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Anthropology Chapel Hill 2005 Approved by: Kaja Finkler, Chair Michele T. Berger Glenn Hinson Catherine Lutz Karla Slocum 2006 Kaaren M. Haldeman ALL RIGHTS RESERVED ii ABSTRACT KAAREN M. HALDEMAN: Expectant Fears and Racialized Reproduction: African American Women’s Lived Experiences of Pregnancy and Motherhood (Under the direction of Kaja Finkler) This study explores the lived experiences of pregnancy, childbirth and motherhood among African American women living in central North Carolina. Although there are many anthropological studies of reproduction, there is very little in the way of explorations of the lived experiences of pregnancy . This work was conducted between April 2002 and July 2003 with a group of 62 African American women who received prenatal care at a local OB -GYN office founded by two African American physicians and located in central North Carolina. An in -depth analysis of life history interviews with six of these women grounds the final analysis. I have used an overarching theoretical framework that examines pregnancy as a life process and a unique physiological event in order to understand the full range of life experiences that can come to bear on a woman’s pregnancy. I have combined phenomenological understandings of perception and embodiment to explore the intersections of social, cultural and existential lif e in the contexts of pregnancy and motherhood. The women in this study have pointed to experiences of pregnancy that include experiencing pregnancy as fear of bearing a son and have developed a new way of understanding class experience in the context of a lived pregnancy. This study has pointed to experiences in African American women’s lives that are positively , negatively, or neutrally felt that inform how they live their pregnancies. Those negatively felt experiences and perceptions that are related to being a pregnant African American woman emerged out of lived experiences in a iii racist U.S. culture whose histories, practices and ideologies of exclusion are still based on skin color. This work is informed by a Black Feminist perspective in which the re searcher is compelled to engage in a “critical radical praxis” to effect change in African American women’s lives. The goal of my research has been to provide information about those lived experiences of pregnancy in the lives of African American women tha t may help to address persistent and glaring inequalities in health. iv To My Loves Gavin, Egan and Jameson And In Memory of Ira Brooks Walsh v ACKNOWLEDGEMENTS This work was supported in part by a National Science Foundation Fel lowship that aided in its timely completion. I would first like to thank the women who participated in this study, my consultants and friends, who have shared and entrusted me with their deepest and often painful experiences and who invited me into their families to share their joys. Thanks especially to Helene, Zakiyyah, Eva and Tisha for our continuing friendships and your thoughtful reflections on this work. Thanks to the local OB -GYN practice for permitting me to conduct the research amidst a busy work atmosphere and for sharing with me their visions of health for all women. I am also very grateful to Ms. Betty Summers, whose thorough transcription of life histories helped move this project along. There are so many people who have helped inform my work and intellectual development over the last several years. I owe many thanks to my mentor and long -time friend Kay Lund for all of her guidance in career and life. I especially wish to thank Kaja Finkler, advisor and friend, for introducing me to the field of Medical Anthropology, for her encouragement in pursuing it as a career, the numerous inspiring discussions we have had over the course of nine years, and for her unending support of this work including her close reading of this dissertation. Thanks to my committee members Glenn Hinson, Karla Slocum, Catherine Lutz and Michele Berger for the many enriching discussions about work, family and the world of ethnography. Thanks especially to Glenn and Catherine for experiential understanding of my life as a mother and for their heartening responses when I became overwhelmed in attempting to balance family vi and academic life. I could not have completed this dissertation without the patchwork of child care -providing friends who have come to my rescue in the last fo ur years, with a special note to Amy Sullivan and Scott Seibel. Thanks Amy, for the invaluable conversations, long walks and your enthusiastic support as friend. Thank you to Nicole Angliker for our