Body Size and Social Self-Image among Adolescent AfricanAmer.docx

Body Size and Social Self-Image among Adolescent African
American Girls: The Moderating Influence of Family Racial
Socialization
Ellen M. Granberg,
Department of Sociology & Anthropology 132 Brackett Hall
Clemson University Clemson SC 29634
864-656-3812 [email protected]
Leslie Gordon Simons, and
Department of Child and Family Development 204 403 Sanford
Drive University of Georgia Athens
GA 30602 [email protected]
Ronald L. Simons
Department of Sociology 116 Baldwin Hall University of
Georgia Athens GA 30602 706-542-3232
[email protected]
Abstract
Social psychologists have amassed a large body of work
demonstrating that overweight African
American adolescent girls have generally positive self-images,
particularly when compared with
overweight females from other racial and ethnic groups. Some
scholars have proposed that elements
of African American social experience may contribute to the
maintenance of these positive self-
views. In this paper, we evaluate these arguments using data
drawn from a panel study of socio-
economically diverse African American adolescent girls living
in Iowa and Georgia. We analyze the
relationship between body size and social self-image over three
waves of data, starting when the girls
were 10 years of age and concluding when they were

approximately 14. We find that heavier
respondents hold less positive social self-images but also find
that being raised in a family that
practices racial socialization moderates this relationship.
Keywords
obesity; adolescence; racial socialization
The relationship between body weight and self-image among
African American adolescent
girls has been the topic of considerable study (Ge, Elder,
Regnerus, & Cox, 2001; Lovejoy,
2001; Smolak & Levine, 2001). Overall, the results of this work
show that, while African
American girls are more likely to be overweight than females of
other racial groups, they also
feel good about their bodies and exhibit a relatively weak
association between body size and
outcomes such as self-esteem, self-evaluation, and
psychological health (Berkowitz &
Stunkard, 2002; Neumark-Sztainer, Story, Hannan, & Croll,
2002). These patterns have led
scholars to suggest that elements of African American life may
serve a protective function,
limiting the negative influence of body size on self-image
(Roberts, Cash, Feingold, & Johnson,
2006). In this paper, we explore these arguments by assessing
the association between body
size and social self-image within a sample of adolescent African
American girls. We then
Direct all correspondence to Dr. Ellen Granberg, Department of
Sociology & Anthropology, 132 Brackett Hall, Clemson
University,
Clemson SC 29634 ([email protected])..

NIH Public Access
Author Manuscript
Youth Soc. Author manuscript; available in PMC 2010
December 1.
Published in final edited form as:
Youth Soc. 2009 December 1; 41(2): 256–277.
doi:10.1177/0044118X09338505.
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examine elements of African American social experience that
we hypothesize may be the
source of this protection.
The Meaning of Body Size among Adolescent African American
Girls
Adolescence is a time when the self-concept evolves to more
fully incorporate the world and
its expectations (Rosenberg, 1986). Concerns with popularity,
attractiveness, and social status
rise dramatically as does anxiety about the perceptions and
evaluations of others (Seiffge-
Krenke, 2003). During this developmental phase possessing a
stigmatized physical
characteristic, such as being overweight, can make both self and
social acceptance even more
challenging and contribute to the development of a negative
self-image (French, Story, & Perry,
1995; Phillips & Hill, 1998; Smolak & Levine, 2001).
Given the importance adolescents place on the positive regard
of others as well as the degree
of stigma attached to obesity in the culture at large (Brownell,
Puhl, Schwartz, & Rudd,
2005), it is not surprising that body size influences social self-
images among adolescent girls.
Further, though there is ample evidence suggesting African
American girls are less vulnerable
to these pressures (Hebl & Heatherton, 1998; Nichter, 2000),

this should not be taken to mean
they are immune from the psycho-social impact of weight
stigma or unconcerned about the
aesthetic and health consequences of weight gain (Granberg,
Simons, Gibbons, & Melby,
2008; Siegel, 2002). Rather, the relative protection enjoyed by
African American girls is
detectable primarily because they are so often compared to girls
from other racial groups,
especially Caucasians, where concerns with body size are more
salient (Beauboeuf-Lafontant,
2003). Research focused specifically on African Americans
suggests that while they hold more
moderate attitudes about weight than those found among
European Americans, they still view
obesity as a negative characteristic (Flynn & Fitzgibbon, 1996;
Kumanyika, Wilson, &
Guilford-Davenport, 1993; Paxton, Eisenberg, & Neumark-
Sztainer, 2006). For these reasons,
our expectation is that when heavier adolescent African
American girls are compared with
thinner girls who are also African American, heavier girls will
show a deficit in social self-
image. Also, in line with developmental theories of self and
body image, we expect this
relationship to become stronger as respondents enter mid-
adolescence.
Exploring the Body Size Paradox: Why African American Girls
are Less
Concerned with Weight
While we anticipate that weight will be relevant to the self-
images of adolescent African
American girls, we also propose factors that may contribute to
the differential protection they

enjoy relative to other groups (Ge et al., 2001; Molloy &
Herzberger, 1998). Specifically, we
hypothesize that elements of African American social life
provide resources upon which
African American girls may draw when assessing their physical
size and that, when available,
these resources can buffer the impact of broader social
standards regarding attractive body size.
This, we argue, contributes to the relative protection they
experience when compared to girls
from other racial groups.
Interest in the notion that elements of social experience could
protect the self-esteem of African
American children gained ground with Morris Rosenberg's 1971
study of self-esteem
(Rosenberg & Simmons, 1971). In explaining the finding
(surprising at the time) that black
children did not demonstrate evidence of reduced self-esteem,
Rosenberg and Simmons cited
the effect of what they termed a “consonant social context:” an
environment in which social
feedback and proximal social comparisons emphasize positive
aspects of one's group
membership while limiting exposure to negative aspects (1971).
Among African American
children, they argued, growing in such a context reduced
exposure to bigotry and racial
Granberg et al. Page 2
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discrimination which in turn promoted positive self-esteem even
among children living in
highly disadvantaged circumstances.

Researchers studying the association between body size and
self-image have proceeded along
a similar path arguing that elements of African American social
and cultural life may protect
girls' self-images by reducing exposure to negative feedback
and promoting positive social
comparisons (Root, 1990). This expands the resources upon
which African American girls can
draw to make positive evaluations of their weight and
appearance providing a differential
protection not as readily available to girls in other racial groups
(Halpern, King, Oslak, & Udry,
2005; Paxton et al., 2006). In this paper, we hypothesize two
resources that may be particularly
important for this process: the structural availability of
comparison others who are also African
American and the practice of cultural education (i.e., racial
socialization) among the families
of African American teenagers.
We expect these factors to influence the evaluations African
American girls make about their
bodies by shaping the sources girls use to judge their physical
size. For example, research
examining sources of body dissatisfaction indicate that social
comparisons are one of the
primary mechanisms through which adolescent girls assess their
bodies (Evans & McConnell,
2003; Thompson, Coovert, & Stormer, 1999). Downward
comparisons, in which a girl judges
herself smaller than those around her, typically produce greater
body esteem and result in more
positive self-evaluations (Morrison, Kalin, & Morrison, 2004).
African American women are,
on average, heavier than their peers from any other major racial
group and also show greater

variation in body size (Neumark-Sztainer et al., 2002). This
would suggest that when African-
American adolescents compare their body sizes with women
from within their own racial
group, they are more likely to perceive a favorable (i.e.,
downward) social comparison than
they would if comparing themselves to women who are not
African American. Thus, the
availability of comparison others who are also African
American may improve access to self-
enhancing social feedback.
The protective effect of African American racial group
membership may also develop by
facilitating access to cultural resources that enhance
adolescents' self-images – again giving
teens the ability to buffer the impact of body size status. We
propose that racial socialization,
the practice of educating children about the meaning, history,
and significance of being African
American (Caughy, O'Campo, Randolph, & Nickerson, 2002;
Hughes, 2003) may have this
effect. Racial socialization has been linked to a number of
positive psycho-social outcomes
including higher self-esteem and lower rates of psychological
stress (Bynum, Burton, & Best,
2007; Hughes et al., 2006). It also produces two effects that
suggest it may contribute to more
positive evaluations of body size: bi-culturalism and positive
feelings about one's ethnic group
(Brega & Coleman, 1999; Demo & Hughes, 1990; Hughes et al.,
2006; McHale et al., 2006).
A bicultural orientation may reduce the impact of mainstream
body size standards by
facilitating recognition of the biases inherent in western, white

