A Summary of Five Focus Groups:
African American Women’s Views on
Heath Care Use, Satisfaction, and
Community Strength in
South Phoenix, Arizona

Brackette F. Williams, Ph.D
Text Management Services, Tucson, Arizona
Drexel G. Woodson, Ph.D
Bureau for Applied Research in Anthropology
University of Arizona, Tucson, Arizona
Prepared for the Alliance for Innovations in Health Care and the
Maricopa County Department of Public Health
July 9, 2007
For additional information on the Alliance, contact Alyce-Anne Meadows
alyce-annemeadows@mail.maricopa.gov 602-506-6347

Table of Contents
Executive Summary....................................................................................................i
I.
Method and Subjects ....................................................................................i
II. Access and Deliberation ................................................................................i
III. Coping, Recall, and Refusal .......................................................................... ii
IV. Community Strength ................................................................................... iv
Introduction..............................................................................................................7
I.
Method .......................................................................................................7
II. Scenario Topics ...........................................................................................7
III. Population ...................................................................................................9
Chapter 1 Access and Deliberation .......................................................................... 10
I.
“Just keep your legs closed”: Home, School, and Church Training................. 10
II. “‟Cause they hot”: Raging Hormones and Media Influence ........................... 17
III. “They‟d Be Lying”: Shame and Secrecy ....................................................... 27
IV. “Unless something is broken off”: Papa‟s Baby, Mama‟s Labor ...................... 53
Chapter 2 Coping, Refusal, and Recall ..................................................................... 60
I.
“I‟m on my sixth one”: Sexuality and Reproduction as Status Competition ..... 60
II. “She decided”: Coping with Unwanted Pregnancies...................................... 64
III. “I never wanted you in the first place”: Parenting, Discipline, and the
“Village” .................................................................................................... 69
IV. “It‟s just ingrained in who we are, visually”: Race, Age, and Color ................ 77
Chapter 3 Community Strength ............................................................................... 90
I.
“I didn‟t come in here with a community”: Refusing to Be the Forest of
Stereotypes ............................................................................................... 90
II. “I found out about Ahwatukee”: Health Care and the Extended Community .. 97
III. “There is no community”: Networking to Share Health Care Information ..... 104
IV. “We broke!”: The Welfare System and Creative “Refusal”........................... 116
Appendix 1 Focus Group Script and Topic Scenarios ............................................... 124
I.
Introduction ............................................................................................ 124
II. Begin 90-Minute Session .......................................................................... 124
III. Close ...................................................................................................... 129
Appendix 2 Informed Consent and Permission Form ............................................... 130

Executive Summary
I.

Method and Subjects

Between August and September 2006, the Alliance for Innovations in Health Care
conducted five, 90-minute focus groups, using five scenarios to explore six topics—
access, deliberation, community strength, coping, recall, and refusal.
 Access—when and how South Mountain residents learn about
reproductive issues, health care needs, and how timing influences the use of
prenatal health care and other social services.
 Community Strength—assets in South Mountain Village and South
Phoenix neighborhoods that promote healthy outcomes for mothers and
babies.
 Coping—strategies women devise to manage their own and their
children‟s health care.
 Deliberation—knowledge and planning that influence how mothers
decide to when to reproduce and when to use prenatal and other health care
services to have healthy babies and maintain their children‟s health.
 Refusal—factors that keep women from using services for which they are
eligible.
 Recall—experiences with health care workers that influence use of and
satisfaction with health care services.
The 59 women, ages 18 to 43, had completed high school or the Graduate
Equivalent Diploma. Fifty-four had completed two-year technical school, two or more
years of college, or a Bachelor‟s degree, and five held Masters‟ degrees. Only four
women reported personal income over $30,000, with 15 exceeding this figure as
combined household income. In Groups 4 and 5, accounting for 21 and 13
participants, respectively, only ten had personal or combined household incomes
equal to or exceeding $30,000. These two groups did not differ by education, and
included two of the persons holding a Master‟s degree, both of whom were
employed in health care and social service.
Scenario discussions produced views that interrelated topics. Chapter 1
summarizes views that interrelated access and deliberation, Chapter 2 coping,
refusal, and recall, and Chapter 3 community strength.
II.

Access and Deliberation

1. Resources for health care and other social services are scarce and poorly
advertised. Single and two-parent-working households do not have time to locate
hard-to-find resources. Girls (ages 11 to 17), who become parents, do not have the
knowledge to locate and use scarce resources.

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2. Parents are often physically or effectively absent during their children‟s
early years. When fathers are present, they do not instruct and monitor children
because gender-roles make females responsible for these tasks. Many mothers and
female relatives are also physically absent because they are chronically ill, or
addicted to drugs or alcohol. More important, healthy parents may be effectively
absent because, based on their own childhood experiences, they consider it
inappropriate to inform their children about sexuality. Therefore, they do not begin
instructing children or monitoring their sexual activities until they are involved in
practices that the parents find difficult to change. Schools and churches may offer
instruction, which is either too late or ineffective, because parents do not permit
young children to take part, thinking they do not need the service.
3. Differences in household income, education, and composition influence
when and how children receive parental instruction, but these differences do not
ensure that first-time mothers have the necessary reproductive knowledge or health
care and parenting skills. Adults in higher income, two-parent households, may be
too busy with work and other obligations to attend to these matters. The current
generation of effectively present parents uses their own and others‟ negative
experiences to devise reverse role modeling for parenting practices. They closely
monitor their children and openly discuss matters on which their parents were silent.
4. Gender role traditions result in young males receiving less parental
guidance, learning few parenting skills, and attending to their own health care only
in a crisis. These role traditions also mean that women take responsibility for
children‟s and adult males‟ health care needs. Young unwed mothers, trying not to
alienate male affection and economic support, do not press men to become involved
in seeking or using health care and other social services for their children.
III.

Coping, Recall, and Refusal

1. A young unwed mother, who does not care for her first child, does not
learn parenting skills and acquire the knowledge for effective infant health care. She
may continue having children, either because she still lacks knowledge about
contraceptives or because certain, mainly aesthetic, side effects discourage their
use. Successive pregnancies result in increased shame and decreased support from
family and friends. When parents and grandparents take over, rather than assist a
young mother, she may not learn to take responsibility and may continue having
children that neither she nor the children‟s father or fathers support. If the
pregnancies involve multiple fathers, this further increases shame and decreases
approval and support. Shame encourages hiding a pregnancy, and some expectant
mothers do not receive prenatal care before the fifth or six month, and others not
until delivery. Although rare, the same factors encourage some expectant mothers
to deliver without medical assistance.

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2. Young girls raised in the church see anal and oral sex as meeting parental
and church calls for abstinence. Despite the spread of alternative sexual practices,
girls eventually engage in vaginal sex and become pregnant, but may have already
contracted sexually transmitted diseases from the alternative sexual practices. They
may not learn about infection until care for a pregnancy begins.
3. Low contraceptive use, community proscription of adoption, and doctors‟
refusing young women‟s requests to have their tubes tied, make abortion a takenfor-granted solution to unwanted pregnancy. Using abortion to reduce the number
of children after having several adds to its prevalence. Focus group participants
estimate that some mothers of six children may have had three or more abortions.
Available insurance funds assure that most abortions are medically assisted.
However, lack of insurance and hiding pregnancies from parents encourage some to
self-abort. Unless health care workers check for signs of self-abortion, they may
diagnose premature labor and miscarriage. Young girls who abort consecutive
pregnancies do not process the emotions that may follow from abortions, and
community proscription of mental health services means that they are unlikely to
seek psychological counseling. Some mothers, mentally stressed by raising several
very young and unwanted children, may abuse the children physically and mentally.
4. A mother who takes responsibility for raising her first child learns from this
experience. Responding to fears from her first pregnancy, she may not use certain
prenatal services for subsequent children. At the same time, as other obligations
consume time, the mother depends on older children to care for younger ones. The
lack of attention to all children may result in reproducing negative patterns that
begin with children looking for attention and affection outside the home.
5. Over generalizing from a few badly behaved patients, especially the
youngest and least informed mothers, health care workers develop negative
stereotypes, which they extend to all African Americans. They also assimilate all
African Americans to negative stereotypes about welfare recipients as freeloaders.
To present themselves as exceptions to negative stereotypes, and, thus, as
deserving health care workers‟ respect and professional care, the women attend to
dress, speech, and other aspects of comportment that they associate with displaying
self-respect. Using available sources, such as hot lines, triage nurses, the library,
and the Internet, mothers get information to become medically knowledgeable
before going to the doctor. They expect these efforts to improve the quality of care.
Instead, they consistently interact with health care workers, who convert ignorance
of medical knowledge, poor comportment, and difficulty communicating about
symptoms into a stereotype of race-based low intelligence. Responding to their own
presumptions, health care workers consider it a waste of to answering African
American patients‟ questions, because they are incapable of understanding the

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explanations. Persistent patients confront health care workers who see them as
aggressive, hostile conduct that threatens the worker‟s safety.
6. Although mothers devise strategies to “educate” health care workers,
faced with negative responses, they simply get through the interaction or
immediately request another health care worker. When insurance and other factors
permit, patients change doctors, facilities, or both, for future care. Such interactions
mean that mothers bring a child to the doctor only after trying home remedies or
they cease using health care. Confronting these problems during a child‟s medical
crisis is more frustrating. Health care workers dismiss the child‟s complaint as
insignificant, offer no treatment, provide little or no useful information, or continue
prescribing ineffective treatments. These ineffective responses result in repeat visits,
multiplying co-payment costs.
IV.

Community Strength

1. Failing to find a satisfactory facility in the community, mothers expand
community boundaries by using facilities in bordering municipalities. Some find that
outside facilities offer better care, are cleaner facilities, and have shorter waiting
times. The nearest facilities often have large patient populations and, therefore offer
no greater opportunity to see a primary care physician or the same health care
workers on successive visits. Involvement in a series of humiliating and unproductive
interactions sharpens the mothers‟ understandings of systemic medical practices,
which, in addition to the stereotyping of their community, produce negative health
care outcomes. After trying facilities in one bordering community or in several, they
return to South Mountain Village or South Phoenix, or cease using health care.
Mothers who return use what they learn about systemic medical practices to select a
facility where workers cooperate with the mothers‟ strategies to reduce co-payments
for repeat ineffective visits. Community facilities are more likely than outside ones to
recognize and accept their strategies.
2. Despite a shared view of creative strategies and individual resilience, focus
group participants insist that there is no community. This means that patterns of
interaction among residents of South Mountain and South Phoenix do not facilitate
sharing and using poorly advertised scarce resources. Many factors, the participants
explain, create obstacles to cooperation among African American residents, who
confront increasing competition for scarce and diminishing resources from growing
populations of other races and ethnic groups. Efforts by individuals to solve their
own and their families‟ problems promote individualism, which encourage status
envy, jealousy, and invidious distinctions, which, in turn, discourages cooperation.
Persons who feel disadvantaged in status competition may not attend events that
could promote community building. While recognizing that joint action is needed to
solve community problems, the participants note that the African American
population, contrasted with other populations, is not a voting block for race-based

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government representation. There are few African American elected officials, and
they make “backroom deals” undermining campaign promises that would benefit the
community. There are many self-help organizations “working behind the scene,”
participants say. However, working parents (sometimes holding several jobs), can
only take advantage of the organizations‟ resources during special or annual events.
Consequently, they do not assist organizations to build community and increase
resources.
3. For new arrivals—resident for a few months to decade or more—the sense
that there is no community begins with ethnic or racial demographics. The small,
scattered local African American population differs from concentrated populations
and services to which the new arrivals are accustomed. They find few gathering
places in the community to meet African Americans who might informally share
resource information. This problem is exacerbated, both new arrivals and long-time
residents note, when African Americans encountered in other social spaces and
workplaces ignore or spurn greetings.
4. The lack of gathering places in the community is difficult to change. If the
facility is in the community, residents might use it, but creating the option is possible
only by overcoming a mind-set that judges the activity as beyond the boundary
distinguishing Black and White “culture.” The range of culturally acceptable activities
decreases, because once acceptable but long-absent ones become White and,
therefore, difficult to reintroduce.
5. Comparing Phoenix and Arizona with other locations, especially those in
“down South,” the focus groups contend that residents lack traditions for joint
action, in part, because schools teach the young generation little about the history
of African American civil rights struggles. Apathy (passively waiting for other races
to provide resources) reflects individuals‟ long-term adjustment to scarce resources
and the lack of government representation. It is demoralizing, participants say, to
realize that, despite self-help actions, they have little outside support. The
government favors new immigrants, who communally share resources within their
identity boundary. Class diversity increases problems as the private sector takes
over space to provide middle- and upper-class housing for persons who, even if they
are African Americans, keep to themselves.
6. Mothers must “deal with what comes.” Underemployed mothers quit work
because they cannot afford help to care for preschool children or to monitor older
children after school. Focus group members say these mothers trade work for
welfare dependency and humiliation, because health care and social service do not
design regulations to “uplift families.” To qualify for benefits, one must “work to
system,” circumventing the regulations by denying other sources of support. Hence,
a mother with adequate resources avoids the “welfare trap,” even if income and
housing subsidies, health care insurance for her and her children, or fees for

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education would improve her situation. Lacking adequate resources, mothers may
present themselves as single and “broke,” and deny knowing their child‟s father.
This strategy lends support to health care workers‟ negative stereotypes, thus
making the mothers‟ and other African Americans‟ subsequent interactions more
difficult.
Despite the sense that others act to undermine African American self-esteem
and destroy their community, individuals must make choices. Even when choosing
between bad and worse options, parents must try to break negative cycles and
silences, because if they wait for good choices, African Americans in South Phoenix
will “drop like flies.” Resenting health care workers‟ “nasty attitudes,” focus group
members contend that these workers should understand that they have jobs
because South Mountain residents have babies, because many are in poor health,
unemployed or underemployed, and because, facing life as “hustle and hassle,”
some abuse drugs or alcohol, while others commit crimes and fill the jails and
prisons.

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Introduction
I.

Method

The Alliance ran five focus groups to learn about factors that promote or impede
South Mountain women using health care services before and during pregnancy to
assure a healthy delivery and to keep themselves and their growing children
healthy. The scenarios for six topics three sets of questions:
1. What do young women know about conception and prevention? At what
ages do they learn these facts, and from whom? How does this knowledge
influence their decisions about when to become pregnant, how to gain
prenatal care, and how to maintain their own health and the health of
infants?
2. How does recall of experiences with health-care facilities influence their
decisions to use or refuse use of health care facilities, or other social
support services for subsequent pregnancies, and to maintain their own
and their young children‟s health?
3. What community strengths and forms of individual resilience do African
American women reveal that shape and direct their coping strategies?
II.

Scenario Topics

To order discussion across the focus groups, a subcommittee composed of Thelma
Brandon, Rose Howe, Wanda Thompson, Carole White, the moderator, and Andrea
Sturzen, a co-moderator, devised six scenarios to probe the basic topics (see
Appendix 1). The subcommittee defined the topics as follows:
 Access—when and how South Mountain residents learn about
reproductive issues, health care needs, and how timing influences the use of
prenatal health care and other social services.
 Community Strength—assets in South Mountain Village and South
Phoenix neighborhoods that promote healthy outcomes for mothers and
babies.
 Coping—strategies women devise to manage their own and their
children‟s health care.
 Deliberation—knowledge and planning that influence how mothers
decide when to reproduce and when to use prenatal and other health care
services to have healthy babies and maintain their children‟s health.

7

 Refusal—factors that keep women from using services for which they are
eligible.
 Recall—experiences with health care workers that influence use of and
satisfaction with health care services.
To achieve a balanced discussion of the six topics across five groups, the
moderator deliberately varied the time devoted to each topic within the 90-minute
limit. For example, the first group addressed Scenario 1 (access) for 25 minutes and
devoted approximately 15 minutes to each remaining scenario. The second group
devoted 25 minutes to the deliberation scenario, and so on through the five groups.
With six topics and five groups, the last topic—refusal—did not receive 25 minutes.
However, the overlap between this topic and all the others did not pose a problem
for obtaining substantive commentary on refusal. Differences for time
notwithstanding, groups discussed some topics in greater detail and responded to
probes in different ways. The summary reflects transcript coding for five groups
responses to the six topics. 1
Following each focus group, Rose Howe, Wanda Thompson, and the
moderator held a conference call to review the discussion and add probes as needed
for the different topics. Following the final group, the two co-moderators joined in
the conference to discuss how to summarize the five discussions.2 Chapter 1
1

An identifier number (e.g., G2) refers to a focus group, and fictive names to participants in that
group. MV plus a number (e.g., MV2) indicates that several participants responded simultaneously.
When the transcriber could not identify the speaker, but the comment was audible, UNK plus the
group number identifies the quote.
Ideally, a focus group should not include more than 15 participants. When the group is
larger, the note taker has difficulty keeping track of who is speaking, and the transcript includes more
unidentified speakers. For example, Group 4, with 21 participants, has the largest number of
unidentified speakers, despite the efforts of three note takers and the transcriber. While many
comments were audible and the transcription captures them, tracking a particular speaker‟s
comments proved more difficult for Group 4 than for the others. Tracking speakers builds up
accounts of participants‟ statements about themselves and highlights the experiences on which they
base their comments about all of the topics. Where participants disagree on a point, it is important to
consider the experience that may influence their different points of view. The description of the
population refers only to the information collected in a one-page questionnaire designed to assist the
transcriber in using the notes to identify speakers and relate their comments during a group. It does
not include information Rose Howe and Wanda Thompson used to select participants for the focus
groups.
2
Co-moderator Andrea Sturzen and Dr. Jarita Holbrook of the Bureau of Applied Research in
Anthropology (BARA) at the University of Arizona, served as a volunteer co-moderator, and took
notes during the focus groups. Andrea Sturzen assisted with transcription and with coding the
transcript to set criteria for general coding. Dr. Holbrook, using Atlas ATI, helped sort the initial topics
to compose code sets from the total transcript. Rose Howe and Wanda Thompson gathered
information, such as selection criteria for age, residence in the research zones, and number and ages
of children in each household, and assisted with taking notes during focus groups. After an initial

8

concerns the participants‟ views on access and deliberation, Chapter 2 their views on
coping, refusal and recall, and Chapter 3 their views on community strength.
III.

Population

The focus group population totaled 58 African American women ages 18 to 43. A
brief profile questionnaire for each group revealed that all but ten participants
completed high school. The rest finished two to three years of college, or completed
a bachelor‟s or masters‟ degree. Over half of the women earned personal or
combined household incomes below the currently established poverty line. For most
of the others, incomes ranged from $20,000 to $30,000. During discussion,
however, some participants indicated that their personal or combined household
incomes were $10,000 or more above the profile questionnaire‟s $30,000 cut off.
Others indicated both on the questionnaire and in discussion that they earned no
personal or household income.

draft in February 2007, Dr. Brackette F. Williams of Text Management Service, Tucson, Arizona, and
Dr. Drexel G. Woodson, authored the five-group and Executive summaries. All public documents
based on these summaries are the responsibility of the Alliance for Innovations in Health Care, of
Maricopa County, Arizona, and should include a byline consistent with the changed authorship.

9

Chapter 1
Access and Deliberation
 Access—when and how South Mountain residents learn about
reproductive issues, health care needs, and how timing influences the use of
prenatal health care and other social services.
 Deliberation—knowledge and planning that influence how mothers
decide when to reproduce and when to use prenatal and other health care
services to have healthy babies and maintain their children‟s health.
I.

“Just keep your legs closed”: Home, School, and Church Training

Learning about biological reproduction or childcare, the participants say, comes too
late and sources of knowledge are too few. We begin with Frances (G2), a 39-yearold mother of a 15-year-old daughter and a preteen son.3
I mean I‟m college educated and blah, blah, blah, blah, and haven‟t seen the inside
of a clinic and all that kind of stuff. Um, was married many years, five or six years
before I had a baby, right, and blah, blah, blah, blah, did all the stuff you‟re
supposed to do. But, I just didn‟t know, I didn‟t have any children… little babies
around me, I didn‟t have, little… Bebe‟s Kids… sisters, and the kids across the street.
I didn‟t have any of that. So, when I had my daughter I, I, I, I didn‟t even know
what… She was just like… I‟m like, “What do I do with this?” You know? The doctor
said, “Give her a half a jar of baby food,” and, so… gives her a half a jar of baby
food.

Frances, like other participants, thinks that schools do not provide timely sex
education and moral guidance, because general American cultural values set the
timing of this instruction without reference to the realities of children‟s exposure to
factors that promote early progression from sexual awareness to sexual activity.
Questioned about when young girls first learn about reproduction and
contraceptives from school-based instruction, the groups agree that it formally
occurs between fourth and eighth grade—with sixth grade as the most prevalent
answer. They disagree on whether all schools include sex education, basic human
biology, or human reproduction classes. Catherine (G1) sums up the view,
consistent across the groups, of instruction that schools offer.
I would say that she [a female grade-schooler] learns about getting pregnant, she
would learn something about that in elementary school, fourth grade, fifth grade, at
3

Frances reports a household income higher than the profile cut off. She completed a bachelor‟s
degree, placing her among participants with the highest formal education; second only to four who
had completed postgraduate degrees.

10

least… Ah, I know at school, they have sex education. They teach them about their
bodies, and, ah, ah, what‟s developing. I have a 12-year old, and I know she is
learning about that, you know, in elementary school, and [from] her peers, too.

Members of Catherine‟s group and others also agree with qualifications Carine (G3)
introduces in noting the rudimentary content of instruction that they think schools
offer children.
Okay. I think she would learn about [basic human biology] when she‟s… ah… within
seventh and eighth grade. If they do health or sex education, as far as, like, the
human reproductive system. But… other than that… [shrugs].

Other participants add that schools do not offer this instruction before the ages at
which girls may already be sexually active or become pregnant. They think that
schools might respond better to this reality by lowering the grade at which
instruction begins.
As two further comments suggest, however, participants do not always agree
on when schools first offer instruction. Dianna (G3) thinks sixth grade is later than
schools teach basic reproductive biology. Beatrice (G3) agrees with Dianna. Based
on her experience raising two teenage girls, she remarks, “I think they start
prepping them around ten.” When others look doubtful, she adds that she is
referring to “Their parents… the moms,” not the schools. Darlene (G2), who works
for AHCCCS at a hospital, speaks from her work experience, from her first
pregnancy at 17, and from her knowledge of friends and neighbors whose first
pregnancies occurred even earlier.
She sums up critical aspects of the participants‟ view that sexual activity is
happening earlier today and well before schools begin instruction. “I feel like, in this
day and age, they [schools] should [provide earlier instruction], because there are
kids that—I mean like ten, 11 years old—having kids, and they don‟t have no idea
what‟s going on.”
Yet, even if schools lower the grade of first instruction, participants agree
with Elena‟s (G3) view that a girl‟s substantive learning begins “…when she gets
pregnant, [then] she learns about [conception].” Considering the likely age of first
pregnancy, multiple Group 5 speakers, agreeing with an unidentified speaker,
remarked, “That period… It‟s the period… when that period starts.” Their remark
echoed comments by participants across the focus groups.
Probed to report the earliest age at which a first pregnancy occurred among
siblings and friends, participants across the groups provide examples ranging from
11 to 13, but one replies that she knows of a girl who became pregnant at age ten.
Overall, participants agree with Paula‟s (G5) conclusion: “[Age] 13, and after they
have a baby. Yeah, I have a couple friends who had babies at 13.”

11

Participants‟ accounts of their own and their siblings‟ ages for first
pregnancies—12, 13, 14, and 15—support their general responses. The self-reported
age range for first pregnancies among the 58 participants was 12 to 38, and their
comments about siblings, other relatives, and friends suggest that 15 is the most
prevalent age for first pregnancy. Still, Dana (G5) reports the extreme age that
participants recount in their stories: “I know someone who had a baby at eleven,”
which suggests a progression to sexual activity as early as age ten. Participants
across the groups also agree with Elena (G3) about the need to change the timing
of sex education in school and at home: “[E]arlier. I know a lot of my friends
learned… [when they got pregnant], you know.”
When the moderator asks Group 5 why they think girls become pregnant at
such early ages, UNK (a participant who, unfortunately, typically comments in side
whispers) replies, “„Cause they hot!” Others in Group 5 concur. Across the groups,
participants discuss the factors underlying and motivating being “hot.” Generally,
they agree with Margaret (G3): “They [are] not listening to their parents.” Evelyn
(G4) elaborates on this view.
But you have to remember how many kids did what their parents said. Our parents
told us all that [i.e., the dangers of sexual experimentation and early pregnancy], at
least half of it, but we still chose to go out and do [what they advised against], on
your own or with your friends…. I think back to some of the things I was doing as a
little girl that I had no business doing, and thought it was okay, because it was
taught to me, not by my parents, but by other places in society.

Where schools provide instruction on sex-related matters, the focus group
participants note, parents must sign consent forms. Based on experience with family
and close friends as parents, the participants insist that many parents are unwilling
grant consent because they do not want their children to “have that conversation.”
When parents are physically or effectively absent, younger siblings, who become
substitute parents, are too young to sign consent forms. For parents who are trying
to be effective, participants also agree with Paula (G5), who counters:
Parents in poverty, they don‟t have time to teach their kids a lot that they would like
to teach [them] in [a] way… in the manner they wanna teach „um…. You have to
work so much. And, by then, you think sex education in school is good, but that is
not good lotta times.

Fern (G5), sums up another general view, explaining that what schools teach may
be distorted by peers and, thus, have unintended negative consequences. “When I
was growing up, I learned it from people who had already learned in high school,
and they were telling middle-school kids, this is how to use condoms.”
The problem, Fern and others note, is that these secondhand lessons on
condom use are as likely wrong as right, and a girl‟s male peers suggest that there
is no need for condoms. Young boys, says Dana (G5), tell their female grade peers

12

that condoms are unnecessary because they know how to prevent pregnancy:
“[T]hey will pull it out”.
Helen (G1) links the impact of working parents to media influence and peer
misinformation.
Yeah, it‟s gotta be because you go outside… If you don‟t get [information] because
your parents are busy working three or four jobs, trying to make it, you have to get
that information from somewhere. Nowaday, with this generation, they get it from
TV. The kids, they sit in front of the TV or… the video game and they pick up all that
stuff. And, it‟s not like when my Grandma…. [You] could go to her Grandma‟s house
[noting another participant] and sit and, you know, get educated, just like it was my
Grandma‟s house. It‟s totally different these days. And, when the parents are
working, you get the kids out at the Y and stuff, and they are getting advice from
people, like their coaches or just their friends. And, whatever they think the advice
is, because their parents are not at home, when things are not in their household,
they are going to get the information elsewhere.

When Group 5 participants agree on the increasingly lower age for sexual activity,
and an unidentified speaker stage whispers, “Yeah, they are getting younger and
younger by the year.” Lois (G5) adds, “That‟s what I am saying, that [grade school]
may be too late—by the time they learn about it.” Dianna (G3), a parent of two
teens and foster home mother to grade school and younger children, expands on
this view in her group.
I think things are changing, because, I know, the kids now get, ah… You know, the
parents have to sign consent for them to learn about good touch, bad touch. My
daughter has learned about puberty [and she is] in the fourth grade… Yeah, so, I
think times are changing, but I think that the school is mostly responsible, versus…
the parents.

Ula (G4) makes a similar point during her group‟s discussion: “In society today… I
think, I think ages [for sexual awareness] are getting earlier. It‟s normal in today‟s
society.”
The focus groups see changes in school curriculum and in society moving in
opposite directions. Participants 40 and older recall grade schools teaching “human
development” in health education classes, which included basic biology, hygiene,
and nutrition, and some schools offered sex education. Mary (G4) says:
Um, gosh, I am 41, so… [when] I went to Julian, Martin Luther King—some of you
know these schools—they were teaching us about our period; about a lot of things.
They taught us about sex.

Participants 30 and younger say this is no longer true, even when schools offer
classes in the sixth, seventh, or eighth grades. They think that, currently, the
earliest school instruction occurs in the sixth grade, but insist that today‟s classes
include less information. Hence, younger participants in Mary‟s group quickly and
13

persistently counter the older women‟s experiences. “It‟s not that way anymore,”
they say, referring to their own school years and to schools that their children now
attend.
Returning to Dianna‟s point about school versus parental responsibility, some
Group 3 participants agree that parents are most responsible, while others disagree
by considering constraints on parents. While seeing the school as having a critical
role, Glenda (G3) places this role in a racial context, emphasizing society‟s generally
negative view of African Americans. For this reason, parents should not count on
schools, participants agree, especially in Arizona.
My parents… I know from my parents. My mother, you know, and my grandmother.
My grandmother is from Mississippi and you had no choice, you had no choice but to
stand strong. Those were hard times, back then… and it‟s still hard times this very
day. Nothing has really changed. It has gotten better for us African American people
generally, but, still, we are in hard times. And, it goes back to the home front. We
can‟t expect society to raise our child.

Hearing this, Alexis (G3), in her mid 20s and the mother of three grade-school-age
boys, and a younger girl, responds:
Not necessarily. I look at [it] not as society is raising our kids, but there are some
people who feel they have that teaching ability. And, honestly, I know that I don‟t
have no kind of teaching ability, because I don‟t have no patience. To teach
somebody, you have to have patience. And I‟m the type of person, if I say, “Two
plus two is four,” I don‟t want my child… if I tell him how to add it up to four, I don‟t
want him not to understand how to do it the very first time.

Therefore, while the mothers agree that parents have primary responsibility
and individuals some of their own problems, they see social influences as integral to
community problems and individual responses. When children enter school, even the
most diligent parent loses control of what the school environment exposes their
children to and how peer pressure influences the children‟s responses to home
training. Within and across groups, participants disagree on the relation among
school assistance, parental supplements, and individual resistance to parents‟
advice. Only one participant, an unidentified speaker in Group 4, insists, “I did
everything my parents said.”4 Overall, participants agree that basic knowledge is the
key to understanding both reproductive dynamics in the community and their
implications for when expectant mothers begin using prenatal care. However, many
other factors affect whether mothers continue prenatal care during a first
pregnancy, and whether they will use social services for subsequent pregnancies.
The focus group participants‟ experiences of negative attitudes toward African
Americans and South Phoenix residents lead them to question how schools can help
4

Unfortunately, we cannot track how this might influence her other views, because the transcript
does not identify her.

14

raise their children‟s self-esteem. Participants see low self-esteem among parents
and children (especially among “children raising children”) as a major cause of
negative community dynamics. Along with peer pressure once children enter school,
they note that the media promote negative messages. Working parents have access
to few resources, participants say, to establish positive role models. Resources are
both scarce and hard to find outside working hours. For African American children,
participants add, American values do not offer messages to build self-esteem, but
rather encourage the children to think of success as “living the exception.”
The lack of options for building self-esteem, participants say, begins with a
school curriculum that excludes positive African American role models or only
highlights a few individuals who achieve high status and high incomes by “living the
exception.” As examples, they mention sports stars, musicians, and entertainers.
Irene (G1) sums up this view and the participants‟ criticism of it.
[N]owdays, they want us to live by the exception. Kari [the young father in the
scenarios] came straight out of high school and now he‟s a big star. And, “I‟m gonna
push you to go through high school „cause, you know, I ain‟t got no money, so you
need to git, to get that football scholarship or whatever it is.” But, that‟s the
exception… I tell my daughter this all the time, and she is only nine: “It‟s up to you
to go out and seek the resources.” And, I always inform her that no matter what
choice you have, regardless of the lowest of your low, whatever it is, wherever you
are at, you have a choice. It may be one choice, but you have a choice of that
choice, whether you take it or not.

Across the groups, participants also suggest that differences in resources for
schools in South Mountain and South Phoenix, as compared to other areas, make
the parents‟ task still more difficult. Glenda (G3) addresses this point and its
implications for inadequate school instruction.
[I]t is a problem because, I feel like, in different districts… South Phoenix, there is
not enough education… sexual education, for our children. It should start as early as
first grade. They start that in Tempe. They learn about their bodies. [Beatrice
agrees, “Yeah.”] They don‟t learn… about the sexual aspects of it. They learn about
the body—how their bodies function, and so forth. That should be brought to South
Phoenix itself.

Asked to account for the difference, Glenda responds, “It‟s because of the race,”
thereby pinpointing a factor reiterated across the groups as an influence on the
quantity and quality of all services, including health care facilities, in South Mountain
and South Phoenix.
To summarize: Seeing knowledge as the most important factor for access and
deliberation, participants agree that some instruction occurs in school, but say times
are changing, and schools offer too little information too late to address the realities
their children face. Nonetheless, the participants see many parents making matters
worse by denying their children‟s early sexual awareness and progression to sexual
15

activity. Regardless of what schools provide, they emphasize, the bigger problem is
that many parents neither sign school consent forms nor actively instruct and
monitor their children at home. Many participants base their views about the rate of
refusal to grant consent on experiences with other parents, but some mention their
own refusal until they confronted a crisis.5 Too few African American parents, the
focus groups conclude, are willing to talk to their children and monitor their
maturation.
Parents resist, focus group participants agree, because they fear that
providing accurate information, even basic biology, might encourage children to
experiment with new and undesirable activities. Where parents take this position,
participants say, it results in unconstructive denial. Often, the parents believing most
insistently that their children are sexually unaware or active, learn too late the error
of their assumptions.
Betina (G2), now in her late 30s and the mother of three college-enrolled
children, was a teen mother. She had her first child at 16, following an abortion of
the baby she conceived at age 12. For Betina, her early life experience is a
“testimony of how far God has brought me.” Founder of “The Women‟s Global
Ministry,”6 she offers sex education classes for teens that stress abstinence until
marriage. Her classes are voluntary and require both parental consent and
agreement to children‟s confidentiality. Parents resist allowing her to talk to their
children about general sexual matters, Betina insists, and think she is “crazy” when
she uses her personal experiences to support her views. In Betina‟s account of her
early progression from sexual awareness to sexual activity, she hints at incest and
admits to sexual relations with older men.
People… when I talk about things, people look at me like I‟m crazy. But they don‟t
understand, this is my testimony! Why should I be ashamed of how far God has
brought me? Why should I be ashamed of the things that I have been through? I
should want to share it. You know, it helps someone not to go through the same
thing. You know… it bothers me, it bothers me.

