Mamas on Bedrest: Implications for African Americans from Familism Study

January 7th, 2013

I’ve been mulling over the study, “Maternal familism predicts birthweight and asthma symptoms three years later” by Dr. Cleopatra Abdou and her colleagues. This study, summarized in our last blog post, states that for mamas to be,  familism (assessed as maternal endorsement of traditional {cultural?} views on familial obligation) is a stronger predictor of health over and above mamas’ relationships to ethnicity, nativity, and lifespan familial socioeconomic position (FSEP). In plain terms, the stronger mamas’ beliefs in family and familial roles and obligations, the less likely they are to have low birth weight babies and children who develop asthma within the first 3 years of life.

Most people correctly assume that in well to do families, every possible provision is made to ensure that the anticipated infant has every possible advantage to have a strong start in life. It is also well known that children born to families of lower socioeconomic status and with far fewer resources, while no less loved and anticipated, are often at risk of being born low birth weight and subsequently developing a variety of illnesses as a result. But there is a paradox within all of this,  first referred to as the Latino Paradox by Markides & Coreil in their 1986 publication, The health of Hispanics in the Southwestern United States, An Epidemiological Paradox. The consensus regarding the paradox is this,

It seems that among certain segments of ethnic minority populations in America, including those who are presumed to be less acculturated to mainstream America and/or to have retained more traditional (cultural) values, particularly surrounding family, unassimilated minorities are among the healthiest Americans, particularly where pregnancy and birth outcomes are concerned.

Since the phenomenon is increasingly observed in other minority groups, including U.S. and foreign born Blacks and Whites, the paradox is becoming more broadly known as the Epidemiological Paradox.

I observed this “paradox” during my clinical practice years, most notably in Hispanic and Asian families. In “traditional” families, when a mama was pregnant there was often an entourage that accompanied her to prenatal visits and although she may have been recommended certain medically accepted treatments, it was abundantly clear that mama was under the watchful eye and in the hands of  of her mother, grandmother, aunts, sisters and cousins and whatever they deemed best for mama and her baby would be done (as had been done for generations of babies within that culture) regardless of what any “medical professional” had to say.

What was most striking to me is that Abdou’s most recent publication makes a clear argument that the legacy of slavery (if one can call such an atrocious miscarriage of humanity a legacy) has had profound detrimental effects on African Americans not only from a cultural and economic standpoint, but also from a health standpoint.  For almost every chronic disease (i.e. Heart Disease, Diabetes, Asthma, and Most Cancers just to name a few) African Americans are at greater risk for contracting the diseases, fare far worse, suffer more debilitating complications and are more likely to die from the complications of the diseases than any other ethnic group. As a physician assistant student, I learned about the various body systems and how they work to regulate metabolism and enable the body to function. As I looked at African Americans, I couldn’t understand why diseases hit us with what seems like catastrophic effects.  The Epidemiologic Paradox puts it all in perspective and gives a partial explanation.

African Americans are the only ethnic group that came to America against their will and were unable to maintain any of their cultural traditions. Families and tribes were separated, languages and dialects were forgotten, lineages were disrupted, tribal/cultural rights and customs were lost. Africans brought to America as slaves had a physiologic make up adapted for a very arid and nomadic lifestyle. In America the climate and food and environment were markedly different. Slaves were purposely separated from their families, communities and tribes, a move made to prohibit congregation and revolution. They were prohibited from exhibiting any of their nativity; dances, languages, oral traditions, dress, even names.  They were not free to move about or to even eat foods to which they were accustomed or for which they were physiologically adapted. In so doing, the American Slave Trade effectively obliterated families, cultures, tribes, traditions-and the general health of African Americans.

Fast forward to today. African American women and infants have the highest rates of perinatal and infant mortality among all ethnic groups, and in light of Dr. Abdou and her colleagues’ research this should come as no surprise. What cultural heritage  do African American women possess and pass on to future generations? African American women as slaves were at the whim of slave owners. African rights of passage from childhood girlish years into womanhood were replaced by random seizure and rape. The children that they bore, whether those of slave owners or of other slaves, were often taken from them either as infants or as children, and ritual pregnancy, birth and infant blessing ceremonies were lost. Traditions and rituals that should have been passed down from mother to daughter were lost and have been replaced with advice on how not to draw attention to yourself as a means to stay safe and possibly avoid sexual attention. Today some might argue that it has been replaced with do whatever it takes to get and keep a man-any man-even if he doesn’t respect you or treat you well in light of the deplorable state or African American relationships and families. But that is a discussion for another time. By and large it is safe to say that the family structure in African American culture is severely fractured, relationships between African American men and women is strained, African American children are at risk for sickness, disease, violence and death and if we accept and understand the Epidemiological Paradox as a veritable and verifiable factor in the health of Americans of different ethnic backgrounds and cultures, then we have to acknowledge that this paradox is no more clearly evident than in African Americans.

African Americans have little to no native culture upon which to draw. Most of us  don’t have century old traditions or regal family ties.  Many African American mamas have little or no support and move through the prenatal period alone, while at the same time trying to navigate where they are going to live, how they are going to eat and how they are going to pay their bills.  If they have other children from other relationships they also face social disdain and at times overt disgust for their station in life. And even when everything is “in order” there is the pervasive perception that African American mamas and their babies are less likely to be of means, education or ability. I say this from experience as when I had my son, I was married and insured and yet the day after my son was born, a social worker came into my hospital room and proceeded to present me with “information I would need” to apply for WIC and medicare for my son. She obviously never looked at my chart for she would have seen that we had private insurance and that we were in no way eligible for-or in need of-WIC.

The current American culture is a capitalistic, solitary, “dog eat dog” type of culture. Americans pride themselves on “pulling themselves up by their own bootstraps”,  “being self made individuals” and “I did it my way.” The work of Dr. Abdou and her colleagues, the Epidemiologic Paradox in other Americans who have retained their native cultures and the life and legacy of African American people shows us that this American lifestyle is unhealthy to say the least and for African Americans (as well as for people of other cultures who become more accustomed, more Americanized), it’s deadly plain and simple.

As Dr. Abdou rightly states, cultural familism is a readily available resource for many women. The next thing we health care practitioners, advocates and public health scientists  must do is consider how we’ll take this information and the resources available to us to help craft a cultural resource for African Americans in the hope of not only lowering maternal and infant morbidity and mortality rates, but improving the overall health and well being of African Americans as a whole.


Cleopatra M. Abdou, Tyan Parker Dominguez, Hector F. Myers. Maternal familism predicts birthweight and asthma symptoms three years later. Social Science & Medicine, 2012; DOI: 10.1016/j.socscimed.2012.07.041

Markides, K. S., & Coreil, J. (1986). The health of Hispanics in the Southwestern United States An Epidemiological Paradox. Public Health Reports, 101, 253e265.

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