Black Caribbean Women Research Articles

Ethnicity, psychosocial risk, and perinatal depression—a comparative study among inner-city women in the United Kingdom

Objective The objective of this study was to explore the relationships between psychosocial risk, ethnicity, and prevalence of depressive symptoms in the perinatal period. A comparative study among a cohort of Black Caribbean and White British women was undertaken. Methods A predominantly inner-city sample ( N=301) was recruited at a large teaching hospital and at community antenatal clinics in the north of England. Women were screened for depressive symptoms in the last trimester of their pregnancy and 6 weeks their delivery with the Edinburgh Postnatal Depression Scale (EPDS). Results Black Caribbean women reported higher levels of psychosocial risk for perinatal depression compared with their White British counterparts. They were more socially and socioeconomically deprived. To elaborate, the Black Caribbean women were more likely to live in the most deprived areas of the city ( P=.002), to live on benefits ( P=.014), and to be lone parents ( P<.0001). However, despite higher levels of deprivation and other known risks for perinatal depression, Black Caribbeans were not more likely than White British women to score above the threshold on the EPDS (cutoff point, 12/13). Conclusions During and after pregnancy, approximately a quarter of the Black Caribbean women in this study recorded symptom scores suggestive of clinically significant morbidity. These findings are not reflected in clinical practice, suggesting that there may be substantial levels of undetected and untreated perinatal depression among this ethnic group. This has potentially serious implications not only for the mental health and well-being of individual women but also for their families.

Perinatal depression and Black Caribbean women: lessons for primary care

Perinatal depression and Black Caribbean women: lessons for primary care

Race and Belonging: A Review of Recently Issued National Film Board DVDs

Race is a Four-Letter Word. Written and directed by Sobaz Benjamin. Produced by Annette Clarke. National Film Board of Canada, 2006.55 mins, 19 secs, Language: English. Full Screen, $59.95. Closed captioned--decoder required. Dolby sound. This film is a collage of autobiographical and biographical narratives combined with artistic performances on the complex issue of race, racism, and identity in contemporary Canadian society. The director and narrator is a young black radio show host who presents the audience with a personal journey of exploration to address his own demons centering on race and belonging. He interweaves his story with those of three others: a young black Caribbean woman from England who moved to Canada to escape British racism; a young black Canadian female performance artist who reacts to the dominant racialized aesthetic of beauty as white; and an aging white, male artist who was raised by a black family and sees himself as more attached to blackness as an identity than whiteness. This is also a film about the body politic and representations of self. For instance, in a photo-shoot, the aging male body is contrasted to the young body as well as white to black, each in opposing masks--black to white. The photo-shoot is a performance of race, gender, ageism, and sexuaiity, where the homoerotic context of two nude male bodies entwined also comes face to face with the issue of miscegenation and ageist fears in Western society and the race masks that we all wear, whether we are white, black, or in-between. The nude masked poses are an effective means of de-stabilizing how the black male body is stereotyped and viewed in Western culture through its Other, the dominant image of the ideal: the young white male body. As another example, the young black performance artist challenges dominant images of white beauty and beauty queens by declaring herself Miss Canadiana. Resplendent in red satin gown and beauty queen sash and tiara, she features herself in parades and public events at a variety of locations across the country. Sobaz Benjamin does a wonderful job of personalizing the painful scars of racism on individual lives, without reducing it to simply a problem of the individual. If his objective is for the audience to understand the complexities of race as the lived experience of individual Canadians, he has done that masterfully and in an extremely personal yet abstract and thought provoking manner. The film is successful in raising questions about race and identity, about racial issues that go far beyond structural issues of discrimination. Through the characters' reflections on their lived experiences of race and self-hatred, racism is exposed as a personal struggle for racial identity and feelings of home in a society that privileges white skin. While the use of art, performance, and personal narrative makes the film extremely compelling, the narrator's leaping back and forth between different people's stories is somewhat annoying. The film needn't have been organized in a traditionally linear fashion, but there is too much self-conscious post-modern collage that ultimately contributes to a sense of confusion. The stories also do not have equal weight. While Sobaz and the female performance artist are the strongest characters, the white male artist, though complex, remains aloof, while the young English immigrant, who came to Canada to escape racism in England, is little more than a rant against the hypocrisy of Canada as a country of racial tolerance. This leads to a superficial understanding of their issues. Without more information on these characters' stories, their issues are only about race. Perhaps this is the point of the film, but since the viewer is not able to connect with these characters, they remain shallow, and we do only see their skin colour. In this regard, the white male artist's story seems out of place: while his life story was moving and, in some ways, even tragic, Sobaz Benjamin needed to do a better job of explaining why this person is in the film in terms of what his identity crises can tell us about racism in Canadian society. …