In a later exchange with Betina, Frances (G2) dubs Betina‟s testimony the
“dark, dirty stuff.” The exchange between these mothers of teens is instructive.
Frances begins by explaining why parents resist Betina‟s classes.
„Cause we think—if you talk to [my daughter] about that dark, dirty stuff that you did
when you were 15 or 16—that you might expose [too much]. Now, now, she might
only be thinking about drinking Apple Bacardi. But if you tell her about the—I don‟t
even know what—dadadada that you did, now my daughter might say, “Hmm, so
there‟s marijuana, so I can get…” So, so, so, that‟s why moms aren‟t putting their
daughters in front of you to say okay. I don‟t know your name, but, lady in pink

5
6

How many parents refuse to sign, is a matter that needs documentation.
I have altered the name of Betina‟s ministry to protect her identity.

16

[referring to Betina], don‟t talk to my daughter because, hell, she might… you
might… that‟s like putting… [shrugs].

The possibilities of Betina‟s “dark, dirty stuff” leave Frances speechless and she
retains her view, despite having trouble with her daughter. Frances links her own
lack of instruction from a mother “who raised her on silence” to being unprepared to
note signs of her daughter‟s sexual activity and alcohol abuse. Only when officials
called Frances to school after finding her daughter passed out in the bathroom did
Frances awaken to her daughter‟s realities.7
When the moderator asks Betina about the ages of the parents most likely to
resist her classes or the church‟s involvement in children‟s guidance, she suggests
age 60 and above. This sparked immediate, negative head shaking around the table.
Frances (G2), reflecting on her own parental conduct, voices the point of
disagreement.
Yeah, I‟m not [60, but]… I‟ll tell you, I‟m one of those people. I did not realize…
because, I didn‟t have that, that experience. I came—I think everybody in here
probably came from some kind of dysfunction in their home—but, because I didn‟t, I
didn‟t know that I was supposed to be talking to my daughter, or I just thought, if I
made sure that her belt matched her shoes and that she had that… [it was enough].
I didn‟t [talk about other matters], because that‟s how my mom raised me.

II.

“’Cause they hot”: Raging Hormones and Media Influence

Across the groups, participants expand on why, by age 12, maturing girls and boys
(the latter, perhaps, becoming sexually active earlier) are bundles of raging
hormones. They experience feelings they do not understand and about which they
cannot speak to their parents and other adults in the community. Instead, they
discuss the feelings among themselves. Participants see “the media” as the prime
source of misinformation that peers distribute. Most particularly, the media
broadcast messages that transform sexual awareness into early experimentation.
Peers combine distorted information from schools and parents with responses to
media messages linking sexiness and self-worth to produce the misinformation on
which they act. Participants say that peer competition to obtain or to become what,
according to the media, creates self-worth, promotes a fast progression from
understandable or “natural” curiosity and sexual awareness to sexual activity.
Well before first grade, participants insist, the media expose children to
messages that equate sexiness with competitive self-worth. When speaking of
negative media influences, participants do not refer to print products, such as
7

In every focus group, at least one participant insisted on “keeping it real.” Betina took on this role
Group 2. When any participant seemed to speak about ideal situations, others challenged the ideal
with what they saw as hard realities. Insisting on keeping it real accounts, in part, for the
participants‟ attention to the negative aspects of personal experiences and community conditions,
even as they charge outsiders with seeing only the negative.

17

magazines, books, or newspapers. Instead, they focus on audiovisual media,
emphasizing television shows, commercials, and music lyrics and videos. They also
mention Internet websites as a source of problems in homes that have personal
computers.
Raised on television, participants first recognize the power that the media had
in their own lives. Frances (G2) explains:
I had to cut off cable because I was addicted to the videos. Not the kids. So, that
helped them by me [not watching videos], because I love…. I‟d sit up there, after
work, just sit there and watch them myself all daylong.

Referring to rap music lyrics and videos, Frances also expresses shared contentions
as she insists: “I think [it is] these nasty boys… I got a ten-year-old son, too. But I
think… I think these, these, um, these disrespectful, dirty boys, and, I guess, girls
because they [the boys] couldn‟t do it by themselves.” Though once she was
addicted to television, Frances goes on to say, now:
I can‟t even listen to my radio and I can‟t watch television…. I mean the
commercials… I am just, I‟m just sickened by the way these girls wear these little
shirts, and, I just, I think that television has made it okay…. And, it was bad when
we were growing up, you know; you don‟t be disrespectful, but now it is just…

Frances‟s comment fades into other Group 2 participants‟ statements about today as
a time when “anything goes.” She sees her daughter copying the media messages
and using sexiness and, in her view, self-deprecating names to gain peer approval.
My daughter would say, I‟m Mia—her name is Mia8… and her little moniker is Mia Bia.
Well, somebody had to tell me bia means B-I-T-C-H. I didn‟t know that. But my
daughter—my little cookie-cutter daughter—is Mia Bia… and rocks Mia Bia; wants to
be Mia Bia; is proud to be Mia Bia.

The transition from awareness to activity, Group 2 agrees, is both happening
more quickly and drawing in progressively younger children. Frances comments on
the different climate for her teen years and those her daughter faces today.
Yeah. I‟m 39 and I learned it [facts about reproduction] at 25 when I had one [a
baby]…. But, I‟ll tell you what, I have a 15-year-old daughter that I talk to, I mean
on a daily basis, because just in the twenty-year difference between her and I, the
world—something just… something has happened, you know. And, so, now, my um
cookie-cutter-Ivy League little girl that I think ought to be in the Angel Choir, and on
the Junior Usher Board, and doing all the things that my parents insisted that I do
(wasn‟t even an option) wants to be a hip-hop chick; wants to be a badabada; wants
to ride or die! So, I have no choice but to say “Well, Mia, you know, but let‟s talk
about condoms, let‟s talk about… um, your body, let‟s talk about sex, let‟s talk about
oral sex, stuff like that. I mean, conversations that I never even had I‟m having to

8

The daughter‟s name is fictive, included for the sake of the rhyme on which Frances comments.

18

have with my 14-year old because… I mean she‟s, she, …it‟s her life! It‟s the stuff
that‟s going on around her. So, 25 for me, 15 for my baby—something happened.

Others in Group 2, like participants across the groups, were quick to
conclude, “Television happened” (MVG2). In Group 5, Paul says, “Television—they
see it on TV,” and an unidentified speaker add, “Yeah, all you have to do is push a
button.” Ester (G2) adds, “It‟s television and music!” Then, she goes on to explain
the connection other participants also see between exposure to media messages
and children‟s motivations to transform sexual awareness into sexual activity for
competitive self-worth.
And, those videos and television shows have said, “If you‟re not sexy, if you don‟t
put it out there, you won‟t be successful.” So, [children] have correlated how
successful you will be to how much you put out there. And, I think for young girls
and young boys, they cannot differentiate between what that means. To them, that‟s
the, that‟s the end all.

Lois (G5) qualifies and places the dynamic in community space.
I would say it‟s the community you are in. „Cause, I know, me being in South Phoenix—I haven‟t lived
here all my life—but, just being around, and knowing certain areas, you learn some areas do and
some areas don‟t. So, if there are children out there—12 years old—out there kissing, shaking their
butt, doing something they see on the videos, you like, “What she doing?” And, the dudes—don‟t get
me wrong—[girls] like, “He‟s a cute dude,” and [he] may not have nothing at all. And they, like, “He
messing with that girl shaking her butt. I want him, so I‟m gonna shake my butt, too.” Well, he‟s
already hitting that [having sex with the first girl], he‟s like, “I wanna hit that [have sex with the
second girl, too]. I wanna see what she got.” So, that‟s where that comes from [inaudible]. And, [if]
you don‟t have a mother and father… [shrugs, indicating that the second girl becomes sexually
active].

Responding to Group 2 participants‟ comments, Frances (G2) later qualifies
her reference to those “disrespectful dirty boys.” She and other participants make it
clear that they do not see the problem as either limited to the community (as a
spatial or as a generalized African American identity unit) or to African American
male rappers or hip-hop musicians.
Because, if [Mia] is looking at, um, Brittany Spears and Paris Hilton, and I don‟t even
know the Black folks, but, but all these people [Group 2 laughs]… who are
whomever… —uh, Little Kim and, you know, whomever else. To… see somebody
that, that‟s got clothes on, it‟s gotta be Clare Huckstable [wife and mother on The Bill
Cosby Show], or you, or me. And, we‟re not cool; we‟re so not cool. So, who‟s cool
and got clothes on? I don‟t know. Does anybody? You guys [referring to other
participants] are young. Who? …So what are the other options? If they‟re not looking
at somebody‟s butt in the camera, then what channel can they turn to and see Maya
Angelou or somebody talking about something that‟s of value?

Fern (G5) qualifies the family structure/community conjunction of which Lois speaks,
when she notes that two-parent households are not proof against children‟s
absorption in the sexy-as-self-worth dynamic.
19

I had both parents, and my dad was in the military, so they were always there; made
you want to do it more. Like, well, I‟m gonna sneak out and do it anyway. „Cause
[that‟s] what got… the guys. And, no matter what… how your parents talk to you,
because you see everyone in the community… it looks hip, it looks hot, and you want
to do it…. Because I had both parents, I was like, “She doing it and she popular.” So,
if you don‟t have someone in your ear telling you, “It‟s just not right,” even though
your parents say [it], well, they ain‟t nobody.

Across the groups, other participants agree, basing their views on their teen
behavior, on being members of two-parent households, and on raising children in
both single- and two-parent households. To the conclusion by Frances and others
that mom and dad are “so not cool,” Fern (G5) adds that children, intent on being
popular with peers, believe their parents speak “to be mean.” She returns to
Frances‟s questions: How can parents find alternative sources of knowledge, role
models, and moral guidance? What do communities offer to aid parents and teens
struggling with media-driven messages and resulting peer pressures?
You don‟t know there are, like, people in the community you can go to and talk
about it. I didn‟t know you could go to the school counselor and talk about that kind
of stuff. I thought the school counselor‟s only help was with school stuff, not “I‟m
feeling pressure to do this.” I didn‟t know you could do that. It is not known because
people don‟t spread that; they don‟t let you know, “Oh, you can talk to anybody
about it.” Most kids would be like, “Well, they school counselors [and] I‟m not
listening to my mom and dad [because] they just saying it to be mean.” People know
that sex can get you pregnant, but, like, they are not thinking about [that].

Beatrice (G3), raising three teens in a two-parent home, echoes Fern‟s views. She
adds the home/community interface to the difficulties that parents manage as
schools and peers expose children to activities parents once could control.
I can tell you this, my 16-year old—„cause I have a set of 17-year- old twins, they
are a boy and a girl—… when my 16-year old started, ah, junior high, sixth grade,
ah, we had this… I would buy whatever kinda music they listen to and play it in the
car. We didn‟t do the radio. Well, she rides the bus to school. What they doing?
[Laughs] They playing the radio…. I‟m not living in a fantasy world. I know.

Beatrice insists that home training can overcome these influences.
[I]f you train up a child a certain way, there are certain things that they just won‟t
desire. Because, I don‟t have to say, “Don‟t do that, don‟t do that, don‟t do that.” If I
don‟t make a big deal out of it and you know what it is. [It‟s] kinda like you know
how you can take a little baby wandering around, you don‟t want him to go here, so
you set him in that direction and they go that way. That is all it was. I did not have
her pay attention to what was over here, so she just focused to what was over there.
That‟s her focus. So now, she is a junior in high school.

Where parents are patient and work at guiding their children, they still face
negative societal influences. Individual responses to different household mentalities

20

produce variations in outcomes that parents otherwise expect to see from reverse
role modeling. Linda (G4) remarks,
I think it depends on both. You can have a child that grows up in a dysfunctional
family, but [is a child] that‟s real stern and disciplined. And they just got something
inside of them that‟s, like, that is just not me. You know what I mean.

She goes on to insist that a child‟s intellectual capacity should determine when
parents begin instruction about sex and reproduction.
If a child is aware of everything, and can sing the song and memorize the lyrics, and
do this and that, they should be able to know. I got a six-year-old daughter and she
knows. She knows what sex is and she knows not to look at it on TV. When people
are kissing, she turns her head. She knows it‟s just something she not suppose to
do, and she will tell me like, “Mom, they not suppose to do that „til they get out of
college. Mom, they not suppose to be kissing until they get out of college.” You
know, you just… you instill it in her; this how it is suppose to be. Not, “Oh, this is
how it‟s done; what you see.” She [is] thinking, they doing something wrong. They
are supposed to do that when they get out of college.
Other Group 4 participants disagree. Like Frances, they note the pervasiveness of
negative influences with which parents must contend at earlier ages and from new
sources. They also see sexual activity as “human” and note the many influences a
child will face before finishing first grade. As Linda talks, other speakers express
doubts in the background about the long-term effectiveness of her home training.
An unnamed speaker sums up the basis for doubt: “Everybody bonks.” Karen (G4)
provides another reason why participants question Linda‟s view, seeing her as the
kind of overconfident parent who notices a child‟s sexual activity too late.
I think it has to with do we are all human. When you think back to when you were
young, and what children see on TV. It has nothing to do with society. It has to do
with everybody is human and they are gonna do things. And, as long as your
children are able to talk and can hold a conversation with you, they ought to be
taught all of that, because anything can go on anywhere. So it should, it should have
no basis in any of that.

Anita, Mary, and Evelyn agree, but, like participants in other groups, do not
see inherent human sexuality as independent of social influences. Instead, they
comment on why outsiders may see this human response more often or only among
young girls and women in South Phoenix. Evelyn (G4) says,
But, it‟s true. It‟s just more out there. It‟s too obvious with women in South Phoenix,
which is sad, because other women, they try to hide it…. [E]veryone in the human
world does what we do on the Southside…. But it‟s true. It‟s just more out there.

“It‟s just walking down the street in front of you with us,” Anita (G4) remarks, and
Mary (G4) elaborates:
21

We are always exposed in South Phoenix as being bad, but they never focus on the
good things that Black women in South Phoenix does. They always talking about that
negativity. You know, we don‟t do no badder than any other side [of Phoenix]; any
other race. We may put our stuff out there… ‟cause we may be proud. They don‟t
know our situation. They never been in our situation. They don‟t even know us, to
portray us to be like that [referring to the deliberation scenario].

Group 2 agrees about the influence of television, radio, and music videos, but
adds “the Internet” to the mix. “They are on that…”—others, speaking
simultaneously, finish Betina‟s thought—“MySpace! MySpace!” The problem of
Internet influence begins, according to Group 2, with children as young as age ten.
Other focus groups place less emphasis on the Internet because they think that few
people have personal computers or make use of those in libraries. Nonetheless,
participants agree that a personal computer at home becomes one more source of
negative social influences on children, access to which parents must take primary
responsibility for monitoring. Computer-based interaction makes it more complex
and more difficult for parents to monitor children‟s exposure to negative influences
and associated peer pressures.
Yet, while the focus groups see audiovisual media as motivations for
children‟s behavior, they do not consider the media the only cause of negative
reproduction patterns. The participants detail family and community dynamics that
worsen media influences. Most important, they insist again, is parental denial—“Not
my child!” Denial allows children to progress from sexual awareness to sexual
activity before parents are willing to accept the reality and intervene. As Catherine
(G1) puts it,
A lot of parents won‟t go there [face sex education issues]. They are like, “I don‟t
want my child to know about that stuff at their age.” But what you don‟t know was
that your child watches TV. There is a lotta stuff on TV that your child shouldn‟t be
seeing, but they see and they sit up there and they get curious. And, they like, “I
wonder what that‟s like? Oh, I don‟t have that body.” And, “I wonder why I don‟t
look like that. Maybe if I do this, this boy will like me. If I have that, that boy will like
me.” Maybe they—kids—see stuff, and they repeat what they see.

Across the groups, participants agree that, once youths begin destructive conduct, it
is very difficult for parents and social institutions to redirect them. Youths interested
in being popular in peer competition willfully act against parents and other family
members‟ efforts to redirect their conduct.
Parents, as previously noted, turn to religious institutions for assistance,
thinking that raising a child “in the church” offers protection from peer pressure.
Churches may be more open to discussions of sexuality than parents are, but
parents must accept church intervention for children to benefit from it. Betina (G2),
running her own ministry as “a testimonial to God‟s blessing,” presents a view with
which Group 2 and participants in other focus groups agree.
22

I‟m a minister. And, uh, a lot of churches are lacking. They don‟t want to deal with
the real issues…. I‟m gonna be real with you. Um, I have a ministry that deals with
the real issues…. [When] the church steps up to the plate and deals with the real
issues, that‟s when we get something solved. We need to be [real]. Like this
church—I was… amazed that it [the focus group] was being held at a church. I really
agree, it‟s daunting [redirecting youths‟ destructive conduct]…. [Invention by
ministers is] a beginning.

Speaking about her own ministry and her experience with other ministers, Betina
adds, “[Church] people are scared. Some of them be like, “No! We don‟t want to talk
about that; we not supposed to talk about that in church!”
Still, some participants see churches stepping up to the plate, but fewer
today than during their teen years. Irene (G2) describes a discussion group at her
church:
It‟s called “Girl Talk.” You know, letting teenage girls come together, and then [they]
have a ministry for the boys. So, the girls get together with an adult, and share what
they want to know about. Questions they don‟t dare ask their parents.

Beatrice (G3) offers her opinion:
[T]hey want to say this is the problem, but they don‟t wanna be part of that
solution…. And, yes, it is church, but, you know, it‟s kinda like this is how you get the
education out. You don‟t have to have [the church] explaining the reproductive
process. You can have preventive. You could start with that self-esteem class for
these women to know that they are important, and it‟s important to make your kids
feel important…. Our churches are probably the only thing we have left, community
wise, [where] we all come together and… communicate…. [B]ut you can‟t just, like I
said, hide the problems…. You got that teen pregnant girl coming into the church,
whatever. So, something happened, so you know.

If some churches start programs, the moderator asks Group 3, why are they not
helping parents? Church programs, the participants suggest, do not last. They fail
either because parents do not allow their children to participate or because parents
want instructors to report to them what children say. Beatrice expresses a view with
which other participants agree: Like schools, the church is responsible for helping
parents deal with realities, not with ideals. Yet, Group 3 holds parents accountable,
first, for facing up the realities and, then, for accepting assistance when others offer
it. Churches might offer assistance, participants say, where parents and schools fail.
Nonetheless, participants in all of the focus groups emphasize that the
effectiveness of church programs depends on parents‟ responses. Brenda (G1)
makes this point:
When I was growing up in church, we had, a group called YWA. They called it young
women, but it was Young Women‟s Association. But it was [for] any child under 18

23

and we actually had open discussions about sex, things we were curious about. Our
parents weren‟t there…. I think one thing we can all agree: parents didn‟t show up
there; they don‟t wanna talk about this, you know. I started my period, they didn‟t…
[really talk]. My mom‟s like, “You need these [tampons] right here,” and I‟m like
[looking puzzled]. You know?

Unwilling parents—those who would prefer that no one broach sexual topics—may
be no more open to churches than schools teaching their children.
Yet, parental reluctance is neither the only obstacle nor the most critical one
for this cooperation. Even when churches and parents work in concert, peer
pressure affects youth “in the church.” In fact, some participants note, they may
play a leading role in teaching increasingly younger children about sexual practices,
such as anal and oral sex.
An unidentified speaker opens Group 5‟s discussion of this sensitive issue by
muttering, “Some shake [their butts] more” [meaning some young churchgoers are
more sexually active than their peers]. Other participants elaborate on this point.
Involvement in the church may encourage forms of sexuality that young people see
as satisfying parents and church officials, while remaining popular with peers. Thus,
church youth may engage in all sexual activities, participants across the focus groups
contend, except sexual intercourse. As Betina (G2) explains, “That‟s how… a lot of,
um, young girls that go to church… think, too…. They think if they do the other, the
other sexual… um, enjoyments, that they‟re still a virgin.”

Betina‟s use of “too” is important, because the focus groups see these
alternatives to sexual intercourse spreading for reasons other than fooling parents in
the church. They can make an already difficult parent-youth conversation more
difficult. Even women who became mothers in their early teens may be of “another
generation” in their response to these sexual alternatives. Participants say they find
the sexual activities of today‟s youth “gross.” Recall that Frances (G2), recounting
how awakened to her daughter‟s sexual activity, was stunned by the “dark, dirty
stuff” she was doing, not merely that she was sexually active. In other words,
children today engage in sexual activities, the participants think, that African
American females of their generation as well as their older siblings‟ and parents‟
generations did not, because they “respect[ed] themselves.” Oral or anal sex and
sexual intercourse during menstruation are acts that participants attribute to
females of “other races,” particularly Whites. These acts, they complain, are
becoming acceptable—“bleeding into the community”—as young African American
girls, who want to remain a virgin while being hot enough to compete with peers
within and outside the race, expand their sexual activities.
Three women‟s statements illustrate general views about these changes
across the focus groups. “They [boys mainly, but also girls] tell you,” Lois (G5)
observes about her high school days, “you can‟t get pregnant when you are on your
cycle… and other gross things.” Ester (G2) reports:

24

Anything from kissing to touching, to what they call, “dry humping,” or, ah, oral sex
[goes]. Anything but what they call, “vaginal sex,” anything but that, they consider
okay… I mention this group of girls that… [considers] things like—now I hate to be, I
don‟t mean to be graphic about it—but they consider things like anal sex as not
having sex [because] you can‟t get pregnant. They are still a virgin.
“In my generation,” Edna (G5) notes, “they weren‟t doing it in the mouth.”

The focus groups clearly associate changing patterns of sexual conduct with
church youth, but they do not consider them the only young people promoting
“gross” sex acts. Until recently, participants contend, African American women‟s selfrespect limited non-vaginal sex and, therefore, limited sexually transmitted diseases
whose symptoms appear in the mouth. For instance, Lois (G5) says, “I don‟t know
about the older generation, but I didn‟t learn about doing it in the mouth and butt
until I got older—21. I didn‟t hear about oral for Black girls.” These acts were
racially out of bounds, participants across the groups agree, because “White girls
were doing [them]” and, as many Group 5 participants simultaneously explained,
White girls behave that way because “they nasty!” An unidentified speaker exclaims
her agreement, “Yeah!” Then, Edna (G5) adds, “They will do things that Black girls
won‟t do.” Lois (G5) continues:
They do that! So, I didn‟t hear about that until I got older. Black girls be like, “That‟s
the wrong hole! [Group laughter.] She like, “What you doing?” We were fast, but not
that fast. We were like… who could be best dressed, who had the best clothes on.

If self-respect once precluded non-vaginal sex for African American women,
Group 5 participants claim, desegregated competition for male affection now
undermines restraint among young African American women. “[White girls] throw it
at [Black males, especially athletes],” according to Charlotte, behavior which others
also see as setting the conditions for interracial competition. “[W]e [are] telling you
they [African American males] like White,” adds Margaret. “White is right.” [Many
voices echo agreement.] “Yeah,” Charlotte concludes, “That‟s the bottom line, right
there.”
However, for Group 5, mere color preference is not the bottom line. “White
girls, Edna insists, “have the money and the cars.” African American self-respect
restraints, if they existed, no longer hold. “[That‟s] because… we do… we respect
ourselves, but then it just starts bleeding into the community, and everybody do it.
Ménage-à-trois and….” [Group laughter]. Edna continues, “Well, [Black males] got
the White girls over there, and they will do anything. And [Black males] come back
to the Black girls, and [say], „It‟s just you and me, „I would never do anything [like
that],‟ and, „Why you bring it up?‟” As Frances (G2) learned when she took her
daughter Mia to see a pediatrician, Group 5 participants also think that parents
become aware of their children‟s oral sex practices when a doctor diagnoses mouth
sores as symptoms of a sexually transmitted disease.

25

Whether young African Americans engage in “gross” sex acts to achieve intraor interracial peer popularity, their parents, as members of generations with
different values, may confront the possibilities of their children‟s behavior too late.
These possibilities—previously unfathomable—came together as Frances (G2) talked
with her daughter after the school emergency.
So, of course, I took her out the door, and she got in the car and said, “Mama, I‟m
drinking alcohol and I‟m having oral sex, and I‟m doing this and I‟m doing… [spoken
in the daughter‟s crying voice].” I said, „What is going on with you?,‟ expecting to
get, like, [resuming the crying voice] “I don‟t know, Mom.” But, she said, “Well, I
was at the movie theater and so-and-so told me to go in the bathroom and blah,
blah, blah.” And I just… just listened to her, and so I took her to the doctor, and I….
I know about diseases of the mouth and all that stuff because, of course, I didn‟t
know how much Mia was telling me was true. And, you know how we all tell
something, but you never tell everything? [Several others finish the last phrase with
her]. So, how much did you not tell me? So, it was at that time that the doctor sat
with us—that was our pediatrician, because she‟s a baby—and talked to us about this
is what it looks like, this is what herpes is, this is…. [names other diseases].

As usual, Frances fades into speechlessness. Neither she nor most participants in
other focus groups led sheltered childhoods. Yet, some parents simply cannot
imagine what their children may be doing based on their own experiences.
Despite sexual creativity, participants across the focus groups say, young girls
eventually “put out” to remain popular, and pregnancies follow. First-time mothers
may only learn that they have contracted a sexually transmitted disease when they
begin prenatal care, Charlotte (G5) notes, expressing a prevalent view across the
groups. Participants in all five groups also agree with Lois‟s (G5) conclusion that
expectant mothers often delay health care until delivery, and only then learn of their
infection and get treatment.
The focus group does not see this problem as class-restricted, but its
economic aspect (“White girls have the money and cars”) suggests that the
youngest African American girls with the lowest incomes are the least materially
competitive. The girls‟ interest in popularity shapes their willingness to “do
everything.” Thus, they rapidly progress from petting to oral and anal sex, exposing
themselves to sexually transmitted diseases. “Stepping up their game” in the peer
popularity competition may also result in vaginal sex and pregnancy. Self-respect
and shaming or disapproval from family and friends already dispose the girls to hide
pregnancies. They also discourage the girls from seeking treatment for sexually
transmitted diseases. According to the participants, this combination of factors helps
to explain the prevalence of young girls, pregnant for the first time, who receive no
prenatal care before hospital delivery. The moment when the girls must reveal one
problem exposes their other problems.

26

Lois (G5) describes the situation that many young, African American women
expecting their first children face with sexually transmitted diseases.
They probably don‟t know till they go to the hospital, pregnant. “Oh, also, I see you
have Chlamydia. Oh, also I see you have gonorrhea.” They never know. That‟s
probably why she was hot, and infected a lot of people around the „hood. And, she
got pregnant, they, “Oh, I hope you know you gotta git treated for this, and she
probably, like “Dag! I‟ve infected all these people. Now, I gotta go tell them.” But,
before, she don‟t know.

Paula (G5) comments on problems that follow from the expectant mother‟s
lack of knowledge: “Well, hopefully, she gets some prenatal care and the doctors
prescribe something. But most of the time, it don‟t work like that.” Other fears
discourage a young woman from seeking treatment for diseases, Paula notes,
especially fear of censure or violent responses from… well, from everybody. She
might not want her mother to know, you know…. [S]he scared of what the
boyfriend gon‟ say. „Cause, if you having babies and stuff, that‟s already bad, then,
now you are diseased! That‟s the problem…. No one is going to take her to the
doctor…. She probably wouldn‟t tell her parents. She would probably talk to her
friends, and they know about it, and tell her, “Why don‟t you go here, and they
won‟t tell your parents and you can get it taken care of.”
When neither friends nor family prod the person experiencing symptoms to seek
treatment, participants believe, the health authorities will eventually catch her.
“[T]hey come get you,” according to Charlotte (G5). Edna (G5) adds, “I see them
come around. They like, „You ain‟t registered.‟” However, neither family and friends‟
prodding nor health department surveillance ensures that young expectant
mothers—especially first-time mothers—will get treatment in time to decrease
potentially adverse effects on fetal development.
When commenting on communication about sexually transmitted diseases
between young, unmarried couples, focus group participants speak only of the
expectant mothers‟ fears about revealing their infections. Some participants mention
fear of violence, but their references to “being beaten up” mean unpleasant
encounters that endanger continuing the relationship as readily as physical assault.
Summing up this view, an unidentified Group 5 speaker emphasizes, “It ain‟t gon‟ be
pretty!” Overall, participants see the emotional stress of being infected adding to the
disdain and censure that a young, pregnant, unmarried girl expects from family,
friends, and the community.
We turn next to the influence of shame and secrecy.
III.

“They’d Be Lying”: Shame and Secrecy

27

The focus groups contradict statements suggesting that the African American
community (local and national) and American society morally condemn unwed teen
pregnancies less today than in the past. An unmarried teen mother, the groups
insist, expects condemnation from family and friends, the condemnation creates
shame, and shame promotes secrecy. Group 2 expounds most clearly on how shame
and secrecy may delay an unmarried teen mother‟s effort to seek prenatal care or
prevent her from getting it. Alice (G2) expresses her group‟s general view, as she
agrees with calls for change to combat the influence of shame and ignorance.9
I feel like we need some more information. „Cause, like I say, there‟s lots of kids
having kids. But, if they don‟t have no information, they have no clue about maybe I
should go to the doctor; maybe I should do this [or that]. Because it‟s, like, I [the
expectant mother] feel ashamed. But, [it would be better] if there was more
information out there available to young kids [telling them] where they could go to
get information.

Darlene (G2), pregnant at 17, experienced her father‟s shame, but also his
later support and pride in his grandchild. Her mother took her to doctors‟
appointments and, for Darlene, that support was a positive difference between her
and her peers. Still, Darlene experienced the disdain of friends and kin, as well as
health-care workers, for the “cheerleader who got herself knocked up.” Working at a
hospital now, Darlene sees patients much younger than 17, who lack family support
as they face her co-workers‟ disdain.
Well, I work for AHCCCS at the hospital. And, we… I have a lot of clients that go up
there, like little girls that‟s pregnant. I think the youngest I‟ve seen are like 12, 12 or
13, and they don‟t have no prenatal care, no nothing the whole pregnancy…. [They]
don‟t hear about nothing. [They don‟t] know nothing about any of that until they get
to the hospital having a baby.

Betina (G2) adds, “Especially if it‟s a secret, and it‟s not told until after a certain
amount of months, then, yes [they know nothing]. It‟s a lot, a lot of secrecy.”
Crystal (G2) emphasizes health-care workers‟ disdain for her as a very young

9

Some focus group participants‟ comments, though not directly concerned with shame and shaming,
reveal their importance within and outside the African American community. Betina (G2) insists on
sharing her testimony and challenges those who see her as “crazy” by asking why she should be
ashamed to discuss wild youthful experiences that shaped her views as a mature woman. Karen (G4)
rejects blame for exposing her children to drug addiction, drug dealing, and prostitution. She is not
ashamed to speak truthfully, and she will allow anyone to look down on her for her past. Likewise,
when Evelyn (G4) says, “We put our stuff out there because maybe we proud,” she does not refer to
high rates of illegitimacy, premature births, or infant deaths, but to the fact that it is morally more
acceptable to own up to than to hide one‟s conduct and its consequences. These indirect responses
help to understand participants‟ explanations of young mothers‟ behavior. Belligerent responses to
shaming and disapproval, participants maintain, encourage competitive reproduction among a subset
of young mothers. In addition, many young mothers reject both adoption and abortion as failures to
honor values in the expression, “If they are woman enough to lie down and make a baby, they
should be woman enough to stand up and raise it.”

28

mother, recalling the courage her family‟s support gave her to return to the doctor
after experiencing humiliation at her first appointment.
I think [it is] the attitude when you go to the doctor‟s office…. Because I was a very
young mom and a lot of the nurses were very rude to me. And, thank goodness, I
had the support of a family that encouraged me, you know, to keep on going. But, if
I didn‟t have that support, maybe I wouldn‟t go back, because I would feel so
ashamed, you know.

For focus group participants, doctors, nurses, and other health staff add to
community and family censure. Their attitudes, insults, and humiliations make it
difficult for the young mother to use prenatal care. Like Crystal and Darlene, other
participants who experienced early first pregnancies, think that very young mothers
who have no support from family or friends face the greatest difficulty. As Crystal
(G2) puts it,
It‟s just a tremendous amount of shame. Especially for families, and that‟s what I
hear a lot. You‟ve shamed our family name. And, so, they spend so much time trying
to push that person, you know, out, away from their family, so it doesn‟t reflect
poorly on them. Instead of trying to help them, and figure out what‟s going on with
that little [girl].

Therefore, Betina (G2) voices a view the focus groups accept when she contends
that, if people say unwed teen pregnancy is no longer a source of shame, “They‟d
be lying.” Nonetheless, she sees unwed teen pregnancy having “become a part of
society. It‟s accepted now, you know. No one no longer talks about abstinence [until
marriage], and stands up in front of children and says what is abstinence, and why
is it important to practice abstinence.”
Still, whatever Betina means by “accepted,” neither she nor other participants
think it implies an absence of shaming practices or shame for unwed teen mothers.
Instead, they promote secrecy about a first pregnancy and attempts to hide
subsequent ones. Alice (G2), who had her first child at 38, recalls how shame
resulted in the tragic death of a friend‟s second baby when they were teens.
But, see, I can say I know from personal experience that there is [shame]. One of
my friends, she was a teenager, and she hid her pregnancy through the whole
time—went outside and delivered the baby herself and that baby died. And, the baby
died because she was too ashamed to tell, because it was her second kid—to tell her
parents that [she was pregnant again].

The combined effects of shaming and disapproval, Alexis (G3), notes may reduce
support from family and friends as young girls continue having babies.
Maybe some people don‟t have family members. Maybe the family members that
they have are not the best role models for them to be going to. So, if you feel like
you are in something all alone, and the only person you can go to—let‟s say you
were the older, the oldest sister… you were the oldest and best friend, or whatever.

29

And, that was the only person that your best friend can come to, and your best
friend came to you and told you she was on her third baby. And, you automatically
were like, “You haven‟t learned from the first two?” And, you gon‟ automatically send
the thought, like, “Well, dang! If that‟s how people feel about me having a third
baby, well I shouldn‟t have it.”

With each pregnancy, Alexis continues, shame may increase and longer delay
revealing the pregnancy and seeking health care.
I‟m gonna have to take care of [another baby]. I have two that I‟m already taking
care of [and I‟m] gonna need to do more to take care [of three]. And, then
somebody—let‟s say, you don‟t even tell somebody—you get to the point where you
say, “I‟m not gonna tell you, because I already know how you are gonna react to it.
Either you gon‟ be, “Oh, I‟m so happy for you! [or, you will disapprove].”