standards of beauty (Lovejoy,
2001). This may be part of what allows African American
women and girls to distinguish their
own body evaluations from those standards (Evans &
McConnell, 2003; Poran, 2002).
Similarly, positive feelings about one's own ethnic group are
likely to increase the salience and
appeal of the in-group standard. Such recognitions may also
reduce the influence of social
comparisons made with non-African American others. If racial
socialization has the effect we
hypothesize, then girls growing up in families where it is
practiced frequently should show a
weaker relationship between body size and social self-images
than do girls growing up in
families where racial socialization is not a focus.
Our intent with this analysis is to deepen understandings of the
relationship between body and
self-image among adolescent African American girls. Our first
goal is to assess the relative
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importance of body size to self-image as these girls move
through adolescence. Second, we
test the idea that growing up within a “consonant social
context” may protect girls, to some
degree, from negative feedback about their bodies. Specifically,
we hypothesize two forms of
this consonant social context: the structural availability of
comparison others who are also
African American and the practice of cultural education (i.e.,
racial socialization) within
respondents' families. In both instances, we expect that these

factors will have a moderating
effect, reducing the relationship between body size and social
self-image.
METHODS
Sample
The data for this analysis are drawn from waves one through
three of the Family and
Community Health Study (FACHS), a multi-site study of the
emotional and social health and
development of African American pre-teens and adolescents.
The complete FACHS dataset
consists of approximately 900 African American families living
in Georgia and Iowa. The
FACHS sample is unique among data sets focusing on African
Americans because it was
designed to identify contributors to African American children's
development in families living
outside the urban inner city core and from a wide range of
socioeconomic strata. Wave 1 of
FACHS was collected during 1997 when target respondents
were between 10 and 11 years of
age; Wave 2 took place in 1999 when target children were
between 12 and 13. Wave 3 data
collection occurred in 2001 when the target children were aged
14 to 15. Details regarding the
FACHS sampling strategy and data collections procedures can
be found in Simons et al.,
(2002).
In the present analysis we use only the female respondents from
the FACHS sample.
Approximately 400 girls participated in the FACHS data
collection at wave 1; of these, 320
completed waves 2 and 3. Missing data from the body size

measures (explained further below)
and other scales reduced the final sample to 256. We used t-
tests to examine whether
respondents included in the sample differed from those excluded
on any of the dependent or
independent variables and found no significant differences.
Measures
Social Self-Image—Our primary research focus is on the
association between body size and
social self-image among adolescent girls. We measured social
self-image using a five-item
index capturing social characteristics that are meaningful to
adolescents and that have been
linked to behavior and attitudes regarding smoking, alcohol use,
diet, and exercise (Gerrard,
Gibbons, Stock, Vande Lune, & Cleveland, 2005; Gibbons &
Gerrard, 1995, 1997; Simons et
al., 2002). The items were reverse coded as necessary so that a
high response indicated a more
positive social self-image. Items were summed and the
Chronbach's alpha for this scale was
approximately .65 at both waves two and three.
Body Size Measures—The FACHS measures “visible body size”
on a nine-point scale
ranging from significantly underweight (1) to morbidly obese
(9). These ratings were made
from videotapes of the FACHS target children recorded during
each of the first two waves of
data collection. We elected to use visual ratings of body size
rather than clinical measures such
as BMI because our theoretical interest is in the implications of
body weight for social
comparisons and social self-images. Thus, a visual assessment
of obesity was more a more

valid measure than one drawn from BMI-for-age growth charts
(National Center for Health
Statistics, 2000). Finally, ratings of body size made from
videotapes have been shown to be a
valid representation of weight status (Cardinal, Kaciroti, &
Lumeng, 2006).
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Observer ratings were based on the Figure Rating Scale (FRS:
Stunkard, Sorenson, &
Schulsinger, 1983) as well as assessments of particular body
parts (e.g., upper arm size, etc.).
Details regarding the procedures used to arrive at target body
size ratings, and to ensure
reliability across videotape raters, can be found in Granberg,
Simons, Gibbons, & Melby
(2008). Body size ratings from wave 1 videotapes correlated
significantly with those from wave
2 (r=.516**). The distribution of body size ratings for waves 1
and 2 are reported in table 1.1
We used the observers' ratings to identify those respondents
whose body sizes could be
considered “visibly obese” during wave 2 scoring. Previous
validity studies using the FRS
have identified body size ratings of 7, 8, and 9 as “visibly
obese” (Bulik et al., 2001).
Approximately 12 percent of the FACHS sample fell into this
category. We then looked at
wave 1 classifications of body size. We set the visible obesity
cut off for wave 1 at 6 (rather
than 7) because CDC growth charts set clinical obesity cutoffs2
for 10 year olds at
approximately 2.5 BMI points lower than those applied to 12

year olds (for example, a 10 year
old is classified as obese with a BMI of 23, a 12 year old is
classified as obese with a BMI
slightly above of 25.2) leading us to feel a similar adjustment
was appropriate on this measure
(Centers for Disease Control, 2005).
Respondents whose body size ratings were scored at 6 or higher
in wave one and at 7 or higher
in wave two were coded “1” for the measure “large body size,”
all other respondents were
coded “0”. Requiring that respondents be evaluated as “large
body size” at both waves 1 and
2 ensured that this was a long-term physical state and lessened
the likelihood that a respondents'
elevated body size was the result of puberty alone.
In approximately 18 cases, data for this measure were missing
because tapes could not be found
or respondents were not sufficiently visible for observers to
reliably assess body size. In these
cases, we replaced body size scores missing from wave 2 with
the value from wave 1, if
available. (We made no replacements for cases where body size
was missing in wave 1.) We
felt comfortable making this replacement because girls tend to
get heavier as they enter
adolescence and so replacing missing wave 2 scores with those
from wave 1 would tend to
understate, rather than overstate, the number of girls who were
of large body size, resulting in
a more conservative test of our hypotheses. After this coding
was complete, 35 girls were coded
as “large body size.”
Family Racial Socialization—The dominant arguments

hypothesizing that racial
socialization moderates the relationship between weight and
self-conception has focused on
the importance of being aware of one's ethnic culture and
history (Lovejoy, 2001). We
measured this aspect of racial socialization using a scale based
upon work by Diane Hughes
(Hughes, 2003; Hughes & Chen, 1997) which asks respondents
to report on five family
activities (e.g., museum visits) that promote knowledge
regarding the culture and meaning of
being African American. Each item's responses ranged from
“Never” (1) to “10 or more
times” (5). The items were summed and Chronbach's alpha for
the scale was .84.
Availability of African American Comparison Others—We
measured the availability
of comparison others using the percentage of African-
Americans living in respondents' Block
Group (BG). Block groups are clusters of contiguous residential
blocks analogous to a
1Questions have been raised as to the suitability of FRS for use
with non-Caucasian populations (Patt, Lane, Finney, Yanek, &
Becker,
2002; Pulvers et al., 2004) and, with this concern in mind, we
did examine a number of other rating systems. We chose the
FRS because
of the extensive body of research validating its effectiveness as
a measure of visible obesity in diverse populations (including
African
Americans) and well as evidence demonstrating its validity for
use with videotaped data (Bhuiyan, Gustat, Srinivasan, &
Berenson,
2003; Cardinal et al., 2006; Patt et al., 2002).

2CDC Growth Charts do not use the term “obesity” when
classifying children's weight; however a BMI-for-age at the
95th percentile or
higher is typically considered “obese”.
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respondents' neighborhood (Bureau of the Census, 1994). In
rural areas where housing does
not always follow a block design, block groups are identified
based upon a combination of
factors including the extent and density of existing residential
housing, natural and manmade
boundaries (e.g., lakes, rivers, thorough fares), and local land
survey information. Starting with
the 1990 census, local authorities also provided input so that
rural block groups accurately
captured local residential patterns.
When the FACHS sample was originally identified, African
Americans composed at least 20%
of the residents in each BG from which respondents were
recruited. Over time, however, some
FACHS families have moved, increasing variation in the
sample. As of wave 3, the proportion
of African Americans living in respondents' BGs ranged from
less than 1% to over 90% (Mean
26%; s.d. 28%).
Control Variables
Quality of Parenting—We control for quality of parenting in
this analysis because parents
who engage in racial socialization tend to be involved with and
attentive towards their children
in other ways (Caughy et al., 2002; Simons, Chao, Conger, &

