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I think one of the things that’s been a problem for me is lack of support, like I have all these skinny friends who don’t exercise, and it’s fine for them, they feel like they don’t need to exercise, which bums me out, but they’re like why are you doing x, y, z? And you know I’m walking there [to the gym] . . . sometimes I’m the only woman of color there, so gosh, thanks, great. So that’s sort of daunting sometimes in the gym, you know, and everybody’s so happy to be there and I’m not really happy. . . . I think I lack the support . . . and people say you should exercise, but that’s not really supportive. I mean it sounds supportive from afar, but it’s really not supportive, sometimes it’s like preachy. You should exercise. I know! Look at me, I know!

—Focus Group–Mothers

When I think of what makes a woman healthy, I think of choices—the choice to be positive, to be in control, the knowledge to sustain your body or at least even the knowledge to know what you should do . . . and some feeling of living in an environment that is safe and comfortable, and free of danger. Because I think there’s health and then there’s existing.

—Focus Group–Mothers

She [my mother] told me that I eat too much and I went to the doctor and [found out that I] . . . gained too much weight. So me and my mom had a conversation about eating healthy, but it didn’t work.

—Focus Group–Daughters

I think health means that I feel happy about myself and I’m satisfied with myself . . . I don’t really think that it’s about how skinny I am or that kind of stuff. ’Cause I may be skinny . . . but I just may not be happy.

—Focus Group–Daughters

For the past decade, I have witnessed and recorded conversations about health and well-being by African American mothers and their daughters. Conversations between mothers were often animated, opinionated, engaging, and thought-provoking. The same was true in observing conversations between the daughters. The quotes above express central tensions and complexities of lived experiences that are often left out of the more common statistical presentations of health for African American women and girls.

Understanding how African American mothers and daughters discuss their health and what emerges from those discussions provides a window into the dynamic interplay between individual decisions and the structural forces that often assume an invisible role in shaping individual choices and preferences. Mothers in my study were asked the question: What is health? In each answer above, we get a glimpse into the individual experience and the possible structural forces that may exist in their lives that perhaps affect their ability to maintain their health (i.e., awareness of being a minority at a local gym, the importance of safety in relation to perceived neighborhood violence).

The last two quotes are from daughters in my study. They responded to the question: What conversations have you had with your mother about health? Analyzing the first response encourages us to be curious about what kind of cultural messages regarding weight and/or ideal body type the daughter may have been exposed to and how that mimics hearing a similar message about weight from her mother. And, we may also be curious about what it means to not get it right when it comes to health. What does healthy eating mean in this context? These are questions that deserve more attention. In the second response from a different focus group, we see that the speaker defines health as something positive and robust. And in thinking about this quote, our curiosity might be drawn to the word “skinny” and the ways that descriptor tells us something about girlhood and cultural norms. Our curiosity might allow us to consider the pointed messages that Black girls encounter regarding weight, how they may be susceptible to certain kinds of messages and may resist them in other instances. As I will discuss below, Black women’s voices are infrequently theoretically centered in health literatures about how they experience and co-create their health, and it is even rarer for Black girls to be considered reliable knowers.

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Medical and popular discourses shape much of what is known about Black women’s and girls’ health status. While African American women and girls show up repeatedly in broad national rankings and risk categories, researchers know little about the varied ways that African American mothers and daughters experience health as individuals or within family units. Moreover, we know even less about the quality and nature of health discussions that take place between African American mothers and daughters or how such discussions can, over time, affect health behaviors and outcomes.

This book evolved out of my experiences leading a team of researchers to explore mother-daughter communication, social support, and HIV risk. I began this work when North Carolina had the distinction of having the highest rate of HIV among southern states. One of the beautiful occurrences in research is when a project shifts in unexpected ways that demand new frameworks, skills, and abilities from the researcher. As the project moved on and deepened, it became less about HIV and more broadly about Black women’s health and mother and daughter communication about health. It became examining the ways in which Black women and girls speak about and conceptualize health and well-being.

Black Women’s Health explores the meaning and practice of health in the lives of African American women and their adolescent daughters. This work is developed through micro-theory that emerges from resonant themes from focus groups. Focus groups provide an organized way for researchers to convene everyday people and engage them in conversations of substance. Themes that I explore from the rich narratives include similarities and differences in external and internal barriers to health for mothers and their daughters, intergenerational legacies of caring, and the use of outdated gendered scripts by mothers in communicating about sexual health.

As I discuss below, this is timely work as both the study of Black women’s and girls’ health is being radically rethought by many scholars, and the public discussion and activism regarding Black women’s and girls’ well-being has become more visible in the last five years. What connects both developments is a call that Black women’s and girls’ complex lived experiences are integrated into research, policymaking, and activist agendas.1

This new direction in research especially constitutes an insurgent intervention because, as a group, African American women’s health has never occupied a privileged place in America’s health-care frameworks. As African-descended people, Black women’s and girls’ health has been shaped by and intertwined with the institution of slavery, Reconstruction, and post–World War II events that have positioned them as chronically and systemically situated low-wage workers and of lower social status than members of dominant communities. As many have documented, health care in the United States was not set up to support the flourishing of Black women and girls, and it continues to perpetuate staggering incompetence in both access and care resulting from the nexus of -isms, including but not limited to racism, sexism, classism, ableism, and heterosexism.2