The Mental Health of Black Caribbean Immigrants: Results from the National Survey of American Life

We examined the prevalence of psychiatric disorders among Black Caribbean immigrant ("Caribbean Black") and African American populations and the correlates of psychiatric disorders among the Caribbean Black population. We conducted descriptive and age-adjusted analyses of the data from the National Survey of American Life--an in-person household mental health survey of noninstitutionalized US Blacks. We assessed psychiatric disorders as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria with the Composite International Diagnostic Interview. Compared with African American men, Caribbean Black men had higher risks for 12-month rates of psychiatric disorders. Caribbean Black women had lower odds for 12-month and lifetime psychiatric disorders compared with African American women. Risks varied by ethnicity, immigration history, and generation status within the Caribbean sample. First-generation Caribbean Blacks had lower rates of psychiatric disorders compared with second- or third-generation Caribbean Blacks, and, compared with first-generation Caribbean Blacks, third-generation Caribbean Blacks had markedly elevated rates of psychiatric disorders. Mental health risks were associated with ethnic diversity within the US Black population. Increased exposure to minority status in the United States was associated with higher risks for psychiatric disorders among Black Caribbean immigrants, which possibly reflects increased societal stress and downward social mobility associated with being Black in America.

Perinatal depression: its absence among Black Caribbean women

Anecdotal evidence from clinical practice suggests that Black Caribbean women rarely consult with symptoms of perinatal depression. Reasons for this are unclear. Unlike White British or South Asian women, there has been little perinatal research within this ethnic group. In-depth qualitative interviews with a purposive sample of Black Caribbean women were undertaken in order to gain insight into the factors which might account for this phenomenon. The sample was drawn from a larger mixed-method, comparative study of prevalence and risk factors for perinatal depression among both Black Caribbean and White British women in the northwest of England (Edge et al, 2004) Interviews were audiotaped, transcribed and analysed thematically using QSR NUD*IST4 to facilitate data management. Findings suggest that women's beliefs about mental illness underpinned by personal and socio-cultural attitudes to help seeking might act as barriers to accessing primary care mental health services. Additionally, service provision, antenatal education and the attitudes of some health professionals might prevent women from this ethnic group receiving care and treatment for perinatal depression. The confluence of structural, socio-cultural, and personal barriers might account for the apparent absence of Black Caribbean women from those receiving treatment for perinatal depression.

From Nielsen Estate to Africa House: Ed“we”cation and Male/Female Relations in Rural Woodside, Jamaica