Elder, 2001) and effective racial
socialization requires calling upon many of the skills that also
make for good parenting. In
addition, both constructs are associated with better psychosocial
competence in children,
potentially improving social self-image (Constantine &
Blackmon, 2002; Fischer & Shaw,
1999; Maccoby, Martin, & Mussen, 1983). The items for the
parenting scales were adapted
from instruments developed for the Iowa Youth and Families
Project (IYFP: Conger et al.,
1992) and have been shown to have high validity and reliability
(Simons, 1996; Simons et al.,
2001; Simons, Johnson, Conger, & Elder, 1998). Coefficient
alpha for the target child's
instrument was approximately .90.
Family Social Class—Some researchers have suggested that
body standards are more
stringent among members of more affluent SES groups (Molloy
& Herzberger, 1998). In order
to ensure we were not confounding class-based associations
with our variables of interest, we
included family class status as a control. We measured class
status by ranking respondents
based on a combination of the primary caregiver's work status
and the total household income
(Billingsley, 1992). The measure generates five class groups:
(1) nonworking poor, (2) working
poor (3) working non-poor, (4) middle class, (5) upper class.
Class status measures from waves
2 and 3 were correlated at .9. As a result, we used the wave 2
measure in all analyses.
Opposite Sex Relations—Adolescence is a period when
relationships with the opposite

sex take on heightened salience and are viewed as particularly
relevant for status within one's
peer group (Seiffge-Krenke, 2003). In order to account for the
possibility that the relationship
between body size and social self-image was due only to
perceptions of romantic success, we
included a control for the degree to which respondents saw
themselves as successful at “making
and keeping friends of the opposite sex”.3 Respondents
evaluated themselves on a scale of 1
to 3 where 1 corresponded to “not well” and 3 corresponded to
“very well.”
Objective Social Skill—The stigma associated with obesity may
limit the opportunities
overweight people have to develop effective social skills
(Miller, Rothblum, Barbour, Brand,
& Felicio, 1990). In order to account for this association, we
included primary caregivers'
assessments of respondents' social abilities. This measure is a
four-item scale assessing skills
such as working well in a group. Responses to these items
ranged from 1 to 3, with 3
3It would have been preferable to use a question that did not
assume an exclusively heterosexual orientation. However, the
data do not
include a comparable question for respondents who are gay or
lesbian. In this analysis, a very small number of respondents
(N=5) identified
as “mostly homosexual” or “homosexual”. Due to the small
number, we felt the benefits of controlling for this aspect of
adolescent
interactions justified the use of the question.

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corresponding to the most socially skillful evaluation. PC's
answers to these questions were
standardized and summed and the Chronbach's alpha for the
scale exceeded .8.
Academic Skill—As with social skill, self-image in domains
such as intelligence may reflect
concrete information, such as grade point averages (Felson,
1985) and some studies have
suggested overweight girls do better in school (Pesa, Syre, &
Jones, 2000). To account for
these associations, we controlled for the primary caregivers'
assessment of respondents' ability
to learn math, science, reading, social studies, and computers.
PCs rated each academic subject
on a scale from 1 to 3, with 3 corresponding to high ability. The
responses were summed to
create the academic skill scale; reliability on this scale also
exceeded .8.
Analysis
We used ordinary least squares regression to assess the
multivariate relationship between body
size and social self-image and to test our moderation arguments.
Due to the block group
sampling strategy employed for this project, however, we were
not able to assume compliance
with the assumption of independent observations. In order to
correct for this, we employed the
“cluster” option available within the statistical program Stata
(StataCorp, 2003). This option
produces robust standard errors, which correct for correlations
due to block group sampling.

RESULTS
Bivariate Analysis
The correlation coefficients, uncentered means, and standard
deviations for all measures used
in this analysis are shown in Table 2. Bivariate correlations
show that being of large body size
is not related to social self-image at wave 2 when the
respondents were approximately 12 to
13 years of age. However, large body size is related to this
measure at wave 3, when respondents
were about 15 years old. Racial socialization and percentage of
African-Americans in the
neighborhood are both positively related to our wave 3 outcome
but only racial socialization
is related to our independent variable. Quality of parenting, at
both waves, is correlated with
racial socialization as well as with social self-image.
Surprisingly, family social class is
significantly and positively associated with body size; however,
it shows only a marginal
association with the outcome measure.
Our first research question asked whether the association
between weight and social self-image
became stronger as girls entered adolescence. In order to
explore this issue, we regressed our
dependent variable on large body size while controlling for
quality of parenting and class status.
This regression was first run using wave 2 and then repeated
using wave 3 assessments.4 All
the hypotheses evaluated in this analysis were directional;
consequently we report one-tailed
results in all of our tests of significance. The results of these
regressions are shown in Table 3.
Model 1 shows that being of large body size has no significant

association with respondents'
evaluations of their social attributes at wave 2 when they are
roughly 12 to 13 years of age.
However, model 2 indicates that there is a small but significant
negative association between
large body size and social self-image at wave 3 when the
respondents averaged 14 to 15 years
of age. Further, model 3 shows that large body size significantly
predicts wave 3 assessments
after we control for social self-image assessed at wave 2. This
suggests that girls who have had
a large body size since at least age 10 experience a decline in
social self-image as they move
into adolescence. This pattern supports our hypothesis that
being of large body size becomes
4In separate regressions we examined whether pubertal
development might influence the relationship between body size
and self-image.
We found pubertal status was associated with social self-image
but the relationship between body size and our outcome was
unaffected.
For the sake of parsimony these models are not shown.
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relevant for self-image as girls move into their teenage years.
Once the control for social self-
image at wave 2 is included, family class status also becomes
significant.
Our second hypothesis was that experiences that provided a
“consonant social context” with
respect to racial group membership would reduce the impact of
large body size on social self-

image. We tested this by examining the extent to which our
measure of family racial
socialization and of the percentage of African Americans in
respondents' neighborhoods
moderated the effect of a large body size on social self-image at
wave 3; the results are shown
in Table 4. Model 1 shows the results of adding our additional
control measures to the regression
equation estimations shown in Table 3 (Model 2) and indicates
that adolescents who see
themselves as able to relate successfully to members of the
opposite sex also have more positive
social self-images. There is also an association between parental
evaluations of respondent
social skills and targets' social …
Cultural Diversity and Ethnic Minority
Psychology
Pubertal Timing as a Moderator Between General
Discrimination Experiences and Self-Esteem Among
African American and Caribbean Black Youth
Eleanor K. Seaton and Rona Carter
Online First Publication, September 19, 2019.
http://dx.doi.org/10.1037/cdp0000305
CITATION
Seaton, E. K., & Carter, R. (2019, September 19). Pubertal
Timing as a Moderator Between General
Discrimination Experiences and Self-Esteem Among African
American and Caribbean Black Youth.
Cultural Diversity and Ethnic Minority Psychology. Advance
online publication.

Pubertal Timing as a Moderator Between General
Discrimination
Experiences and Self-Esteem Among African American and
Caribbean
Black Youth
Eleanor K. Seaton
Arizona State University
Rona Carter
University of Michigan
Objectives: The present study used a nationally representative
sample of African American and Carib-
bean Black adolescents to examine whether relative pubertal
timing moderated the relation between
general and racial discrimination experiences and self-esteem. It
was anticipated that discrimination
experiences would be more harmful for early maturing African
American and Caribbean Black girls and
boys compared to their on-time and late counterparts. Method:
The participants included 1170 youth
(e.g., 563 males and 607 females) from the National Survey of
American Life-Adolescent (NSAL-A)
who ranged in age from 13 to 17. Youth completed self-report
measures of pubertal development, general
and racial discrimination experiences, and self-esteem. Results:
Moderation was evident such that
African American and Caribbean Black girls who perceived
their pubertal development as early relative
to their same-age and same-sex peers exhibited higher self-
esteem than African American and Caribbean
Black girls who perceived their development as late at high

levels of general discrimination experiences.
Moderation was not evident for racial discrimination
experiences among African American and Carib-
bean Black girls, nor was it evident for general and racial
discrimination experiences among African
American and Caribbean Black males. Conclusions: The
findings suggest that relative pubertal timing
operates as a potential moderator for general discrimination
experiences among African American and
Caribbean Black girls.
Public Significance Statement
The study suggests that African American and Caribbean Black
girls who start puberty earlier than
their female counterparts had high self-esteem when they
experienced discrimination. This was in
contrast to African American and Caribbean Black girls who
started puberty later than their female
counterparts who had lower self-esteem when they experienced
discrimination.
Keywords: African American, Caribbean Black, adolescents,
perceived pubertal timing, discrimination
experiences
Discrimination is a common experience for Black1 youth. Cur-
rent estimates from national data suggest that the majority of
African American and Caribbean Black youth reported discrimi-
natory experiences within the past year (Seaton, Caldwell,
Sellers,
& Jackson, 2008). Although discrimination may be attributed to
various demographic characteristics, the most prevalent
attribution
included race/ethnicity among African American and Caribbean
Black youth (Seaton, Caldwell, Sellers, & Jackson, 2010).

