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Black women’s health does not belong to medicine, nursing or public health. We all have something to contribute to our survival. (Barlow and Dill 2018, 220)

The health realities of African American women and girls are not uplifting ones. By almost every criterion of fitness and mental and physical health, African American women and girls lag behind their white counterparts. African American women and girls experience both high rates of diabetes and low rates of physical exercise. African American women have the highest rates of being diagnosed as either overweight or obese of all groups in the United States: Approximately four out of five African American women are overweight or obese. African American girls are also disproportionately affected by obesity.18 The statistics are startling, as one-quarter of African American girls ages 6–11 are obese (as compared with 14% of white girls) and 25% of African American female adolescents are obese (compared with 15% of white girls).19 These figures reflect the challenging context in which African American girls mature into their own bodies and experience their health choices. They also provide a prism into the multidimensional factors that shape the context for decisions that African American mothers must make on a daily basis. From an intersectional perspective, these statistics reflect the larger landscape of racial and gender health disparities and structural inequalities.

Turning to African American women’s and girls’ sexual health, particularly concerning HIV/AIDS, the statistics are especially alarming. Despite a recent dip in 2010, the overall rates of HIV infection for African American women remain high. African American women account for 64% of new HIV infections among women, even though they constitute just 12% of the female population in the United States. African American girls, like other minority girls, also face high rates of HIV infection. The rates are especially high in the Deep South, which during 2008–2011 had the highest rates of HIV and AIDS diagnosis of any region in the United States. New trends suggest that one-third of all people living with HIV are in the South.20 This disturbing new trend of rising rates of HIV in southern states also underscores long-standing issues of poverty and racial and gendered health disparities.

Much of what we know about Black women’s health has come from academic inquiry, particularly through the fields of public health, social work, nursing, and to a lesser extent, sociology. Typically, much of the scholarship on Black women’s and girls’ health is quantitative, driven by biomedical frames. This scholarship historically tended to ignore context, intersectionality, regional variations, and the importance of intergenerational learning, especially in communities of color. Biomedical studies are unable—or less interested in—unpacking the contexts of domination and subordination in the structural arrangements through which health services are delivered and health is experienced. This work also does not often acknowledge the political contexts that influence how resources are distributed and the stereotypes, representational context, and discursive frames that may also affect how health is delivered.21 Another criticism leveled at standard biomedical frames is that they remain focused primarily on individual behavioral change and are less focused on historical, community, and group experiences that many argue mediate health and reproduce health inequalities.22 African American mothers’ and daughters’ health is not typically discussed or researched in connection to health disparities.

What’s missing when we look only at the numbers? From a numerical perspective, there is a lot to know about the realities of African American women’s and girls’ health. However, from a critical theory, intersectional, and Black feminist approach, there is much to question. Self-identified Black feminist theorists, activists, and journalists have pioneered critical inquiry about African American women’s health over the last three decades when most of academic inquiry ignored Black women’s health.23 Early work sought to identify the legacy of slavery, segregation, sexism, and classism as defining levers of Black women’s experience of health and the legacy of health activism by Black women.24

When we look at Black women’s and girls’ health from only one dimension of analysis, we miss the rich legacy of theorizing that helps to bring about a robust analysis of how discrimination impacts Black women and girls. Black feminist approaches stem from the recognition that African American women experience the world through systemic and interrelated systems of oppression that include racism and sexism. The impact of these markers shapes power relations and creates unique experiences that differ in comparison with African American men or white women. As Patricia Hill Collins has identified, controlling images of African American women are shaped within power relations and have helped to produce the stereotypes of the Hottentot Venus, Jezebel, Mammy, Sapphire, and the more recent “baby mama.”25 There is a rich legacy of Black feminist theorizing that examines how representations of the Black female body, through various discourses, shape lived realities.26 Black women’s bodies have been historically devalued and governed by discourses of the grotesque, deviant, monstrous, disruptive, and masculine, or hypersexualized and subject to experiences of misogynoir.27 This legacy of representation stands in direct contrast to representations of white American women and African American men. These discursive frames of “normalcy” and “dominance” have long perpetuated Black women’s “outsider” and “disabled” status.28 Thus their “disruptive bodies” provide further justification for their devaluation and discrimination.29 Scholars have used the frame of controlling images to examine media portrayals of African American women, perceptions about African American women and entitlement programs, the criminalization of African American women, as a feature of material culture of the antebellum South, and the social organization of motherhood.30 Furthermore, Black feminist theorizing recognizes and seeks to document that African American women have a shared historical reality and thus, “a shared worldview of historical resistance to their own oppression and dehumanization.”31

The dramatic picture of Black women’s and girls’ health calls for new tools, methodologies, and epistemologies beyond traditional approaches used in the applied and natural sciences (i.e., public health, nursing, etc.). Black feminist-driven approaches to health question the very tools and assumptions that have guided inquiry about health.32 Turning to Black feminist epistemologies provides an opportunity to move beyond current tropes (i.e., “the strong Black woman” and hyper-resiliency) and familiar themes that are over-represented in the literature. Using Black feminist approaches, scholars have the opportunity to understand how trauma, resistance, and the legacies of racism and sexism affect Black women’s and girls’ health.

As Jameta Nicole Barlow and LeConté J. Dill note, the study of “Black women’s health has too often been relegated to issues of sexual and reproductive health and chronic health conditions such as mental health, obesity, diabetes, hypertension and breast cancer. Yet our health encompasses so much more.”33 They do not argue that we ignore these overstudied areas and certain empirical findings, but that we advocate for a paradigm shift of what constitutes the study of health and who is qualified and encouraged to speak on it.34 As I discuss in the next section, this movement in academic inquiry dovetails with the revitalization of Black women’s health activism nationally and enriches the conversation. This new work is about grounding and context. Barlow and Dill’s work follows scholars making ongoing recommendations for studies of Black women’s health that employ methodological variety, represent the diversity within African American communities, and conduct research grounded in Black feminist theoretical insights.35 Women’s and gender studies analyses of Black women’s health have more recently focused on reproductive politics and justice as well as on Black women’s health and fitness regimes as part of identity politics and how African American girls navigate sexual scripts.36

My work methodologically and theoretically intervenes in the literature on racial and gender health disparities and moves this work into critical health studies and medical humanities, an interdisciplinary endeavor. This book contributes to conversations across various fields—most notably in sociology, public health, and women’s and gender studies—about African American mothers’ and daughters’ health and sexuality. The majority of health literature on Black women treats the health status of African American girls and women as separate and rarely explores the connections between mother and daughter health.

This research also expands the sociological emphasis on Black families and the interdisciplinary interest in Black sexualities,37 Black Girls’ Studies,38 and scholarly works on African American women’s experiences of sexuality, love, and relationships.39 It also engages intersectional questions about health.40

Discourses about Black women’s and girls’ health and well-being do not exist in a vacuum or solely within the domain of academics. I now turn to how African American women’s and girls’ health has been represented in popular culture during the past decade. I ask: What are the discursive and popular frames that shape African American women’s and girls’ health? There are three areas that are important to consider in framing aspects of Black women’s and girls’ health generally and mother and daughter health more specifically. I will briefly touch on Michelle Obama’s “Let’s Move” campaign (policy), the film Precious, the television shows How to Get Away with Murder and Luke Cage (media), and the activism of #SayHerName and Black Girl Magic interventions (social movements) and their influence in stimulating and shaping debates about race, gender, and health.