friendship and the many discussions and play dates for our kids that saved my sanity over the last few years. I owe an immense debt of gratitude to my mother and father, Marianne and Richard Haldeman, for traveling hundreds of miles so I could sit at my computer in relative peace, for their enduring support and love in all of my life and academic pursuits, and for teaching me that compassion is not bounded by color. Thank you to my sisters and brothers —Kristin, Rik, Lauren, Katrin, Elizabeth, Eddie and James —for your love and for shaping who I am and who I strive to be. A thousand thank yous also to my parents -in -law Peg and Ed O’Hara for their patience, love and support and to Peg for her weekly watching of my boys especially in these last months of writing. To my husband Gavin, I cannot thank you enough for your enduring patience, continuous intellectual engagement, encouragement and love during this long process. I couldn’t have done this without you. Thank you Egan and Jameson—you have been so patient when I “had to do work” instead of playing outside. Finally, I would like to thank my late aunt Ira Brooks Walsh whose very presence in my life helped me to understand my passion for African American culture and my duty to combat those forces that still work to undermine its richness. vii TABLE OF CONTENTS Page List of Tables…………………………………………………………………………………xi Chapter One Introduction……………………………………………………………………………1 Two Review of the Literature…………………………………….……………………….12 Medical Anthropology in Historical Perspective and Anthro pologies of Pregnancy and Reproduction…..…………………...……13 Theoretical Perspectives in Medical Anthropology……………………..………..25 Preterm Labor and Delivery, Low Birthweight and Infant Mortality in Public Health Perspective ……………..………………...36 Gender and Health/ Reproduction…...……………………………………..…….45 African Americana/ Race …………...………………………………….…….…..48 Three Relationships Between African Americans and the Worlds of Biomedicine and U.S. Health Care in Historical Perspective ……………………………………..50 African Conceptualizations of Health, Healing and Illness in the Context of Enslavement and the Politics of African American Vernacular Healing Practices …………………...…………....50 A History of Race and Medicine: Experiences of Enslaved Africans with the World of Biomedicine—Medical Experimentation Part I …………...…55 A History of Race and Medicine: The Relationship Between African Americans and US Health Care 1900 -Present—Medical Experimentation Part II…..………59 Reproductive Health Care………………………………………………………...71 viii Four Methodology……………………………………………………………………...….77 Choice and Establishment of Field Sites…………………………………………77 Recruiting and Profile of Women who Participated……………………………...78 Quantita tive and Descriptive Data Collection……………………………………79 In -depth Interviewing……………………………………………………………..80 Life History Interviews…………………………………………………………...82 Participating and Observing………………………………………………………83 Ethnographic Data Analysis…………………………………………………...…84 Reciprocation and Managing Relationships in the Field…………………………85 Experiencing the Field……………………………………………………………86 A Methodology that “bleeds into daily life”……………………………………...88 Five Ethnographic Place and Oral Histories of an African American OB -GYN Practice………………………………………….….…90 Snapshot of North Carolina—A Brief History and Local Contexts of Fieldwork…...……………………………………….……..…91 Field Settings………..……………………………………………….………….100 Women who Visit this Practice……………………………………………....….103 Profile of Physicians, Staff and Clinic Setting……………………………….….104 Oral Histories of Local Practice…………………………………………….…...115 Six Women Who Participated in this Study………………………………………….....120 Seven Life Histories in Narrative: Foregro unding African American Women’s Voices………………………………………………..134 Helene—A World in Black and White and Fears of Bearing a Boy...…………………………………………………………….…...137 ix Zakiyyah —Emerging from the Flames of Her Own History and Mothering Sick Children ….………………..……………………………..……..155 Sheri —“I’m a different kind of mommy.” —A Story of Motherhood Lost.……..…………………………………..……....172 Tisha—“There’s nothing to me like prayer.”…………...……………………....189 Tania —The Fail ure of Intimacy: Male -Female Relationships and the Dreaded “My baby’s daddy.”………………………………..……..…...205 Eva—“I just wish someone would have told me the whole story.”……...….…..219 Eight Synthesis and Conclusions……………………………………………………….…234 The Concept of Negatively Felt Perceptions and Experiences of Pregnancy…………………………..…………………….……..240 Maintaining Balance: Positively and Neutrally Felt Experiences of Class and Being an African American Woman, and Means of Coping……………………...………………..……………………………..……255 Mapping