Given
the prevalence of discrimination and racial discrimination
experi-
ences among Black youth, it is unsurprising that a recent meta-
analysis indicated that these experiences are linked to a variety
of
negative outcomes among minority youth, including Black
youth
(Benner et al., 2018).
Burgeoning research has identified several moderators for racial
discrimination experiences among Black youth, including
ethnic/
racial identity, racial socialization, parenting behaviors, and
coping
strategies (Brody et al., 2006; Fuller-Rowell et al., 2012;
Gaylord-
1 The term “Black” refers to individuals of African descent in
the United
States including the descendants of enslaved Africans,
Caribbean Black
immigrants and their descendants, and African immigrants and
their de-
scendants.
X Eleanor K. Seaton, T. Denny Sanford School of Social and
Family
Dynamics, Arizona State University; Rona Carter, Department
of Psychol-
ogy, University of Michigan.
Funding for the National Survey of American Life-Adolescents
(NSAL-A)
was supported by contract (U01-MH-57716) from the National
Institute of

Mental Health and the Office of Behavioral and Social Sciences
Research
at the National Institutes of Health. We thank everyone who
participated in
the NSAL-A.
Correspondence concerning this article should be addressed to
Eleanor
K. Seaton, T. Denny Sanford School of Social and Family
Dynamics,
Arizona State University, P.O. Box 873701, Tempe, AZ 85287-
3701.
E-mail: [email protected]
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Cultural Diversity and Ethnic Minority Psychology
© 2019 American Psychological Association 2019, Vol. 1, No.
999, 000
ISSN: 1099-9809 http://dx.doi.org/10.1037/cdp0000305
1
https://orcid.org/0000-0003-3285-4767
mailto:[email protected]

Harden & Cunningham, 2009; Saleem & Lambert, 2016; Varner
et
al., 2018). However, one moderator that has not been examined
in
conjunction with discrimination experiences is pubertal timing,
a
critical developmental transition that can alter how adults and
peers respond to developing youth (Carter, Mustafaa, & Leath,
2018). The rationale for examining pubertal development as a
moderator for discrimination experiences is due to the fact that
discrimination experiences precede pubertal development among
Black youth. Prior research indicates that Black youth reported
racial discrimination experiences around the age of five (Coker
et
al., 2009) and increasing experiences in early adolescence from
peers and teachers in school settings (Chavous, Rivas-Drake,
Smalls, Griffin, & Cogburn, 2008; Niwa, Way, & Hughes, 2014)
and adults outside of school (Niwa et al., 2014). Although Black
youth begin pubertal development earlier than their White,
Latino,
and Asian American counterparts (Keenan, Culbert, Grimm,
Hip-
well, & Stepp, 2014; Mendle, Harden, Brooks-Gunn, & Graber,
2010), one study indicated that advanced pubertal development
among Black youth occurred between the ages of 11.5 and 13
(Cance & Ennett, 2012). Thus, discrimination experiences
precede
pubertal development among Black youth even though Black
youth are the first to undergo pubertal development. The current
study examined whether pubertal timing moderated associations
between general and racial discrimination experiences and self-
esteem among nationally representative samples of African
Amer-
ican and Caribbean Black males and females.
Discrimination Experiences and Self-Esteem

Racial discrimination is a ubiquitous part of middle childhood
and adolescence for Black youth, with the majority experiencing
racial discrimination over long periods of time (Gee,
Walsemann,
& Brondolo, 2012). Black youth experience racial
discrimination
early in middle childhood (Coker et al., 2009), and report
increas-
ing experiences from adolescence into adulthood (Brody et al.,
2014). Although Black youth may experience discrimination for
a
variety of reasons (e.g., gender, age, physical appearance), prior
work has demonstrated that race/ethnicity was the primary attri-
bution among nationally representative samples of African
Amer-
ican and Caribbean Black youth (Seaton et al., 2010).
Racially discriminatory experiences are prevalent such that
most
Black youth report these experiences regardless of the measured
time frame (see Brody, Yu, Miller, & Chen, 2015; Tynes,
Umaña-
Taylor, Rose, Lin, & Anderson, 2012). National data indicated
that
87% of African American youth and 90% of Caribbean Black
youth experienced at least one discriminatory incident in the
prior
year (Seaton et al., 2008). Given the pervasiveness of racial dis-
crimination, prior research has demonstrated that racial
discrimi-
nation has been linked to low self-esteem among African
Ameri-
can youth (Cogburn, Chavous, & Griffin, 2011; Seaton, 2009).
A
recent meta-analysis conducted among ethnic/racial minority

youth indicated a positive relation between racial discrimination
and socioemotional distress, which included measures of self-
esteem (Benner et al., 2018).
The Importance of Pubertal Timing
Pubertal development includes biological processes designed to
prepare individuals for sexual maturation and sexual
reproduction
(Dorn & Susman, 2019). There is variation in pubertal develop-
ment as articulated by Mendle and colleagues (2019, p. 91):
“There may be substantial variation in the timing and onset of
key
milestones, the pace at which the process unfolds, the
correspon-
dence of different pubertal indicators with each other; and the
ways in which social identities might intersect with the psycho-
logical response to puberty.” Pubertal timing encompasses the
age
at which youth physically mature (Mendle et al., 2019), and
Black
girls begin pubertal development earlier than White, Latina, and
Asian American girls (Keenan et al., 2014; Susman et al.,
2010).
The trend of earlier pubertal timing is also consistent among
Black
boys (Herman-Giddens, Wang, & Koch, 2001; Rosenfield,
Lipton,
& Drum, 2009; Sun et al., 2002).
There are two ways to assess pubertal timing, objective and
subjective assessments, and the current study examined
subjective
assessments. Subjective measures of pubertal timing assess a
con-

vergence of biological, social, and cognitive changes related to
puberty, and include self- or parent-reported questionnaires
related
to relative development or specific indicators (Mendle et al.,
2019;
Moore, Harden, & Mendle, 2014). Prior research examining
sub-
jective pubertal timing has primarily focused on internalizing
outcomes among Black youth. Among Black girls, previous re-
search has indicated that Black girls who develop earlier than
their
same-age peers exhibited internalizing outcomes such as anxiety
and depressive symptoms (Carter, Caldwell, Matusko,
Antonucci,
& Jackson, 2011; Carter, Jaccard, Silverman, & Pina, 2009;
Carter
et al., 2017; Ge, Brody, Conger, & Simons, 2006). Yet early
pubertal effects are substantially less well understood among
boys
compared to girls (Mendle & Ferrero, 2012). Although research
is
scant on subjective pubertal timing among Black boys, previous
research has indicated that Black boys who developed earlier
were
more likely to exhibit anxiety and depressive symptoms (Ge et
al.,
2003, 2006).
Yet one aspect of mental health that has rarely been examined
in
conjunction with subjective pubertal timing indicators is self-
esteem. Self-esteem is important because puberty has a social
component such that bodily changes alter how adults and peers
respond to adolescents as their bodies develop (Carter et al.,
2018;
Ge et al., 2006; Reynolds & Juvonen, 2011). Thus, how other

individuals respond to developing youth can be a critical
determi-
nant of how adolescents feel about their developing selves, and
ultimately their self-esteem. One study conducted among ethni-
cally and racially diverse girls indicated that girls who were
categorized as early maturing evidenced lower self-worth than
their on-time counterparts (Reynolds & Juvonen, 2012).
Another
study conducted among ethnic/racial minority youth indicated
that
being labeled a victim of peer-victimization was linked to low
self-worth, and this was especially true among early-maturing
boys
and girls (Nadeem & Graham, 2005). Similarly, Black youth
who
perceived their pubertal timing as “late” indicated the least
favor-
able self-perception of their bodies (Siegel, Yancey,
Aneshensel,
& Schuler, 1999). Lastly, a study indicated that non-White
females
had the highest levels of self-esteem such that early and on-time
developers exhibited self-esteem similar to males, and late
devel-
opers had the lowest self-esteem levels (Morin, Maïano, Marsh,
Janosz, & Nagengast, 2011). Thus, pubertal timing has been dif-
ferentially linked to self-esteem among early and late
developers.
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2 SEATON AND CARTER
Ethnic Subgroups and Puberty
Ethnic subgroup difference within the Black population in the
United States are largely neglected in developmental research
(Collins, 1992). The Black American population comprises indi-
viduals with varied languages, countries of origin, history,
cultural
beliefs, and socialization practices (Hopp & Herring, 1999).
These
differences may influence the meaning that Black youth
attribute
to pubertal development as well as how adults and peers
respond
to developing Black youth. As of this writing, one study
examined
ethnic subgroup differences in pubertal effects (i.e., menarche
and
relative pubertal timing) using the National Survey of American
Life-Adolescent (NSAL-A; Carter, Silverman, & Jaccard, 2011).
The NSAL-A includes nationally representative samples of
Afri-
can American and Caribbean Black boys and girls (Jackson et
al.,
2004). Caribbean Black girls were more likely to perceive their
pubertal timing relative to peers as early, whereas African
Amer-
ican girls were more likely to perceive their pubertal timing as
average compared to girls of their respective age (Carter et al.,