Group 3‟s responses to Alexis‟s personal and hypothetical accounts
demonstrate the reactions to which she refers. Glenda (G3) interrupts Alexis to ask,
“But you had the first two. Why, if you [are] struggling with the first two kids, and
you know all…” Alexis, cutting her off, interjects that birth control sometimes fails.
Whatever the reason for having more babies, where the mother has transferred the
care of her previous children to relatives, their shame combines with their
resentment of her continuing poor choices and impractical economic decisions.
Across the focus groups, participants agree that a first child may result from
efforts to give birth to a love object, a substitute for lack of love in the mother‟s
natal household. Yet, producing a child to give and receive love, participants
emphasize, does not mean knowing how to love. Young unmarried mothers often
see children as dress-up dolls, participants say, and have skewed priorities. They
expend scarce resources on status appearance and this increases family and
community censure. As the mothers have more babies, family and community
members see the mothers‟ concern with dressing up doll babies as a poor use of
scarce funds. Onlookers judge harshly young mothers who cannot afford medicine
for their well-dressed babies when health insurance does not cover it. Greta (G1)
reports:
[T]hese are things I [would] see in the community all the time… especially when I
worked at the pharmacy…. I had one mother once come in and say, “If my baby
needs it, then I need to buy it.” The medicine‟s not covered…. But, this was only one
instance where the girl said something like that. I‟ve seen other times when there‟s
the best lotion, the best soap, and the best of everything in the cart. You got Mickey
Mouse outfits, everything, and your child needs this antibiotic to get better, and
you‟re not willing to pay for it. (G1)

As Crystal (G2) puts it, “[T]he little outfits—put a baseball cap on it, and [they have]
someone to love them.”
Frances, who had her first child after 20, asks younger Group 2 members
who became mothers when they were younger than 20, about the love-object
30

motive for giving birth. Others agree when Betina (G2) replies, “Yeah, [you are]
looking for someone to love [you]—especially if you come from a dysfunctional
family, and you don‟t know… [T]he family is not practicing love, don‟t know the
definition of love, [is] not walking in love. Oh, yeah, definitely, for me, I was seeking
for love.
The baby, as love object, offers ways to attach the affections of family,
friends, and a male. The structure of disaffection in a young mother‟s natal
household influences how she may seek attachment and to whom. In large families,
focus group participants report, younger children receive either the most attention
or the least attention, depending on parents‟ reasons for varying attention by age.
Helen (G1) responds to the focus group scenario about the implications of
birth-order position for three siblings: Kari, a boy, and two girls, Kesha and Karla.
Her response presents a view that participants in other groups express.
So, I just think with that the older child, [Kari] may have been the leader. Then a lot
of responsibilities was on him that maybe he didn‟t want. So, therefore, he wanted to
be himself in his youthfulness, and go—I don‟t wanna say „sow his oats‟—but, you
know, go do his thing. The middle child [Kesha] was trying to find her niche. And,
then, the younger one [Karla] was like, “I have everybody telling me what to do.” I
mean, it could be a variety of things that are going on.

Brenda (G1), a middle child in a large family, was looking for attention, but she
could not get it by having a baby. Her competitor for attention was an older sister,
who already had a baby and had “stepped up her game,” moving past her “slip up”
to continue her self-development.
We [middle children] do feel left out… like nobody is paying attention to us, „cause
[parents] are always worried about what the older one is doing, and what the baby
is doing. So, I have two older sisters and two younger siblings, a… brother and…
sister. And, my older sister, she‟s the nurse—an RN. My second oldest, she was a
really famous hairdresser in Detroit. She was known all over the city. And… there is
me… I‟m next in line. So, now, I feel like I have to prove myself. I have to step my
game up. I have to do something, you know, because I have a child. My oldest
sister… had a child when she was 15. And, even though she did slip up—not that she
made a mistake, because none of her kids are mistakes—she slipped up. But, she…
stepped her game up, and now she is a registered nurse… doing good for herself.
[S]he owns her own house and everything. But… nobody wasn‟t paying attention to
me. And, I‟m like, “You need to step your game up.” You need to [do] this because
your sister is doing this, your other sister is doing that. And, it‟s like I‟m invisible.

The implications of being the oldest or middle child also differ with the size
and paternal/maternal reproduction composition of a household. Ellen (G1)
describes why her youngest sister thought having a baby was a way to gain
attention and distinction because Ellen had done everything else well.

31

I‟m the oldest of 14 [children]. My mom and my dad had three—the first three—and
the rest are my dad‟s…. [M]y sister said, “The only thing that I could have done that
you did not do was have a baby.” Because, I went through school, and all that. And,
[my parents] like, “Be [Ellen], be like [Ellen],” [by my sister says] “I‟m not [Ellen].
So, that‟s the only thing I could do that distinguished me from [Ellen].”

Yet babies do not guarantee mothers a place in others‟ lives. The price of
trying to secure this place for a mother is greater emotional and financial
dependence. Failure means greater insecurity and feeling more neglected or
abandoned. The support and approval of family and friends dwindle as each child
shows the mother‟s inability to learn from her mistakes. Alexis (G3) notes that,
“[I]t‟s like, when people care enough to say, „Okay, this is what you need to do‟,
then that‟s when I do it.” The moderator asks whether the lack of support from
others might influence a mother to seek or use prenatal care for her second, third,
and later babies. Alexis‟s response is consistent with other focus group participants‟
views.
Not as much. If you in pain, you will go to the emergency room. [With] my third
baby, I ended up going to the emergency room. Yeah, because, by then, I have four
different fathers—and… I‟m with the last one, right now, so I guess that‟s a good
thing. But, in the end, if that other person is not there for you—and, I mean, your
family is like, “We know that this is your baby,” you know, “so we gon‟ be there.”
But, you can‟t always count on the guy to be there. And, every child always, like—it
might sound weird—but it takes something out of you. If there is not a whole lot of
love around you and around the child, then that weighs on you, as well.

Elena (G3) agrees.
[B]y the third one—I think about someone I know right now who‟s in that
[position]—she just don‟t even wanna tell nobody, because they [will] say, “Well,
where is the first two babies‟ daddies? Are they helping? You need help some more?
Well, you should have thought about that.” I wanna say there‟s some depression; I
don‟t even wanna know.

Babies thus become capital for making other kinds of love in families, among
friends, and with males, as fathers or potential new relationships.
Nevertheless, participants describe mothers who are more interested in
partying, alcohol, drugs, and sex than in their children. As Brenda (G1) says of her
mother, and as Anna (G1) and Karen (G4) say of earlier periods in their lives, some
mothers are strung out and trying to manage drug problems. Yet some neglectful
mothers, participants insist, only appear callous and indifferent to their children‟s
welfare because they are following models that their mothers and other female
family members set.
Turning to young fathers, Lois (G5) expresses a view consistent across the
groups: “He probably went [with the mother to health care or birthing class] the first
time and thought it was a waste of time, and wouldn‟t go again.” Most young
32

women concerned with holding onto male affection, participants contend, allow the
males‟ reactions to direct their involvement with prenatal health care and social
services.
The moderator asks, “So, she just follows him?” Katrina (G5), replies, “Yeah,
because she probably thought she was in love.” Lois (G5) agrees:
Pretty much. She thought she was in love, and she thought she might lose him, and
that one thing and another thing—having kids as a teenager, and dealing with the
dude—[are difficult]. That dude tell[s] you whatever you wanna hear. And like [the
girl says], “I‟m gonna do whatever he say, because I wanna keep him.” But, really,
that‟s not gonna keep him. But, she doesn‟t know that, because she doesn‟t have
enough resources, and probably nobody talked to her when she was younger,
[telling her], “You can‟t keep a man by just listening to what he say.” You know what
I mean? That was probably why she like, “He don‟t wanna go [to a health-care
facility]. I don‟t wanna go either; whatever he said.

Paula (G5) adds:
I think they were probably scared to go by they self. She needed that back and support. She also
need[s] somebody. She probably felt she needed someone there to go see how the [birthing or
parenting] class would be. You know what I mean? She was like, “He‟s not going to go with me. I‟m
not going by myself. So, I‟ll just do it the best way I know how.

Closing the exchange, Dana (G5) remarks:
They feel that… their love is coming from… [the males in their lives]. That‟s where
their attention is. That‟s who gon‟ keep them safe. That‟s who is going to protect
them. So, that [is] who they gon listen to.

When the moderator asks whether males (as legal spouses or unwed fathers)
provide protection, Group 5 asserts that mothers cannot count on them. Instead,
they say that males (particularly young ones) often convince young women not to
use contraceptives, especially condoms. Summing up this view, Edna (G5) observes,
“He kept her from protection she needed earlier on.” Yet the opposite view also
emerges—that a young woman undermines male efforts to prevent pregnancy if she
want a child to secure male affection. According to Charlotte (G5), “She put[s] a
hole in it [the condom].” Young girls or women do this, participants think, because
having a baby is a means to more firmly attach that male‟s affection and, perhaps,
to ward off female competitors.
IV. “When reality sets in…”: From Dress-up Doll to Baby’s Body
Resistance to parental advice or other constructive guidance produces lack of
knowledge. This, in turn, encourages first-time mothers to think of babies as dressup dolls for competitive show, focus group participants across income and education
levels insist—until reality sets in.

33

Most young mothers are raised on silence and, thus, unprepared for the
complex realities they face rearing children and managing health care for
themselves. Participants maintain that neither income nor formal education ensure
knowing the difference between the needs of adult and child bodies. As children
mature, mothers will not automatically understand their children‟s realities or know
how to manage them. Frances (G2) elaborates on this point:
I was best dressed in high school. I mean, we had all the accouterments of what you
were supposed to look like. Right? But, maybe your heart wasn‟t right or your soul
wasn‟t right. So, of course, I have a kid… [but] I don‟t know… you‟re not supposed
to give them Coca-Cola.10 I had this little girl, and so I start putting all this papiermâché on her and dressing her up, but I didn‟t know that she was dealing with real
stuff. So, I‟m probably one of those people that are 60 in that elderly group, and… I
just didn‟t know what I didn‟t know… until… I got a call from the school saying that
Mia was passed out drunk in the bathroom, and didn‟t know what was wrong…
[exclamations of surprise]. And so, mind you, I don‟t know anything that‟s happening
with my kid, so I‟m thinking that she‟s got low-blood pressure. She‟s anemic [selfmocking sarcasm]. So, I race across town to deal with some medical issue,
because… I can‟t even fathom that [it is anything else].

Ester (G2) echoes and generalizes this point about lack of knowledge: “But, they
don‟t [know]. They see baby, they see cute, dress it up. You know?”
Fatima (G3), reflecting on her sibling‟s experience, addresses what happens
when a mother‟s interest in dressing the doll confronts the complexities of caring for
an infant.
She would have her baby dressed up in all these fancy clothes and shoes and all this.
But, then, once that wore off, reality set in. [She realizes], “Now I am mother and
father, and I‟m not cut out for all that right now. I wanna go out and show who I
am, out in the community, and I do have a baby but, you know, my, my life is more
important.” …I am hearing like, “It‟s your responsibility as a parent,” but… [young
mothers] are not getting it. So, you can preach, preach, preach all daylong that… it‟s
your responsibility to take care of your children, get them to the hospital, or get
them the care they need. But, they‟re not listening to that.

As very young mothers (or older, but also uninformed ones) confront the
reality of childrearing, their lack of basic biology knowledge influences how they
view a baby‟s body and how its needs differ from their own. Young or first-time
mothers do not understand the details of parenting, participants insist, and thus play
at mothering. They do not agree, however, that this means general ignorance or
translates as indifference for all.

10

She refers to another Group 2 participant‟s account of observing a young mother feed her infant
Pepsi in a baby bottle.

34

Yet, whether young mothers take on or transfer their children‟s care, the
base problem remains. Raised on silence, they are not prepared for childcare and for
negotiating health care. Their efforts to attach and maintain the affection of other
people through responses to the child only complicate the lack of basic knowledge
and role models for learning needed skills. Mothers, participants say, begin by
seeing children merely as small versions of themselves and, so, think that what is
good for them as adults or what did not harm them during childhood, will not harm
their babies. When a mother‟s younger sibling assumes responsibility for childcare,
this lack of knowledge about parenting—especially, when, how, and where to seek
appropriate health care—becomes even more critical.
In Group 2, Ester provides an example that shocks the other women.
[In] the delivery part… a lot of those women—like a few that I know of—by the
complete Grace of God, they have a healthy baby. And, it‟s nothing that they‟re
doing to, you know, to get their bodies ready. …[T]he most disturbing part is when
you see the baby in the infancy, those first few months, when things like breast milk
or formula are important, [the mother will] give them Pepsi in a bottle. Have you
ever seen that? I kid you not. I was behind someone that did that yesterday—took
her Pepsi, opened it up, poured it in the baby‟s bottle, turned the cap, and gave it to
a two-month old! [Group moans] And I was like, “Oh, my God, [I] can‟t say nothin‟
„cause we‟ll be fighting.” [Group laughter] “It‟s not my business.” Of course, it‟s not
right. And, my husband‟s like, “Don‟t say nothing here.” And I‟m like… I‟m just
twitching…. [The mothers do not provide] the proper nutrition, because they just
don‟t know. No one ever told them that you‟re not supposed to do that. No one ever
told them.

Frances thinks that even a young first-time mother should know how her body
responds to the drink, and generalize from that. “You know what Coca-Cola does to
you, if you drink it, burns your throat, burns your mouth.” Ester agrees, but, along
with others, counters that mothers probably act on their own childhood experiences.
As children, they survived many things that were not good for their growing bodies
and, so, have no reason to think their actions might harm a developing fetus,
newborn, or infant. Ester concludes:
Lack of information—I mean, but no one ever told them not to do it. Do you know
what I mean? And, people only do what they know how to do. Their point of
reference is, as far as they‟ve been educated on things, “So no one ever told me that
drinking Pepsi was bad for me, and I‟m drinking it and it hasn‟t killed me yet. So,
why‟s it gonna….” I mean that‟s the mentality.

Many first-time mothers (young or old), Group 2 generally agrees, do not sense that
their babies are too frail for some things, which, as children, the mothers survived.
The best nutrition and care, as they understand them, are those their parents gave
them.

35

School instruction about childcare based on play-acting, Ester (G2) maintains,
fails to give young mothers adequate practical experience, even as it encourages a
sense of competence.
Something that you‟d have to care for [like a fragile egg]… seemed kinda facetious.
…[You‟re] like, “Oh, I‟m just going to buy another egg… I‟m gonna go… whatever…
(not that I ever did that!) [group laughter] …[B]ut, what I‟m saying [is] that right
now there‟s no, there‟s no modeling. I think that‟s what it is…. [Girls will learn more
if they]… have some of those dolls… an opportunity to spend some time in a crisis
nursery, or something where they had practical experience about [babies]….
Because, what they conceptualized as a child, you know, [is not one] that screams all
hours of the day, that demands complete attention, that… could tear up… and could
eat anything poisonous…. I think that, for [young mothers and younger siblings who
raise older siblings‟ children], it‟s overwhelming, and no one would choose that.

Frances (G2) interjects, “So, I‟m thinking that [a young mother‟s sister is] probably
dealing with these nieces and nephews… and [thinking] I don‟t want no kids.”
Agreeing, Alice (G2) chimes in, “Heck, yeah! It was for me.”
During a similar discussion in Group 1, Greta recounts her disinterest in
having and rearing children after she cared for young siblings.
[W]hen you are a family of five—take my older siblings, every summer, they had to
baby sit the younger ones. That irritated me. I just didn‟t wanna ever be… I couldn‟t
stand kids at that age. That‟s why I didn‟t get pregnant… until I turned 30…. I saw
that there was more to it than just having a baby.

Like other participants, Greta recognizes why her parents called on older siblings to
care for young siblings. This does not reduce older siblings‟ resentment of their
experiences, which often influence their feelings about becoming parents.
Because… [of]… my parents (because of their economic situation; not being able to
afford day care, not having no alternatives), we were forced to raise our siblings.
Which instilled envy in me for that, you know. I still resent [it]…. They did the best
that they could do. I don‟t resent my parents; I resent the situation. I don‟t resent
my parents, because they did what they had to do. But that plays in with a lot of
things with the middle child. They look at experiences that their older siblings are
going through and learn from them. [A]t the same time, they are being annoyed;
being affected by the other children that are in the household.

Perhaps more important, Greta combines the typical responsibility for childcare in
low-income families with her response to intense involvement with her older sister‟s
teen pregnancy and the premature baby‟s death.
My older sister, she got pregnant early and her first baby died…. Something about
the sac broke—I still don‟t understand a whole bunch about babies—and, ah, the
baby slipped out, and she had premature birth. And the baby died a week later,
which tore her up. And I went through all those experiences with her and her having
a baby. And what happens is that when you have a sister that has a baby, that sister

36

relies on you a whole lot. Especially when you are two years apart, they rely on you
a whole lot to fix a bottle, to do this, to do that. And I just never wanted… and that‟s
irritating.

Problems in small, high-income households, Frances (G2) points out, mirror
those in low-income households. Mothers reared in both later face the consequences
their childhood training and trying to compensate effectively for the absence of
parents and other elders.
I have a small family. Everybody is, um, a jet-setter. My granny… my grandma… is
“Mother dear,” because she‟s too fine to be granny. And, my mother—the grandma,
the grandmother of my children—is, um, “Nana.” So, I have these high-profile, jetsetting, page-me-if you-need-me grand women in my family, you know. Women in
our life… in my life are really independent. And, so, nobody is nurturing and suckling,
and showing how to clip toenails. So, that‟s why I had to look to people in my
community, [people] around me, to figure out, you know, what [to do].

For Betina (G2), the emotional and effective absence of elders in a three-generation
household occurred long before divorce “broke” her family.
Well, I come from a very dysfunctional family. For me, at 12… I come from a, okay,
a… three-parent family: my grandfather, my mother, and my father. I grew up in an
abusive home where I watched my father beat my mom. He was an alcoholic. So,
um, they were separated around—I was around six, when they got divorced—and,
by that time, I experienced a lot of other things with the family; with boys, with boys
that I was related to. So, by the time I got to 12 years old, I was messed up…. [S]o I
was looking for love; not only from a mother, but from a man, as well. And, a lot of
times, as a teenager, when you don‟t have it at home, you seek it. And, sometimes
you seek it by having early relationships…. For me, a man—it wasn‟t a boy; It was a
man.

Time for adults to show younger children affection and attention becomes
scarce in households coping with substance abuse, long workdays, elders who
continue to produce and rear younger full and half-siblings, and siblings who
produce nieces and nephews. These conditions exist across African American
households, focus group participants say, despite differences in income, formal
education, and generational structure. Consequently, young women begin learning
what they need to know after becoming pregnant. Mothers learn about parenting
and, later, health care needs by trial and error. They diligently seek information and
advice as necessary, while trying to find role models among neighbors or among
persons in other spaces of social interaction.
Frances (G2) got help from women who volunteered it and from others she
approached, because she saw them as caring and knowledgeable.
[O]ne of the ladies told me, “You don‟t let people touch your kids.” My baby was
little and everybody wanted to mess with him. But, one of the ladies said, “Don‟t let
them; you don‟t know if people are clean.” And then… [another one said], “I might
hold tight and you might hold loose.” So, here‟s this baby that‟s getting squeezed

37

and… maybe you hold the face, and, so maybe, she‟s sore at the end of the day. So,
I just tried to put those things in motion when I dealt with both the kids. But it didn‟t
come from Mother Dear or Nana, because they were in Europe, and doing their own
things. So, it came from the lady in the church that would say, “Baby, I would wrap
that so-and-so.” So, …like that, you know, [is how it was] for me.

However, Betina (G2) became aware of parenting problems when her mother
ordered, “Either have this abortion or get out of my house.” At 12, she had the
abortion, but she was pregnant again at 16. Only then did she learn about positive
parenting models. When Frances asks if Betina should have had the child conceived
at 12, she says yes, because [the abortion] “Messed me up.”11
The focus groups disagree with simple cause-and-effect relations between
different household types (by size, income, education, and generational structure)
and ignorance resulting in teen pregnancies or negative parenting practices. Yet the
participants also disagree with one another about whether typical views of the
African American community as rife with drugs and dysfunctional families provide
adequate explanations. This disagreement, as an exchange in Group 3 illustrates,
reflects different understandings of class demographics in the community. Fatima
remarks:
And, another thing, I would have to say about, you know, going right back to
parents. As far as, you know, the young women getting pregnant, and the scrubs per
se or whatever. I think that in this community, if you really look at a lot of parents,
[they] are on drugs; a lot of parents. The mothers have their own issues to deal
with… [and] they abandon the girls… [who] are really left with doing their own
thing… I am blessed, because I have a lot of information. [But] I have friends who
are getting pregnant, and they have six and seven babies. But, I have two [children].
I feel very blessed and fortunate to have stopped at, you know, that number. And,
[to] just have more information on sex education and, you know; the different
preventive ways not to get pregnant. But, again, going back to the parents: Yes, the
parents are responsible, because they have [been] given… that right to have the
child, and then educate that child. But then, at the same time, if we are talking about
them in this community, you have to look at again that a lot of people are on drugs.

Beatrice replies:
I disagree. There is a lot of drug use, but there is a lot of positives—probably more
than we know about. But, that‟s the problem. We don‟t know about it. There are a
lot of affluent African American people in this community, who keep to themselves.
And, ah, if I was at a forum with those same people [referring to the deliberation
scenario], I would say you have what in their mind is a drug-infested community.
What would be the next way? If you know that you won‟t get the parents to educate
[their children], how would you do it? Well, in the first place, what used to be [true
in] a predominantly African American community, would be [involving] the churches.
So, you get these church leaders to come into a contemporary process of thinking.
11

This exchange sparked Group 2‟s discussion of abortion as a solution to problems created by young
women‟s ignorance about sexuality, pregnancy, and childcare. Other focus groups added detail and
complexity to the discussion of this issue (see Chapter 2).

38

And, say, you know, this is something that, ah, our young people are dealing with.

Not knowing is the key, the focus groups consistently maintain, for
understanding individual and community dynamics. Beatrice (G3) points to class
demographics about which the participants do not know and cannot use to their
advantage, because the affluent “keep to themselves.” Yet participants in other
focus groups see a larger problem: parents who are present and healthy, but who
do not provide the information their children need. When the participants‟ own
parents, mainly mothers, were present and engaged, communication included little
of substance. In Group 2, Ester observes:
My mom used to threaten me. She‟d say, “I will kill you, if you come up [pregnant],”
you know what I mean. It probably wasn‟t the right way to [have that conversation],
but, yeah, that‟s kind of how that conversation went.

Alice succinctly reports, “My mama didn‟t tell me nuthin‟!” Before Betina‟s first
pregnancy and abortion, she could not talk to her mother for fear that “[I]f I asked
any questions, I might get beat down.”12
Francine sums up how Group 1 connects the consequences of home and
school silences.
I would say the same thing, because I was 16 when I became pregnant with my son,
and everything was hush-hush. I was real sheltered. In church, they don‟t talk about
that, you know, having [sex or babies]. The only thing I was told by them was “Just
keep your legs closed.” So, when I got in high school, everything was new to me,
and it was just like, ah, you know, I just kinda went wild [laughs].

Denise reports similar experiences with a lack of home training and school
instruction that comes too late.
For me, I learned it on my own. I was a teenage mother. I got pregnant at the age
of 13 and had my child when I was 14…. [S]ex was not… talked about in our
household. Everything was kept quiet. So… I pretty much learnt about it [on my
own] when it happened to me. „Cause, I was six-months pregnant when my mom
found out…. [T]hen, even after having my baby… it was like a little baby doll to me,
you know. …[So] I had to become a mother, and didn‟t know how [to be a parent].

All focus groups emphasize that children in South Mountain need earlier
instruction about sex and its consequences, instruction before the typical age of first
pregnancy. Girls in particular, the participants underscore, need instruction not
merely about reproduction, but also about parenting skills as well as when, where,
and how to seek health care.

12

“Beat down” may, but need not, include physical assault. We understand it better as verbal
castigation, humiliation, withdrawing approval and support, and other responses that depress a
person.

39

V. “I think it’s our generation”: Breaking Silence and Cycles
For focus groups, generations are eras of acceptable attitudes, values, and practices
regarding sexuality in American culture and in their community. Rooted in
experience, these eras involve different patterns of individual sexual conduct and
different styles of parenting communication—mainly between mothers and
daughters. “Older generation” parents might only be in their late 20s to mid 30s
when their oldest children mature. However, they do not talk about sexuality and
parenting in their households, and this silence distinguishes them from parents of
the “younger generation.” At most, parents of the older generation hint, joke,
threaten, and, when faced with failure, punishes. When emotions cool, these
parents may offer whatever emotional or financial support they can muster,
depending on an expectant child-mother‟s attitude and behavior.
Ranging in age from 18 to 43, the focus group participants see themselves as
a generation that contrasts with two other generations in different ways. Regarding
style of communication, their generation contrasts with the previous one that “does
not talk” about sexuality. Their generation also contrasts with the following
generation, the children they are raising, based on attitudes and values about
acceptable sexual conduct. “[M]ost of us came from another generation than these
kids now[a]days,” says Patricia (G4) summing up this view, “because they are from
another brand!”
Negative experiences that shape childhood, the focus groups maintain,
provide examples for reverse modeling. Raised by the generation that refuses to
speak about sexual matters, the participants, now parents themselves, see breaking
the silence and cycle of negative outcomes as learning how, with scarce resources,
to turn bad examples into good practices. According to Brenda (G1),
[I]n South Phoenix, there is a lack of resources… or… a lack of resources available to
young African American women. [They] should be taught. They get a brief discussion
about [sex] in grade school, but, in grade school—in my eighth grade class, seventh
and eighth grade class—there were girls who were pregnant. So… obviously, the
information was not brought into the homes. We also need to educate the parents.
It‟s okay to be open, but I feel it‟s a fine line to walk. Because sometime, if you are a
little too open… your daughters, your sons can consider you a peer.

Beginning to parent at a young age combines with what Helen (G1), like many other
participants, sees as the drawbacks of personal responses to poor childhood
training.
[A]s parents, we have drawbacks to our history—what we did as a child. We have to
take some of the blame, because, your kids are eventually gonna ask, “You did, why
can‟t I? Why was it all right for you and not me?”… And, while you know what you
struggled through, and how hard it was, they may not see that. They may just see,
“I want brand-new tenny shoes, and Mom can afford to get „um now.” They don‟t

40

know what mom had to do—how much overtime mom had to punch in—to do it. All
they know is, they have the things that other kids may not have.

A young mother‟s problems with becoming an open and engaging parent do
not result from trying to be “cool,” but rather from her oldest child becoming
sexually aware and perhaps active when the mother is less than twice his or her
age. In addition, although a boy‟s female peers have little information, gender-role
differences promoting the view that “boys will be boys” encourage parents to ignore
a young male‟s information needs. Therefore, participants think, young males are
unprepared to contend with earlier male sexual awareness, experimentation, and
peer pressure to become sexually active. They are also less capable of being good
parents, even though they may become parents as early if not earlier than girls do.
Glenda (G3) puts it this way:
I feel like from that stage…—boys… around eight to 10… [and] girls… around 11,
12—the hormones are kicking in. …[T]hey‟re experiencing unknown body, you know,
pleasure. And, then, they gaze out toward, toward the other sex. But, like I say, it
goes back to the home front. The parents are supposed to be monitoring their child‟s
life. Whether female or male, it is [irrelevant]: sometimes… [children] are naive, very
naive, at that stage. That is why the parents have to step in and participate more in
[children‟s] activities, to prevent… [negative outcomes from sexual experimentation].

Parents may be unaware that, or unwilling to consider how, their different
responses to boys‟ and girls‟ sexual conduct produce “scrubs.”13 Influenced by
gender-role practices, some young males target female age peers who, they think,
receive no home training about sex or do not listen to their parents. Nonetheless,
when the moderator asks Group 3 who raises the scrubs, Beatrice‟s response
captures the general view.
The same women, who have let another scrub… [get them pregnant]. My first child
is not by my husband. No, not my first child; my first child died. But… my oldest now
is not by my husband. But, when… her father—he was going to school in Texas or
whatever (he‟s an engineer now)—could have been potentially something positive in
her life, he chose not to be there. I made up my mind right then and there that the
next man that fathered my child was going to be my husband… [even if] that
meant… I did not have… another boyfriend. I told the Lord, “You her daddy.” …But it
took me, within myself, to say how much more I was going to take… [and] “I don‟t
like this.” …[N]ow, my husband, who I have been married to for 11 years, is the only
father my child has ever known. And, when she met her real father, she said, “I
13

“Scrubs” are young males pursuing sex without parenting responsibilities, but interested in
producing babies to compete with male peers. While scrubs have no resources, some focus group
participants say, this does not mean that all scrubs are products of low-income households. As
Beatrice‟s comments suggest, scrubs adopt a negative attitude toward parental responsibility and,
thus, may include well-educated men and those with adequate incomes to support their children. In
Chapter 3, we will hear participants‟ views about factors that specifically influence parenting among
males from low-income households. The focus group methodology centered on women‟s responses
to pregnancy and use of prenatal or general health care. Thus, it did not capture sufficient
information to understand men‟s views about or involvement in reproduction and parenting.

41

already have a father.” You know, “I have a daddy.” …And, so I think there are
cycles to be broken. …[W]ithin our individual self, we have to say, “No.” We have to
say, “Is it important to have a warm body next to me or is it important for me to just
love myself?” And, then, make someone else know how to love me.

Still, the focus groups agree that parents give boys too little information
about sex and parental responsibility. Group 5, responding to the young male parent
scenarios, illustrates comments from the other groups. Fern concludes, “He had to
learn a lot of things on his own.” Edna adds, “I think he didn‟t receive any
encouragement, so he just started… he said, “I‟ll just go for it. They don‟t think
anything of me, so I‟m not gonna make anything of myself.” For Charlotte, one
popular young male was under extra pressure, “„Cause he was into sports and the
White girls [were] just hitting on him” [group laughter]. An unidentified speaker
mutters in the background, “That why he got those babies,” referring to the
scenario describing the male‟s two children‟s mothers as Hispanic and White.
Although Margaret does not dismiss the importance of these factors, she concludes,
“Naw, he [is] just too hot in his pants.”
As noted above, Beatrice (G3) believes that girls and young women must
achieve self-realization to gain control over their reproduction. Group 3 agrees, but
insists that, before self-realization occurs, parents and young girls may be unaware
that a naïve girl‟s male peers target her. Girls remain naïve, participants explain,
because parental denial and inadequate school instruction leave girls without the
necessary knowledge.
Alexis reports a version of this experience that Group 3 finds shocking but
credible, while doubting that male practices are usually so blatant and flagrant.
Alexis begins:
I believe that boys definitely know [more about sex than girls]! I‟m sorry, because I
know… I got pregnant when I was about 16. But before I got pregnant by the
person I got pregnant by, he sat at a table and told my mom that he gits little girls
pregnant so they can go back home cryin‟ to they mamas. And, he said he git „um
pregnant to teach what they mama should‟a taught „um, and basically had been
trying to tell „um.

As Alexis continues, the women‟s facial expressions change from surprise to
astonishment.
[My mother]… was sitting there in awe. Like maybe thinking, “You didn‟t say that at
my table!” [Others mutter assent in the background.] So, by the time I did git
pregnant and he was gone, it was more that I was in a state of confusion. Because,
I‟m like, “Hey, now I don‟t have no baby for my dad” [intends the reverse]. And, if I
do mention this dude, you know, they gon‟ be like “Did you not hear him say he git
y‟all pregnant for this purpose, right here?”

42

At 16, Alexis was too old, Glenda thinks, to be as naïve as she presents
herself. Fatima thinks Beatrice, at 20, was too old to expect that younger mothers
can achieve the self-realization necessary to “break the cycle” of succumbing to
scrubs. She also sees Beatrice‟s first experience (a stillbirth) influencing her later
decision. That experience and her older age made Beatrice‟s decision-making ability
greater, Fatima concludes, than younger mothers in her family and those she
encounters at the Birthing Project.
Well, [Beatrice] said she was 20. All I heard was 20. And, I think a 16-year old
versus a 20-year old is a little bit different in the mindset because of what they‟ve
[older persons] experienced and what they‟ve gone through. That‟s not necessarily
all true, but I just think a 16-year old versus a 20-year old…. Because, I know I am
different. When I was 16, I thought a certain way. Now that I am 20, I have more
information… [Now] I say, “No.”

Glenda also disagrees that parents must respond to gender differences when
monitoring children‟s early sexual awareness.
Untrue. Untrue. A child is a child. Whether male or female, a child has a whole
different way of thinking. They are scared. They are lost. Um, in fact, they don‟t
know who they are at that point. They‟re experiencing changes through their body.

In addition, supporting Fatima‟s view that age-based experiences are important for
maturation and self-realization, Glenda contradicts her earlier comment about how
mature Alexis should have been at age16.
[S]o far as pregnancy wise… a 16-year-old woman is still a child in my eyes, because
either they are coming from a broken home [or] lack of supervision [or] lack of love,
and they figure if [they] git, got pregnant, they will find love with this particular
person [the baby‟s father]… [U]nfortunately, they find more issues that they have to
deal with: the abuse from that individual, having to move out of their parents‟ home,
and so forth.

As Glenda continues, we get the sense that the male‟s blatant and planned actions
motivate her challenge to 16-year-old Alexis‟s naïveté.
A 16-year old would be more frightened at that age being pregnant than anything
else. I had my sister—she was 16 when she had got pregnant and she moved out of
the house. I mean she had to grow up fast. But, the fact was, she never grew up
mentally because she was still at that age frame. Luckily, she had adults—his adult
family helping her raise her child—because she was still considered a child. I mean, a
child doesn‟t know how to raise a child, honestly.

Young single mothers raising children who become sexually aware or active
at an early age face especially difficult parenting problems. While still maturing, the
mothers must deal with the consequences of patterns of conduct that their parents
inadvertently established. At the same time, the young mothers must manage their
children‟s involvement in matters about which they are only beginning to gain the

43

necessary knowledge to devise coping strategies. Aside from having their first
children as teenagers, women may continue to give birth throughout their
childbearing years and, thus, raise children of very different ages. By age 30 or 40,
some women are “running on empty” and looking for ways to “refill” enough
manage basic responsibilities.
Offering glimpses of these parenting difficulties, Elena (G3) reflects on the
importance of self-esteem.
I think a lot of the parents are empty. They have low self-esteem. They‟re working
hard. I have two sets of kids. I have… a 20-year old, [and] I have 21-month-old
twins. So, I have the whole gamut. And, I know, that there‟ve been times when I
was just wiped…. I am not making excuses for anybody; I‟m just saying I was wiped.
My self-esteem was very, very low. And, I was doing the very best I could, but with
low self-esteem, with me being empty, giving to everybody else but me being empty
emotionally, it‟s hard to connect. …[M]y son, my older son, had some problems in
school at the time. And, I‟m sure the teachers make judgments of me. It‟s like a
fight… it‟s like a fight when you have no energy. And, I think, if we could put selfesteem back in the women or in the families… [O]ne of the things I started doing
after I had my twins was going to the Women‟s Center. I didn‟t even know it existed.
But, there is a women‟s center in downtown Phoenix, across the street from Good
Sam.