This essay will address the relationship between development and gender relations in rural Woodside, Jamaica. Woodside faces some of the typical issues devastating rural communities globally. These include the decline of agriculture, natural disasters, narrow range of social and economic options for its residents, youth unemployment and underemployment which may result in teen pregnancy, involvement in illegal activity, depression and/or departure from the family and community. Yet with the help of local historian Erna Brodber, Woodside has struggled to build and sustain some unique village institutions which at least partially respond to these ongoing crises. These include the Woodside Community Development Action Group (WCDAG), an Educo-tourism program, an indigenous Emancipation celebration, an Emancipation Summer School, five or six small businesses and most recently, the You/We Shared Learning Institute. As an outsider who has been semi-adopted by members of the Woodside community I have had the opportunity, during five consecutive summers, to observe the dynamics of male and female behavior between community members, within community organizations, as well as between residents and visitors from outside. This paper therefore, will describe both these gendered behaviors and the logic behind them as I see it, as well as how these dynamics relate to the community's struggle towards self-sustaining cultural and economic development. Woodside and Me I first went to Woodside in the summer of 2000, during reunion of my mother's extended family in Jamaica. Cousins, aunts, and uncles from all over the island as well as Canada and the U.S. came together for week of celebration. My sister and I were taken to Woodside by friend of mine and her husband, in order to introduce me to Erna Brodber, scholar extraordinaire, whose work I was familiar with, and who had made lasting impression on me some four years earlier. I had migrated at fourteen years of age to Boston, Massachusetts with my immediate family where I finished high school and college before attending graduate school in California. In 1996 while I was doing dissertation year fellowship in Santa Barbara, I attended conference in honor of Rex Nettleford at U. W.I.'s Mona campus in Kingston. There, I heard Prof. Erna Brodber deliver keynote address entitled, Re-engineering Black Space. In it, she stated that we as Black people needed to complete the task of emancipation and she charged that 'un-schooled intellectuals had done more to further this goal than so-called schooled intellectuals.' She challenged ivory-towerites to give our children more than slavery to carve out a Black space in this white world. Brodber's speech made profound impression on me and it shaped the subject matter of the first article that I published three years later. At the end of her speech I distinctly remember half the audience standing and applauding while the other half sat and refused to clap at all. I had attended the talk with noted female Caribbean scholar who was part of the group who chose to sit without applauding. She told me afterwards that she was disturbed by Brodber's seemingly exclusive focus on Blackness at time when the creolized nature of Caribbean populations was being championed and celebrated, as she saw it, in academia and elsewhere. A year after hearing Brodber speak, I was in the throws of writing my dissertation when I finally read her short text Perceptions of Caribbean Women: Towards Documentation of Stereotypes. This study was published by the Institute of Social and Economic Research with poignant introduction by Trinidadian writer Merle Hodge. Despite having read what I felt were hundreds of essays dealing with feminism and gender identity from scholars of all backgrounds, this short text, and Hodge's five page introduction did more than any other single piece of literature that I had read up to that point towards developing my understanding of the relationship among gender, class, and culture on the one hand, and my own social formation as Black Caribbean woman on the other. …

Ethnic variations in sexual activity and contraceptive use: national cross-sectional survey

Objectives Our objective was to compare data on contraceptive use in relation to reported sexual activity in women from different minority ethnic groups. Design We analyzed the National Survey of Sexual Attitudes and Lifestyles 2000. Subjects Women aged 16–44 years, numbering 6932 and residing in Britain, participated in this study. Main Outcome Measures Our main outcome measures are as follows: percentage of women reporting sexual activity, use of contraception and type of contraception (hormonal, barrier or permanent methods). Results Overall, fewer women from the UK's four main ethnic minority groups reported recent sexual activity, compared with white women. Among sexually active women, contraceptive use was significantly lower in all ethnic minority groups than in white women, but this pattern differed according to marital status. In ever-married or cohabiting women, lower contraceptive use was reported by Indian (78%) and Pakistani women (74%) than by other groups. Among single women, black Caribbean (88%) and black African (82%) women reported using less contraception compared with white (95%) and Indian (100%) women. Women from all ethnic minority groups were less likely than white women to report using hormonal contraception and permanent methods and were more likely to use barrier methods. The differences between ethnic groups remained significant after adjusting for educational achievement and parity. Deprivation and acculturation did not account for the use of contraception or the type of contraceptive method used. Conclusion Sexually active married Pakistani and Indian women reported the lowest overall use of contraception. Among sexually active single women, black African and black Caribbean women reported levels of contraceptive use that were lower than those reported by white women. Sexually active women from all four minority ethnic groups were less likely than white women to use reliable methods of contraception.

A Life-course Perspective on Ethnic Differences in Women's Economic Activity in Britain

This paper examines the relationship between family formation, qualifications and employment for women from white and minority ethnic groups using a life-course approach. Cross-sectional data from the British Quarterly Labour Force Survey for 1992–2003 were used to estimate the relationships. There are major differences between ethnic groups in the likelihood of being economically active, after controlling for life-course and level of qualifications. These are greatest for Pakistani and Bangladeshi women and least for Black Caribbean women. However, predicted probabilities of being economically active are very similar – over 90 per cent – for all young women (aged 19–34) with a degree level qualification who have neither partner nor child. For all women, rates of economic activity are lower with young children, but again vary between ethnic groups. Employment patterns for Black Caribbean women are consistent with economic migration and norms of motherhood that encompass both roles of bread-winner and parent. In contrast, Pakistani and Bangladeshi women’s patterns of economic activity reflect a strongly gendered division of labour where motherhood is associated with full-time care for children.