2011). Furthermore, Caribbean Black girls who perceived their
development to be early engaged in more externalizing
behaviors,
although menarche did not significantly predict Black girls’
symp-
toms of externalizing behaviors and depression (Carter et al.,
2011). Prior research has not examined ethnic subgroup differ-
ences in pubertal effects among Black boys.
The Present Study
A recent paper called for more research examining descriptive
puberty processes and related outcomes among ethnic/racial mi-
nority youth, sexual minority youth, transgender youth, and
boys
(see Deardorff, Hoyt, Carter, & Shirtcliff, 2019). The current
study
answered this call with examination of whether relative pubertal
timing moderated associations between discrimination
experiences
and self-esteem among Black youth, and is noteworthy for four
reasons. Initially, the current study examined one aspect of sub-
jective pubertal timing, relative pubertal timing, which assessed
whether adolescents report themselves as being non-normative
in
one direction (e.g., early) or the other (e.g., late) relative to
their
same-sex and same-age peers (Graber, Petersen, & Brooks-
Gunn,
1996). This affords the opportunity to assess girls’ and boys’
interpretation of pubertal changes relative to their same-age and
same-sex peers. Second, the current study explored general and
racial discrimination experiences. Although Black children have
an awareness of racism in early and middle childhood (Dulin-
Keita, Hannon Iii, Fernandez, & Cockerham, 2011) and
experience

racial discrimination as young as age five (Coker et al., 2009),
not
all Black adolescents attribute their discriminatory experiences
to
race/ethnicity (Seaton et al., 2010). It is of interest to examine
if
relative pubertal timing moderated general and racial
discrimina-
tion experiences among Black youth. Third, it was anticipated
that
relative pubertal timing moderated general and racial
discrimina-
tion experiences, because previous research demonstrated that
Black children are perceived to be older than White children
who
are the same age and penalized more harshly than their same-
age
White counterparts (Goff, Jackson, Di Leone, Culotta, & DiTo-
masso, 2014). Given the prevalence of discrimination
experiences
based on race/ethnicity (Seaton et al., 2010), it is possible that
early-maturing Black youth experience more general and racial
discrimination than their on-time or late-developing Black
coun-
terparts because they are perceived to be older by peer and adult
perpetrators (Goff et al., 2014), and manifest more negative out-
comes in response. Fourth, ethnic subgroup differences in
associ-
ations among relative pubertal timing, general and racial
discrim-
ination experiences, and self-esteem among African American
and
Caribbean Black boys and girls were explored using the NSAL-
A.
With few exceptions (see Carter et al., 2011, 2017), the bulk of

pubertal research conducted among Black youth has primarily
used African American samples. Utilization of NSAL-A affords
the opportunity to examine ethnic subgroup differences in
puberty
among Black boys and Caribbean Black youth, two understudied
populations in pubertal research (see Deardorff et al., 2019).
The current study hypothesized that general and racial discrim-
ination experiences would be associated with decreased self-
esteem among African American and Caribbean Black boys and
girls as consistent with a recent meta-analysis (Benner et al.,
2018). It was also expected that pubertal timing would moderate
general and racial discrimination experiences such that
discrimi-
natory experiences would be more harmful for early maturing
African American and Caribbean Black girls and boys compared
to their on-time and late counterparts (Goff et al., 2014).
Moder-
ator variables explain under what conditions specific effects
occur
(Baron & Kenny, 1986), and it was conceptualized that early
pubertal development is a condition by which discriminatory ex-
periences are negatively linked to self-esteem, unlike average or
late pubertal development. The current study also examined
whether ethnicity moderated the relation among relative
pubertal
timing, discrimination experiences, and self-esteem. Given the
lack of research examining ethnic differences in the Black
Amer-
ican population, no hypotheses were offered regarding the role
of
ethnicity in the relation between relative pubertal timing,
discrim-
ination experiences, and self-esteem among African American
and
Caribbean Black boys and girls.

Method
Participants
The participants were African American and Caribbean Black
youth who participated in the National Survey of American
Life-
Adolescents (NSAL-A; Heeringa et al., 2004; Jackson et al.,
2004). The participants included African American (n � 810)
and
Caribbean Black (n � 360) youth ranging in age from 13 to 17
(M � 15 years; SD � 1.42). The overall sample was equally
composed of males (N � 563 unweighted, 48% weighted) and
females (N � 607 unweighted, 52% weighted), and there was an
equal gender distribution for African American and Caribbean
Black youth. Approximately 96% of the sample was still
enrolled
in high school, and the average grade was 9th. The median
family
income was $28,000 (approximately $26,000 for African Ameri-
cans and approximately $32,250 for Caribbean Blacks).
Specifics
of the original NSAL-A sample have been described elsewhere
(see Carter et al., 2011; Seaton et al., 2008).
Procedure
A national probability sample of households was drawn based
on adult population estimates and power calculations for
detecting
differences among the adult samples. Every household that in-
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3PUBERTY, DISCRIMINATION, AND SELF-ESTEEM
cluded an adult participant in the NSAL was screened for an
eligible adolescent in the targeted age range (e.g., 13 to 17).
Adolescents who met eligibility criteria were selected using a
random selection procedure. The adolescent supplement was
weighted to adjust for nonindependence in selection
probabilities
and nonresponse rates within households, across households and
individuals. The weighted data were poststratified to
approximate
the national population distributions for gender and age
subgroups
among African American and Caribbean Black youth. The
specific
sampling procedures for identification and recruitment of
African
American and Caribbean Black households have been described
elsewhere (see Carter et al., 2011; Seaton et al., 2008).
Informed
consent was obtained from the adolescent’s legal guardian as
well
as the adolescent prior to the interview. The majority of the
adolescent interviews were conducted with same-race
interviewers
using computers in their respective homes, and a small minority

(18%) were conducted entirely or partially by telephone. For
privacy purposes, the adolescent interviews were conducted
with
no family members present. The adolescents were paid $50 for
their participation.
Measures
Demographic variables. Adolescents were asked their age in
years at the time of the interview. Ethnicity and parents’
nativity
status were assessed with standard questions used in the
household
sampling procedure. Imputed family income was calculated
based
on information provided by the adult respondent for the
household
in which the adolescent lived for the year prior to the adult
interview.
Everyday Discrimination Scale. The Everyday Discrimina-
tion Scale assesses chronic, routine, and less overt experiences
of
discrimination that have occurred in the prior year (Williams,
Yu,
Jackson, & Anderson, 1997). The revised measure includes 13
items, and psychometric analyses indicated that the measure
was
valid and reliable among African American and Caribbean
Black
youth (see Seaton et al., 2008). The stem question is “In your
day-to-day life how often have any of the following things hap-
pened to you?” A sample item includes “You are followed
around
in stores.” The Likert response scale ranges from 1 (never) to 6
(almost every day), and internal consistency was acceptable for

the
sample (� � .86). The responses were coded to indicate
whether
an event occurred versus an event never occurring. A count
score
was created such that higher scores indicated a greater number
of
events that occurred in the previous year.
Discrimination attribution. The specific question read,
“We’ve talked about a number of things that may have happened
to you in your day-to-day life. Thinking of those things that
have
happened to you, overall what do you think was the main reason
for this/these experiences?” The participants were instructed to
choose an overall attribution for the 13 items, and selections
included 1) race/ethnicity, 2) gender, 3) age, 4) physical appear-
ance (i.e., height or weight), or 5) other (Williams et al., 1997).
Relative pubertal timing. Perceived pubertal timing (e.g.,
overall) relative to peers was assessed with one item that asked,
“How advanced would you say your physical development is
compared to other girls/boys your age?” The response scale in-
cluded the following: 1 (I look younger than most), 2 (I look
younger than some), 3 (I look about average), 4 (I look older
than
some), and 5 (I look older than most). Higher numbers indicated
greater perceptions that one’s pubertal development was earlier
relative to same-sex and same-age peers. Studies have demon-
strated reasonable confidence using a one-item variable to
measure
youths’ perceptions of their pubertal timing relative to peers
(see
Dubas, Graber, & Petersen, 1991; Graber, Lewinsohn, Seeley, &
Brooks-Gunn, 1997). Dubas and colleagues (1991) demonstrated

that feelings regarding puberty were related to perceived
pubertal
timing relative to peers but not an objective measure of pubertal
timing. Moreover, the perceived pubertal timing item is a well-
established and effective method for assessing perceptions of
the
timing of pubertal changes compared to peers (see Coleman &
Coleman, 2002; Dubas et al., 1991; Negriff & Susman, 2011).
Self-esteem. The Rosenberg Self-Esteem Scale is an assess-
ment of self-acceptance (Rosenberg, 1965). The 10-item Likert
scale (� � .72) consists of rating items with responses ranging
from 1 (strongly disagree) to 4 (strongly agree). Previous
research
indicated that this measure was valid among African American
and
Caribbean Black youth (see Seaton et al., 2008). Sample items
include “I feel that I have a number of good qualities” and “On
the
whole, I am satisfied with myself.” Negative items were
reversed
so higher scores represent high levels of self-esteem.
Data Analytic Strategy
STATA 15.0 was used to calculate the complex design-based
estimates of variance. Actual numbers are reported for sample
sizes, while weighted data are used in the analyses. Linear
regres-
sion analyses were conducted to assess if discrimination experi-
ences were associated with self-esteem, while controlling for
eth-
nicity, household income, age, and nativity status. A relative
pubertal timing � discrimination interaction term was included
in
the analyses to examine if the relation between discrimination