Considering her emotional state before attending Women‟s Center classes, and
thinking of stages in her struggle, Elena reflects on why Alexis‟s mother may not
have responded to the young man‟s blatant comment.
[The Women‟s Center has] all kind of classes on self-esteem and boundary setting,
and all that kind of stuff. And, it‟s making me feel stronger, because I can sit here
now and say, “What did your mother say?” But… six months ago… I may have just
like [takes a deep breath indicating resignation]. You know, just one more thing, you
know what I mean? Not totally empty; just one more thing. Now, I would probably
say, “You got to get out my house. You got to stay away from my daughter.” But,
you have to have the esteem to start with.

Dianna (G3) is a foster mother caring for young children and two teens. She
sums up other participants‟ views on finding the energy for parenting despite
“running on empty.”
I have a 12-year old daughter and a 13-year-old son. …[L]ike you say [referring to
Beatrice], there is no parental controls, but… I am a stay-at-home mom. So, I don‟t
drop them off at the skating rink; I take them. We go bowling, we do things… and
we go to Denny‟s and get free bowling tickets, you know. I hustle for the kids. If
they are giving up something free, an activity for the kids, I‟m there. My 12-year old,
I started her off at nine. I started training her up, building up her self-esteem. You‟re
a beautiful child. You don‟t just take that. Okie-dokie? Then, I don‟t give them that
leeway to even experience anything like that [referring to negative TV or peer
influences]. I‟m up in her face, because I want her to have better than what I had.
And she started her period over the summer, so we‟re like… and my 13-year-old son;

44

we sit there and watch Maury. You know, here‟s a brother, been on there 12 times…
[referring to Povich‟s paternity-testing shows].

VI. “We weren’t talked to”: Role Modeling in Reverse
Having begun parenting from ages 13 to about 30, some of the focus group
participants see themselves as the generation that learns and builds parenting
practices by reverse role modeling. They undertake practices directly opposed to
their own parents‟ practices regarding communication with children, involvement in
children‟s lives, and monitoring their physical and social maturation.
In Group 1, both Francine (first child at 16) and Greta (first child at 21), now
raising teenage daughters, count themselves as members of the generation that
parents by reverse role modeling. Greta observes,
I think that‟s our generation. We weren‟t talked to, but I know I am very open and
candid with my daughter, because I don‟t want her to find out [about sex and its
consequences] from some boy or whatever. You know, I would rather be the one to
tell her. …I mean, I learned from my mom… from her experience, as far as not
having children [too young]. I did wind up pregnant…. I was… 21, but my mom‟s
experience, she had me… got pregnant with me when she was 15. …From her
experience, she was typical… of the community, in her house, [about]
communication with her mother, as far as pregnancy, STDs and stuff like that
[inaudible], as far as what went on in her home. Now, I have a younger sister who is
12… and, at certain ages, things like, for instance, having breasts, just the
development of the young woman… [happen, but my mother does not talk about
them]. [I]n my [mother‟s] household, sex education is not open at this time…. But, I
[talk]. I [also] think [young girls] learn a lot of stuff from their friends.
Francine picks up the theme, saying, “So, from my experience, having two girls, I don‟t shelter them.
I let them know what‟s out there. I let them have their space, but….” Francine fades out when the
moderator asks two questions that Group 1 finds difficult, given that they define their generation by
the lack of information they received from their parents‟ silent or near-silent generation. How much
does a parent say and when? How can they know if they have no positive childhood role models to
guide them?

Across the focus groups, participants disagree on whether mothers who did
talk about sex provided information about contraceptives. Darlene (G2) had her first
and, so far, only child at 17. Her mother talked about contraceptives, warning her to
use them if she became sexually active. On learning that she was pregnant,
Darlene‟s parents were emotionally and materially supportive. Darlene did not use
pregnancy as a reason not to attend college. Instead, she attended a local college,
worked, took responsibility for her child‟s care, and used contraceptives to prevent
another pregnancy.
Effectively present parents, the focus groups agree, respond to the expectant
mother‟s response to her pregnancy. Yet participants maintain that parental support
after the first pregnancy does not always provide a positive model for the young
45

mother to learn childrearing skills and to take responsibility. In Group 2, Darlene
describes differences between her conduct and her cousin‟s during their first
pregnancies. She then explains complex cause-and-effect links between the two
mothers‟ conduct and their parents‟ responses.
A lot of [young mothers] I know don‟t learn any lessons. Like, I remember when I
got pregnant I was 17. It was like, you seen me you seen my cousin. 14…She was 19
[and] she had two kids. Well, so, she got pregnant… [in] May and mine was in July,
so we were both pregnant. And, you know, they‟re cracking jokes that we really do
do everything together, because we were both pregnant at the same time. And, I
remember her excuse was like, “Well, at least I graduated. I waited until I was 19.”
And, well… I had my son a month before my 18th birthday. My parents… of course
they got used to it that I‟m going to have a baby. But, it‟s like, when it came to
wanting to go out,… it was like they were not going to just [snaps fingers] [allow me
to] throw them off, throw them off [leave children with them]. But like my cousin
that‟s 19, it‟s like you call her, “Where your kids?” Nowhere in sight.… [Her parents]
didn‟t teach her her lesson. Not teaching her, but, you know, let her take her own
responsibility [for her kids].… Like, “I can‟t just go drop them off, drop them off,
drop them off.… I basically learned my lesson, you know? Now… I‟ll be 22… and…
she turned 24, and now she has three kids, and I still have my one.

When grandparents take over childcare for their grandchildren, young
mothers may learn negative lessons about parenting responsibilities. For the focus
groups‟ older participants, first-time mothers in their 20s and 30s, the children‟s
great-grandmothers may be just over 50. By contrast, for the youngest mothers, a
first child‟s grandmother may only be in her late 20s. Yet, even in considering
grandmothers‟ and great-grandmothers‟ age as factors, we should keep in mind
Frances‟s earlier account of her children‟s grandmother and great-grandmother—jetsetting, independent, beep-me-if-you-need-me professional women. Participants in
both single- and two-parent households, whose parents and grandparents were
effectively present, see getting help from them as a burden the elders can ill afford.
Ester illustrates Group 2‟s discussion of this issue.
[Y]ou talk about the whole thing—family issues, and that whole idea of self-esteem
and self-worth, and things like that. It is so generational that, I think, more often
than not, I‟ve seen more grandparents with young babies at doctors‟ appointments
than I‟ve ever seen before. And, it‟s… looking like, that can‟t be your [child], you
know?

Grandparents often engage in a form of reverse role modeling, Group 2 admits,
attempting to fix mistakes they made with children by raising grandchildren. Yet this

14

Although Darlene and her cousin were very close friends, their different responses to childcare
have altered the closeness that might have served them as parents. It is important to keep this in
mind later when we consider how female friendship circles influence reproduction choices and
decisions as well as decisions about taking responsibility for childcare when a woman‟s choices result
in several pregnancies or babies before age 20.

46

strategy does not produce constructive results if it prevents a young mother from
learning to be a responsible parent. Ester concisely makes the point:
You‟re in your 50s or 60s, and you have a six-month old, or three of them, or
whatever. And, I think, for [the grandparent in that position], they‟re still trying to fill
a gap or a hole or whatever exists in their heart or their mind or their soul. And,
whatever they felt they couldn‟t do for their children, they‟re now feeling, “Well I‟ll
just do it for the grand babies.” But, what you‟re doing is a huge disservice to the
child [who is the parent], because you‟ve basically said, “Go ahead, you give me the
kids, baby, you go do whatever.”

Elders who assume parenting and childcare responsibilities may be in poor
health. Some may have substance abuse problems, and others may suffer the longterm effects of poor nutrition or genetic family diseases. Pointing to these
possibilities, Carine (G3) simply states, “Not all grandparents are stable.” Charlotte
(G5) says, “They already tired and used up… from trying to help they self. And, if
they still living… sometimes you have relatives that‟s in the house with them and
need help.” Other participants agree that many young mothers face this situation
when they turn to parents and grandparents for support.
Alexis (G3) had her first child at 16, and her stories suggest that her mother
had a first child at 14 or 15. Thus, when Alexis‟s eldest sister had her first baby, at
15, the child‟s grandmother would have been about 30. “They 50, almost 60,”
Alexis, now in her mid 20s, says of her parents and her children‟s paternal
grandparents. She seldom sees her mother and, still more rarely, her children‟s
paternal grandparents who live in Arkansas.
With my second child, I was out in Arkansas, and even though I was around his dad
and his grandma—I mean, he‟s 6 now—they don‟t call for birthdays, and, if they do,
they tell him they sending him something, and, ah, it‟s so far and few in between
that I would rather not have to deal with that. So, when it‟s only one person that feel
like… they are there for their child, by the time the third one comes around, it‟s just
like, whatever. I don‟t feel like I have to tell y‟all „cause y‟all gon‟ look down on me
anyway. Y‟all look down on me for the first one. I mean, you may go get that first
set of vitamins and, you know, the first check up and everything, and it‟s like, “Well,
it‟s all good now, it will be all good later.” With the first one… I stayed with my sister,
because, um, ah, I don‟t think I told my mom until I was probably like four or five
months pregnant. „Cause that‟s how much I seen my mom.

Then, reflecting further on her pattern of reproduction and its implications for a
sibling‟s role modeling with regard to prenatal health care, Alexis says:
I moved out. It seemed like every time I moved away from home, I got pregnant.
That‟s also a thing. But, seriously, um, with the first one, my sister was there. She
made sure I went to my appointments. She was like, “No, [Alexis] you need to go,”
because she had already had kids. You know? So, she stressed the importance of me
needing to go with the first one. With the second one, I was engaged to be married,
so she was, like, “You‟ll be out there in Arkansas, just remember to go to the
appointments.”

47

Responding to Alexis‟s views, Glenda (G3) speaks to the frustration of family
members who, caring deeply about children, try to help their relatives. Like other
participants, she sees family members become overwhelmed as young mothers
transfer responsibility, continue producing babies, and need persistent prodding to
get pre- and postnatal health care.
It‟s just ridiculous. I mean, okay, we‟re suppose to be adults, adult women. After
your first child, you should know better. Second, third—I… have a sister just like that
[referring to Alexis‟s self-account]. You know… because I am the oldest, I took care
of the siblings, the younger one‟s, and it‟s amazing, that pattern, it‟s like, “Don‟t you
get it? You are a mother, now. It‟s your responsibility to step in and raise these kids,
and if you don‟t want any more kids, take prevention. Get on birth control. That‟s
what birth control [is for].” It‟s just so frustrating! I am hearing from you [Alexis];
that‟s how my sister speaks. She has no clue.
Alexis closes the exchange with a typical retort: “When you get too frustrated, it don‟t help the
person who is pregnant, trying to make it. They know they have another baby on the way [and] that
don‟t make it easier.”

Speaking of grandmothers and great-grandmothers, some focus group
participants express views that we might more readily associate with the ideal model
of elders—wise and strong people, ever ready with sound advice for family and
community. While describing this ideal, Glenda (G3) expresses a view that many
focus group participants hold: Arizona is less conducive than the South to producing
strong elders. Her stability of her parents and grandparents, she thinks, is a result of
growing up in Mississippi. This made them strong and wise because, they have told
her, strength was the only option for African Americans in the South.
My parents, I know from my parents. My mother, you know, and my grandmother.
My grandmother is from Mississippi, and you had no choice… choice but to stand
strong. Those were hard times, back then.

Nonetheless, Glenda strongly disapproves of transferring parenting responsibilities to
the older generation.
My grandmother [her child‟s great-grandmother] is 86 years old and she is fully
stable. Why are we counting on other adults… [to take] our responsibilities? Why…
can‟t we put that on ourselves?

In addition, as both Darlene‟s and Glenda‟s views stress, grandparents‟ support for
their children and grandchildren depends on how the children manage parental
responsibility.
Some young mothers may have been substance abusers or effectively absent
for other reasons when a child had a baby. In the household dynamics that follow
effective absence, they may lack parental authority or have fewer childrearing skills
than their eldest children and, sometimes, their middle or youngest children, have.
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The child who took on the parent role learned hard lessons. Distrust weighs against
the parent-substitute easily surrendering control to the returning parent.
Anna (G1) addresses this issue, speaking about her past addiction and its
importance for understanding current dynamics in her single-parent household.
I was… an absent parent; I was strung out on drugs for a while…. I have three girls
and one boy… [and] my oldest daughter kept my youngest kids. … . I have a middle
child that‟s a 17-year old, and then my baby is 15… My middle child and my 17-year
old, I have to be careful with them, how I treat them, because they‟re like night and
day. One is like… real rebellious and stuff, and she is real quiet. She is not use to
being around people. And, coming back into their lives, I have to… you know… let
them see that they can trust me. That I‟m not going nowhere. I am responsible now.
I pay bills.15

Anna reenters her household as a single parent and a grandmother to the child of
her eldest daughter, a single parent. Household dynamics during Anna‟s absence
now offer her assurance that her 15-year-old daughter is less likely to become a
teen mother.16
I am a single parent. And, my oldest daughter had a baby, which my 15-year old
helped her with. So, [eldest daughter‟s name] was, like, [youngest daughter‟s] mom,
because my [17-year old] was the daughter [who] worked all the time.… [M]y
youngest daughter, I don‟t have to worry about her getting pregnant because she
has a resentment. She like, “I‟m not taking care of no kids! Nuh-uh.”

Yet Anna admits that she has few skills to offer her eldest daughter, who developed
her own skills in Anna‟s physical and effective absence. Therefore, Anna finds it
difficult to relieve her daughter of responsibilities for parenting younger siblings,
Anna‟s children.
So, now my [oldest] daughter… she‟s real strict… real firm in what she says. And,
she‟s like the mother figure, and there was times when I could not interject to what
she wanted my youngest child to do, because she was taking care of her. So, it‟s
like… she preaches to my 17-year old, because she do not want her 17-year old
[sister] to go through things.… [S]he‟s a dental assistant right now, so she‟s doing
good with her life. And she has a child, and she‟s real informative to her younger
girls about where their life should go.… [S]he‟s like the overseer, and sometimes I
have to look at her like, “Nigger, you like a warden. Hold up!” Because, she‟s real
firm about stuff.

15

Although Anna mentions her son, she does not describe him, his reactions to her absence, whether
he is a parent, or whether, during Anna‟s drug episode, her eldest daughter was his substitute
parent. Once again, the focus group methodology concentrated on women. This accounts, in part, for
the participants‟ limited discussions of their male children as parents, married or unmarried.
16
Across the focus groups, participants stress the influence of household dynamics on younger
daughters. Having helped older sisters with childcare, these young women show little interest in
having children and may decide not to become mothers.

49

The view of the older generation shifts when Anna places her household in
her kin group. We see a social history of inter-household skill exchange, and her
daughter produces reverse role modeling from information she gains in this
exchange. Anna describes her sister‟s role in their natal household.
I come from a family of ten, so my sisters raised [my eldest daughter]. She got her
resources from my sister, „cause my sister was a good mom, and she took care of
her kids. Because she had all those resources [from her aunt], now she is able to
help her little sisters out with these resources [by] directing them which way to go
and… tell[ing] them about the little diamond, and you know.… When I sit and look at
her… I say, “Man, where you get all these mothering skills from?” And all this
information. [B]ut she‟s real… she has a voice on her, you know.

Unlike Anna, Karen (G4) had no family support during her drug addiction. She
had her children during her struggle, and kept them with her. Karen‟s story reveals
how her children experienced her previous behavior, and why it was more difficult
for her to parent by reverse role modeling.
I showed my kids a lot negative things through [my experience], my ignorance.
When did you start showing them these negative things? (Moderator)
Ah, man… before they were even birthed into my ignorance. What I mean by
ignorance is my experience, and I don‟t have no shame saying nothing, „cause folks 17
gave my kids education in a lot of different areas. But I exposed my children, at an
early age to street life, as far as watching they Mama do drugs. Watching me have to
suffer and struggle on the street in making money, selling drugs, prostitution—you
name it, I been there, I have done that.… I didn‟t have a family life where my family
was there to help me out, so my children were with me during my struggle.

Karen is in her late 20s and the mother of three children, and her seven-year-old
son is sexually active.
My child—my oldest one—is just turned 14. My middle one will be ten in December.
And, my son will be eight. And, what I‟m speaking on is, like I told you, he‟s seven
and in second grade, and already caught behind the bleachers with a child that is in
the fourth grade. And, that‟s my fault and I won‟t let nobody look down on me for it.
But, by the same token, I put the fear of God in them.

Her son‟s partner was probably ten, lending support to the point made by all focus
groups about the early age for the beginning of female sexual activity. Here that
issue passes without comment. Group 4 focuses instead on Karen‟s son. When a
participant asks if she tells her son that having sex at age seven is not good, Karen
replies:

17

Karen‟s reference to the folks who educated her children is unclear. She may refer to social service
workers, but it appears more likely that she means persons who, though also involved in street life,
were better able than she to attend to her children‟s needs.

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Yes, but like this lady [another participant] said, that‟s going to be so hypocritical of
me to say “No, no, no,” when [my children] say, “Mommy, guess what we seen you
do?” So, what I try to do is put the fear of God in them, and love them at the same
time, and give them a freedom of choice. Because, when my mom said, “Don‟t you
go to that dance, tonight,” I went to that dance. I give them a choice, and express it
through love, [saying], “This is what‟s gon‟ happen if you choose to do what Mommy
did.”

Karen blames her own conduct for her family‟s lack of child-raising support.
However, she sees a motive for her conduct in the “mentality” of her community
and her natal household.
I was raised in a nice area… [an area which society considers high-class]… but chose
to go out there in an area we call the street, right. Because, if it wasn‟t [for my low
class household in the high-class area], I would have never went… where they
consider the Southside low class, [but] where the mentality is very high class. And,
ah, so, I think [young people‟s negative behavior] has to deal with, with the
mentality of the household, before they even hit the streets.

Karen‟s use of “high-class” and “low-class” is a confusing mixture of economic
and moral criteria. Nonetheless, it captures what she mean by “mentality” or “mindset,” a controlling factor for the individual, household, and community. Mentality is
not a fixed or inherent property of these units, comments by Karen and participants
in the other focus groups suggest. Instead, their comments point to social dynamics
as explanations of how mentalities continuously develop from and reproduce new
causes for behavior and new consequences of it. Responding to Karen‟s story, Rita
(G4) provides an example of cause-and-effect feedback between mentalities and
sexual behavior.
I think it has a lot to do with when the parents became [sexually] active, or what age
they were at when they first learned, and… like [Karen] said, mentality. And,
whether or not they feel it‟s okay for me to talk to my child about sex… I know these
children at this age are already involved, and I want to make sure that my kids are
knowledgeable about what‟s going on out there. So, I agree one hundred percent
agree with her: it has to do with the mentality of the parents.

Thus, individual mentality also refers to variations in what parents have to
work with—the differing fields of experience that Helen (G1) mentioned. Likewise,
for cause and effect, focus group participants suggest that one cannot predict
household mentality from household structure. Differences among comments by
Carine (G3), Anna (G1), Darlene (G2), Fern (G5), and Karen (G4) about their
household structures and dynamics underscore the participants‟ caution about these
variations. They explicitly discourage hasty generalizations about causes and effects
based on household type and composition. All household types—single-parent,
female-headed, two-parent, or three-generation households—potentially expose
youth to poor or unsatisfactory role models for parenting (including instruction about
sexuality) and use of health-care services. When focus group participants describe

51

positive outcomes in two-parent households, they qualify and explain causes and
effects that might account for them.
Group 4‟s discussion of this point is an example.
I think it‟s determined [by how soon children become sexually aware, or parents
should be or are willing to begin sex education].… I think it is based off your living
environment. So, it can be as early as six or it can be as late as your menstrual cycle.
(G4 Fredricka)
What kind of living conditions would make the difference? (Moderator)
Depending on what your, ah… If you are a single parent, or if it‟s two parents, and
one of the parents is in the medical field. It just really depends. (G4 Fredricka)
Uh-huh. [Does] everyone agree with Fredricka? (Moderator)
To a degree. (One unidentified speaker)
To a certain degree. (A second unidentified speaker)
I think it all has something to do with, ah, the mentality, period. (G4 Karen)

Neither “beating children with love” (that is, putting the fear of God in them)
nor reverse role modeling have deterred Karen‟s seven-year-old son from initiating
sexual activity with an “older woman” (age ten). Still, participants see many younger
and older siblings taking responsibility for morally guiding one another. In Anna‟s
story and accounts by others, younger siblings become effective role models, even
though this situation is not ideal and may cause problems for using health care
services. The reasons for parent-substitutes differ, but the consequences—a need to
role model in reverse—do not.
The focus groups‟ accounts of household and family support clearly suggest
two conclusions. First, the amount of reverse work everyone must do depends on
intergenerational and inter-household skills. Those skills develop, largely, from
individuals‟ negative experiences in the past. Second, the success of reverse role
model work by this generation of parents or their substitutes depends on positive
patterns of conduct in the present.
It is already too easy for youth to progress from sexual awareness to sexual
activity, the focus groups agree, and family support may only make it easier for
them to continue reproducing without a clue about the responsibilities that this
involves. Therefore, participants insist, effective reverse role modeling requires that
parents become their children‟s first positive role models. Discussion in Group 4
illustrates general agreement on this point. Mary asks, “But, what if you are
teaching your children everything, but you are not living the example? So, you also
have to be the example for your children, as well as teaching them. Patricia adds,

52

“You can say, „Don‟t do this, don‟t this,‟ but [if] mommy got every man—Tom, Dick,
whoever—running in and out the house, then she‟s got a conflict of interest. You
say, „Don‟t do this,‟ but you doing it.”
IV.

“Unless something is broken off”: Papa’s Baby, Mama’s Labor

The physical or effective absence of fathers influences how youth mature. Mothers
or other female relatives must compensate for a lack of male role models while
learning to control their own reproduction, basic childcare skills, how morally to
guide children. Boys receive less parental instruction and guidance than girls do, and
the focus groups did not report older brothers as substitute father figures.
Only one participant speaks in detail about her brother offering guidance,
although some mention male siblings when speaking about other topics. Even
participants who discuss sibling competition in large families attend only to how their
older female siblings influence their conduct. When participants comment on males,
they emphasize the view in the community and in households that “boys will be
boys.” Comments across the focus groups suggest that boys must “make it on their
own.” Others expect little of them, or look to them to “live the exception” by
achieving success in sports or entertainment.
Asked about the role of fathers and grandfathers in sex education for
children, some participants answer that these men were present, but not involved.
Most say they did not know their fathers. Others knew their fathers‟ families,
although the fathers were not part of the natal households. Brenda (G1) expresses
the most prevalent response.
A lot of people who have a lot of siblings have an absent father. With me, I have no
idea who my father was—no clue whatsoever; never had a father figure, really. I‟ve
been from home to home, you know, with family members [but] never felt wanted.
My mom, she was strung out somewhere. So, I was just a statistic. You know, just a
statistic like everybody else, because of how my life played out. … . [I]t‟s, like… most
of the time you don‟t really know your other siblings, because y‟all all spread out
everywhere; you‟re everywhere. We were everywhere. And, my sister was 15, with a
baby; doing it on her own. She couldn‟t go to nobody else, because nobody cared.
My mom didn‟t care because she was strung out.

Although gender roles make females responsible for childrearing, participants
see both mothers and female relatives failing to fulfill the responsibility. Alexis‟s
comments on her child‟s paternal kin in Arkansas are suggestive. However, the high
number of absent fathers among the participants means that too few comment on
paternal relatives to gauge their roles in young mothers‟ lives. Participants speak of
maternal relatives, although they were not always positive sources of support. For
example, in Brenda‟s mother‟s absence, a maternal aunt cared for Brenda and her
siblings as their state-appointed foster mother. Brenda (G1) notes the role that

53

gender prejudice played in worsening their aunt‟s generally unsympathetic
childrearing.
My aunt, she was just in it for the money. To take care of us, she got paid. She
treated us like dirt. We were just her little slaves. My brother—I‟m not gonna say
that [it was the same for him]. Me—my older sister and I—were treated like dirt. It
was like she hated us. My brother was a prince. He got treated with the best of the
best; with everything. I don‟t understand that, but that‟s how it was.

Brenda now works toward her own self-realization. She practices reverse role
modeling to raise her daughter.
I became another statistic. I got pregnant at 17. I have a daughter, but I‟m changing
now, and I am not going to be a statistic for long. I‟m gonna finish school, I‟m gonna
go to college, and I‟m gonna show my daughter that there is more that [she] can do
with herself. I‟m not gonna shelter her, too much. I‟m gonna let her know what‟s out
there and let her go from there. Because, you can only do so much.

The beginning of self-realization, participants maintain, depends on the foundation
for reverse role modeling that past experiences provides. Brenda continues:
[Y]ou had your mom and dad [pointing to several preceding speakers]. My mom, she
was there for bits and pieces. She missed a lot of my life. She wasn‟t there for my
first period, she wasn‟t there for graduation, she wasn‟t there for the first boyfriend.
… . [W]hen my mom came home, I couldn‟t go to her and say, “Mom, can I talk to
you about this?” I‟m the sort of child, I wanted to have that mother-daughter
relationship, so I could communicate with you about anything. I told her that, and
she was, like, “I don‟t wanna hear that.” You know, she was real, real closed off, just
„cause that‟s how she was raised.

Group 1 participants “adopted” Brenda and, throughout the session, offered
her advice. Their actions demonstrate their general premise that how others
respond to a young, unmarried mother depend on signals that she is working to
continue her self-development and taking responsibility for the present care and
future possibilities of her child.18

18

We will later hear from focus group participants about the difficulties of “coming together” to form
networks for sharing resources and building community. However, Group 1‟s action demonstrates
that the difficulties result, in part, from a lack of opportunities to do so. As the session progressed,
the women began passing a sheet to exchange contact information. On behalf of the Alliance, Wanda
Thompson asked if they wanted to remain in contact, with the idea of forming a network among
focus group participants. We added this option to the focus group process. With two exceptions
across the five groups, participants consented to have Wanda draw up a contact list. Each focus
group stressed the lack of gathering places for informal interactions that would allow them to get to
know community residents and to share resource information. After each session, many participants
told the moderator and Wanda Thompson that the focus group provided them with a rare, and much
appreciated, opportunity to speak with other women about matters that they had never openly
discussed.

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Anna (G1) notes how an effectively absent father made it necessary for her
mother to take on both parenting roles.
My dad was there, but he was very much an alcoholic, and my mom carried the
weight. So, sometimes you[r] parent can be in the home but absent … He‟s gone for
two weeks; you don‟t see your dad. You get where you don‟t even worry about it.

In marriage or outside it, participants point out, gender-role differences mean that a
father was, as Darlene (G2) puts it, “in the picture, but… wouldn‟t talk about
[sexuality or other moral issues]. He would most likely prefer my mama to [do
that].” When the moderator asks Groups 1, 3, and 5 for a roundtable response
about the physical absence or ineffective presence of fathers, Betina (G2) sums up
the most prevalent answer: “Mine wasn‟t in the picture.” Earlier, Betina described
her three-parent household, and her parents‟ divorce. Here, she does not mean that
her father was physically absent before the divorce, but rather present and
negatively involved in parenting. Other participants stress gender-role difference to
explain the ineffective presence of fathers. Fathers talk to their sons, participants
think, but the conversations are no more instructive than those between girls and
mothers who talk.
Only one participant, Alma (G5), who is over 40, speaks of older brothers
who offered her guidance. They taught her by their negative behavior and by
pointing out other males, whom they saw acting on the same predatory response
toward young girls.
I grew up with five brothers, so, I knew about sex, at probably, eight, because they
were talking about the girls they were [pursuing for sex]. So, they were talking about
the girls that were hanging out, that they really didn‟t like, but they were gon‟ get a
piece from. But, they would say, “You stay away from him, because all he wants is
this.” So, I learned very young.

Heeding their advice accounts for why Alma did not have children until she was
older. Still, she, like participants across the groups, does not reduce the problem to
differences between single- and two-parent households. Instead, she expresses the
participants‟ view of factors that shape interactions in households to which the
community‟s children respond.
I think the bigger issue—I do think it is true that when you have one parent, it is
difficult. I also think (and I‟m older) that you can have two parents, but if they‟re not
talking about sex, if… sex is bad, and that‟s how they talk about it, but… you have all
these hormones going all over the place, you like, “How can I not do that when it
can feel so good?” Also, I think even if we have parents around, we don‟t put the
loving on our kids that we really should. Because, I think, even though you have
those feelings when you are young, a lot of it is out of “I wanna attach to someone.”
You know, “I want somebody to make me feel special.”

55

Alma pauses, clearly frustrated by the search for words to convey her point, before
continuing.
[A]nd lot of times our mothers are getting on us, „cause they‟re tired; they‟re
working, you know—no dad to help with kids. And, fathers are very distant; business
and whatever. So, I don‟t know. I think that part of the problem is that it is not
about the baby and all that, or sex. It‟s, like, empowering kids and giving them other
choices. [Saying], “Yeah, you have these feelings, but you don‟t have to do this, you
don‟t have to do that. [Y]ou know, run [meaning exercise]. [Y]ou can talk to boys
[but] demand respect.” And, so, I don‟t know. I just wanted to give that view to it.

Consequently, comments that show mothers taking total parental
responsibility may encourage us to think that the outcome is the “strong African
American mother” ideal. Yet participants strongly discourage viewing this as an
inevitable outcome or the most frequent one. Mothers and fathers are busy making
a living. Equally important, mothers are products of their parents‟ training and their
own experiences before having children. Many tasks continue to consume women‟s
time and shape their interactions with their children and grandchildren. Real
mothers, participants emphasize, are a complex mix of strengths, weaknesses, and
vulnerabilities.
Recall Anna, a teen mother strung out on drugs, who is now trying, with
great difficulty, to resume her parenting role, after her eldest daughter has become
a strong woman—one with a “voice” or authority. Mothers who develop such
strengths may manage well the dual parenting role. Do mothers provide instruction,
the moderator asks Group 2, when fathers delegate the responsibility? Darlene,
pregnant at 17, but who eventually had support from both her mother and father,
answers from her experience with her mother: “A little. Not like… specifically. … She
would like… joke around with me to see if… [I was sexually active, but]… we never
like sat [and] had… an actual talk.” Across the groups, participants report that their
mothers did not want to “have that conversation.”
While the participants say they try to be open and instructive, and to monitor
carefully their children‟s conduct, they admit that the negative impact of gender-role
differences continues in their generation‟s practices. In discussions of various issues,
their examples emphasize daughters. Like Anna, when recounting their parenting
practices, many participants mention, but do not expand on experiences with male
children, unless the moderator probes.
Thus, in Group 1‟s discussion of recommended interventions, Catherine
makes a typical comment focused on girls.
[T]here needs to be some place where these girls can meet and talk openly about
[sex and reproductive health], you know, however they want to talk about it. That
was… was helpful for us. We had questions, and we just asked off-the-wall stuff, and
it was stuff we knew we could not go to our parents and ask. And, they told you up

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front they would not tell your mother or your father. Now, whatever goes on in here
(they were careful back then) goes no further.

The moderator asks Group 4 how schools and other social institutions help parents.
Demetria, recalling a program in her area, also passes over males.
Well, I know there was an African American education director at the Boys and Girls
Club in this area, and she taught the girls, from six- years old on up. She used to
have girls‟ day. And, what she would do, she would explain everything about
hygiene—comb, brush, pads, tampons—and explain to the girls what they was. She
did not go as far as talking about sex. She would explain things about their body,
menstruation.

Although other Group 4 participants knew about this program, none could say
whether it offered a boys‟ day. Asked about the earliest grade in which schools
provide instruction, the group settled on sixth grade for boys and girls. Yet, when
the moderator asks what boys learn in school classes, few could describe any of the
topics.
Far from indicating that the focus groups do not recognize gender as an
important factor in sexuality, reproduction, parenting, and health care, the
participants‟ comments show that they had to pause, or even push themselves, to
consider the implications of gender-role traditions for their reverse role modeling
practices as mothers. They are aware of the need to include their sons in ways that
disrupt gender-role expectations. Dianna‟s account of interacting with her 13-yearold son, reported earlier in this chapter, illustrates the point. In Group 2, Ester
presents a typical view.
You know, and before I lose my train of thought, there‟s one thing that—when you
[the moderator] were reading that last scenario—that I find disturbing, because I
have a young boy. I think the conversations that we have with young girls are
different than the ones we have with young boys. And I think [that]… has to change.
You know, with young boys, it‟s like, “Boy, don‟t do that again!” Even though they
have two babies out there, you know. And, so I think, as we have these
conversations, they have to be translated to young boys the same way.

When participants stop to think about gender-role differentiation, they quickly
recognize that it has a negative influence on male involvement in health care for
themselves and their children. In Group 2, Frances joins Ester in an exchange that
reveals how participants view this influence.
I think… that men don‟t really seek medical care. My experience has been… they
don‟t really pursue medical care… unless something is broken off of them. … . So, I
imagine… if [at] 37… you not going to get your prostate checked out, you not going
to care about your baby‟s stuff at 17.

Ester responds by recounting how she has to “trick” her husband into going to his
doctor and accompanying her to their son‟s appointments.
57

Right. “That‟s your [the mother‟s] responsibility. That‟s your job. What you need me
there for? I can‟t do nothing.” And, they certainly won‟t be proactive about it, you
know… things like dental. I ask like, “When [are] we taking [our son] to the dentist?
My husband‟s like, “I don‟t know.” Yeah, I mean, and this is an educated man. To
him, he‟s never had to think about it. He‟s never had… to. He doesn‟t plan for
himself, so you know he‟s not gonna go [to a child‟s appointment]. … I have to trick
him. Tell him were going to church, then stop off. [Laughs] And, it starts off early,
and he has a late appointment in the afternoon, and [I] say, “Let‟s stop by this place
a minute.” And we go in, and it‟s a doctor‟s office. Because his mentality is, unless
something is not broken, it‟s a waste of time, waste of money. And, you know, it‟s
very sad, just all things, like prostate cancer, that are just more prevalent in the
African American community. I literally have to threaten him, have to trick him. I
have to use other things.