Are women with chlamydia infection who self-refer to genitourinary medicine clinics different?

The objective of this study was to explore whether patients with Chlamydia trachomatis infection who self-refer to genitourinary medicine clinics have different demographic characteristics to those who initially attend other agencies. This study took place in three genitourinary medicine clinics from Birmingham, Nottingham and Sheffield. Demographic and post-code data were collected from female patients diagnosed with genital chlamydia infection in 2000. Townsend scores, as an index of socioeconomic status, were derived from post-codes from a subset of the cohort (from Birmingham). Comparison was made between those who were diagnosed by genitourinary medicine clinics and those diagnosed in the community and referred to genitourinary medicine clinics for further management. Data were collected from 1047 genitourinary medicine and 816 non-genitourinary medicine women, of whom 686 (84.1%) attended genitourinary medicine clinics following referral. After excluding those with incomplete data, 1614 (987 genitourinary medicine and 627 non-genitourinary medicine) patients were included in the study. Using logistic regression analysis, we were unable to demonstrate any significant differences in age or Townsend scores between genitourinary medicine and non-genitourinary medicine patients. However, significantly more Black Caribbean (odds ratio [OR] = 2.72, 95% confidence interval [CI]: 2.22, 3.20) and single women (OR = 1.97, 95% CI: 1.64, 2.29) self-referred to genitourinary medicine clinics compared with other health-care settings. This trend was consistent between Birmingham and Nottingham. In Sheffield, there was no difference in marital status. Ethnicity was not a factor as there were no Black Caribbean patients in the Sheffield cohort. Women who were diagnosed with genital chlamydia infection in genitourinary medicine clinics have some different demographic characteristics to those who were diagnosed in the community.

Prevalence of hepatitis C in an ethnically diverse HIV‐1‐infected cohort in south London

There is limited information on the prevalence of and risk factors for hepatitis C virus (HCV) infection among HIV-1-infected patients in the UK. Our objective was to determine the prevalence of HCV infection among an ethnically diverse cohort of HIV-infected patients in south London, and to extrapolate from these data the number of co-infected patients in the UK. A total of 1017 HIV-1-infected patients who had attended King's College Hospital HIV clinic between September 2000 and August 2002 were screened for HCV antibody using a commercial enzyme-linked immunosorbent assay (ELISA). Positive results were confirmed by polymerase chain reaction (PCR) or recombinant immunoblot assay. Demographic, clinical and laboratory data were obtained from the local computerized database and medical records. We applied our HCV prevalence rates in the different HIV transmission groups to the estimated number of HIV-infected persons in these groups in the UK, to obtain a national estimate of the level of HIV-HCV co-infection. Of the 1017 HIV-1-infected patients, 407 (40%) were white men, 158 (15.5%) were black African men, 268 (26.3%) were black African women, and 61 (6%) and 26 (2.6%) were black Caribbean men and women, respectively. Heterosexual exposure was the most common route of HIV acquisition (53.5%), followed by men having sex with men (36.9%), and current or previous injecting drug use (IDU) (7.2%). The overall prevalence of HCV co-infection was 90/1017 (8.9%), but this varied substantially according to route of transmission, from 82.2% among those with a history of IDU (which accounted for 67% of all HCV infections), to 31.8% in those who had received blood products, to 3.5% and 1.8% in those with homosexually and heterosexually acquired infection, respectively. Multivariate logistic regression analysis identified several independent risk factors for HCV infection: a history of IDU [odds ratio (OR) = 107.2; 95% confidence interval (CI) = 38.5-298.4], having received blood products (OR = 16.5; 95% CI = 5.1-53.7), and either being from a white ethnic group (OR = 4.3; 95% CI = 1.5-12.0) or being born in Southern Europe (OR = 6.7; 95% CI = 1.5-30.7). Based on the 35,473 known HIV-1-infected persons in the UK and the 10 997 estimated to be unaware of their status, we projected that there are at least 4136 HIV-HCV co-infected individuals in the UK and 979 who are unaware of their status. Overall, 9% of our cohort was HIV-HCV co-infected. The prevalence was highest among intravenous drug users (82%), who accounted for most of our HCV cases, and lowest among heterosexual men and women from sub-Saharan Africa and the Caribbean [< 2%]. Our estimate that a significant number of co-infected persons may be unaware of their HIV and HCV status, highlights an urgent need to increase the uptake of HCV and HIV testing, particularly among injecting drug users, to reduce the risk of onward transmission.

Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey

Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain. We did a stratified probability sample survey of 11161 men and women aged 16-44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4-20]) and black African (9 [3-20]) men, and in white (5 [2-9]) and black Caribbean (4 [2-7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2.74 [95% CI 1.22-6.15]) and black African (2.95 [1.45-5.99]) men compared with white men, and black Caribbean (2.41 [1.35-4.28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions.

Dealing with it: Black Caribbean women's response to adversity and psychological distress associated with pregnancy, childbirth, and early motherhood

This paper focuses on Black Caribbean women's ideas about perinatal depression and the ways in which these are linked to coping with personal adversity. An epidemiological survey found that despite higher levels of social risk among Black Caribbean women living in the UK, they were no more likely than White British women to record above-threshold depression scores postnatally and were significantly less likely to have done so during pregnancy. In-depth interviews were undertaken to illuminate the models, experiences, and meaning of perinatal depression held by Black Caribbean women. Women's narratives suggested that they rejected ‘postnatal depression’ as a central construct for understanding responses to psychological distress associated childbirth and early motherhood. Rejection of depression as illness was associated with imperatives to normalise distress and a self-concept which stressed the importance of being ‘Strong-Black-Women’ for maintaining psychological well-being. This identity served to reinforce notions of resilience, empowerment, and coping strategies characterised by the need to problem-solve practically, assertively, and materially. The study questions the utility of attaching psychiatric labels to the emotional and psychological distress experienced by Black Caribbean women around the perinatal period.

Investigating ethnic differences in sexual health: focus groups with young people

Objectives: To compare normative beliefs about sexual health in young men and women from black Caribbean, black African, and white ethnic groups in order to better understand ethnic inequalities in...

Ethnic Differences in Behavioural Risk Factors for Stroke: Implications for Health Promotion

Objectives. Ethnic minority groups are at a higher risk of stroke and heart disease. However, designing effective prevention strategies requires responding to the needs of different ethnic groups. The aims of this study were to estimate the prevalence of four behavioural risk factors (smoking, drinking, exercise and weight) for stroke among Black Caribbeans, Black Africans and Whites, and also to examined reported willingness to change these behaviours. Design. A random sample of 311 Black Caribbean, 300 White, and 105 Black Africans aged 45-74 registered with 16 practices in south London were surveyed in 1995. Information was obtained on smoking, drinking and exercise patterns, body mass index and perceptions of being at risk of stroke, and willingness to change risk behaviour. Results. White respondents (31% age and sex standardised prevalence) were more likely to smoke than Black Caribbeans (23%) and Black Africans (10%) (p < 0.001). Self-reported rates of drinking were higher than the government's 'sensible drinking levels' for 19% of Whites, 11% of Black Caribbeans and 4% Black Africans (p < 0.001). In contrast, fewer Whites (51%) were overweight (BMI > 27) than Black Caribbeans (60%) and Black Africans (68%) (p = 0.001). A high proportion of smokers wished to give up (89% Black African; 83% Black Caribbean; 74% White). A higher proportion of Black Caribbeans (35%) reported a willingness to reduce their alcohol intake compared to only 15% of Whites (p = 0.040). There was a difference between groups in attitudes to weight reduction with 69% Black Caribbean women expressing a desire to be thinner compared to 86% Whites and 82% Black Africans (p = 0.051). Conclusion. Strategies to reduce behavioural risk factors for heart attack and stroke need to emphasise different risk factors among ethnic groups, especially in relation to alcohol use in the White population and weight in the Black Caribbean population. Influencing the change of these behaviours requires working in partnership with local community groups.

The Social Construction of Black Feminist Thought

Sojourner Truth, Anna Julia Cooper, Ida Wells Barnett, and Fannie Lou Hamer are but a few names from a growing list of distinguished African-American women activists. Although their sustained resistance to Black women's victimization within interlocking systems of race, gender, and class oppression is well known, these women did not act alone.' Their actions were nurtured by the support of countless, ordinary African-American women who, through strategies of everyday resistance, created a powerful foundation for