experiences and self-esteem varied among the relative pubertal
timing groups. A three-way interaction (e.g., pubertal timing �
discrimination � ethnicity) was included to assess if these rela-
tions varied for African American and Caribbean Black youth.
The
analytical techniques adjusted the standard errors to account for
the complex sample design of the NSAL, which involved
multiple
stages, clustering, and stratification. Standard errors adjusted
for
complex design effects are usually larger than nonadjusted stan-
dard errors. In this study, the standard errors for Caribbean
Blacks
were typically higher than those for African Americans because
the Caribbean Black sample is significantly more clustered than
the African American sample. Ethnic differences that appeared
to
be large were not necessarily statistically significant.
Results
The results indicate variation along the relative pubertal timing
dimensions among African American and Caribbean Black girls
(see Table 1). Although most African American girls perceived
their development as on time in comparison to their same-sex
and
age peers, the majority of Caribbean Black girls perceived their
pubertal development to be earlier than some compared to their
same-sex and age peers, F(1.9, 75.99) � 7.2, p � .01, consistent
with prior research (see Carter et al., 2011). There was no
signif-
icant variation in the relative pubertal timing dimensions among
African American and Caribbean Black boys such that the
major-
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4 SEATON AND CARTER
ity perceived that their pubertal development was on-time
relative
to their same-sex and age peers, F(2.5, 101.6) � 0.14, p � .91
(see
Table 2). There were no gender differences in self-esteem
(B � �.01, p � .63) among Black boys (M � 3.55, SD � .02)
and
Black girls (M � 3.56, SD � .02).
There were gender differences in general discrimination expe-
riences (B � �.13, p � .05), with Black boys (M � 5.45, SD �
.27) reporting more than Black girls (M � 4.79, SD � .21),
consistent with previous research (see Seaton et al., 2008).
Among
the 87% of Black youth who reported a discriminatory incident,
the breakdown for the attributions included race/ethnicity
(48%),
gender (9%), age (18%), physical appearance (16%), or other
(9%), consistent with prior research (see Seaton et al., 2010).
Given the small sample sizes for the attribution groups, the
second
set of analyses were restricted to the subsample of Black girls

and
boys who chose race/ethnicity as the attribution for their
discrim-
inatory experiences. There were gender differences (B � �.12,
p � .05), with Black boys (M � 6.29, SD � .41) reporting more
racial discrimination experiences than Black girls (M � 5.60,
SD � .32).
African American and Caribbean Black Girls
There were no ethnic differences in self-esteem among African
American and Caribbean Black girls (B � �.02, p � .05; see
Table 3). General discrimination experiences were associated
with
decreased self-esteem (B � �.03, p � .01), and the general
discrimination � pubertal timing interaction term was
significant
(B � .01, p � .01). The Aiken and West (1991) procedure was
used to graph the interaction (see Figure 1). The results
indicated
that at high levels of general discrimination experiences,
African
American and Caribbean Black girls who perceived their devel-
opment as early relative to their same-age and same-sex peers
exhibited higher self-esteem than African American and
Caribbean
Black girls who perceived their development as …
13
Reproductive Laws, Women of
Color, and Low-Income Women

LAURIE NSIAH-JEFFERSON
Introduction
Reproductive rights, like other rights, are not just a matter of
abstract theory. How these
rights can be exercised and which segments of the population
will be allowed to exercise
them must be considered in light of existing social and
economic conditions. Therefore,
concerns about the effects of race, sex, and poverty, as well as
law and technology, must
be actively integrated into all work and discussions addressing
reproductive health policy.
This chapter concerns the six areas identified by the Project on
Reproductive Laws
for the I 990& as they affect low-income and women of color.
Many, though not all,
women of color are poor. Women of color are not all one group,
just as women of color
and poor women are not one group. They have different needs,
behaviors, and cultural
and social norms. One thing they do share is having been left
out of the decision-making
process concerning reproductive rights. Although my experience
is as a black woman, I

will attempt to identify issues that appear to be nearly universal
to both women of color
and poor women and point out instances where their
perspectives might differ.
There is little information available about the reproductive
needs of women of color.
In general, the demographic data about non-Caucasian women
are clustered together
under the heading “nonwhite,” as if there were only two racial
groups, white and non
white. For example, published abortion statistics are broken
down only into two ethnic
categories—white and black. As a result of this
dichotomization, understanding of the
experience of specific groups such as Native American,
Asian/Pacific Islander, and Latina
women is inadequate. This dichotomization is itself evidence of
the pressing need for
more precise data gathering on issues concerning women of
color. The information that
is available generally fails to consider the obvious cultural and
social differences related
to differences in ethnicity and national heritage. In many cases,
this has made it difficult

to define and address particular problems and to make
recommendations about their
solutions.
For many women of color, taking control over their
reproduction is a new step and
involves issues never before considered. The reason for this is
that women of color have
not always had access to the prochoice movement. In the past, it
has been difficult for
many middle-class white feminists to understand and include
the different perspectives
Reproductive Laws, Women of Color, and Low Income Women
323
and experiences of poor and minority women. Thus, it is
particularly important that ade
quate information on the needs and experiences of all women be
made available now.
The broader economic and political structures of society impose
objective limitations
on reproductive choice, that is, decisions as to when, whether,
and under what conditions
to have a child. Very simply, women of color and poor women
have fewer choices than

other women. Basic health needs often go unmet in these
communities. Poor women and
women of color have a continuing history of negative
experiences concerning reproduc
tion, including their use of birth control pills, the IUD, and
contraceptive injections of
Depo-Provera;2sterilization abuse,3 impeded access to abortion,
coercive birthing pro
cedures and hysterectomy,4and exposure to workplace hazards.3
Thus, the primary reproductive rights issues for poor women
and women of color
include access to health services and information, and the
ability to give informed consent
or informed refusal; access to financial resources; an end to
discrimination relating to
class and race, which creates the potential for abuse of the new
technology; development
of new policies and programs geared toward their needs;
medical experimentation; and
the need to explore and promote the extended family concept
and alternative family
structures. Given the history and circumstances of these groups,
there are two overarch

ing concerns. One is the desire to make reproductive services,
including new technologies,
broadly accessible. The other is the need to safeguard against
abuse.
After considering each of the six topics, this chapter makes
policy recommendations
relating to the needs of poor women and women of color. These
recommendati
ons are
designed to ensure
I. Access to quality prenatal care.
2. The birth of healthy, wanted children.
3. Protection against sterilization abuse.
4. Protection against occupational and environmental conditions
harmful to fertility
and health.
5. Protection from pharmaceutical experimentation and
unnecessary medical proce
dures.
6. Access to accurate information about sex, conception, and
contraception.
7. Access to safe, affordable abortion.
In light of the structural nature of the limitations on the
exercise of reproductive choice

by poor women and women of color, the recommendations often
focus on affirmative
policy initiatives rather than legal restraints.
Time Limits on Abortion
Poor women and women ofcoloroften live under circumstances
that make it difficult for
them to obtain early abortions. For instance, in 1971, nearly one
in three nonwh
ite
women of reproductive age lived below the poverty level. It is
therefore important to
develop affirmative programs that improve access to early
procedures and, even m
ore
importantly, that reduce the risk of unwanted pregnancy.
Unfortunately, however, su
ch
affirmative programs cannot totally obviate the need for late
abortions. Thus, it is impor
tant to understand that laws restricting late abortions will
continue to have a particular
impact on poor women and women of color.
324 On Freedom

The Disproportionate Need for Post-First-Trimester Abortions
A significantly higher percentage of nonwhite women who get
abortions do so after the
first trimester, or first twelve weeks, of pregnancy. Of all
abortions obtained by white
women in 1983, 8.6 percent took place in the thirteenth week or
later, but 12.0 percent
of nonwhite women having abortions obtained them in that
period. These figures rep
resent the numbers of women who actually succeeded in
obtaining post-first-trimester
procedures, and they may seriously understate actual demand.
Financial, geographical,
and other barriers to access are likely to have a greater impact
on nonwhite women, whose
overall abortion rate is more than twice that of whites.
There is little information directly concerning very late
abortions. Available data on
women who obtain abortions after the first trimester, however,
demonstrate that financial
factors are very important. The enactment and implementation
of the Hyde amendment
terminating federal Medicaid funding for abortions has caused
many poor women to
delay having abortions while they raise the necessary funds. A
study of a St. Louis clinic,
for example, showed that in 1982,38 percent of the Medicaid-
eligible women interviewed
who sought abortions after the tenth week attributed the delay
between receiving the
results of their pregnancy tests and obtaining their abortions to
financial problems. Yet
Medicaid-eligible women were not significantly later in
obtaining abortions than other

women before the Hyde amendment went into effect. Even
where state Medicaid funding
is in theory still available for abortions, it is often not available
in practice. Welfare work
ers and other state officials do not always inform Medicaid
recipients of their right to
obtain Medicaid-funded abortions. Not all abortion providers
are aware that reimburse
ment is available from Medicaid. Some providers who are aware
are unwilling to except
Medicaid, inpart because doctors are reluctant to assert that the
abortions they perform
fall within the particular categories being funded in their states
and in part because Med
icaid reimbursement rates are so low.6
Difficulty in locating abortion services also causes delay. In
1984, there were no abor
tion providers identified in 82 percent of the counties in the
United States—that is, where
30 percent of all women of reproductive age lived. The
availability of abortion services
also varies considerably by state. Because abortion facilities are
concentrated in metro
politan areas, access to abortion services is particularLy
difficult for rural women. In 1984,
79 percent of all nonmetropolitan women lived in counties that
had no abortion facili
ties.7 Although geographic access may not pose a significant
problem for women of color
from northern states who are concentrated in inner cities, it is a
concern for women of
color in southern states.
Not only are Native American women who live on reservations
denied federal fund