By “his mentality,” Ester does not refer to individual personality. Instead,
“mentality,” like “mind-set,” is shorthand for the cause and effect of gender-role
training. Thus, following Ester‟s comment about using feminine wiles on her
husband, Frances quickly links such practices to the difficulties a young mother
faces getting a father involved in his baby‟s health care. For Frances, a young
mother‟s greater difficulties result from trying to gain the assistance of a child‟s
father assistance without alienating his affection for her.
And, if you‟re the young girl, are you trying to keep that guy? You said that the

babies are by the same father. So, maybe you are still dealing with that dude… [and]
you don‟t really wanna piss him off or mess with him too much, because then he
might not buy the package of diapers. I don‟t know, I‟m guessing. You guys—I don‟t
mean that condescending—but I am just guessing that you are not messing with a
17-year-old boy about taking the baby to get shots, because you might still be trying
to have him in your life. So, you probably aren‟t asking him for that, right?

During Group 3‟s discussion, Fatima, adds male imprisonment to the list of reasons
why women must assume parental responsibility for childcare and reproductive
health.
My sister… has three children by the same man. When he is out of jail, he takes care
of them, but when he‟s in jail, I‟m taking care of them. And, you know, she‟s
partying and doing whatever to go out and have more kids.… But, as far as the birth
control, a lot of African American women look at it like it‟s harmful to their bodies, so
they‟re not gonna do it. But, they would rather have [speaking over group laughter]
the, the, you know, sexual encounter than protect their self.

The focus groups agree that very young, unmarried first-time mothers have
the most serious problems. Male disinterest and lack of involvement, the participants
maintain, strongly influences whether or how actively these mothers seek health
care. Eventually, young mothers learn that doing what men desire does not keep
men in their lives. Women‟s efforts to do so may increase disapproval from family
and friends, who become frustrated with the mother and less willing to help her with
childcare.
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We turn next to the interrelations of coping, recall, and refusal. Chapter 2
explores how community “realities” shape mothers‟ decisions about whether, when,
and how to use health care and other social services.

59

Chapter 2
Coping, Refusal, and Recall
 Coping—Strategies women devise to manage their own and their
children‟s health care.
 Refusal—Factors that keep women from using services for which they
are eligible.
 Recall—Experiences with health care workers that influence use of and
satisfaction with health care services.
I.

“I’m on my sixth one”: Sexuality and Reproduction as Status
Competition

Seeking affection outside the home, young girls turn to males, usually peers, but
sometimes older men. They first produce babies as “mistakes,” “slip ups,” or “love
objects,” and may continue having babies as they try to retain male affection. This
pattern may begin with the “fast girl” in a friendship circle. Participants say the fast
girl, as the first to become pregnant, sets the tone for her friendship circle. Her
friends may see becoming sexually active or having a baby as part of female peer
status competition. Expecting all girls in the friendship circle to “put out,” other girls‟
boyfriends press them to become sexually active. Fast girls, who do not learn from a
first mistake, then look for status approval among young mothers experiencing
similar shame, disapproval, and inadequate family support.
Very young girls (ages 11 to 15), with little reproductive knowledge, do not
expect to become pregnant. Initially, they are confused. Faced with censure, feeling
isolated and overwhelmed, some become belligerent. As a consequence, they
continue reproducing and may have several babies by age 20. The pattern,
deliberate or inadvertent, creates a reproductive competition—bragging about the
number of children they have had. Confronted with such behavior, health care
workers develop and extend negative stereotyping to other African American
patients. The extensions assimilate negative stereotypes of African Americans as
welfare recipients and AHCCCS patients, whom health care workers see as
freeloaders. These “non-paying customers” do not deserve the professional service
they accord “paying customers.”
To her friends‟ mothers, Alexis (G2) was the fast girl in her circle of friends.
She describes how the pattern begins, saying, “Yeah, „cause, like, my friend‟s mom
told me that basically, before [my pregnancy], I was the fast one. And I did not see
myself as the fast one. It was just that I was the one that got pregnant first, but I

60

was hanging out; before, all I was doing was going to school.” Alexis speaks of her
initial confusion.
I remember when I was 16—before I was 16, so probably around 14 or 15—when I
entered into high school. And, I grew a whole new group of friends, because that‟s
kind [of] what you have to do when you go into high school. You like, “Hey, hey, I
know her, I know you, we all cool,” you know. And at that point, I was going to
parties and everything else. So, everything was introduced to me that I was not
naturally accustomed to, but [the activities], had became a part of me, so to speak.
So, that‟s why, when I ended up pregnant, I was seriously confused. That‟s why I
agree with you [referring to Fatima or Glenda], because I was confused completely—
through the whole pregnancy. I mean, after I had my first son was where I agree
with you [referring to Beatrice]. When you tell someone not to do something, they
do it.

Asked if they mean patterns following this confusion produce a literal competition,
Fatima replies, “Yes, sometimes,” and Glenda, Dianna, and Alexis agree. Alexis adds
that some of her friends have had more babies than she has had, and contends
several would have had more, were it not for abortions.
Consequently, the first baby in a circle of friends is a warning signal to other
girls‟ mothers. Whether a mother responds quickly and openly to this warning
depends on whether she accepts or denies the possibility of her daughter‟s sexual
awareness. Those who accept this possibility devise “reality checks.” For Group 1,
Francine explains her response when she thought her daughter might follow fast
friends.
[M]y daughter was among a group of girls, and some of „um already had kids, and…
some were pregnant. And so, it was kind [of] getting into her mind that it was okay,
like, “Oh, it‟s a little thing to do.” Well, I took her to the store. I went down the baby
aisle, and I explained to her everything you actually need. And she‟s like, “Wow,
that‟s very expensive.” I said, “Well, on top of that, you don‟t have a job.” And when
I broke it down for her, that‟s when there came the realization that this is not a good
thing.

The daughter may still become sexually active, however, because the reality check
includes no reproductive knowledge or because she believes she will “beat the odds”
and not get pregnant. Once pregnant, girls respond to a community prescription,
which takes as failures African American women who do not have and raise their
babies, and a proscription of adoption. Alexis recounts how, for her first baby, her
mother encouraged both the prescription and proscription.
I think [it depends on]… people‟s outlook on, like, unexpected pregnancy. … . [O]ne
thing is, like a person did not expect to become pregnant, but I know, my mom told
me, if I was “woman enough to lay down and make a baby, then I need to be
woman enough to stand up and take care of it.” So, not every person‟s mom or
person that‟s taking care of them, would see it that way.

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Parents may expect that standing up to assume responsibility also means
taking contraceptives to prevent another “unexpected” pregnancy. Some, like Alexis,
may have three babies before they begin thinking about managing reproduction.
With two or more babies, the girl may then look to her circle of friends to decide
whether she should continue having babies. Alexis also stresses the importance of a
family‟s and friends‟ disapproval in directing this decision, declaring, “But when you
have other people sitting around saying, „Girl, I can‟t believe you pregnant, again,‟
and, you know, it puts in your head, maybe I shouldn‟t be having another baby. If
my friend only have two, maybe I shouldn‟t be having more than two, especially if
you on your third one.”
Referring to their own or siblings and friends‟ behavior, across the groups
participants agree with Alexis‟s conclusion: “The competition is—I have had friends
to say, „Hey you on your fifth one.‟ „Hey girl, I just had (I‟m pregnant right now), I‟m
on my sixth one,‟ you know. So, they are competing to say how many, and they
have these different fathers.” None of the participants hazard an estimate for young
girls that become involved in reproductive competition, but they acknowledge that
the competition produces a subset of young unmarried mothers, whose conduct,
and what participants take as their belligerent attitudes, make them highly visible,
and promote health care workers‟ negative stereotypes of all African American
mothers. Bragging about reproduction does not mean that taking part in the
competition begins as a deliberate decision. Instead, as noted, the underlying
belligerence is more likely an inadvertent consequence of responding to censure by
others, combined with community proscription and prescription.
However, once involved in this competition, even grave risk to the mother‟s
health may not encourage her to use contraceptives or to resist the prescription and
proscription. Instead, she may continue thinking she can “beat the odds,” even if
losing the wager may mean her death. During her first pregnancy, startled by a
buzzing bee, Alexis stumbled on some stairs. The accident, she explains, resulted in
her baby “hitting the bottom of the cervix or something.” Her second pregnancy
damaged her spinal cord, she was in pain throughout the pregnancy, and doctors
warned her that she might die if she had another child. Alexis recounts her
belligerent response to this advice.
And knowing you should have no more babies, if you have any more babies you
could die (and I probably should have listened), but I‟m one of the beat-odds type of
person. So, when my second child came around, and it sort [of] messed up my
spinal cord—„cause it kind [of] like hit a nerve, so I was having, like, back problems.
And, they [health care workers] were like, “Your blood pressure is above and beyond
what it should [be], and you shouldn‟t have no more kids.” I‟m like, “Yeah, okay.”
[She speaks with disinterested, lackadaisical tone.] “Yeah, I heard that the first time
around.” You know. Then, it was with the third child [laughs self-derisively], that I
was like, “Okay, maybe I shouldn‟t be having no more kids.” Because, at that point,
they had went into my spinal fluid, and by the time they let me out [of] the hospital,
I had spinal fluid leaking out [of] my back. So, my whole body was shutting down,

62

and when I went back, I was being treated like I was some kind [of an] alien, with a
contagious disease. … They put me in a room, and I‟m like, “Okay, I just left last
night, and came back because I can‟t hold down in any water, any food, I can‟t see,
I can‟t talk,” you know.

A confused young mother, even if belligerent, counts on others to encourage her to
use health care as evidence of their affection. Nevertheless, when castigation
accompanies encouragement, she may ignore the prodding and, as others‟
disapproval increases and their support decreases, take her cues for conduct from a
circle of censured friends.
Moreover, general responses depend on whether others, who assist the
mother with the first child, insist that she assume primary responsibility for
childcare, develop self-help skills, and use health care and other social services. If
the mother‟s have children by many fathers (a likely outcome of reproductive
competition), participant reports that this is not desirable. Instead, having children
by multiple fathers provides evidence that the mother is not learning from her
mistakes, and increases censure. In turn, lack of support makes her more
dependent on acceptance among similarly disdained mothers.
Operating in the least informed circles and with little adult support, the
mother expects or confronts humiliating experiences from health care workers. The
humiliations further discourage her use of prenatal and subsequent health care for
herself and her babies. Negative experiences, participants say, have the greater
influence on the youngest mothers, in particular those who are not accustomed to
public humiliation. When physically or effectively absent parents do not accompany
these mothers to appointments, often they do not continue health care.
Girls who become pregnant at the youngest ages (e.g., 11 to 13) do so
before they learn about contraceptives. Older girls (e.g., 14 to 17), may know about
contraceptives, but either do not use them or stop when they experience negative
side effects, such as weight gain or secondary hair growth. In Group 3, Alexis also
recounts how others‟ responses to these side effects discourage using
contraceptives.
[T]he patch [did not work]. Then, I went to the shot in my arm, and [it] seemed like
every since… I was just fat. And so, people would always be like, “Girl, you pregnant
again! And I‟m like, “No, I‟m not pregnant. I got the darn shot in my arm. I‟m just
fat! … . [W]hen people continue to call you fat, because you taking steps not to have
no more babies, then you like, “Well, dang! I don‟t wanna be all big and fat, and,
then, people always questioning am I pregnant. So, I need to get off this shot, so I
can lose weight, so people won‟t always look at me like I am pregnant.

Darlene, whose mother accompanied her to doctor‟s appointments when she
became pregnant at 17, agrees with the side-effect response, but notes that a girl‟s

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reaction depends on parental support, and her life plans before the first pregnancy.
Darlene contrasts her response to her closest friend‟s, a cousin, saying,
And another thing I know that contributes to [reproductive competition] is a lot of
girls, they don‟t want to get on birth control because (well, the birth control I was
on), it makes you gain weight—the Depo. And they say it makes you look… manly
[facial hair growth]. Something, I don‟t know. I just know it tended to make me gain
weight. Yeah, so, a lot of them, they don‟t want to get on birth control, because they
say it makes you gain weight. And, the way I look at it, I‟ve never weighed over 120
in my life, which I definitely weigh over that now. But, I have one child I can support
fully. And my cousin, she still weighs 115, but now she has three kids [and] she can‟t
support the first one.

These factors influence the role of contraceptives in managing reproduction,
but other participants question why doctors limit their reproductive choices to
contraception and abortion. They ask why they can easily get abortions if
contraceptives fail, but doctors refuse their requests to have their tubes tied. For
example, Carine did not experience negative side effects from birth control, but it
failed. Pregnant with her second child, she asked for a different contraceptive and to
have her tubes tied. The doctor told her she was too young for the procedure.
Perhaps, as her comment suggests, the doctor thought she would later want to have
another child. Nonetheless, the doctor‟s response angered Carine, who offered to
pay for the procedure, even if her insurance did not cover it.
I had my first daughter—I was 19, twentyish—and I went in (I wasn‟t ready for
another kid). I was like, “Hey, I gotta step up. I been doing good, so far. When I was
gonna have a second baby, the first visit, I went in, I told them, “I wanna be put on
birth control and I also want my tubes tied, and they told me that they couldn‟t tie
my tubes, because I was too young. Why can‟t they (if I feel that right now I‟m like,
“I can‟t keep my legs closed”)… just tie my tubes? I was willing to come out of
pocket or whatever it took for them to tie my tubes, because I was taking birth
control and [it] wasn‟t working.

They find it tragic that they can risk successive pregnancies or have consecutive
abortions, but they cannot risk wanting another child later, even if they are unlikely
to be able to afford it, and cannot support those they already have.
II.

“She decided”: Coping with Unwanted Pregnancies

Faced with these choices, abortion becomes a taken-for-granted and consecutively
exercised option for girls. Participants question whether girls who have consecutive
abortions “process” the emotional and physical consequences. In Group 2, Betina,
who, at her mother‟s demand, aborted her first pregnancy at age 12, agrees with
other participants that abortion is “not on the table” as an issue in parental and
community responses to sex and reproduction.

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When neither a girl nor her family has a position on abortion, it becomes an
option for managing unwanted pregnancies. Personal or family opposition does not
discourage a girl from considering abortion, but it may result in her rejecting the
option. Refusing the option, she begins thinking about how to manage childcare
responsibilities. Darlene‟s remark on this point in the same group captures the
general experience.
[A]fter… my first appointment—when I confirmed I was pregnant—I was like, “I‟m
not going to have an abortion. I‟ve always been against abortion. I‟ve been against it
my whole life.” So, it wasn‟t an option, basically. But, at first, it crossed my mind,
because I was scared, you know.
Darlene also recalls, “I was like supposed to be on my way to U of A. And, oh, my gosh! I‟m a [high
school] senior and da-da-da. And, at first, I was scared. And I was like, „How am I going to have this
baby?‟ I don‟t got a job, you know, [but because] for my parents and, you know, my sisters, it
[abortion] wasn‟t an option.”

Young girls who have babies between ages 11 and 15, participants say, are
either too young to have a stance on abortion or cannot talk to parents about it.
Fearing the physical experience and expecting censure, they abort if they can get
funds to do so. While the youngest, first-time mothers are most susceptible to these
fears, the lack of reproductive knowledge and information on contraceptives means
that college students may also take abortion for granted. Speaking of an African
American self-help group at the college she attended, Darlene describes how this
group of 18 to 20-year-old students included abortion as the solution to an
unwanted pregnancy.
[W]e had done a class on abstinence and stuff like that. And, what most teens think
(if they think) is [that] if they do everything but [sexual intercourse], you know, they
won‟t get pregnant, or we can just get an abortion. … . And, we do [have classes],
like, usually about every year… but they [persons teaching the class and the
students] don‟t know too much. They don‟t know too much of nothing.

Thus, participants see young girls, as they face pressures to become sexually active,
assuming that they will get an abortion if they become pregnant.
Seeing very young girls as incapable of assuming parenting responsibilities, in
Group 2, Frances insists the mother who forces her daughter to abort makes the
right choice. Frances, the mother of a 15-year-old sexually active daughter, explains
her view.
If Mia got pregnant, I don‟t think I would let her have the baby. I know that (I mean,
we don‟t need to get into the whole abortion debate, and all of that), but… when you
guys were 17 and 16, and when you guys were little, when you all were having these
babies, did… you guys talk that through? Was that just not an option? Did you love
the little boy? You going to have his baby. … . Because, it seems like I would just be
like, “Okay we‟re… that‟s over.”

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Several participants object to her view, suggesting that her solution only encourages
reproductive irresponsibility. In effect, it promotes subsequent abortions and, no
less important, can encourage the girl‟s younger sisters to give into boyfriends who
pressure girls to become sexual active at increasingly earlier ages. Darlene recounts
this outcome for her pre-teenage neighbors after their mother ordered their older
sister to have an abortion.
Oh, no! I know somebody who… made [her daughter] do that. The beginning of her
freshman year, she ended up pregnant. This girl lived across the street and… it was
only her and her sister. [They] were like, 12 and 13 or 13 and 14, and… they were
always fast. … . She [the younger sister] was in eighth grade, like saying, “Well he
kept bothering me to do it, so I done it.”

Consequently, the participants‟ objection to abortion stems as much from their views
of complex pragmatic consequences as from religious or other moral grounds. Ester,
married, in her late 30s, and the mother of a five-year-old son, has a Master‟s
degree, and a personal income above $40,000. She explains views among girls with
whom she works, the oldest of whom have already had one or more abortions.
[I]t‟s scary what‟s happening here, you know. You talked about the issue of abortion,
and abortion is becoming like part of the solution. I mean, it‟s like you hear them,
girls, talk about two or three abortions, and I‟m thinking… I would be mortified after
the first! I can‟t imagine that [multiple abortions] would be, like an option. And, their
only concern is, I may not have the money. How am I going to pay for it without the
money to pay?

After having several children, other young mothers abort to limit the number.
In Group 3, Alexis recounts how she learned that her friends abort for this purpose:
“[O]ne of my other friends, she ended up having—I think she would have had more
[babies] than me—but, I know she has had two abortions. That was her choice,
because she did not want to have so many children. She decided.” Insurance,
including AHCCCS, participants conclude, make funds for abort readily available.
Thus, responding to Ester‟s view, Darlene, who works at a hospital and sees
expectant mothers as young as 11, insists, “AHCCCS will pay for that one,” implying
that while the insurance does cover other needed services, it covers abortion. Ester,
again referring to the 13-year-olds among the girls with whom she works, reinforces
this contention.
Oh, yeah! Absolutely! Absolutely! … . I was telling you about the group of young girls
that I had, and, at 13, one had already had an abortion, and [she] said, “Well, if I
get pregnant again, at least I know that that was an easy process”—not even
processing the emotional piece; because when those things hit you [one might
expect emotional or physical difficulties].

Despite the participants‟ claim that insurance covers abortion, self-induced
abortions add to the total. Some expectant mothers self-abort, participants contend,
because they are too young to have insurance, or to know how to get a medically

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assisted abortion without adult approval. Others do not seek parental help, because
they are hiding the pregnancy to avoid shaming. These possibilities mean that some
young girls delay revealing the pregnancy until a medically assisted abortion is
impossible. Others prefer self-induced abortion to avoid revealing a pregnancy. An
exchange that follows Alexis‟s explanation of self-induced abortion as “premature
labor” captures the participants‟ general agreement that self-induced abortion
supplements medically assisted abortions.
Whether they went to the clinic and had the baby taken out, I mean, a lot of times
people go through steps to make themselves have an abortion. (Alexis)
How is that? (Moderator)
I know, for instance, they tell you, you should drink castor oil, and… that will send
you into labor. (Alexis)
Yeah. Yeah. (Fatima)
All I‟m saying is, once you go to the hospital, they look at you and like, “Okay, you
are having a baby early.” They don‟t necessarily check [for signs of self-induced
abortion]. (Alexis)
So, it counts as miscarriage? (Moderator)
Yeah. (Alexis and other voices)

Probed for knowledge of other ways to abort, participants did not provide other
methods.
In Group 5, Margaret provides a different reason for self-abortion. “They get
pregnant faster than they have abortion money,” she declares, implying that
frequency of consecutive abortions may mean that insurance coverage for additional
ones is not available. No one in any group knew the regulations for either public or
private insurance. In any event, they understand Margaret‟s comment as also
applying to persons who try to find funds because they are not old enough to have
insurance and do not inform parents. Thus, they do not have access to their parents‟
insurance. Those who use parents‟ insurance to abort a first pregnancy may not
seek parental help with a second or third pregnancy, because they expect censure.
Although rare, participants report knowing friends who delivered their own babies,
with tragic consequences.
From programs in the community, the young sexually active girl seeking
contraceptives also receives advice on abortion, if she is pregnant. This, participants
contend, encourages frightened young girls to abort. Asked for services in the
community that provide contraceptives, all of the groups mention Planned
Parenthood. In Group 3, when Fatima mentions Planned Parenthood as a source of
contraceptives, other participants respond that it also advises the pregnant girl

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about abortion or offers information. Comments in Groups 3 and 5 capture
participants‟ views on Planned Parenthood and abortion.
They offer, like, birth control and methods to prevent pregnancy. (G3 Fatima)
Don‟t they [Planned Parenthood] also terminate? Abortions? (G3 Beatrice)
Yes, yes they do. (G3 Alexis)
They ask, “Do you want it?” (G5 unidentified speaker)
It—the baby? (Moderator)
Uh-huh. (G5 another unidentified speaker)

Nonetheless, participants do not see Planned Parenthood having a major influence
on young girls‟ decisions to abort, because most do not know about Planned
Parenthood. For Group 5, Edna explains why this is so, noting, “You can go by
Keyes [Community Center] and get referrals, but, you know, there is no
advertisement for these things. They are out there, but you never know, until you
get referred personally.”
Young girls who learn about Planned Parenthood also learn that it offers
parenting-skill classes, sex education, and information on sexually transmitted
diseases. However, seeing Planned Parenthood as primarily a profit-making service,
participants say its fees are too high for most young mothers. Some disagree, saying
that Planned Parenthood accepts volunteer work in exchange for services, and bases
its fees on an income scale. Overall, inappropriate timing and poor advertisement
reduce any service‟s value for young girls.
Still, participants recall getting their first contraceptive—condoms—from ”the
bowl” at Planned Parenthood. Anyone can take free condoms in strict confidence.
Discouraged by boyfriends, participants say few young girls use the free service.
Already pregnant during sixth, seventh, or eighth-grade health classes, having
become sexually active as early as third or fourth grade, girls lack timely knowledge
of contraceptives and turn to abortion. Thus, when the moderator asks Group 3 to
consider how many abortions a mother in her early 20s, with six children, may have
had, four members provide the following responses.
Three. (Dianna)
About three. (Fatima)
Yeah, about three. (Alexis)
You are saying they probably got pregnant nine times? (Moderator)
Yeah. Right. (Multiple voices)

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I would say so. (Elena)

The Group 3 estimate is consistent with unsolicited estimates in other groups
derived from members‟ comments on friends‟ and siblings‟ reproductive histories.
Even so, participants also stress the consequences for mothers and children, when
girls have unwanted babies.
III.

“I never wanted you in the first place”: Parenting, Discipline, and
the “Village”

Like adoption, counseling or psychotherapy is a proscribed behavior for “real”
African Americans or “Black folks.” An exchange in Group 3 explains the
consequences for mothers who accept these proscriptions. First, Alexis, already
raising two young children, recounts her mental distress as she faced censure for
having a third child, which motivated her to try self-abortion.
I had actually got to a point where I was mentally stressed. I was borderline suicide,
where I did not wanna kill myself, per se. I just didn‟t wanna have the baby. But,
because my mom told me I had to stand up and be a mom (I did not want to be a
mom to this baby), and [laughing] I ended up getting strapped to some kind [of]
chair and stuff in the hospital, and they were like, “You weren‟t gon‟ kill yourself,
were you?” I‟m like, “Naw, just the baby,” you know. And they were like, “You can‟t
do that” [laughs]. And it was at that point, where they were like, “[You] probably
need to talk to a psychiatrist.”

Second, and despite Alexis‟s reference to community proscriptions, other
participants ask why she did not get a medical abortion.
Just the baby! (Multiple voices, repeating Alexis‟s words)
Why didn‟t you get an abortion? (Simultaneous multiple voices, some using different
wording)
„Cause my mom told me I had to stand up and be a baby… a mom. And, so, I was
like… not quite sure that [was] what I wanted to do. But, [I did] because of that
initial thought that if I was woman enough to lay down and make a baby, I had to
take care of it. I‟m already taking care of two, and ya‟ll coming down on me with the
third. I think, if they would‟a been more open to the third one, I would‟na been
through that. (Alexis)

No less important, as Alexis‟s account suggests, only when African Americans
engage in extreme behavior that motivates health care workers to insist on
counseling are mothers likely to act against the community proscription.
Self-respecting African American women are also unlikely to use adoption,
because, participants insist, doing so is “taboo.” As Group 2 discusses abortion,
Crystal asks, “How about adoption? I know, in my family, two of my cousins are

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adopted—their birth moms… [were] 12 and 11.” An unidentified speaker responds
with a rhetorical question, “But do we put our kids up for adoption? Do we do that?”
Adoption, multiple voices insist, is “taboo,” because, as one concludes, “[If] you
can‟t take care of [the baby], you‟re a failure.” Ignoring the possibility of medical or
self-induced abortion and miscarriage, another unidentified speaker adds, “You
know, someone got pregnant [and] then the baby never came—I‟ve never seen
that.” Crystal explains that girls accept the adoption taboo “because people think
about themselves, or like, „What will I be like if I give my baby up?,‟ instead of
thinking [about the baby].” Participants across the groups agree the taboo
discourages adoptions, and the lack of community discussion encourages abortion
as a solution that hides failure.
As the Group 2 discussion continues, an unidentified speaker expresses
shared views of consequences that may follow when a mother tries to raise children
she does not want: “Right. So, you know, personally, like I said, they have their
child and then they don‟t want it. Then, they start raising their child, but they start
being abusive to their child, because [they say], “I never wanted you in the first
place.” In short, the combined community proscriptions and prescription produce
conditions for intense mental stress and physical exhaustion. Distressed, censured,
and lacking friend and family support, some mothers mentally and physically abuse
unwanted children. Participants distinguish this abuse from their support for
disciplining children with corporal punishment, which, they contend, “Whites” see
only as child abuse.
Mothers who do not abuse their children nonetheless may have little time and
patience for the interactive ideal that participants refer to as “the village raising or
minding the child.” The ideal should help stressed mothers. Instead, stressed
mothers conserve their energy and try to secure their homes against negative
community influence. Mothers who, in their own homes, witness other people‟s
children misbehaving, expel them rather than discipline or report the misconduct to
their parents. Allowing a flow of children in and out of the home, participants say,
undermines control over children and exposes them to negative community
influences. Hence, busy mothers weigh help from this ideal against introducing
negative behaviors, and the possibility of conflicts with other mothers over discipline
or reporting their children‟s misconduct.
Alexis, speaking of her three young boys and a younger girl, summarizes
strategies that stressed mothers use to protect their energy and homes from others‟
misbehaving children.
I think it all depends on the parent, really, and most parents don‟t care who comes in
and out of they house. That may sound crazy, but I‟ve seen where it is just a steady
flow of people coming in and out. But, that‟s a natural thing for that particular
household. But for me, I have adopted this attitude that, although I love my kid, it‟s
times when I just really don‟t like kids. So, if I have times when I really don‟t like

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kids, I don‟t want somebody else‟s kids over there. „Cause, see, I can discipline my
kids. I can‟t discipline somebody else‟s kids. So, I don‟t want somebody else‟s kids…
(it all depends on how that child is raised), if I hear a little kid in there saying “B”
and “F you,” I be done went in there and like, “Whoa! Who is it in here cussing?”
You know? And it‟s not my child, then my anger level goes up just another whole
notch, and I‟m like, “You need to go home.” And, so, I rather choose not have
nobody else‟s kids in my home, except my own kids.

Not allowing one‟s children to play with a foul-mouthed, misbehaving child who
visits one‟s home may provide a positive influence on the visitor, but the action does
little to advance the ideal of “the village raising or minding the child,” where it
implies disciplining or reporting misconduct.
Less stressed mothers may also reject this ideal. The participants themselves
avoid interacting with close kin, whose parenting practices expose their children to
badly behaved relatives. For example, in Group 2, Crystal notes that she limits her
children‟s interaction with her brother‟s family, because her sister-in-law does not
discipline the children, and her brother is not involved in rearing them.
Well, my niece and nephew, they‟re half Mexican. My sister-in-law‟s Mexican and I
love her to death, but we do things differently—our discipline. I mean, I discipline my
children, you know, [but] she don‟t do that much with hers—acting nutty on the kids.

Although Crystal notes ethnic diversity among her kin, she emphasizes the
importance of a father‟s involvement. Beginning with Kari, the young father in the
scenarios, she explains,
I just think it depends on the individual father. Like with [Kari], it depends on age. If
they have not been taught to be more, um, involved in their child‟s life—if the
seniors, if the parents, are not in the home—how can they see… what‟s important?
That it‟s important to go to the doctor with your child‟s [mother].

Other participants do not dismiss the importance of parental involvement, but
insist that ethnic and racial diversity also account for different disciplinary practices.
For these participants, an interracial or multiethnic “village” is a liability for effective
parenting. Addressing this issue in Group 3, Dianna explains how ethnically or
racially different disciplinary practices become a liability.
I have an older daughter and younger daughter. [Y]ou try… [to] make life better for
or the same for them. I sent [my older daughter] to (we lived in a White
neighborhood), I sent her to the better schools, you know. Then the, the Caucasian
people taught her how to disrespect your mama, her mother—kick your ass, and ah,
ah run away from you. She‟d run away, and I‟m dragging her out of other people‟s
houses.

In the same group, Beatrice, who moved to Tempe to find better schools for her
children, interjects, “Oh, Yeah… because that‟s what they [White parents] do. They
have a different culture.” Dianna concludes that White children “don‟t respect their

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parents, because that‟s the way they are [what parents‟ allow]. They don‟t whip
their ass, for one thing, you know. And, White, White families, the kids are whipping
the parents‟ asses.”
White parents, participants contend, accept their children‟s abuse, but
censure other parents‟ use of corporal punishment as child abuse. Arguing that this
means Whites ignore the failures their practices produce, Dianna adds, “They don‟t
talk about it [how children abuse parents]. Children have to have their say—„Oh,
Mom, shut the fuck up!‟—you know, because, they have to have their say.” Beatrice
adds, “They got rights!” Interested in promoting open discussion as part of reverse
role modeling, participants do not intend that children should be physically beaten or
mentally cowed. Instead, as Dianna states, “I let them have voice, [but] not that
kind [of] a voice.” Again, Beatrice expands the point, saying, “[T]hey need to have
an educated voice.” Agreeing with these views, Alexis includes corporal disciplinary
practices in parental efforts to help children overcome negative community
“realities” that can derail their development.
They can‟t cuss me! I mean, my kids, my children, I let them go only so far. If they
start to get to a point where they getting out of hand, I‟m like, “Who do you think
you talking to?” You know, I have to get that mom up in me. Like, “I‟m not your
friend, right now, I‟m your mama. You need to understand that. And, if you sit up
there and decide that you want to say something else, you gonna git hit.” They go,
“No, no mama, I was just playing.” “No, you don‟t play with me like that.” I draw a
line, and I think you have to draw a line when it comes to kids getting outta hand.
And, if you sit up there, and let your kids run around and cuss, like I seen some of
my little kids‟ friends (I got three boys, and my youngest is a girl), and I seen little
five-year-old boys running around saying “B” this and “H” that. And I‟m like, “Oh, no,
you will not be playing with him!”

Focus group participants look to their childhood experiences, rather than
current “White” standards to judge the value of corporal punishment in parenting.
Alexis, attributing her derailed development to a first pregnancy by a boy who
deliberately took advantage of naive and rebellious young girls, uses her ignorance
as a foundation for steering her older son to take a different view of his selfdevelopment and responsibility to girlfriends.
And honestly, I have taught my kids right now that as they get older there is only
certain things I want—I expect of them. Now, I know the kids gon‟ do their own
thing, but like I say, “[names oldest son], when can you have a girlfriend?” He like,
“When I got a job and I can take care of her, just in case something happen.” I‟m
like, “Are you going to be in school?” And he like, “Yeah, I got to finish school. If
nothing else, I definitely have to finish high school and, then, I‟m gonna go to
college.” I say, “I‟m glad you got your plan set out ahead of you.” Because, I think
because of what happened when I was young, I honestly felt like, I was not
(although I felt like I was being naïve), I felt like he [the father of her first child] was
more intelligent than I was. So, if I would‟a had more education—like, “[Alexis], if
they come at you with this, don‟t say this, you know; If they come at you [with] this,
don‟t do that”—I would not have gone down the road I went.

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Consequently, the “village” (as racially or ethnically diverse disciplinary practices),
the “street,” schools, and even the church are liabilities against which parents must
protect their homes. Home training becomes the primary, if not sole, means for
effective parenting practices to keep a child on track. Otherwise, “the village raising
or minding the child,” engulfs African American children in negative media messages
and stereotypes that damage self-esteem and promote sexiness as a criterion for
self-worth in peer status competition.
The racially or ethnically diverse “village” poses still more obstacles to
effective parenting by reverse role modeling, when it entails a lack tolerance for
variations in disciplinary practices to suit community realities. “White” or “better”
neighborhoods represent conditions, participants across the groups agree, that
undermine or undo the results of home training, because those conditions
encourage behavior that increases the risk that their daughters will become single
mothers. The same conditions also encourage early parenthood for males, but, more
important, they inspire males to “live the exception,” meaning to ignore less
glamorous employment in favor of occupations, such as sports, that promise “get
rich quick” and the associated status.
Conserving their energy to protect home and children, does not mean older
mothers are untroubled when they see young mothers engaging in behaviors that
threaten to harm babies and young children. Even when older mothers do not
intervene, they feel guilty and worry about the consequences of their silence. Some
decide that, as mothers, they must speak, even if doing so embroils them in
conflicts. In Group 2, Ester describes the emotional turmoil her inaction produced
when she observed two young mothers‟ poor parenting—one involving potential
long-term nutritional damage, and the other a possibility of immediate death or
serious injury.
You know, my thing about it is I have gotten to the point where (although it‟s not my
business), because I am a mother, and because I see it, I kind of feel like, I‟ll take
whatever you will give me [for interfering], but I won‟t ever disrespect you. I‟ll just
say, “You know, can I just share something with you?” And you can say, “Hell no.”
Or, you can say, “What?” Or, I mean, you can respond however you want to. But,
like yesterday, I felt bad for the rest of the evening. I went through all this like, “I
wonder how old that child was? I wonder what else—have you given a pacifier
[before giving Pepsi]? I went through this turmoil, and it‟s not even my child! I don‟t
even know this person. … . Or, just like, like last week, I saw a woman put three
children in her front seat with no seat belt, and peel out of the parking lot. A sixmonth old laying on the car seat, another child on the floor, [when she pulled out] in
front of a car! And, I thought, “Oh, Lord, have mercy!”