ing for abortions, but no Indian Health Service clinics or
hospitals may perform abortions
even when payment for those procedures is made privately. The
Indian Health Service
may be the only health care provider within hundreds of miles
of the reservation, and as
a result the impact of the regulations can be quite severe.
Women in prison, who are disproportionately poor and of color,
may also have great
difficulty in gaining access to abortion facilities. Abortion
services are rarely available at
the prison, and prison authorities are unwilling to release
inmates for treatment. Recently
adopted federal regulations specifically deny abortion services
to federal prisoners.
Even where abortion services exist, lack ofinformation about
them deters early abor
tion. Language barriers and the absence of culturally sensitive
bilingual counselors and
educational materials make gaining information about abortion
services a special prob
Reproductive Laws, Women of Color, and Low Income Women
325
lem for Asian/Pacific and Hispanic women. This information
gap would be severely exac
erbated by the Reagan administration’s proposed new Title I
regulations, which would
prohibit family planning services receiving federal monies
under the Title X program
from giving any information about the abortion option.9

Three factors have been identified as especially important in
accounting for very late
abortions: youth, medical conditions, and fetal anomalies. At
least two of these, youth
and medical problems, are likely to have disproportionate
significance in the case of
women of color. The significance of the problem of fetal
anomalies for poor women and
women of color is discussed below in the section on prenatal
screening.
In 1981 (the latest year for which data are available), 43 percent
of all abortions per
formed after the twentieth week of pregnancy were performed
on teenagers. Women
under fifteen years of age are most likely to obtain the latest
abortions (those at twenty-
one weeks or more gestation). Their delay is understandable in
terms of the difficulties
very young women experience in obtaining abortions. These
difficulties include the
parental notice and consent requirements in effect in some
states, as well as the financial
and information problems already discussed. Teenagers of color
often have particular
difficulty in obtaining an abortion. One study found that four
out often black teenagers
were unable to obtain a desired abortion, as compared to two
out often white teenagers.’°
Medical problems are also a factor in late abortions, including
very late abortions. A
major reason for very late abortions is the onset or worsening of
certain diseases. Given
the nature of their health problems, poor women and women of

color are particularly
vulnerable to such developments. For example, black women
have higher rates of dia
betes, cardiovascular disease, cervical cancer, and high blood
pressureH than other
women and may therefore be in greater need of late abortions.
Similarly, the lack of pre
natal and general health care that results from poverty may
mean that serious health
problems arise during pregnancy for many poor women.
Different Forms of Time Limits
The limits on abortion may be imposed by various laws.
Currently, there is concern about
statutes that impose prohibitions on postviability abortions or
seek to compel the use of
the method most likely to preserve fetal life unless the woman’s
health would bejeopard
ized. Poor women and women of color bear the brunt of such
laws because women with
money and power can find ways to circumvent the law, just as
they did prior to the legal
ization of abortion. Affluent women can either travel to a place
where a procedure is legal
or find a doctor who will certify that their health is at stake.
Poor women who do not have
such options are denied autonomy because, as the experience
with Medicaid provisions
allowing reimbursement only for health-threatening situations
suggests, few doctors are
willing to risk prosecution under these statutes.
Time limits on abortion may result from a provider’s decision
not to perform pro
cedures past a certain point in pregnancy. Poor women and

women of color today have
limited access to facilities that provide abortions after the first
trimester. Public hospitals
are a major source of health care for poor women, yet only 17
percent of all public hos
pitals report performing abortions in 1985. Even where the lack
of access does not result
in an outright denial of abortion, it may cause women further
delay that subjects them
to increased heaLth risks)2
Because most poor women must get abortions where they can
find them, they may
be severely limited in their choice of method. Although
abortions done by the dilatation
326 On Freedom
and evacuation (D & E) technique, are safer and less upsetting
for women, D & Es are
not universally available. To obtain a D & E, a woman may be
required to pay for a pri
vate gynecologist or travel to a facility where the procedure is
done. The problem of
obtaining an abortion after the twentieth week is even more
acute. Because such a limited
number of providers perform this procedure, locating a facility,
scheduling the procedure,
and traveling can all impose serious burdens on poor women.’3
The question of abortions very late in pregnancy pits the well-
being of the pregnant
woman and other people against that of the unborn fetus.
Although there is no consensus

among poor women and women of color that the woman’s
interests are paramount, there
is widespread appreciation of the circumstances that bring
women to late abortions and
a general sense that the state must not make the decision for the
woman. Compelling the
use of abortion methods that lead to fetal survival raises serious
questions. How wouLd
the fate of a surviving fetus be determined? If a fetus were born
alive, who would be
responsible for its care? What if the mother did not want it?
Who would be responsible
for financial support? Where would the unwanted fetus be sent?
Could it be experimented
on? Given their economic circumstances and their history of
being subjected to experi
mentation, poor women and women of color have valid fears
about the intentions of the
state toward an unwanted fetus.
Family Planning and Life Choices
The number ofabortions needed can be drastically reduced by
teaching men and women
how to prevent unintended pregnancy, but the process may not
be simple. When mem
bers of a community are denied their rights, how can they know
what those rights are,
much less learn to assert them? To be effective, family planning
services must present
information and services in culturally appropriate ways,
involving bilingual materials
and personnel. Family-planning programs must also take
account of cultural attitudes
and biases about birth control. Some women of color have been
unwilling to limit their

reproduction in order to redress past population decreases that
resulted from war, famine,
infant mortality, or genocide. Thus, such programs must make
women of color aware of
how the ability to take control of reproductive decisions will
benefit their lives.
Another important aspect of providing family-planning services
is helping teenagers
make life-enhancing decisions despite the many barriers for
young people in our society
today. Many teenagers, faced with an empty future, believe that
becoming a parent will
stabilize their lives. Teenagers need information services,
decision-making skills, oppor
tunities for success, and help in building their skills and
interests regarding both school
and work. They also need family life and life-planning
education, and adolescent health
services staffed by concerned adults.
Recommendations
Family Planning
1. Information must be made available to young people and
adults, on sex, pregnancy,
contraception, and abortion and on how to make choices about
them in ways that
are culturally appropriate and targeted to the needs of specific
communities. Inter
preters should be available where necessary. Television,
magazines, newspapers, and
radio should help provide this information in a variety of
languages.

Reproductive Laws, Women of Color, and Lowlncome Women
327
2. Comprehensive job-skill development programs for young
people and adults should
be available in schools and community programs. In addition to
providing needed
job training and workplace skills, this type of training can build
self-confidence and
encourage men and women to make appropriate childbearing
choices.
3. Expanded funding should be available to enable sexually
active youngsters and teen
agers to obtain family-planning services. If more young people
and adults learned
how to prevent unwanted pregnancies, there would be savings in
the Aid to Families
with Dependent Children and Medicaid programs. Knowledge
about spacing preg
nancies and education about prenatal care could also reduce the
incidence of low—
birth weight babies and associated medical costs.
4. Prochoice groups should develop stronger alliances with
those concerned about teen
age pregnancy.
5. Statistical data should be gathered regarding Latina, Asian,
and Native American, as
well as black and white, populations.
6. The Hyde amendment should be repealed.
7. In states funding abortions, Medicaid should offer more

realistic and prompter reim
bursement to encourage more providers to accept Medicaid
patients without insist
ing on cash payments.
8. Where abortion funding is available, information clarifying
abortion payment poli
cies should be disseminated to health care providers. Welfare
workers and hospital
and clinic staffshould be trained to know what Medicaid pays
for. Community-based
nongovernmental organizations should assist in disseminating
information and in
monitoring the information provided by public agencies.
9. Family-planning services must be able to provide abortion
information and referrals.
10. Adequate services must be available at all stages of
gestation.
Postviability Abortions
I 1. There should be no laws compelling completion of a
pregnancy under any circum
stances.
12. Responsibility for determining the fate of a live-born fetus
must lay with the woman
who bore it.
13. Fetal health should be secondary to that of the mother.
000
Fetus as Patient