Although Ester‟s husband, present during the Pepsi incident, discouraged her
interference, she vows to interfere in the future. Other participants agree that
sometimes, for a child‟s sake, one simply has to risk conflict with the mother.

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None of the focus groups express a strong positive view of “the village raising
or minding the child.” However, some participants agree with Rita, in Group 4, who
says aspects of the ideal still operate in certain neighborhoods. “And I come from
the, „it takes a community, it-takes-a-village-to-raise-a-child‟ era,” Rita states. “In
our family, in our home, our neighborhood—our whole community is involved in
things like that [aiding young mothers with parenting skills and children with sex
education].”
Whether mothers intervene, participants express great sympathy and
empathy for very young mothers. Young mothers do not know any better,
participants agree, because they model their behavior on their childhood
experiences, and their friends‟ behaviors. In Group 1, Helen calls childhood a “field
of experiences,” which, other participants agree, establishes “foundations” for young
mothers‟ parenting. To become effective parents means devising reverse role
modeling practices, which must begin with understanding past experiences as they
face problems. However weak the foundation, young mothers must cope by building
on it to change negatives to positives. Judging how positive these practices are,
participants emphasize, depends on how young mothers understand and manage
community liabilities. These result from scarce resources, racial and ethnic diversity,
and, recently, new middle-class and upper-middle-class housing developments that
increases competition for scarce and diminishing resources. Residents of the new
housing developments bring infrastructural resources, but they keep to themselves,
and the space they occupy further segregates and isolates poorest African American
residents.
Helen captures the participants‟ sense of how unemployed and
underemployed African Americans work to develop positives out of negatives.
When they experience, ah, kind [of] what you had and what you didn‟t have.
Because, ah, this is my first time as a mom and I love it, I think my baby is the best
baby, but, [I] take from what I did git and what I didn‟t get, and then just as… a
person trying to put your own… mix, mixture with people, you know. What is it they
say, „the tribe minds the children‟—that who they become [is] through their field of
experiences.

Household types (by composition and single-parent or two-parent heads) are
important, but do not determine individual outcomes, because sibling order and
experience within households varies to make the field of experiences. Helen goes on
to express the participants‟ general view of sibling order as a factor that shapes the
field of experiences within and across household types.
So, I just think with that older child, [Kari in the scenarios] may have been the
leader, then a lot of responsibilities was on him that, maybe, he didn‟t want. So,
therefore, he wanted to be himself in his youthfulness, and go (I don‟t wanna say
sow his oats), but you know, go do his thing. The middle child [Kesha in the
scenarios] was trying to find her niche, and then the younger [Karla in the scenarios]

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was like, “I have everybody telling me what to do.” I mean, it could be a variety of
things that are going on.

Likewise, while sibling order may influence male conduct, other factors also vary the
experiences that males bring to parenting.
Focus group participants see gender-role traditions resulting in males gaining
from all household types a weaker childhood foundation than their female siblings
and girlfriends. Young boys are less prepared for parenting and, as older brothers,
they offer younger sisters little guidance as they grow up together. Alma, with five
older brothers, was the only participant to say that she learned useful lessons from
older brothers about how to interact with males.
In Group 1, Francine provides an example typical of how participants gloss
over brothers‟ childhood experiences, when she says, “I‟m a middle child, and my
[older] brother didn‟t do anything much with himself.” Addressing the same issue in
Group 5, Fern explains Kari‟s behavior (in the scenarios) as the result of a lack of
parental guidance, saying, “He had to learn a lot of things on his own.” In the same
group, Becky adds, “[H]e didn‟t receive any encouragement, so he… said, „I„ll just go
for it. They don‟t think anything of me, so I‟m not gonna make anything of myself.‟”
Also, in contrast to the many reasons for girls‟ early sexual activity, participants
reduce male reproductive irresponsibility to interracial interactions. As an
unidentified speaker puts it, “White girls throwing it [sex] at him, if he is in sports.”
Nevertheless, participants agree with Ester, who paraphrases views of parents‟
excusing their sons‟ reproductive irresponsibility: “Boy don‟t do that again.”
Young mothers, who do not transfer childcare responsibilities, learn by caring
for their first child. Experience eases fears and anxiety. Successful labor and a
healthy baby also discourage using some prenatal health care and other social
services for subsequent children. In Group 1, Helen, raising her first child, explains
what she has learned from this experience.
I don‟t have two, but I have learned from watching the one. If I have a child again,
she will be eating this [something she was told was for older babies] at six months,
rather than ten. You know, you learn different things like that. Because you so
nervous (well I was)—picky; wash your hand before you touch her, but then after
that [you relax].

Group 1 laughs as they agree with an unidentified speaker, who says, “You saw she
didn‟t die.” In addition, the mothers‟ need to use time wisely makes some prenatal
social services excessive. Irene captures a prevalent comment.
To be perfectly honest, you realized that some of all that stuff that you did to
prepare for the first child wasn‟t necessary. … . I went to classes, the birthing
classes. We [as a couple] sat up there, did all this stuff together, then it was a
breeze! And then, some of the things—you kind [of] know the game. You hope that
you got the foundation right. You hope that you know, like, prenatal is important;

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nutrition is important. You hope that you got all of that you needed from the first
pregnancy. You just don‟t need as much coaching with the second pregnancy.

Yet Helen also questions whether relaxing might reproduce conditions that
undermine reverse role model parenting. She asks other participants, “Do you think
that has an influence on you raising that second child? Like the excitement is not
there, maybe, because you did not go through all of that?” Responding, Francine
considers her second daughter and wonders not about prenatal services but about
attention to later children: “I say one thing, I did a lot of pictures, with my first one.
I zoomed through a picture album. Then, I said, ‟You know what, my daughter—my
second—[when she] gets older, she‟ll ask, „Where [are] my pictures?‟” An
unidentified speaker echoes this concern, as she recalls her mother‟s practice,
saying, “Same thing for me. My mother took pictures of my sister, and mine are
nowhere to be seen.” Irene also speaks to this issue, declaring, “Right, because you
already have one and you like, „I‟m gon‟ cut back on your pictures, so I get them
tenny shoes now.‟” Nonetheless, mothers benefit from experience only if they take
responsibility for a first child. They know small things make a big difference for
whether a child feels the need to seek attention and affection outside the home, and
they guard against the search‟s consequences.
The youngest first time and single mothers who do not take responsibility do
not refuse health care and social services. They simply are not primary caregivers.
Across the groups, participants agree that, except when resources permit avoiding
the “welfare trap,” primary caregivers use services for which an infant qualifies.
Some caregivers are younger than the birth parent and, without physically or
effectively present adults, cannot sign for the infant benefit. When the caregiver can
do so, participants insist, she uses benefits and extends these to the next child. She
faces less paperwork and knows more about the relevant agencies.
In Group 1, Greta presents the rationale for using services and avoiding the
welfare trap if other resources permit.
I‟m saying, maybe things will change because you have more information. So like,
she—the lady [Karla in the refusal scenario] was on WIC or AHCCCS, or whatever—
[thinks], “Now, I can make an appointment to get my second child on.” So, you are
using those same resources, the same services, but the work involved is not as hard,
because you have the information. And, maybe, she don‟t need that; the WIC, the
milk, whatever. Maybe, she don‟t wanna do that this time. Maybe she wanna do
something else, or something. She has it there, but then she wants to try something
else.

Another exception is the young married or single mother who does not seek services
because the father considers doing so a waste of time, or objects for other reasons.
If using services does not conflict with male views, as Irene puts it, “She doing all
the work, and he‟s just sitting back and relaxing. That‟s the way a lot of women

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tend to do.” Even when a conflict exists, by the second child, if a mother lacks other
sources of support, she may ignore male views and use available services.
Seeing the risk of reproducing negative cycles increase, working mothers may
quit their job and sign up for services to have time to supervise their children. The
time parents spend with children is the critical factor for reproducing negative
cycles. Therefore, participants say, small, high-income families, with mothers,
fathers, and elders busy with their professions and social life, also create conditions
that reproduce negative cycles. In addition, growing up in high-income households
may not prepare the young for parenthood, because parents there, as in low-income
households, begin instruction too late. Like Frances, these mothers may expect that
as long as they meet infant health care needs and growing children‟s material
needs, they can forego other services.
Many households, regardless of the parents‟ income and education, are
composed of the father‟s and mother‟s progeny. Participants contend that favoritism
influences parental attention in these households. Favoritism is not a unique
problem for these households, but participants suggest it is more prevalent and has
greater negative consequences the larger the family. Some households include 14 or
more children, variously composed of maternal and paternal full and half-siblings. In
such cases, participants see favoritism as another problem to address by reverse
role modeling. In Group 1, Francine describes the situation in her natal household,
focusing on what it implies for parenting by reverse role modeling.
When it‟s bigger families, there‟s favoritism. That is something I learned. On my
mother‟s side, on my father‟s side, we have like 15 children on each [side]. And, a
mother and father always has favorites. I said, ”When I have kids, I‟m not doing
that. If I get one something, I‟m getting everyone something. If I praise one, I will
praise the other.” And I think that makes a difference.

Asked if this favoritism negatively influences attention to children‟s health care,
participants were uncertain, beyond the general neglect of the least favored child or
children.
IV.

“It’s just ingrained in who we are, visually”: Race, Age, and Color

During health care interactions, when African American patients challenge workers‟
insults, focus group members say, the workers concentrate on their own emotional
distress. Patients who “come unglued” in response to workers‟ insults escalate the
workers‟ defensive response. Hence, in Group 2, when Ester recounts being
offended by a nurse‟s response and asking for another nurse, the worker defended
her actions, then complained that Ester was causing her emotional distress.
Participants agree with Frances when she declares, “But, at the end of the day, you
[Ester] were just a nigger woman that rolled in there. You could have been 12 years
old.” Ester agrees, “Absolutely! Absolutely. Absolutely right. She was like, “I‟ve done

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thousands of deliveries, and been working here for 20 years,” and I said, „That‟s a
damn shame.‟” The nurse may have thought the reference to her years experience
with delivery would reassure Ester of her competence and good intentions. Instead,
from the Group 2‟s perspective, the nurse‟s reaction continued the affront. In labor,
Ester had neither time nor the patience to search the workers‟ language for good
intentions.
Ester and Frances‟ reference to age invokes the participants‟ understanding of
how age becomes part of workers‟ view of lower-class disreputability and racial
infantilism, both of which encourage workers to talk down to African American
patients or ignore their questions. However, age prejudice alone, participants
contend, produces the same negative interactions. Darlene, who observes her coworkers interacting with expectant mothers in their pre- and early teens, and also
recalls her teen pregnancy, states, “Yeah, they do that a lot, especially, like how I
was 17, they do that [treat young mothers] real bad. Like, „Do you even know who
the father is?‟ Or like, „Do you know how to fill out the papers?‟”
Without considering the experiences of older mothers, such as Ester, the
workers‟ language might seem to be straightforward information gathering.
Darlene‟s second question might only appear to be the health care worker‟s attempt
to help a very young patient with typical paperwork. Although focus group
participants accept that some negative interactions may result from honest error,
they attend to assumptions in the language workers use to ask questions. To
wording, they add tone and attitude, and these reveal a complex interplay of age,
race, and class as worker prejudices in adverse interactions. This interplay
participants term “candy-coated racism.” Workers‟ candy-coated racism does not
rely on previous patterns of racist conduct. Nevertheless, the resulting practices,
participants insist, deliver consistent insults. Ester sums up the focus groups‟ view of
this racism.
[I]t goes back to the whole thing of racism and the way it‟s demonstrated. It‟s very
subtle and underlying, and it happens at all levels. You know, it‟s not like they‟re
riding through town with hoods and, you know, burning crosses, any more. But, it‟s
absolutely there, and it will continue to be there. It‟s just ingrained in who we are,
visually.

As previously noted, however, when speaking of racism, the focus groups do
not restrict its practice to “Caucasians.” Instead, in Group 2, Betina expresses the
participants‟ general conclusion on this point, saying, “Racism comes in (it just not
only comes from, you know, Caucasians). Racism, it comes from every walk of race.
So, I mean, Black people are racist against one another.” Thus, for Ester, “all levels”
means institutional structures, and invidious distinctions within and across ethnic,
racial, and socioeconomic strata that encourage individuals to erect status and moral
hierarchies in interactions.

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Interracial and intraracial assumptions about skin color differences produce
distinctions that erect such hierarchies. Participants contend that assumptions from
both sources result in dark-skinned African Americans experiencing the worst
consequences of the complex interplay of age, race, and class. Intraracially,
assumptions about color differences result in questioning whether light-skinned and
biracial African Americans are “Black enough” to experience the “real” interracial
consequences of being African American. Across the groups, participants‟ comments
about this issue draw on both intraracial and interracial responses to what they see
as the long history of favoritism for light-skinned African Americans or biracial
persons.
Each focus group included persons whose phenotypes encouraged other
members to question their participation in an African American focus group. Others
who revealed biracial backgrounds inspired the same questioning. In discussions,
when these participants disagree with race as a causal factor for an adverse
experience, others question their ability to assess subtle, candy-coated racism.
Taking color bias as one source of status and moral distinction, these participants
introduce a credibility gap, into which fair-skinned and biracial participants fall as
“not Black enough.”
In Group 5, Rena very fair, with long brown hair, confronts this credibility
gap. Some participants reject her suggestion that health care workers may see
African American and AHCCCS patients after later arriving patients, noting that there
are waiting lines for patients seeking different services. A few participants quickly
agree, but others challenge Rena‟s ability to know the difference. Although Rena is
not speaking of her own experience as a patient, an unidentified speaker responds,
“I just want to say, to them [Whites] she looks like she‟s not Black.” Ola adds, “So,
of course, she‟s not gon‟ git the same treatment that we [of darker hue] do.” These
participants attend only to the color-based credibility gap, ignoring that Rena was
speaking from her observation of systemic practices, and questioning causality for
AHCCCS as well as African American patients.
In this group, Charlotte is the most insistent on workers‟ biases against
AHCCCS patients. She says, “I think it‟s AHCCCS.” Other participants still emphasize
the interracial implications of color bias. Speaking over one another, they insist that
color matters for how White health care workers (and some African American coworkers) treat African American patients “past University.” They mean that color
favoritism operates outside the predominantly African American community as a
fixed spatial area. Edna declares, “It has to be [a factor in treatment] south of
University,” with Paula completing the spatial boundary with, “But north of
Baseline.” Multiple voices agree with Paula‟s contention: “It‟s just that treatment
changes [for color, beyond this boundary].”

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The change does not imply favorable treatment. The role of color bias in
determining the quality of interactions depends on who interprets color and what it
implies to them about patient worth. Interpreting light skin may lead to ethnic
misidentification for equally bad or worse interactions. Thus, Rena counters the
challenges: “To a lot of people, I look like I‟m Mexican,” with Charlotte remarking, “I
was just about to say that.” The challengers concede the point about
misidentification. Rena goes on to note that “according to a lot of people here, they
think Mexicans should not be here, so I don‟t… really think that makes a [positive]
difference.” Unwilling to concede the general point, unidentified speakers switch
from color to hair texture. One declares, “I was just gonna say, when she came in,
„What is she doing here?‟ Then, [I] looked at her hair.” Multiple voices agree that
her hair is a giveaway, but another unidentified speaker adds, “But they [Whites]
don‟t look at that first,” implying that the momentary confusion provides leeway for
more favorable treatment than a dark-skinned, nappy-headed African American
receives.
Group 2 focuses on intraracial bias for light skin and straight or wavy hair.
Responding to these biases deliberately included in two scenarios, participants
explain Kari‟s pride in his children, insisting that his pride is a negative response to
blackness. Thus, Betina states, “He ain‟t studying [does not care about] none of
them [his two children and their Mexican and White mothers]. He just don‟t wanna
deal with—he don‟t want none of Black women.” Frances combines hair and color
preference to explain Kari‟s pride, declaring, “Sure he is [proud], „cause [his babies]
got light skin and wavy hair.” Consequently, participants agree with Darlene, “That‟s
why he ain‟t got no Black woman as his baby‟s mama.” In Group 5, participants joke
that African American girls put holes in light-skinned African American males‟
condoms in efforts to have light-skinned, wavy-haired children. On a serious note,
participants contend that color prejudice in families becomes another source of
favoritism that may adversely influence parents‟ attention to children.
More generally, color bias adds another factor that participants see
encouraging some African Americans to judge others as flaunting their good fortune
over the less fortunate. Speaking to the point, Crystal (G2) reveals that her mother
is White. Responding, Frances discloses thinking, “She kind [of] look White.” Earlier
Crystal notes that her brother‟s wife is Mexican, making her niece and nephew “half
Mexican.” In response to others‟ challenges, she reveals her frustration with African
Americans who think light-skinned African Americans see themselves as “all that.”
I know one thing, my brother has a baby, and so do I. And, as far as like, “Oh,
they‟re so light, they‟re so this, they‟re so that,” and I get tired of hearing it. … . I‟m
like, “So?” And you know, we can‟t help who we‟re born to. I mean the reason I‟m
light is „cause my mom‟s White, you know. And people think, oh, I think I‟m all that,
and I‟m like, “I really don‟t.”

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Supporting Crystal‟s view, Ester reveals that she is biracial and her husband is of
Crystal‟s complexion. She recounts his efforts to signal that their son is “Black
enough” to claim a share in African Americans‟ adverse experiences.
I agree with you [Crystal]. I can understand that, because my husband is, maybe,
about your complexion, and I‟m biracial, also—my mom is White. [I]t drives you
insane. People will see him with our son, and they‟ll go, “Oh, his mama must be
White,” you know. And they immediately assume that, “Oh, he‟s [her husband] one
of them kind of brothers.” [Group laughter] [H]e spends all day trying to justify, you
know, that, “No, no, no, she‟s, she‟s [husband‟s mother] half Black, and she‟s born in
Africa.” And he go through this big diatribe, and I go like, “Why do you care? Do you
know the person that was standing [there questioning you]? I mean, why do you
care?” But to him… there has to be some justification that this child is Black enough
for, you know.

While asking why her husband cares, Ester explains that she too must care, because
color bias affects their son.
It bothers him and me, „cause… I do see some (it‟s not necessarily in health care),
but I do see, you know, people will say stuff about my son. Like, “He‟s cute for a
Black, cute for a Black boy.” I‟ve had that happen twice! [Multiple groans and
indications that this experience is both dismaying and typical.]

Although Ester‟s experience was not with health care workers, other focus
group participants note that when similar events occur in a health care interaction
and the mother challenges the worker, the worker reacts by accusing the mother of
being oversensitive or having misunderstood. The moderator asks whether the
participants return to a facility after such an experience. Ester provides the prevalent
reply: “Oh, no! No, no, you don‟t go there. You find… you transfer.” Neither
transferring facilities nor getting another health care worker is always an immediate
or long-term option. Time, insurance coverage, and other factors require that some
mothers continue using the facility or service. Even if one eventually transfers,
participants suggest, it is necessary to confront the workers. The child‟s care comes
first, but, when the mother has taken care of that, as Betina notes, “You go back
and deal with the issue, because, if it‟s happening to you, it is probably happening
to others.”
Confronting the worker will escalate the altercation, because African
American patients are never right. Responding to Ester being told her son is “cute
for Black boy,” the following Group 2 exchange captures the participants‟ view of a
typical escalating altercation.
Because they can tell you anything. They can tell you it‟s your perception. They can
say you overreacted. They can say a myriad of things. “I didn‟t say that. I said he is
as cute as can be. I didn‟t say that [he is cute for a Black boy].” (Ester)
Right… I‟ve had that [happen]. (Betina)

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That will make me wanna fight. (Ester)
[Y]ou need self-control. (Betina)
“Now [Ester], not only did it I not say that [your son is cute for a Black boy], now, I
think you‟re being harassing to me,” right? “Now, I don‟t feel safe. Security! [worker
calls for intervention] [You] gotta go.” And, you will be [ejected or arrested].
(Frances)
Right. Right. (Alice)
Security! [Multiple voices, agreeing that workers call security to remove a “hostile”
Black patient.]
That‟s why I am saying I am not going back, I‟m knocking you out now. [Group
laughter] (Ester)

Ester jokes about physically confronting the workers, but focus group
participants are serious when concluding that workers take any challenge as
hostility, aggression, and a personal physical threat. If workers do not call security,
participants say, they act to gain their co-workers‟ sympathy against the patient.
Ester captures this view: “But, let me tell you, you pick out the White woman in the
clinic—the nurse or whoever—that made that comment, and you come on too
strong, you know, they going to start crying. „Cause, you know, that‟s what they
do.” Paraphrasing a worker‟s response, Frances adds the finale: “„Now, you are
aggressive. You are getting me upset. Now, you assume… you and your ugly baby.‟”
Thus, while holding themselves accountable for challenging bias, the participants
also agree with Frances, who goes on to declare, “Trust me, I know what you
saying. I leave them alone. I leave them alone.” Faced with these outcomes, in
Group 3, Dianna summarizes the consistent quality of health care interaction: “They
think we are ignorant, you know.”
V. “It is the same”: Stereotyping in Child Health Care Interactions
In Group 3, Glenda expresses the focus group participants‟ general view of how
these factors influence child health care interactions.
It is the same. It is the same. It is very frustrating as a parent, because you are very
worried about your child‟s health. And you are sitting there and they are asking you
questions and you don‟t know anything [to tell the doctor].

In the same group, Beatrice describes a mother‟s frustration as she tries to get
information about her child‟s illness, “You [are] trying to get [information] out of
them [doctors]. … . [Y]ou have to calm yourself down, „cause the doctor would take
[your behavior] as you being hostile towards them.” Consequently, participants
agree with Glenda‟s conclusion.

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And every now and then… it‟s like something crazy [comes over you], but, in reality,
all you asking for is help, you know, to get your child well. [But] „cause you‟re
hysterical (sometimes you are frantic… you can‟t see that [you are frantic or
hysterical]), other people express that for you… then… [assume that patient hostility
has become part of the interaction].
Unable to communicate calmly, Glenda tries to learn “What kind [of] medicine are you giving and what
are the side effects?” The interaction degenerates, because, as Dianna says, “You know, they don‟t want you to
ask questions like that.” For Beatrice, “It‟s traumatic,” as she already wonders whether her failure to insist that
the doctor follow up may have contributed to the death of the baby she lost at age 18. Hence, expressing the
participants‟ view of typical child health care interactions, Dianna states, “When you question them about what
they are doing, I had one doctor tell me, „Well, I am the doctor, I know what‟s best. … . But, you need to explain
to me, as the parent, what you are doing.”

Focus group participants‟ experiences with many facilities, especially outside
South Mountain and South Phoenix, allow them to recognize systemic practice that
make interactions difficult for all mothers. Nonetheless, as African American mothers
of sick children, getting useful information is more difficult, because health workers
see the African American parents‟ hysterical behavior as typical for an ignorant,
hostile Black person. Thus, in Group 3, Elena explains that an absence of good will
results, because “it‟s their [health care workers‟] view of Black folks.” Even the
mothers‟ positive conduct, participants say, health workers take as accidental or
exceptional, and continue seeing negative conduct as typical for all African
Americans. Accepting that the mothers‟ failure to remain calm reinforces health care
workers‟ negative views of African Americans, this adds guilt to these patients‟
already frayed nerves.
Yet, while participants recognize the combined force of interracial and
intraracial negative stereotypes, they try to turn “coming unglued” into a controlled
burn. Given that workers will see any persistence as aggression, patients who get a
“brush off” respond by continuing to ask questions, even as workers become
irritated and try to move on to the next patient. In Group 1, Greta describes using
irritation to get information.
I have a lot of theories about how I should be with people. If I feel like you are
doing this to me—just giving me the brush off—I‟ll start asking more questions to
irritate you. “Here, so let me be clear on this, so you are saying this, this, and this.”
Okay, if I still feel like they are rushing me, then… I‟ll just keep you there. That‟s
what you are here for and I mean… I am not saying I just do it to irritate them, but I
keep asking more questions to get them involved. If you don‟t wanna be involved in
this interaction, in my best interest, I will take care of my best interest—and that is
my child. You better know that I am gonna keep asking those questions, and I don‟t
care if you are walking out the door; walking in with the next patient. I might be in
that room with you, if I have [to], still asking my questions.

If workers associate this strategy only with the patients that engage in it, this would
limit consequences for other African American patients. Instead, participants say it
becomes additional proof of African American aggression and hostility, which
justifies workers‟ extending negative stereotypes to all African American patients.
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Expecting this response, other frustrated mothers try subtle ways of
“educating” medical workers. Also, they do not hold themselves accountable for
wasting energy on self-presentation when a child faces a medical crisis. They expect
and confront the difficulties their lapses produce. Following Greta‟s comment, Irene
describes this alternative approach.
I go when I am sick, so I am not dressed up. I mean, my hair is a mess. I have on
some raggedy clothes that I have on Saturday. And my head [is] dripping, because
when I go to the doctor, I have to drag myself because that‟s, that‟s just me. [W]hen
I went in there, it‟s like, “I am not doing good, something is wrong,” and they [say],
“Okay, we gon‟ take care of you, just sit on the table, lean back, and we will figure
out what it is.” And, I like… (excuse my tone), I get my old form, I have to draw my
energy from wherever and, you know, like you say, speak their lingo, so they can
hear me. He listens, but he is not hearing me. I‟m like, “I‟m… not comfortable with
you right now, give me someone else.” And then, they can hear you. Well, they‟re
like, “What, what aren‟t you comfortable with?” “You!”

When, as was the case with Irene‟s visit, her child is also sick, a mother does not
use subtle strategies. They “gather themselves up,” drawing energy from
“wherever,” to ask questions.
In Group 3, Dianna reports on her child‟s chronic respiratory problems. He
has had acute problems many times, for which she has not received an explanation
for what triggers them. Dianna has learned to administer breathing treatment at
home and, when this fails, has made many trips to the emergency room. She thinks
she knows when her child needs something more than the already prescribed
treatment. Dianna describes health care interaction when her child experiences
respiratory distress.
“[H]e‟s in distress… why are you giving him this medicine?” “Is this a steroid?” I‟m
asking questions. And I‟ve given him breathing treatments at home. Well, the doctor
looks at me like, “You pretty much know what you are doing. You got this under
control.” And he [my child] is still wheezing and, so, we need to do something else.

Mothers like Dianna hold themselves accountable for learning about their children‟s
illnesses, and for learning and acting on patient rights. Nonetheless, interactions
with medical professionals mean continually acting to counter presumed ignorance
as race-based lack of capacity to understand. They see workers who consider their
questions a waste of time, “shutting them down,” and continuing the same
treatment that produces no results. This results in costly and ineffective return visits.
In the same group, Elena, the mother of 21-month-old twins who were born
prematurely, works to understand their illness. She pays attention to how it changes
as they mature and encounter different environments, and knows when to use their
breathing machine. Like Dianna, she has faced many crises that required trips to
emergency rooms, hospitals, and clinics. Elena describes a typically ineffective
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doctor‟s visit when one twin was experiencing severe problems breathing, vomiting,
and was unable to walk without stumbling and falling.
They were born really early, so they were on RSV protocol. They have to get all
these shots. They like can‟t be around sick folks. They can‟t be in day care because
they catch illness. … . So, one of my kids ended up having to go into the hospital to
get an IV to be rehydrated, because he was dehydrated. And, he was just 21-months
old, and he was stumbling and falling, and really, really weak. It was scaring me, and
I hadn‟t slept at night—my baby throwing up, and diarrhea, and then with two of
them. … . So, finally, there was one doctor, then another doctor, then another
doctor, and they would all start off, “This is what…” They would all cut me off, shut
me down. They would say, “I want you to start with Pedialyte.” Well, we done been
through emergency room IVs; don‟t take me back to Pedialyte!

Health care workers who do not “shut them down” before they can explain previous
treatments, mothers say, offer empty platitudes, such as those Dianna recounts.
Focus group members see these as empty platitudes because treatments they report
to have failed do not affect the next treatment the worker prescribes. More often,
they contend, it means that workers send them home to “wait out” the problem.
Beatrice, whose child has asthma, like Elena and Dianna, has learned to
research her child‟s illness. She uses information her private insurer supplies to learn
what she can do at home to prevent recurring crises. She recounts the difficulties
with getting doctors to provide additional information and referrals for treatments
she thinks patient rights afford her.
I think that‟s when [we] have to really question, and know our rights as patients.
„Cause you‟re suppose to leave with an understanding. They have to tell you, they
can‟t act like they don‟t wanna tell you. We learned about my son‟s asthma when he
had an asthma attack. And then, he was three, they sent me home, with the
breathing machine; a nebulizer. He starts kindergarten, and that‟s when all his other
breathing problems [began]. I learned that he should have had maintenance
medicines. … . Here we were, watching the asthma tape or whatever, but, you know,
you listen to the doctors and you trust what they say, and, then, a year later he‟s in
the hospital. … [W]e had to learn that certain times of the year was his trigger. So, it
was like a learning process. And I get upset, because I am like, you know, “We took
the resources that you gave us, but they weren‟t very good.” … [H]e ended up in the
hospital when I had painted and he inhaled it. He was down to 76 percent of his lung
capacity. We didn‟t know [the affect of paint]. It‟s trial and error. I hate that we have
to learn the hard way. But now, he has to get different things. If he needs to do
that, I need to send something to that school. … . The doctor signs off on that.

To gather more information, participants say, proactive parents use hot lines
and triage nurses. Few report having computers. Those who do, get information
from the Internet and those lacking home computers may use Internet access at
libraries. With more information against which to judge previous health care
interactions, some, like Beatrice, look back and wonder whether a child‟s medical
crises or death might have been prevented had the medical professional explained
the ailment and referred the mother for proper follow up.
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Consequently, participants say recalling past poor quality service makes
current interactions, as Beatrice puts it, “traumatic.” Considering her own struggle
and Elena‟s to keep their twins healthy, Beatrice wonders whether greater
knowledge and persistent questioning might have saved her first child.
I think [about] what happened to me with my first baby girl (I was 18). And, I was
exactly 24 weeks when I went into labor with her. And, the only thing I can think
was that, at my first doctor‟s appointment, the doctor was like, “Hmmm.” I guess my
cervix was a little more enlarged than it should have been. And I went along with
that. … . I went through premature labor just about the whole day, because I did not
know I was in labor. This [baby] I lost. … . [T]hey said her chances were under 50
percent. And then, it was 95 with my twins. [We were] in the same hospital, we
[were] in the same situation. And there was a baby that had died in the same bed
my baby had died in. And it was way too much. [I] just kind [of] wondered, when
[the doctor] said, “Your cervix is enlarged” (because what had happened is that my
bag had ballooned, and triggered the labor). So, I kind [of] just think about that.
Why would [the doctor] just tell me that and not address it?

When other members of this group insist that an explanation and follow up might
prevent premature labor and infant death, Beatrice agrees, “Exactly.” Asked how
often they receive diagnoses with no explanations, advice, or referral for follow up,
Alexis voices the prevalent response: “All the time. All the time.”
Participants who had been AHCCCS patients report receiving more
information when they obtained private insurance. These focus group members join
those who are current AHCCCS patients in insisting that health care professionals
provide AHCCCS patients little information on their own or their children‟s illnesses.
Consequently, these patients more than privately insured ones must “learn the hard
way”—by trial and error—but have little with which to work. Private insurance can
make a positive difference. However, overall participants agree with Fern‟s
conclusion that this is less likely for single, young mothers. Fern insists, “It‟s the
same thing, before [doctors] can even talk to you, they look at you as a single mom.
They still treat you wrong. They still look at you for having that child, and you [are]
just wrong.” Regardless of the type of insurance, young, single African American
mothers experience greater difficulties with problems that all African American
patients confront—doctors who provide little information, rush interactions, and
make the simplest, if any, diagnosis—all of which contribute to ineffective repeat
visits.
While some doctors may be callous and uncaring, participants also agree that
AHCCCS regulations set conditions that justify and reinforce all health care workers‟
responses to these patients‟ needs. Paula expresses the typical view: “[I]t‟s like they
say, you always have to get referrals or approval from AHCCCS before they do
anything. My son, something‟ll be wrong with his tooth, and they‟re not going to pull
or fix it, or whatever, until they get approval.” Many voices echo, “get approval,”

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and generally agree with Paula‟s conclusion that “he needs it done now—not later.”
Therefore, in Group 5, Fern attributes health care workers‟ indifference to their
knowing or believing that AHCCCS will not pay for referrals.
[T]he first time I was pregnant, and I got sent to Mountain Park on AHCCCS, I was
like telling them about these pains, and they were like telling me, “We don‟t see
anything wrong, but, if, in the middle of the night, you have [a problem] go to the
County,” or whatever. And I would go to the County, and they would have me
waiting forever. And then, they would tell me nothing is wrong. It turned out my
baby was developing too fast, and I had a miscarriage. And then, a lady at St.
Joseph said, “I don‟t know why somebody didn‟t tell you. They should have been
able to detect it sooner.” … . [T]hey didn‟t even wanna waste time running that
many tests. They like, “Everything sound fine, just go on, and if you keep having
pains, just go to the emergency room.”

In this group, Lois compares prenatal care referrals for her two pregnancies.
I have two kids—the first [a girl] I had on AHCCCS, the other [a boy] I had on
private insurance. And the first one (when I was on AHCCCS), they do you wrong,
they don‟t care. Like [I] came in there with my stomach hurting, [and they say], “We
have to wait and see. We have to get approval from AHCCCS to see if they can
approve you for this procedure, or whatever needs to be done. But, when I had my
private insurance, when I went there „cause I said I had a little bit of blood, they
[said], “Come in, let us take a look at you. Let‟s do this test.” They look all in you. I
had, like 18 ultrasounds. I had problems [when on AHCCCS], but they were just, “Oh
well.” I had one [ultrasound] with my daughter, [although] I had more complications
with my daughter than I did with my son, and my son was practically fine.