The topic of fetus as patient involves attempts by medical and
legal authorities to compel
women to follow doctors’ orders and accept particular medical
procedures while pregnant
and when they give birth. For example, doctors and hospitals
may seek court orders forc
ing women to undergo surgery on the fetus or to submit to
cesarean sections rather than
to give birth vaginally. Women may also be subject to criminal
prosecution for “fetal
abuse” or to civil suit by their children for their behavior while
pregnant.
Medical and legal actions in the name of fetal rights raise many
issues for poor women
and women of color. A basic question is whether it is right to
hold individual women
responsible for poor outcomes at birth when many women are
not able to live under
healthful conditions. This topic thus implicates the general
socioeconomic conditions
328 On Freedom
poor women and women of color experience that result in their
lack of access to basic
prenatal care and advanced prenatal, perinatal, and neonatal
technologies. Holding indi
vidual women responsible under present circumstances is
morally Unjust, and it diverts
attention from the need to correct the serious inequities that
permeate today’s society.
Liability for Poor Reproductive Outcomes

There is good reason to believe that poor women and women of
color will be especially
vulnerable to prosecutors’ attempts to hold mothers responsible
for bad reproductive out
comes. As a general matter, their children experience greater
rates of infant mortality and
low birth weight, which can result in physical and neurological
illness. Infant mortality
and morbidity among mothers who live below the poverty line
are greatly increased,
sometimes to as much as twice the rate experienced by other
women.’4
Although the data differentiated by racial and ethnic group are
sparse and not stan
dardized, they generally show that infant mortality rates for
minority groups are dispro
portionately high. In 1982, for example, infant mortality rates
for black infants were
almost twice those of white infants. The infant mortality rates
for Native Americans are
also extremely high. Hispanics present a complex picture.
Puerto Ricans generally have
the highest infant mortality rates of any Hispanic group.
Although the neonatal mortality
rate for Mexican-Americans is considered low by some analysts,
most studies suggest that
the low death rate is the result of underreporting. Recent studies
have shown that Mexi
can-Americans have a higher neonatal mortality rate in all birth
weight categories than
do blacks. Cuban-Americans have low infant mortality and high
birth weights compared
to other Hispanics. This is not surprising, given the higher
socioeconomic status of

Cuban-Americans compared to the other groups. The Asian
population in the United
States is quite diverse, and available data are inadequate. In
general, perinatal outcomes
for Asians in the United States are good, with relatively low
incidence of low birth weight.
Southeast Asian refugees, however, present a different picture
with respect to perinatal
outcomes, as a result of lower economic status and early
childbearing. °
Socioeconomic conditions are an important element in these
poor reproductive out
comes. Low-income women and women of color lack access to
prenatal and neonatal
care. In addition, many suffer from general ill health, broken
families, and lack of social
supports. They are more likely to be exposed to environmental
hazards where they live
or work. When poor women and women of color lack the
resources necessary to help
them bring healthy babies into the world, it does not make sense
to hold them responsible
for poor reproductive outcomes. Is it fair, for example, to say
that an indigent woman is
responsible for the consequences of deficiencies in her diet
when Medicaid does not pay
for vitamins? Similarly, is it fair to say an indigent woman is
responsible for bearing a
disabled fetus if Medicaid does not pay for abortion? It may be
more just morally, if less
feasible legally and politically to hold the state responsible for
the high incidence ofinfant
mortality and disability among the babies born to low-income
women and women of
color.

Compulsory High-Tech Procedures
Recent evidence suggests that hospital authorities’ efforts to
force pregnant women to
accept high-tech procedures will be aimed disproportionately at
low-income women and
Reproductive Laws, Women of Color, and Low-Income Women
329
women of color. In 1987, the New England Journal ofMedicine
published a report on the
incidence of court-ordered obstetrical interventions, including
forced cesarean sections
and intrauterine transfusions. The report revealed that 81
percent of the women sub
jected to such court orders were black, Hispanic, or Asian; 44
percent were not married;
24 percent were not native English speakers; and none were
private patients. Attempts to
compel submission to procedures such as cesarean section, fetai
monitoring, and other
technologies presuppose that they have been adequately
explained and that the pregnant
woman has no good reason for refusing the procedure. Neither
assumption may be war
ranted.
Health professionals report that most women, irrespective of
color or education, do
not question a doctor’s orders. Indeed they stress that the major
problem is unquestioning
acceptance rather than rejection of prescribed procedures,

particularly among low-
income women. Some women who do question high-tech
procedures may do so because
doctors have not been able to clearly explain the risks and
benefits. Others may refuse
because they have personally had related negative experiences
in the past or heard of oth
ers’ bad experiences. Despite their failure to question the
authority of a physician, poor
women and women of color might have good reason to do so.
They have been the subjects
of experimentation in public hospitals and public health care
services. In teaching hos
pitals, unnecessary procedures are known to have been
performed to give experience to
doctors in training.’6 Individual legal actions directed at women
who do resist doctor’s
orders may divert attention from these problems and encourage
other women to submit
to unnecessary and risky procedures. Genuine informed consent
could be an important
tool in addressing these problems. Women need relevant
information in a form they can
understand and a supportive environment in which to consider
it. It is questionable
whether our informed consent laws concerning these
technologies and procedures work
now. What can informed consent mean today when the informer
and the person being
informed are on the opposite sides of education, class, race,
gender, language, and
culture lines? We must develop mechanisms that will really
allow women to decide
what treatment they want and that will protect women against
being pressured into
accepting tests and procedures they either do not want or whose

implications they do
not understand.
Technology and Resource Allocation
The overuse of sophisticated technology has inflated the cost of
providing routine obstet
rical care for all women. Pennata] regionalization schemes, with
other high-cost equip
ment and personnel, focus on end-stage care for mothers and
babies with medical com
plications. Little or no attention is paid to organizing a system
that ensures that every
pregnant woman receive basic prenatal care in her community
and an adequate diet—
— an investment in preventing complicated pregnancies. More
children are likely to benefit
from prenatal care than from high-tech therapies. Although
greater emphasis on preven
tive care is important for all segments of the population, it is
especially important for the
traditionally disadvantaged. Those concerned with the fetus as
patient should focus on
these needs rather than question the behavior of individual
women.
A change in focus from end-stage high-tech procedures aimed at
individuals to
broadly aimed basic prenatal care programs will make existing
resources go further.
When good prenatal care and other health and social
interventions are not available, the

330 On Freedom
results are more difficult deliveries and more low—birth weight
babies needing expensive
technologies. With fewer pregnancy complications, it should be
easier to arrange for all
those who need high-tech services to gel them.
Recommendations
I. State and local record keeping relating to prenatal care and
reproductive outcomes
for all women of color should be improved by maintaining
separate statistics for
black, Hispanic, Asian, and Native American women.
2. Private insurance coverage of maternity benefits should be
mandated, and all pay
ment caps should be removed. Where insurance is employment
related, costs should
be shared by employers and employees.
3. States should make every effort to enroll all eligible pregnant
low-income women in
prenatal programs funded by Medicaid. Eligibility standards
should be modified to
make more low-income women eligible for Medicaid. States
should establish a payer
of last resort system for situations where neither Medicaid nor
private insurance pro
vide maternity coverage.
4. Services available to low-income women should be increased
by expanding existing
programs for women, children, and families in underserved
areas. Such services

should be culturally appropriate and multilingual.
5. States should continue efforts to increase the numbers of
obstetricians, gynecologists,
family practitioners, and mid-level health professionals
accepting Medicaid patients
by use of incentive programs or legal mandate, if necessary.
6. Medicaid recipients should have the opportunity to use mid-
level health profession
als such as midwives, nurse practitioners, and physicians’
assistants who offer cost-
effective prenatal and infant care.
7. Legislation ensuring informed consent regarding the use of
fetal monitoring, cesar
ean sections, ultrasound and similar procedures, and certain
drugs should be
enacted. Such legislation should be modeled on the present
federal and state steril
ization regulations, which are designed to ensure that the
patient has adequate
knowledge and is not making her decision under pressure.
8. Legal remedies should be available for overuse of
technology, just as malpractice
suits currently result in recoveries for underuse of technology.
9. Attempts should be made to identify and prohibit
experimental procedures that are
potentially harmful. All other experimentation should have
rigorous standards of
informed consent.
10. Legislation should be enacted to make more resources
available for …

White 2
Nicaela White
Dr. Rogers
ENGL 4121
8 April 2020
Research Proposal
The authors I chose are Audre Lorde and Lucille Clifton.
They both have different ideas on the expression of being a
woman and the things that come with being one. Examples
would be menstruation, having children, how it feels being one,
growing into womanhood and living as a woman in society. The
poems that I will focus on are: “A Woman Speaks” and
“Hanging Fire” by Audre Lorde and “Poem in Praise of
Menstruation” and “The Lost Baby Poem” by Lucille Clifton.
Thesis: Being a woman in a society where men have all the
power can be overwhelming, and there are not enough people
that understand how hard it is to be a black woman. In the
poems “A Woman Speaks” () by Audre Lorde, “Hanging Fire” ()
by Audre Lorde, “Poem in Praise of Menstruation” by Lucille
Clifton and “The Lost Baby Poem” () by Lucille Clifton, the
poets use their personal experience of being a black woman by
expressing the different emotions, experiences of growing into
being a woman, how it feels to be a woman, and things that
women have to go through. Each poet exposes that the idea of
women are not as strong as men or how they do not go through
painful things are debunked.

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