Group 4‟s participants also see problems stemming from how AHCCCS
regulations differ for adults and children. They contend adult medical needs go
unmet, while the insurance covers the same ailment for children. Mary, who works
for AHCCCS, summarizes the problem, but also notes that not all health care
workers are indifferent to the regulatory constraints.
[F]or adults, it is hard to get a regular doctor, because they don‟t provide vision care
and dental care for adults. Which I think is crazy. … . [Adults] need to get their teeth
done, too. I work for AHCCCS, and people come in there, they want this, they want
that. [We say], “We can‟t give you that,” and they [say], “Why can‟t you?” I [agree],
why can‟t you? You give [it] to the kids, why can‟t you give it to the adults? It
doesn‟t make sense. People need glasses; they can‟t go buy a $40, $50 pair of
glasses.

Focus group members are particularly concerned about dental and vision care for
adults. The government seeing adult care as “luxuries,” they suggest, accounts for
the restrictive provisions. In Group 2, Ula explains that restrictions occur “not so
much [because adult care is] a luxury, [as because] whoever did these guidelines
stayed in the box, forgetting that life goes outside the box.”

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Group 5 attributes both ineffective repeat visits and misdiagnoses to
restrictive AHCCCS regulations, which make it difficult to get referrals for tests to
ensure the best diagnosis. Paula contrasts diagnoses for her child‟s respiratory
ailment after she changed to a private insurer.
[T]hey gon‟ take their time [to diagnose the problem]. “Oh, she has bronchitis. She
has bronchitis.” I have private insurance, [then] my baby has asthma. [The group
laughs over multiple affirming voices.] And that‟s why she can‟t breath! … . On
AHCCCS, she had bronchitis. She has breathing treatments [now that I have private
insurance]. … . They were like,” Well, kids grow out of it.” And, “Some babies are
born with respiratory problems, and it develops inflammation, and it develops into
bronchitis.” I‟m, “Okay. Explain more to me. Does it go away, you know?” And I
couldn‟t understand how can you keep having bronchitis month-to-month—chest
caving in when you breathing, when you run, you can‟t breath. That‟s not bronchitis.
Something else is wrong.

Asked if she thinks the insurance was the only difference, Paula replies, “Pretty
much, „cause every time I would take my daughter, they wouldn‟t touch her. … . A
few emergency visits, a few private insurance changes, and [a few] specialists
[later], my baby has asthma. As long as I had AHCCCS, it was bronchitis.” In the
same group, Theresa, expresses the prevalent conclusion about AHCCCS: “They
make it seem like they don‟t want to touch your baby, like she‟s infected, or
something. They don‟t really check them.”
Consequently, participants attribute the greater accuracy of diagnoses under
private insurance to doctors‟ care in examining patients, referring for testing, and
explaining cause and effect when patients ask questions. Thus, whether the proper
diagnosis was chronic bronchitis or asthma, Paula‟s conclusion reflects participants‟
greater trust in diagnoses they receive as privately insured patients than as AHCCCS
patients. AHCCCS diagnoses, focus group members insist, are overly influenced by
workers‟ stereotypical responses to patients, and adherence to the program‟s
restrictive regulations concerning referrals. Therefore, participants agree with Paula:
“It‟s like they don‟t care.” In Group 1, Helen expresses an equally prevalent
conclusion: “A problem is a problem, no matter what [the workers] think it is, and
how serious [they think it is]. And it just seems that there is a lack of genuine
concern—a lack of trying to really help with your problem, [instead of] just pushing
you through to [get on to] the next person.”
Nevertheless, regardless of insurance type, participants contend, co-payment
costs are the most important determinants of health care workers‟ attitudes about
the quality of care a patient deserves. The AHCCCS co-payment ($1), focus group
members maintain, accounts for why these patients more often experience adverse
health care interactions. In Group 5, Paula declares, “Oh, yeah, „cause [if you have
private insurance, doctors] can charge you!” Focus group participants do not
mention differences in how AHCCCS and private insurance companies pay doctors
for different services, but, rather, insist that the co-payment signals a difference
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between paying and non-paying customers. The higher the co-payment the better
the chance of receiving useful information and having a positive health care
interaction.
Still, a high co-payment means neither excellent health care nor a lack of
adverse interactions. Private insurance plus high co-payment only signal to health
workers the relative worth of patients. For health care workers, focus groups
members contend, only paying customers are worth the effort required to deliver
quality care within systemic constraints. Moreover, health care workers look most
favorably on the privately insured patients who pay the highest co-payment,
because their jobs depend on these customers. On this equation, participants
conclude, interaction quality decreases and negative attitudes increase the lower the
co-payment. Consequently, across the focus groups, the women conclude that the
AHCCCS co-payment does not buy the respect health care workers grant any
privately insured customer.
In Group 2, Irene summarizes the participants‟ conclusion about co-payments
and the complex interplay of factors that adversely influence health care interactions
for South Mountain Village and South Phoenix mothers and their children.
Number one, [health care workers presume] that I am ignorant, that [my] child is
not ill when [I] bring him there. [Y]ou know, you don‟t bring him in when he first
have a fever; you wait and do whatever to be able to ride it out. … . I‟m giving them
the background of what I have done to help my own child. So, by the time I get
there, [the doctor is] listening to all of that, and he [is] saying, “There‟s really
nothing ill with your child, so let me talk down to you, get you out here, because I
got all these other people in this waiting room, and your problem is less severe.”
Which I can understand that to the point, but at the same time, I have paid my copay to come in here, so don‟t just throw me, “It‟s just a virus.” At least explain to me
what type of virus; give the virus a name. But [do not say], “Just a virus; it‟s going
around. I see it all the time.” I am not all those people. I am here now, and paid my
co-pay just like everybody else, so treat me as an individual, not as a status quo
community person. I didn‟t come in with a community. I came in here by myself.

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Chapter 3
Community Strength
 Community Strength—assets in South Mountain and South Phoenix
neighborhoods that promote healthy outcomes for mothers and babies.
I.

“I didn’t come in here with a community”: Refusing to Be the Forest
of Stereotypes

On the emotional condition that African American patients bring to health care
interactions, focus group participants agree with Elena, who declares, “Life is a
hustle and a hassle,” with residents making decisions when they are emotionally
“empty.” Participants also agree with Irene, who says, “[N]o matter what choice you
have, regardless of the lowest of your low, whatever it is, wherever you are at
[financially and emotionally], you have a choice. It may be one choice, but you have
a choice of that choice, [and] whether you take it or not.” Trying to make the best
of the available choices for health care, mothers insist that health care workers, as
Francine puts its, “[should not] think what [they] think about all of us. Yes, some of
us don‟t want to see others get ahead. Why? I don‟t know.” She goes on to say,
“We have to come together, [and] say we wanna help each other, and this is what
we need to do to help each other.” Consequently, to improve health care
interactions mothers insist health care workers address the problem that brings
them to the doctor, rather than treat an example of a forest of negative stereotypes.
Race-group medical demography and family medical histories are additional
sources of negative stereotypes that encourage health professionals to see the
“status-quo community person,” instead of a patient with a problem. In Group 1,
Helen expresses the participants‟ shared view of how these profiles adversely
influence doctor-patient interactions. “By calling us all one big group—like all African
American women are alike—it is judging us all, and it‟s creating an image for us that
puts up a barrier for [the] physician to give us quality care in the community,
really.”
Yet, focus group members disagree on the value of social statistics as
indicators of medical and social problems. Generalizing from either statistics to
individuals, they agree, encourages unproductive stereotypes. Even so, many of
them think that some statistics might provide useful information on the community‟s
strengths and weaknesses. For example, Helen suggests that gathering statistics on
residents‟ health care behavior might combat the deliberation scenario‟s negative
stereotypes suggesting that mothers in the community are generally indifferent to
their own and their children‟ health care needs. Across the groups, other participants
suggest that some social statistics reveal problems the community needs to address.

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Thus, in Group 2, Frances responds to the deliberation scenario by suggesting that
social and medical statistics reveal community weaknesses.
I would say that statistics would show that we do have the highest rates. And I know
this, „cause [of what] I just went through with my daughter. I‟m keenly aware now of
what‟s happening in the high schools. We do have (across the country) one of the
highest rates of teen pregnancy, dropouts, blah, blah, blah. So, I know that your
heart is telling you [to ask], “How could [the scenario panelists] say that about these
people.” … . . [T]he statistics show that we‟re higher than like, New York; we‟re
higher than Los Angeles. We are off the chart, which is exactly what [the
deliberation] scenario said. I think that the way that it was read, you know, that
people, that women in South Mountain, don‟t care, da-da-da, that was harsh
language.

Hence, focus group participants also agree with Evelyn (G4): “It‟s [the
scenario panelists‟ view] not, it‟s not [false]. I can name at least ten of my friends
who have been pregnant—seven kids, with seven men—and [they] have sex with
different men, without condoms, while they are pregnant. And [they] get high, and
do what they choose to do (and drink).” Still, the focus groups attend to how an
individual becomes “a statistic.” As Brenda (G1) puts it, “The way my life played out,
makes me a statistic.” Participants do not see their interactions improved by health
care workers treating patients as caricatures of social statistics. Therefore, they
conclude that while accurately portraying some factors that weaken the community,
statistics on African Americans undermine quality care for community patients,
because health workers over generalize these and interact with stereotypes.
Mothers enter interactions knowing they must “educate” physicians on how to
see individual patients, focus group participants say, but they differ on whether
physicians are the best workers to educate. Some participants suggest that other
health care workers are more open to learning. For example, Irene (G1) explains the
need to educate, and why some mothers prefer educating medical and physician
assistants.
I educate them. I start telling them, “Yes, I come from a family that has glaucoma.
Yes, I come from a family of high blood pressure, but this is what my need is now.
Don‟t tie me into my back history. Yeah, it might have something to do with it. Yes,
you can‟t rule it out, but don‟t label me just because of what I look like, and what
you may think. Don‟t jump to conclusions.” So, I tend to educate [them]. And,
another thing I found out in the doctor‟s office is I see the PAs [physician assistants]
and the MAs [medical assistants], because they wanna learn. They wanna get all the
information. … . They are ready to learn, as opposed to doctors; they have already
been through school, they know everything. At least they think they know
everything, so they tend not to hear you. Whereas the MAs and PAs take a little
more time, a little more effort, to really get to the nature of your problems.

Before mothers try to educate any health care worker, they work at learning to
speak health care workers‟ “lingo.”

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However, before mothers begin those processes, they counter what they
insist are health care workers‟ presumption of ignorance. That is to say, the
stereotypes according to which health care workers conclude it wastes their time to
explain what ails African American patients and their children, because as a race
they lack the intellectual capacity to understand explanations. Countering this
presumption begins with dress, comportment, and speech—petty details, focus
group members say, that ought not to be, but are very important determinants of
the quality of care they receive.
Thus, in Group 2, Crystal says, “[W]e can all look rundown, when you gotta
go [to the doctor ill], but some of us [drawn out in a tragic voice making others
laugh]. She means that African American patients, who arrive dressed outrageously,
speaking in loud voice, and failing to attend to other aspects of “proper”
comportment, make matters worse for themselves and, more important, all African
American patients. Participants draw on their experiences to support a conclusion
that following such displays, heath care workers extend adverse attitudes to the
next African American patient. Confronted with a few such patients, workers
generalize the behavior to stereotype all African American patients. Among health
care workers, participants consistently single out front office personnel as the worst
offenders. These workers‟ “nasty” attitudes set the tone for the facility. Faced, for
instance with a receptionist‟s entrenched nasty attitudes, mothers say, their best
efforts to signal self-respect seldom alter positively the health care interaction when
finally they see a health care professional.
In Group 2, Greta voices the prevalent contention that despite the lack of
positive influence, African American patients must attend to comportment if they not
do want to encourage worse interactions for themselves and future African American
patients.
[Y]ou should not be judged, regardless of [how you present yourself], but if you
want respect, you [must] carry yourself with respect. … . You carry yourself with the
right poise. You walk in there talking loud and [you get no respect]. I have been to
the doctor‟s office in South Phoenix, and, in all honesty, I am just saying, us, as a
community, not putting color in or anything, but they are loud. And, you know, you
come in with blue hair, and it shouldn‟t matter, but sometimes we have to hold
ourselves accountable. … . I mean, as a community, we do have to face it; [given
such displays] whose gon‟ take [us] seriously?

Ellen agrees with this contention, but reveals participants‟ view that given workers‟
obdurate stereotyping, patients‟ respectability presentations do not control the
outcome. However, Greta goes on to note, African Americans holding themselves
accountable means not being at fault when workers continue producing and acting
on negative stereotypes based on a few cases of bad behavior. The times when a
patient is too ill to bother with self-presentation poses a problem for accountability.

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It shouldn‟t go into what you look like to get service. But, as a person, you should
always have esteem about the way you look—[and for] whoever is with you, how
they look. So, I wouldn‟t even say that [it‟s] a cultural issue. I would say it‟s a
personal thing. You should come into the office, no matter what you look like… I‟m
just saying… so what if I look busted, I‟m coming here to get help, so I don‟t have to
look busted no more. But these things happen.

Therefore, it is unrealistic to hold sick mothers and those worried about
children‟s illnesses accountable for self-presentation. Instead, workers are
accountable for using poor self-presentation to justify stereotypes, while ignoring
lack of proper self-presentation as an effect of a patient‟s medical distress. In Group
1, Helen expresses this view.
[My daughter‟s] sick and I‟m sick, and I have been up with her all night, and I don‟t
feel like [dressing for respect]. So, I snatch her out the bed, and no, I didn‟t comb
her hair today, „cause I said, “I‟m tired.” And, we ran down there, and this is what
we look like. We look like a mess, „cause I feel like a mess. She feels like a mess.

Still, participants agree, complaining about the injustices when one fails to attend to
these details does not increase the probability that workers will take one seriously.
Instead, they must be ready to manage hurtful words, longer waits, and getting no
pertinent information from doctors or health care workers.
Participants insist that being an AHCCCS patient consistently triggers adverse
health care interactions that self-presentation does little to moderate. In Group 5,
Paula voices the prevalent comment on this issue.
I have to be honest, because sometimes if you are on AHCCCS insurance, a lot of
people already have a stereotype of you. [Workers think], “You don‟t really care
about your kids.” You just basically trying to get a check.” And it‟s not always like
that, you know. There‟s a lot of hardworking women out there, and basically that‟s
where I come from. If they put a stereotype on you, you don‟t get as good health
care as somebody who might have a higher insurance. I would go in there and I‟m
pregnant, and I would find out things about my baby later. I‟m like, “Why didn‟t you
tell me about this earlier?” Or, I‟d be sitting in the office for hours, while people… I
was there before… get seen before me. So, in some ways it‟s kind [of] disrespectful.

Educating and properly comporting themselves does not predict what triggers
particular adverse worker responses. Instead, focus group participants say, trial and
error is the enduring strategy to ameliorate health care workers‟ offensive
responses. Helen (G1) describes the complex interplay of factors influencing poor
quality health care interactions.
[W]hen you come in there, they look at [African Americans] a certain way, like,
“Well, they don‟t know nothing.” If you come in there wearing a certain thing or
talking a certain way, well that means that you are not educated enough to know
what you are talking about. That you don‟t know enough to say, “Hey, there is
something wrong.” They‟re like, “No, there‟s not. You don‟t know what you‟re talking
about. I‟m the doctor.” You don‟t know what you are talking about, because of the

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way you are carrying yourself, and such. And that is so aggravating! It so irritating,
because, you know, now you feel like you have got to speak their language in order
for them to hear you, even a little bit.

Seeing patients at their worst (or from the patients‟ perspective, most
vulnerable—looking a busted mess), front office personnel offer the most consistent
disrespect, with AHCCCS patients as their prime targets. Across the focus groups,
participant say the front office undermines quality care by assimilating African
American patients to workers‟ stereotypes of welfare recipients. According to these
stereotypes, all welfare recipients are disreputable “freeloaders.” Independent
comments in Group 1 summarize this conclusion.
The first thing you see when you walk through the door—the office assistant—[this
tells] you every time. It tells me every time, if they have a nasty attitude, [because
they think], “Serving you is not my job.” (Ellen)
[Paraphrasing an office assistant‟s thought] “I‟m gonna be nice, because I am in a
good mood today.” But, the first person that you are presented to, she usually has
the nastiest attitude. (Greta)
[T]hat is such a valid point, because when you are sick, and you‟re going to the
doctor, the last thing you want is somebody with a snotty attitude looking down at
you soon as you walk in the door. (Brenda)

While focus group participants usually imply “Caucasian” or “White” office
personnel when speaking of snotty, nasty attitudes, they carefully note that such
attitudes are not restricted by race. As with other aspects of “candy-coated racism,”
complex interplays of age, class, and race stereotypes assure that the presence of
African American workers does not reduce adverse interactions. Instead, African
American office personnel, who try to position themselves as exceptions to negative
stereotypes of African Americans, sometimes have nastier attitudes than their coworkers of other races or ethnic identities. Thus, for all health care workers,
participants agree with Ester‟s conclusion, in Group 2: “They need sensitivity
training! Go ahead and say it! I mean, seriously [group laughter].” Darlene,
speaking of her African American health care co-workers, declares, “They‟re
pompous,” and explains that African American workers who were once welfare
recipients have the nastiest attitudes. 19 Participants think that these workers‟
identity and welfare experiences should make them sensitive to difficulties faced by
African Americans and low-income patients of other races. However, they agree with
Ester‟s conclusion about the workers‟ offensive conduct: “[M]akes it even worse!
That actually makes it even worse!”

19

At least one participant in each focus group had worked or currently works for a hospital, clinic, or
pharmacy. Several, such as Darlene (G2) works in programs that serve AHCCCS patients. While they
often agree with other participants‟ views, based on their work experiences they sometimes disagree
with or qualify these views.

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Returning to the co-payment equation, participants attribute poor quality
service to how health care workers combine attitudes toward co-payments with
stereotypes of welfare recipients as disreputable freeloaders. AHCCCS-insured
patients are most adversely affected. In the workers‟ view, participants contend,
such patients (especially young, single mothers) do not deserve professional service,
they deserve mistreatment. Group 5‟s comments reveal how participants explain this
combination of adverse influences.
I wouldn‟t necessarily say [it‟s] the people on the panel [referring to deliberation
scenario]. Probably, it‟s the people that feel AHCCCS is not paying them. Because,
it‟s the people that [are] working—the nurses that‟s working in that South Mountain
hospital, or wherever—they are like, “Oh, AHCCCS, we ain‟t getting paid.” It‟s kind
[of] how you feel that you are getting pushed aside. (Lois)
„Cause with AHCCCS (I don‟t know how others do it, but when I had AHCCCS), you
don‟t pay no co-pay. With regular insurance, you pay a co-pay. (Charlotte)
You pay a dollar [with AHCCCS]. What‟s a dollar? (Multiple overlapping voices)
Okay, a dollar co-pay. But, with my insurance you pay… whatever it is. But with
AHCCCS you don‟t pay co-pay, so I feel they don‟t care [because] you‟re not paying
them. … . [I]f you working in customer service, you like, “I gotta be nice to the
people who are paying their bill, because that‟s where I get my paycheck.” But, they
feel, you got AHCCCS, you just government. (Paula)

Despite attributing some community resource problems to ethnic competition,
participants also note that low-income or monolingual Spanish-speaking Mexican
American patients experience similar adverse interactions. Darlene recounts
secondhand her co-workers‟ behaviors.
I work at the county hospital. [B]ecause it‟s [the] County, they already think that
these [are] low-class people that can‟t afford insurance and stuff. Well, this other
lady that works with me (I didn‟t witness [it]) was going to E.R. to get some
applications and stuff. She said there was a Mexican guy there (I know they got it
like real bad, right now)… and she was saying that he had went (he didn‟t speak
English) to get services [for] a sore throat or something. And the lady was literally
cussing him out, without cusswords, saying that he needs to learn English before he
come up there. And this is a worker at the hospital telling him this stuff! And then,
he‟s like, you know, telling some other lady in Spanish how bad [the hospital worker]
treated him, and this and that. I‟ve seen it a lot where they get on [Mexican
Americans]. [B]asically, she was disrespecting him real bad.

In the community, many AHCCCS and other low co-payment patients are African
American. Thus, African Americans‟ visits to pharmacies present the same problems.
Greta (G1) had worked at a South Phoenix pharmacy for many years. Although she
disagrees when participants generalize biases about co-payment, AHCCCS, and
African Americans to all workers, she qualifies her disagreement by noting that it
would have been accurate for the pharmacy at which worked had she not
confronted her co-workers when she noticed them “blue binning” these patients.
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I often had to check the people in the pharmacy. I don‟t care where, what kind of
doctor, I don‟t care if they are on AHCCCS, we are not gonna put this person in a
blue bin because they are all AHCCCS patients. They deserve a certain amount of…
[another participant interrupts to reject her view, before Greta continues]. No, no,
it‟s, it‟s equal. You know, one lady use to come in all the time, and she use to yell at
us, “I‟m not your paycheck! I‟m your patient.”

Looking at co-payment, participants say, blinds health care workers to age
and class differences among African American female patients; they all become
single, low-income, unwed mothers. In Group 2, Ester recounts the kind of
experience on which participants‟ base this conclusion.
[Racism] exists, because, here I am, I‟m 30 [and] I went into Scottsdale Medical to
have my son. My husband had to [work]… you know, so he‟s on the way. I get
there, the nurse registers me. By that time, my fingers are fat, so the rings are off.
I‟m like, “Look, I am just ready!” And she says to me, “Are you married?”

Frances, who is acquainted with Ester apart from the focus group and knows her
class status asks, “She doesn‟t know that you‟re blah, blah, blah [naming Ester‟s
pubic persona]?” Ester replies, “No! No. No. She says, „Are you married‟—first
question. And I said, „Well, not that that‟s any of your business, but what‟s the point
of the question?‟” As the interaction continues, the nurse asks, “Well, is the baby‟s
daddy going to be here when you deliver?” For Ester, and participants generally, the
language of the question delivers a typical insult to an African American patient‟s
morality. Outraged by how the nurse asks the question, Frances responds, “Oh, no
she didn‟t! Did you say, „Do you know who I am?‟”
Participants agree that age and racial identity override class status, unless
health workers see the African American patient as a “Coleangelou,” a term
combining Kesha Cole and Maya Angelou to indicate an acclaimed African American
woman. Noting this exception, Ester expresses the participants‟ conclusion about the
conflation of African American and lower-class disreputability: “Right, if I was
Coleangelou, you would not be treating me like this.” Considering the importance
that participants place on holding one another accountable for dress and
comportment to display self-respect, the moderator asks what happens when they
are wearing only a hospital smock. Ester‟s reply summarizes the typical experience.
I was in the same thing that everybody else [wears], right; the traditional smock that
you wear. But, [the nurse] did a couple of things. She made a few assumptions. She
looked at my… wedding finger and saw there was no ring on, so she immediately
assumed, “Oh, she‟s not married.” I came in by myself and, instead of asking, “Are
you expecting your husband?”, she immediately assumed, and went to baby‟s daddy.
I can‟t imagine her saying to an Anglo patient, “Is the baby‟s daddy coming to the
delivery?” And, I thought, I mean, I literally demanded another nurse.

When workers use baby‟s daddy, focus group participants agree, it signals a
presumption that Black race equals lower-class disreputability. They take the
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expression as a veiled or polite version of the offensive question, “Do you know the
daddy?”
In Group 2, Ester explains that “[baby‟s daddy] refers to being unwed and
just having another person that has donated sperm.” Betina adds, “That dude. That
dude,” with Ester completing Betina‟s thought saying, “That dude that knocked you
up, basically is what they‟re saying, without saying it. And I really, I, I came
unglued.” Frances further explains, “[The dude] means you got multiple partners.
You know, them asking you, „Do you know who the daddy is?‟ means that you are
promiscuous.” Although some participants use “baby‟s daddy,” they all agree that, to
avoid insult, health care worker should use father, spouse, husband, or partner
when regulations require them to ask questions.
Ester expresses participants‟ contention that, if the patient challenges the
insult, the worker defends her or his conduct and ignores the patient‟s medical
distress.
Right. Right. Right. With the different situations that exist in the world right now, I
could have a female partner. I mean, you don‟t know! So, to make the assumption
that, you know, I‟m unwed and having a child—and she was, “That‟s not what I
meant.” I said, “Oh, it‟s not [sarcastic disbelief]? But that‟s what you said. … . I don‟t
have the time to try to figure out what you meant, so you need to go.” And she said,
“Well, I‟m getting upset.” I‟m like, “Hell, you are. Oh, no, you got to go.” And my
mom‟s like, “Please leave the room before she smack you.” I mean, I‟m in labor!
[Multiple voices echo, “In labor!”] I don‟t have time to decipher your prejudices. I
don‟t have the time.

Participants understand that workers are under pressure, work long hours, and see
many patients, and their questions may seek routine information. Mothers also know
hospital regulations determine how workers ask questions, but hold workers
accountable for the assumptions revealed in the language they use.
II.

“I found out about Ahwatukee”: Health Care and the Extended
Community

Trying to obtain better health care, participants extend “community” to include
bordering municipalities. In this sense, they speak of South Mountain and South
Phoenix as “the community” or “inside the community,” and other areas of Phoenix
and bordering municipalities as “outside the community.” Yet greater travel and time
expenditures decrease benefits from this extension. Confronting the same problems,
mothers‟ experiences provide criteria for comparing the consequences of
stereotypes in their community with systemic health care delivery practices that
produce humiliating and discouraging interactions. Comparing the resources in other
communities, they note specific resources that facilities in their community lack.

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Mothers use the knowledge they gain to select the best facilities and doctors.
Apart from less intense negative stereotyping and “nasty attitudes” among front
office personnel, mothers seek in rough order of significance:
 health care workers who listen and answer questions
 opportunities to see a primary care physician or, at least, the same health
care professional on successive visits
 short waiting time
 cleanliness
 separate waiting rooms for sick and well-visit patients
 practices designed to serve families
 helpful information on displays in waiting rooms
Where mothers judge an outside facility satisfactory by these criteria, they
continue using it. Confronted with unsatisfactory service at an outside facility, they
ask for another health care worker. When this request does not improve service,
they transfer within the outside community, and if that fails, try another bordering
community. If these efforts do not improve service, mothers return to an incommunity facility and some cease going to the doctor for themselves or their
children.
Focus group participants agree that inside and outside the community, the
attitude of front office personnel is a decisive factor, in part, because it signals what
to expect from health care workers at the facility. Participants report experiencing
less hostility toward African Americans at some facilities in bordering communities.
Where hostility prevails, participants contend that front office personnel remain the
prime offenders, and they disproportionately target AHCCCS and very young
patients. Regardless of co-payment, African American patients who are very young
and unmarried, participants say, still face the worst experiences in health care
interactions.
Some of the nearest and best facilities in bordering community offer shorter
waits, are cleaner, and display more information in waiting rooms. However, even
though the nearest facilities have reputations for high-quality expertise, this does
not mean increased opportunities to see the same health care professional on
successive visits. Patients see different associates, but note that this is not decisive
for whether they continue using those facilities. Instead, they consider whether
seeing different associates amounts to getting “lost in the system.” When associates

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do not listen to patients‟ reports about previous treatments, they prescribe
treatments that have already failed. Repeat visits for the same ailment increase
expenditures for co-payments. Thus, focus group participants say that their
unsatisfactory health care service, both inside and outside the community, results
from having access to too few medical practices designed to care for families.
Speaking of very young children, focus group participants say that a sick
child‟s siblings will soon become ill, requiring another doctor‟s visit and co-payment.
Illness spreads among children in day care as well as during a doctor‟s visit to which
mothers must bring all children, because they do not have baby-sitters. Exposure to
illness also increases when facilities do not have separate waiting rooms for sick and
well patients. Mothers devise strategies to resolve such problems, participants
observe, and look for family-oriented practices that support those strategies inside
or outside the community.
For “new arrivals” to South Mountain or South Phoenix, focus group
participants report, extending the spatial community begins when they cannot find a
community facility that meets their criteria for quality care.20 Often accustomed to a
large African American presence, the new arrivals look first for African American
doctors or facilities. Failing to find any or any that meet their expectations, they
select an outside facility based on insurer-provided information about facility
reputations and specialties, or by trial and error. Catherine, a new arrival in Group 1,
describes why and how she made this decision.
I moved out here to Phoenix 12 years ago. Didn‟t know… anybody and I went to
Jesse Owens or that clinic over there… I walked in there, and felt like I have
insurance and this is what I‟m paying for? It was terrible. I went to the dentist; it
was terrible over here. So, I found out about Ahwatukee real quick, and I haven‟t
stopped going to that side of town since. Had I known, though, when I moved
here… in South Phoenix there is this good doctor, or that Ahwatukee had this Black
doctor, I would have used that resource. I didn‟t know, and didn‟t know where to go
[to get that information].

Paula (G5) is new to the area. She recounts a variant of this experience at a
facility in Phoenix. On the way to the appointment, Paula had a flat tire, and arrived
tired, sweaty, and in pain after walking a long distance in over 100-degree heat.
I went to a doctor in Phoenix one time. And, the first time I was there, they looked,
and they whispered, and they talked, and they whispered. And I‟m like, “What are
they doing?” I went back [to the front desk], and the lady‟s like, “They did not want
to come in the room. … . They were scary [afraid of her]. … . I was tired. I have this
headache. I was like, “Somebody help me,” you know. [The doctor] finally came in
there, and she was like, you know, “Here, you need this” and “I‟ll write you up a
prescription.” I was having fibroid problems at the time, and so… I needed a referral,
20

“New arrival” refers to time periods from a couple of years to a dozen or so, but generally means
an African American who was not born in Arizona.

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so I had to go see her. And she just asked me a couple of questions, and finally
referred me. And she didn‟t even go into the details, she just, “Uh-huh, uh-huh,
abnormal period. Bye.” That was the first time I was at the doctor, and, you know,
when you go to the doctor the first time, they ask you a long list of questions. They
didn‟t do that. And they got me [waiting] inside of there, and I had that flat tire
outside.

Paula finishes with, “Yeah, it‟s a 115 [degrees]. I am anemic, I got these fibroids,
and they didn‟t tell me anything.” Other participants, sympathetic and with knowing
laughter, echo one another, saying, “They showed you the door.”
New arrivals and long-term residents report going to bordering communities
to shorten waiting time. Greta (G1) provides a typical account of this motive.
In my experience, I reach out of the community for my health care, because I feel
like there is a lack of care for the people around here. I don‟t like long waits. My
opinion [is that] I should not to be at the doctor‟s office for more than an hour. And,
if I go to Ahwatukee, or Chandler, or go anywhere [other than a community facility],
I am not in there more than an hour. There is no long wait. There is a well [waiting]
room and a sick room. When I take my kids to the pediatrician, if they are well (just
there to get an immunization or something), I don‟t want them sitting around a
bunch of sick people, and I bring them back two days later, and [have to pay]
another $25 co-pay, because they‟ve gotten sick in the doctor‟s office.

Yet, all mothers, who have the means and can make the time to travel, look outside
the community. Knowing that if everyone tries to escape community problems
nothing will change, focus group members report their diligent attempts to manage
with local facilities. Combinations of health crises and wasted co-payments override
their commitment to using community facilities. Looking outside, some mothers
draw on knowledge of bordering communities that they first acquire when moving
children or residences for better schools. Although speaking of schools, Glenda (G3)
describes the frustration and resentment that participants across the groups report
when they leave the community seeking better health care.
[M]y daughter is in Tempe, not because I want her to be. It is because she will gain
more knowledge over there versus in South Phoenix. … . I drive her to Tempe. Back
and forth, you know. Yeah, unfortunately, I would like her to be in South Phoenix. I
grew up in South Phoenix, you know.

None of the focus group participants expects that changing facilities (in or
outside the community) will solve all problems. Thus, only if other factors weigh in
favor of an outside facility do they continue using that facility or look for another
facility in the same bordering community or in a different one. Otherwise, they look
for a South Mountain or South Phoenix facility that offers the best service. Paula
expresses a typical view about transferring facilities.
I go to Tempe, Mesa, I go far. But, I have private insurance. You go to the same
locations. „Cause I can‟t get AHCCCS (but I need AHCCCS), I pay all this money out

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of my check every two weeks to get this health care. … . Then, they don‟t even
touch you. They ask you what your symptoms are [and say], “Okay,” [and] write you
a prescription. And then, I am paying $30, $40 for co-pay, then I have to go back,
because they misdiagnosed me. I call my insurance carrier and get a new provider.
But, I mean, how many [of these providers] are on the Southside?

Many of these factors diminish in importance, the focus groups maintain, if
health care workers willingly answer questions to advance a patient‟s understanding
of illnesses. Participants think that patients who are better informed about illnesses,
alternative medical treatments, and the side or interactive effects of prescribed
medicines, would manage their health care more effectively. They would weigh
useful information against racist interactions and other criteria for poor quality
service. In Group 3, Fatima‟s comments capture this view.
It‟s been said, they have a stereotype on how Black people are in general. And they
can just tell you anything, and when you get to asking more questions, then like, you
become a threat to them. Because I have been everywhere… to Scottsdale… to
Chandler. I‟ve been to different facilities, and they really just want to give you the
quickest answers and get you out [of] there. So, that‟s all I felt. I really haven‟t
been, per se, to any of the hospitals in this area, because I feel they are very poor
anyway. When I go into a place, I look for cleanliness and, if that place is not that
clean, I don‟t wanna be serviced there. So, I would… just find them not suitable for
me to go in, because of my expectations of a facility. [The] cleanest one I‟ve found
around this area would be Good Samaritan, and that‟s not that up to par. But I go
there and I‟m given information, and I think Good Samaritan is a good facility to go
to. Whenever I go, I get accurate information… I feel I need to get me to the next
level.

Elena (G3), facing a crisis with her 21-month-old twins and unable to manage with
community facilities, transferred to a facility in a bordering community, only to
return to a community facility. She explains: “I… took my kids out of the
community—my babies—to Mesa Pediatrics. … . I think the doctors there are very
good and very smart. But it‟s a big practice, and they have these policies that don‟t
support families of sick children.”
Other participants begin using bordering community facilities to get better
adult health care, but learn about systemic factors that affect child health care. In
Group 1, Ellen highlights these systemic practices.
I haven‟t been through it with my daughter, because my daughter is only 11 months.
But, I been through it with myself, because I go to the doctor a lot, because there is
always something wrong. I don‟t go as soon as something happens to me. I wait to
ride it out; to see [if] maybe it will go away. Most of the time, I am just in pain. … . I
know something ain‟t right. And, I am going to my doctor, and I‟m like, “Can you
please check this out?” And they telling me, “Well, it‟s not anything, really, just take
this, just take that, go home and lay down.” [She responds], “I‟ve laid down. I‟ve
tried that. Now, I need you to tell me what is wrong with me.” So, I have to switch
doctors, like, all the time. And, I finally get to a doctor who sits down and listens to
me, [but] she‟s so far away. … . [Y]ou have to go out [of] the, the urban community

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and go somewhere else to get the attention you need. Because I‟m going to my
doctor, and most of the time he can‟t even see me. I‟m seeing another doctor. I‟m
seeing a nurse or something, and I want to see my doctor.

Despite complaints about health care workers‟ presumption of “African
American ignorance,” participants in each focus group blame African American
ignorance for the problems that Ellen describes. African Americans do not get to see
primary care physicians, these participants argue, because they try to make lastminute appointments at their own convenience. African Americans go to the wrong
kind of doctor, the same participants add, because they do not bother to learn about
medical specialties, and do not schedule annual exams to monitor their health. Greta
levels this charge in Group 1, claiming that South Mountain residents do not use
information about hot lines and triage nurses that insurance providers supply.
Other participants challenge these charges. Agreeing that because the
charges are accurate for some African Americans does not explain why other African
Americans, who make timely appointments, rarely see primary care physicians or
the same health workers on successive visits. These participants also counter the
charge about annual examinations, noting that, even for this purpose, African
American patients seldom see a primary care physician. Thus, the dissenting
participants do not argue that patients should always expect to see primary care
physicians, but should be able to make an appointment rather than always seeing
another health care professional. Consequently, the underlying problem is seeing
different health care professionals on successive visits, if it means starting over,
because the next worker simply ignores information, and takes persistent
questioning as patient hostility.
Elena (G3) voices the typical response for giving up on outside facilities: “I‟m
driving from 35th and Baseline all the way to Mesa for that. So, finally, I changed the
doctor, and said, “I can‟t deal with this.” Thus, Elena returned to a facility in the
community, like Fatima, who tried facilities in Scottsdale and Chandler before Good
Samaritan. Whether mothers return to community or continue with an outside
facility, some may restrict visits to crisis treatment or cease using health care.
When mothers return to a community facility, they bring knowledge acquired
from outside experiences. This knowledge, focus group participants report, helps in
selecting the best facility or doctor the community offers. To choose the best, other
criteria notwithstanding, mothers look for facilities that reduce co-payment costs
resulting from ineffective repeat visits for an ailment. Whether for themselves or
their children, mothers prefer family-oriented practices. Elena describes her choice
after transferring from Mesa Pediatrics.
I‟m back in the community. Although I have not seen Doctor [names primary care
physician] yet, every time I go, I see the same woman. … . In fact, week before last,
we went twice in the week. She saw one of my kids; they‟d had ear infections. The
second time we went back, they had this awful cough that would keep them up at

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night. But she remembered, she recalled them. We didn‟t get lost in the system. So
that was nice. … . The other thing is, for me, my co-pays. … . To go to Emergency, it
is a $100 co-pay. … . I spent $300 last month in co-pays, and don‟t have it to spend.
So, the last time we went to the doctor, I just took the sickest one.

Across the focus groups, to cut co-payment expenses, participants report making an
appointment for the sickest child, but asking the doctor to see another child during
that visit. In Group 1, Irene furthers describes the influence of co-payment expenses
on facility selection.
The co-pay, I really don‟t understand. Mine‟s not $25. It‟s $10, but I have children
that are younger, so there is a separate room in the doctor‟s office. So, I chose the
higher premium, so I would have the lesser co-pay. But, if I go to see the doctor on
Monday, and he says bring them back on Wednesday or Thursday, why I am I
paying another co-pay? … . That‟s so irritating… and grating, because you already
know you have a sick child, and you go before the doctor, [who] says, “It‟s really not
sick, really [it‟s] a virus and there is nothing you can do, but just make him feel
comfortable.” Well, I came to you, if I hadn‟t done all that at home, we wouldn‟t be
here in the first place.

Mothers who wait out a crisis first exhaust knowledge and advice they get
from family and friends. Faced with ineffective expensive visits, others do not take
children to the doctor. Again, Irene states the typical rationale first for delaying visits
until after a crisis, then stopping visits: “So, I think that is something that has shied
me away. Now, I tend to let their illnesses go. I don‟t go to see the doctor, to pay a
co-pay, so I can be talked down to.” Most mothers continue looking for a
cooperative family-oriented facility where health care workers provide the
information needed to “get to the next level.”
Some community facilities readily cooperate with mothers‟ strategies whereas
outside facilities do not. Elena, speaking of her current community facility, explains:
“I had an appointment for the sickest one. And… [the doctor] said, ‟While you are
here, do you want me to look at your other one?‟ I don‟t think they would have ever
done that at Mesa Pediatrics.” Therefore, Elena concludes, “So, here is an example
where I feel more supported [in the community], „cause I was seeing money go out
that I don‟t have, and I have to pay light bills and house note and, you know.” In
Group 3, Beatrice paraphrases the common view of health care workers who refuse
to cooperate: “„We don‟t have his chart. You didn‟t check him in.‟”
Nonetheless, overall, participants agree that, as a consequence of health care
workers‟ negative stereotypes (not restricted by race or ethnic identity), the quality
of health care experiences for African Americans varies little inside and outside the
community. Hence, they agree with Fatima‟s summary statement, “[I]t all, like,
depends on the expectation… you would have of the persons giving you the
information and servicing you.”

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III.

“There is no community”: Networking to Share Health Care
Information

Asked about community of South Mountain or South Phoenix, participants across the
focus groups first respond that it has no strengths. Within the zone or collection of
neighborhoods, they contend, patterns of interactions do not constitute a
community. Participants, new to and natives of Arizona, Phoenix or South Mountain,
find locating the “Black” community difficult. Based on their experiences in African
American communities in other states, some new arrivals insist that there is no
African American community. First, these participants see the problem as a lack of
gathering places in the area. There are no facilities or open spaces where residents
regularly gather to share information through casual conversations. Second, this
absence hinders meetings among African American residents to share information
about health care and social services.
Elena (G3) pinpoints a new-arrival‟s perspective.
I think part of the problem here… that I see in South Mountain, Phoenix is that there
is no community. There is no community area. Where I used to live (before we
moved here), in Portland, [OR], there were bookstores, and places people gathered.
… . And people got to know each other. So, I‟m at the bookstore, and someone else
comes in and say, “Hey, how you doing?” I could talk to them. And it‟s like, you
know things, and [pointing to women around the table] you know things, you know
things, but I don‟t know these women. I don‟t never see them.

Both natives and new-arrivals see the space and place problems as reflections of the
ethnic and racial demographics of Phoenix, in particular, and Arizona, in general.
When referring to this demography and its consequences, focus group participants
contrast Arizona with locations in Southern states, or “down South” as a region. In
Group 5, Margaret expresses the typical contrast, saying, “Black people here are
very limited [few]. When you go back down South or something, they‟re
everywhere.” Multiple voices agree, “Yeah!”
Therefore, focus group participants emphasize three factors about community
strength. First, the small demographic presence of African Americans explains the
lack of voting-block strength needed to elect racially representative officials to “back
up” individual efforts. Second, Arizona African Americans, scattered as well as
having small numbers, do not develop a political “tradition” of coming together to
solve community problems through joint action. Third, these conditions place
Arizona‟s African Americans at a disadvantage in competition for scarce and
dwindling resources with a rapidly growing population of other race or ethnic groups
that find housing in once predominantly African American space. Margaret (G5)
gives an overview of how these factors influence finding, sharing, and using
available resources: “Even though we get more food stamps than [African
Americans in the South] do, we do get treated worse [here] because we don‟t have

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nobody to back us up. … . [D]own there… they have government that‟s Black or
Mexican or whatever, [but] we don‟t have that.”
On the first issue, Fern (G5) contrasts Arizona and “down South” locations:
“[M]y sister is in Atlanta, Georgia. And she thinks the difference with people down
here [in South Mountain or South Phoenix is] we know a lot of stuff, and we could
[do] this, and we could do that, [but] we don‟t come together, like down South.”
Fern continues: “[African American residents] don‟t understand it takes more than
one person. They say [in general political rhetoric] you can voice this or that, but
you need a group… to actually get it enforced. Come together and this, this, and
that.”
Nonetheless, across the groups, participants suggest there are many
organizations working “behind the scenes” to improve community resources. Edna
(G5) most clearly expresses this conclusion about the role of these organizations in
sharing resources.
There is so many [organizations]. You can‟t belong to so many. There is all kinds of
advocates out there, working behind the scenes. And, you don‟t know, „til someone
puts a flyer up that they exist. And you go for that one benefit, get it, and leave, and
not know all the work it took for you to get it. … . It‟s not sustained.

Hence, when the moderator asks if participants belong to organizations or regularly
take part in any, most answer, “No.” The participants stress the importance of
networking. Yet, when asked how many were part of a network, the highest show of
hands in any group was less than ten percent of the group. As Edna explains,
working residents cannot spare time from childcare and other family obligations.
Thus, Fern asks, “How many of them [organization activities] happen after seven? I
have to go to work.”
As Fern‟s comment suggests, participants see the problem as organizations
sponsoring one-time or annual events. If residents receive information in time to
attend an event, often the activities offer too little information on African American
businesses and social services. Where there is an attendance fee, some low-income
or unemployed residents cannot afford it. For other events, the same residents may
not attend, expecting to be embarrassed because they cannot afford sale items.
In Group 3, Alexis speaks to the advertising problem.
They use to have like a big ole party-type thing. … . They invite the whole
community, but most of the time kids will go. … . If you have people, who would
walk throughout the community, who pass out flyers, there‟s gonna be people that
attend.

Beatrice comments on the problems of a one-time (possibly annual) event, with high
attendance fees and costly sale items. “[T]hese were things… for Black women.
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[Y]ou can network, you can go find different [information or resources]. You can
learn about Black-owned businesses.” However, she goes on to explain, “But, you
know, number one, it was an expensive event to go to, but, once you got there, you
wanted to buy some of the stuff [but some cannot afford it].” Participants across the
groups agree that there are opportunities to gather if a Christmas Bazaar (once
sponsored, they think, by the Black Women‟s Task Force) or Martin Luther King, Jr.
Day and Juneteenth celebrations actually take place.
South Mountain and South Phoenix residents, participants say, find these
events divisive more often than not, because status cliques make the events
unpleasant for some, thus discouraging future attendance. For Group 3, Glenda
expresses this view, shared across the groups, and contrasts Arizona unfavorably
with “Down South.”
I do attend those activities. I notice there are cliques… , [even though] we are
suppose to get together… and communicate. … . It‟s not that [way] here in Arizona.
My parents are from Tennessee. Down South, you had no choice but to be together.
You know what I mean? Here, it‟s totally different.

During gatherings, invidious status jockeying undermines sharing information.
Glenda explains, “[A]s African American people, we need to actually get together
and share information, but, unfortunately, we‟re looking… at what we are driving, at
what we are wearing, and how we are looking.” Alexis interjects, “And, how many
children you got.” Glenda agrees, “And, how many children you got, and all that.”
Elena once again adds a new-arrival‟s perspective, saying, “We are not together. I
felt so isolated, so isolated.”
In Group 1, Anna summarizes obstacles to joint action that participants see
other racial and ethnic groups overcoming.
First, we have to come together, ah, make a plan, make a goal, and we go to the
councilmen. It‟s something we have to do. The Hispanic community, they have all
kind [of] flyers, telling you about what‟s going on. And sometimes, what I found out
about, I learned through the Hispanic community.

New arrivals point out that the first obstacle to overcome is African Americans‟
failure to acknowledge one another, even in passing, in South Mountain or South
Phoenix. In social spaces outside the community and in workplaces, some African
Americans also spurn one another‟s greetings. Edna (G5) describes general views of
this experience: “We don‟t even speak to each other here. We have to start
speaking to one another first. You make eye contact, the Black girl look away, but
she will talk to the White girl!” Regarding the workplace experience, Paula notes:
“People on my job do that! Put their head down when they see you, [you say,] “Hi,”
and [they don‟t answer, because] they don‟t want nobody to know they speak to
someone who is Black.” Agreeing, Lois, a new-arrival in the same group, says, “This

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is truth. When I first came from California, I felt like a speck in a cotton boll. When I
would see somebody Black, they would hurry and put their head down.”
Thus, the inability to meet and informally share information with other African
American residents influences how both new and long-term residents search for
health care and social service resources. As previously noted, Catherine (G1), also a
new arrival, looked for a “good doctor” or a Black doctor in the community, but did
not know how to get the information. Selecting a facility or doctor based on race,
the focus groups recognize, is no less racist than facilities and doctors refusing or
treating patients differently for that reason. Given contrary evidence, they do not
assume that African American doctors will be more sensitive to African American
patients. Instead, participants stress, the absence of doctors diminishes the total
pool of resources available in a poor community.
Consequently, while chiding African Americans for their ignorance of medical
specialties, Greta (G1) notes how pleased she was to have “stumbled across a
sister,” who specialized in internal medicine. Greta explains the medical value of this
encounter and the community‟s loss when physicians, whatever their identity, go
elsewhere to practice their specialties.
I stumbled across a sister, who was an internal medicine doctor, and she ended up
being… a hospitalist. She said, “This is really not where I wanna be,” but we had her
for about two years, and she educated me on so many things that other people
couldn‟t tell me. And she wasn‟t in the, the South Phoenix community. She was right
outside, in Ahwatukee, but she said, especially for us women… adult women, I
should say, an internal medicine doctor is better, because they actually delve into
your family history. They want to know more and more details. They wanna paint a
bigger picture than, “Oh, she is just walking in with a cough today. She‟s just here
for a pap smear.” They wanna know if your mother had cancer, if your
grandmother‟s mother [did]. They wanna know—go into all of these things. And that
stuff, I didn‟t get from this community. … . I had to reach out somewhere else and
get [it].

Among long-time residents who know one another, sharing information is
also difficult. Status competition among residents encourages hoarding rather than
sharing information, because, participants say, those who share resources fear that
doing so will allow others to advance and, once better off than them, flaunt the
achieved status. Evidence of formal education, such as “educated” speech and
“middle-class” styles of dress or comportment, signals flaunted achievements. The
same mind-set that judges some facilities as White also labels evidence of these
achievements as acting or trying to be White. Participants say that this mind-set
limits options for self-development, discourages using some services, and
undermines cooperation in joint action.
In Group 3, when Elena suggests introducing new gathering places,
participants explain the expected mind-set response.

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[I]t could be a few places, but just places people could just relax. You know what I
mean. And you could go any time. Event, you go when the event is happening, but,
if it‟s a bookstore, [you] say, “I think I will go up; I see they are having a poetry
reading, or see they are having a little book reading, or some author [is visiting].

Beatrice interjects: “But, you know what? The mind-set would [conclude that] you
[are] trying to be White. They‟d say, „You [are] not Black.‟” When Elena expresses
disbelief that a bookstore could provoke this response, Beatrice continues, “I am not
disagreeing with you [about the value of a bookstore], but I‟m saying [that is what
some will say].” In this and other focus groups, participants explain that activities of
the type Elena describes once existed in South Mountain or South Phoenix.
However, when the activities have been absent for a long time, residents of this
mind-set judge them, if not solely culturally White, then not culturally Black.
Therefore, participants contend, the mind-set also limits using some existing
facilities because they are White or outside the community, and this also makes it
difficult to introduce Black-operated facilities to the community.
Even if such facilities are Black-owned but not in the community, their use is
questionable. The moderator asks, “How far outside of South Mountain do you think
people would go to hang out in a bookstore like that?” Fatima (G3) provides the
prevalent response for all focus groups: “Not far.” The participants also agree with
Elena‟s conclusion: “It would, I think it would need to be in the community.” Fatima
is more emphatic: “[I]t would have to be in the community.” Thus, to make
changes, participants say they face a double bind. If the gathering place is not in
the community, residents will not use it, but introducing it in the community will
meet resistance because it does not belong in a Black community. Ruling places and
types of conduct out of African American cultural bounds, according to participants,
combines with other factors that leave individuals to solve problems without joint
action.
Where culturally proscribed services exist in the community, the same mindset can discourage using them. During Group 3‟s discussion, Elena, deeply stressed
by problems she had raising a family that “ran the gamut” (a 21-year-old son, and
21-month-old twins), reports that she found helpful mental care service at a
women‟s center in downtown Phoenix. An unidentified speaker quickly tells her,
“People see that as acting White.” She meant seeking assistance from a Whitesponsored mental care service and the African American cultural proscription of
counseling or psychotherapy. In Group 2, an exchange between Ester and Betina
explains the mental health service proscription.
What she‟s talking about is the one thing that I think really affects me as a young
parent, because I‟m big into like, mental health, and just putting it out on the table.
And, there‟s such a huge stigma around [using psychotherapy]. Like, you know,
[saying], “I don‟t tell nobody about my business; ain‟t gonna put it out in the street.
My kid ain‟t crazy.” I have a sister now, that has two children… that are 11 and soon

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to be six. And they are having some serious, serious problems, you know. I‟m always
solution driven. Let‟s try and take them there and talk to somebody. “Oh no, unhunh, no, we don‟t put our business out on the street like that!” (Ester)
Uh-huh. Yeah. Black folks don‟t receive counseling. (Betina)
You know! “We‟ll… we‟ll work it out.” And, I always tell [my sister] that when this
child turns 16 or 17, she‟s gon‟ hate you. (Ester)

Certain behaviors thus become indicators of persons acting or trying to “pass”
culturally for White or another racial group.
Betina and Frances continue, revealing the combined influence of intraracial
and interracial presumptions that set race-based boundaries for cultural conduct.
Speaking from an intraracial perspective, Betina says, “By leaving California and
moving here, and I mean, getting an education… I sound like a White woman, you
know.” Speaking from an interracial perspective, Frances responds, “You don‟t mean
„White woman,‟ you mean „articulate.‟” Betina stresses that she speaks not of the
behavior, but of African Americans of an intraracial mind-set who interpret educated
speech as White: “No, but, to them, they call it White.” Referring to both interracial
and intraracial mind-sets, multiple voices agree that Betina “sounds like a White
woman.” Frances, who remains focused on the interracial mind-set, concludes, “Just
because I have command of the King‟s English, doesn‟t mean I‟m talking like a
White woman.” Overall, the focus groups agree that to be called “articulate” is an
interracial euphemism that signals an exception to the negative stereotype of Black
linguistic competence. By either mind-set, Betina notes, “[They] say my son and my
daughters [are] acting White or „uppity,‟ you know. But, it‟s not that, you know.
When we get [an] education, your vocabulary changes.”
The mind-sets pose different problems for the meaning of community.
However, participants stress the mind-set collusions that influence all aspects of
community life, especially joint action. Adults and children who display certain selfdevelopment behaviors find themselves accused intraracially of flaunting their
achievements, and interracially of being arrogant, aggressive, or, the old standby,
“uppity.” In general, these mind-set limits combine with scarce resources to set
conditions that shape how residents make choices and judge choices that others
make. The limits narrow options for racially acceptable status criteria, encouraging
emphases on sexuality and reproductive competition.
Focus group participants also emphasize how the collusion of intraracial and
interracial mind-sets limits mothers‟ ability to promote patterns of conduct that build
children‟s self-esteem. Participants address this issue most consistently and intensely
as a problem that hampers parents‟ efforts to reduce children‟s susceptibility to
media-driven images of sexiness as the measure of self-worth in peer status
competition. Media messages affect very young children most immediately and
intensively. However, their negative impact is broader and long term, focus group
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participants insist, because it extends into adulthood. Persons influenced by these
messages see achieving status as “living the exception,” which means they prefer
glamorous activities with “get rich quick” potential to other ways of making a living.
Mothers, focus group participants maintain, must continually expend energy
challenging this collusion. Intraracially, challenges create difficulty for mothers in
interactions with African American health care workers, who see speech, dress, and
comportment as putting on airs. In interactions with White health care workers,
mothers must defend against those who see challenges as uppity or arrogant, and
assimilate them to stereotypes that make persistent questioning a threat to the
workers‟ safety. Challenging the collusions, mothers hold one another accountable
for behavior that signals self-respect, but find that the behaviors do not signal for
White health care workers that African American patients deserve respect and, with
it, the best service given systemic constraints. Therefore, participants describe
situations that show how the collusion of mind-sets adds to the complex interplay of
age, race (as color), and lower class status as elements of a disreputable African
American identity. The interplay of factors sets conditions, participants contend, that
discourage mothers, especially very young mothers, from using health care and
social services.
As focus group participants discuss these issues, one glimpses other
behaviors that may signal invidious intraracial distinctions that discourage coming
together for joint action. When describing negative patterns of conduct among
residents that weaken the community, for example, the speaker most often uses
language that excludes her from the negative stereotypes of African Americans. The
speaker negatively characterizes other residents‟ behaviors and their consequences
for community dynamics. Invariably, other speakers challenge the claim of
exceptionality. Focus group exchanges therefore qualify and explain the negative
characterizations. Most qualifications address differences between attributions of
African American cultural patterns, the complex interplay of biases, and the
consequences of long-term resource scarcity.
In Group 1, Ellen‟s comment typifies a frequently voiced negative
characterization of African American cultural conduct.
A lot of time, I would say—the African American community—we don‟t even go out
to search for resources. We just want them to come to us, [want persons from other
races to say], “Oh, let me tell you about this.” And that‟s not the case, I mean, there
is a lot of things [available, but no one is going to bring them to you]. For instance, I
never knew about equity residence, and just like you rent an apartment and a certain
portion of your rent goes toward a down payment on a house.

Based on this characterization, Ellen describes responses to the exceptional person.
[I]t‟s so funny. When you regurgitate this information to other African Americans,
sometimes they look at you like, “Why you giving me this information?” Well, okay,

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I‟m giving you this information, just to help you out. But this—our, our community—
we don‟t wanna see one another succeed. Right? Like other communities, like other
races, would, you know. [Instead, if we try to help someone to] get up, [they]
always think we gonna belittle, you know, [thinking] I‟m telling you this so I can
sound good. That‟s not the case. So, we need to get out of that as a whole; help
each other. If you got some information, get out and help each other, “Hey girl, such
and such,” or whatever you know to say. So, what Kesha [the know-it-all character
in the refusal scenario] is saying is that Karla and [everyone] had the same resources
available to them. … . It‟s gotta be knowledge, and you always have to have
somebody. I think everybody should have somebody that they should be able to
come to, and be comfortable with. … . Everybody needs that, and it may not be your
parents, but you can reach out there and find somebody who can help.

Others hear in Ellen‟s language the presumption of exceptionality that implies that
she is flaunting achievements. In Group 3, Glenda‟s language more pointedly reveals
the put down that all focus group participants hear.
That, that hits home a lot. You know, because I have a lot of friends who lack
information about what is going on the community. Because I decided to further my
education, and I know what is out there, and I try to give them information they
need to help themselves, and they look across—they do say those terms [flaunting
and know-it-all]. Yes, yes, it‟s very hurtful. And they don‟t see past [that] thinking,
they limit themselves, like for the information they really, truly need.
And, later on, they come and I say, “Are you going to listen? „Cause I am saying it
from the heart, you know. I don‟t think I know it all, and all this stuff, because I was
right there where you were. I am not too far from that.” So, yeah, you do get a lot of
feedback. And you stop talking… unless they come to you. The people have to come
to you, because when you go to them, they like, “I don‟t wanna hear it. You Miss
High Ditty,” whatever. So, “Yeah, fine bye!” You know. It‟s very hurtful. And… I
notice, in South Mountain, we‟re not together. African American people… we‟re
biases, we‟re envious, we‟re jealous. It‟s ridiculous!

Speaking to a person who is seeking help, as if that person were a
recalcitrant child, focus group participants say, does little either to offset reactions
that the speaker finds hurtful or to encourage others to come to her for information.
Thus, Glenda‟s inclusion of “not too far from that” signals an invidious distinction
and status comparison. Although a person may voice such comments to play down
differences and indicate good intentions, “speaking from the heart,” listeners hear
the paternalistic tone as an adult chiding a recalcitrant child. Thus, in Group 5, Alma
agrees that hurtful responses occur. Yet, she insists that the persons sharing
information must always consider the low energy and fragile mental states of those
who need help finding resources.
Resources are limited, and I think people have limited time. I think people have
limited energy. Everybody is dealing with something. I mean, you have to really care
about the other person to, to stick with „um, and help out. I mean it takes, it takes a
lot.

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Consequently, in each focus group, when generalizations begin to verge on
stereotyping, participants challenge one another. The challengers qualify negative
characterizations by attending to complex causal factors in community dynamics.
These exchanges sharpen participants‟ explanations of how scarce resources
influence individual efforts to find and use health care and social service.
Alexis criticizes culturally inappropriate media advertisements with useless
information to qualify statements about African American passivity—the most
prevalent negative characterization of the community. She thus counters the charge
that African Americans merely wait for members of other races to deliver resources.
[I]f you do look for the information… they play all kinds of commercials about teen
pregnancies—but, they‟re not… actually gittin‟ down to the root of the problem [as it
exists in the community]. Now, they‟ll show a girl at a party and, then, she turn up
pregnant. At the end of the commercial, all you see is her standing… with a big belly,
and the dude‟s not there. They need to have some kind of classes; some kind of
sexual education class. Have people who‟ve had experience with early teen
pregnancy… come up there and speak from their own experiences. And, maybe,
even give a visual to the… young children, „cause otherwise they would not know
[any more than they did before the commercial].

Francine (G1) adds another factor—demoralization that results from comparing
resources in South Mountain or South Phoenix with those in other communities.
I was helping my daughter out. My daughter was in the Roosevelt School District.
And, they was always in a budget crunch. I mean was… always having to recycle
paper, to make it last throughout the week. I was looking at Scottsdale and Gilbert,
and I was looking at Mesa, at, you know, other areas, where their money was just
flying high. And I was like, “What can we do?” First of all, I think we have to pull
together… to try to come out with a plan to… help the mothers that are struggling
from paycheck to paycheck. We ought [to help] others that are not at home with
young kids. You know, some kids come from families where they don‟t have the
resources that tells them to take a shower, take care of yourself. … . [So] in the end,
the panel [in the deliberation scenario is] looking [at the situation] like that is the
whole, like it‟s everybody. But, there are kids in the Roosevelt School District, where
they come home to nobody. They get knocked up, the mother‟s on drugs, so they
don‟t have anybody. … . [W]e were finding these kids clothes and things, and
helping them any way we can.

Comparing community resources, Catherine insists that lack of adequate resources,
not passivity, is the root cause of both low individual initiative and inadequate selfhelp programs.
I think it requires some kind of revenue to come in, from where, I don‟t know—
maybe, the state, the government can give communities assistance via the church. I
know a lot of people willing to do it, but, you know, you need funds to put flyers out
there. You need money to, to do outreach to children, you know, with no support
from the fathers… and so on. So first off, I think there needs to be some kind [of]
funding available.

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To summarize, while focus group participants see jealousy, envy, and other
negative consequences of individualistic status competition, these are not root
causes that operate independently of adverse factors stemming from long-term and
current resource scarcity. Under these conditions, many individuals no longer see
options for self-development. Ellen (G1) explains that the most demoralized, merely
existing, do not see that changing options apply to them.
I think it also is, we get comfortable, and in a state where we are just existing. And
when you are just existing, and [others are coming out]… with different things…
some [demoralized] people, they are not trying to go here and on [to] there. It‟s like
sometimes when you go the library… you‟re… the only person of color… in the
library. And there‟ a lot of resources in the library—reading materials and, for
instance, they have the Internet—where you can get information.

In simplest terms, apparent passivity actually reflects the lack of time that working
parents have to search for resources that deliberately or unintentionally, are poorly
advertised. Again, Ellen succinctly states both the negative characterization and the
positive qualification.
We have to go out and get the resources, because the resources won‟t always be
there for us to see, or people are not always gonna tell you „cause some of them
don‟t want you see, or whatever reasons. But one of the things that outside the
Black community, what people say about us, is that the best way to keep information
from a Black person is put it in a book, because they will never look for it.

The comment about African Americans and books notwithstanding, focus
group participants say they find in libraries few resources to assist parents to
counter negative media influences, and negative stereotypes of African Americans.
Comparing past and present curricula, participants agree that schools have
progressively provided less knowledge of African American role models in US history.
Ignorance of history promotes passivity. Commenting on present-day children‟s
ignorance of African American leaders, Alexis (G3) contends, “A lot of people are
starting not to go to Martin Luther King [celebrations] because they don‟t know
[about him or the Civil Rights Movement].” She contrasts what she learned to what
her children learn about the Civil Rights Movement and King‟s role in it.
I mean… I use to, like, write reports on him. … . „Cause, I know, I had my kids going
to Cordova and, ah, I think they were just bringing home pamphlets of who people
were. But I don‟t think they were getting the knowledge they needed. They probably
got more knowledge on President Bush or any of the Presidents than they did on
African American leaders.

Across the groups, when the moderator asked if parents teach children about
the Movement and its leaders, multiple voices reply, “Definitely,” and other words of
affirmation. Few agree with Alexis who suggests that, like her, some parents lack
skills and patience for teaching her children what schools neglect. Instead,
participants insist that African American parents must take primary responsibility for

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this task. Disdain in American society for African Americans, they conclude, makes it
unacceptable for parents to expect schools or any American institution to build their
children‟s self-esteem. Arizona than “Down South,” participants say, offering fewer
resources to help parents build children‟s self-esteem. For participants who have
computers, the Internet opens a world of possibilities. Young mothers without
personal computers, participants suggest, must use computers in the library. In both
cases, mothers must monitor children‟s use of computers to guard against them
becoming another source of “candy-coated racism.”
For the youngest mothers, raising several young children, all these matters
are more difficult. Participants consider this difficulty when speaking of these
mothers‟ conduct, agreeing with Brenda (G1), who concludes, “[I]t goes back to
education. I‟m not blaming them, because they really don‟t know better.” Therefore,
when Greta states, “They haven‟t gotten an education… young mother[s],”
participants understand her to mean both formal and “cultural” education. Speaking
of the youngest mothers (ages 11 to 15), for instance, Helen (G1) expresses what
this lack of education means for a young mother‟s plans about pregnancy, and
subsequent decisions about using health care and other social services.
[The deliberation scenario panelists] may think there is no planning because you [as
a young mother] don‟t know what to do next. And, you know, having a baby is not
like writing your name. It‟s a little bit more complicated and, so, just because you
don‟t see the planning, you don‟t see that they have resources. And [because] they
don‟t know what to do, it‟s easy to assume [they do not plan]. But, some people do
plan in spite of their culture; start early to plan. And that‟s when you should make
presentations and discussions after talking to people, not just assume, here is a
trend and this is what I am going to run with.

Understanding community dynamics informs the focus group participants‟
view of individual behavior, and of what residents must do to produce the vision,
which, they say, the community lacks. In Group 3, Fatima sums up the participants‟
contention: “I think… our community does not have a vision. Black women do not…
and Black men, too. They‟re hanging out on street corners. They don‟t really have a
vision.” Like Fredricka, participants say without a vision for the community, the
individual lacks “a focus.” Fatima‟s additional remark captures the outcome—a turn
to sexuality as the measure of self-worth.
[There is no focus] for life and, so, we turn to our sexuality to say, you know, this is
what validates me in the community. So, you can say, all daylong, “Well, you need to
keep you legs closed, you need to this, need to that, but other peoples [races and
ethnic groups] have sexual relationships, and their sexual thing, but it‟s like these
people [in the South Mountain, South Phoenix areas] are turning to their sexuality to
make them somebody in the community. You know, so it‟s really hard.

Negative behaviors made visible by this turn, as Elena puts it, encourage outsiders
to have “very [low] expectations… of Black peoples.” When the Moderator asks
Group 3 to whom they refer (e.g., politicians, health care workers, etc.), Alexis
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quickly answers, “By our own people.” Across the groups, participants agree, African
Americans (locally and generally) share outsiders‟ low expectations for any African
American community. In Group 3, Fatima replying simultaneously with Alexis, says,
“All of the above.” On the interplay of cause and effect that brings together Alexis
and Fatima‟s comments, Dianna explains that those who “hold the purse strings”
expect “so little… so, little [is] put here [in South Mountain and South Phoenix].”
Thus, the focus groups see a parallel between health care workers who consider it a
waste of time to answer African American patients‟ questions, and government
officials for whom low expectations mean wasting public funds giving more to a
community whose residents are incapable of using them.
Comments on the community‟s lack of vision and focus were both absolute
and comparative. In the absolute, a community needs a vision to help individuals
focus on how to develop their lives. However, viewed comparatively “in reality,” that
vision must include strategies for effectively competing with other ethnic and racial
groups. Dianna, referring to impact of competition concludes, “I think we woke up
one day, and, ah, the community was Hispanic. So, when you go to different health
care facilities, there are Hispanics or Spanish-speaking people at the front desk, at
the WIC office. I have run into so much friction, as far as health care [goes] here in
South Phoenix, to where [now] I have to pick and choose where I go.” Karen (G4)
bluntly attributes the competitive imbalance to government policies that promote
interethnic competition for scarce resources, but favor community funding that
addresses new immigrants‟ needs.
It‟s evident. It‟s those coming in across the border. I‟m gonna tell it like it is. It is the
government. It ain‟t got nothing to with us not putting issues on ourselves. Yes, we
do it to ourselves. But, what about those [African Americans who are] raised right,
who are doing right, according to what the government [requires]? They are doing
the most, and they are of the minority race. It‟s not really about race no more; it‟s
about the government not giving a damn about those of us who were here first.

In all focus groups, participants express versions of Karen‟s view. It is
consistent with their contention that the growing population of new immigrants
poses a special problem. Nonetheless, participants strongly agree that African
Americans could compete better if their self-help organizations had more resources.
Again, participants see a double bind—to get more resources one must raise
outsiders‟ and African Americans‟ expectations for the community. To the extent that
effective self-help organizations provide evidence of a group‟s expectations for its
community, African American residents must do more to help the self-help
organizations, because their staffs are overwhelmed and operating with too few
resources. However, working parents have little time to attend events and still less
for sustained involvement. Fatima and Alexis summarize the basic problem: “[W]hen
we talk about [self-help organizations], I think about Chicanos por La Causa, all
that, you know, [and] I am sure we… have something.” Alexis counters, “Black
family health service or something like that, but they don‟t do anything.” Others

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disagree that the many organizations working behind the scenes do nothing, arguing
instead that they are ineffective because staffing and resources are inadequate for
the large and complexly needy populations they serve. In addition, focus group
members stress the negative consequences of poor and inappropriate
advertisements for all services.
Moreover, seeing the spatial community as composed of many distinct race or
ethnic communities, participants adopt a zero-sum view of resource distribution.
Resources that residents of other groups share and use are not available to the
African American community. For example, funds and personnel devoted to assisting
non-English speakers are resources diverted from, not added to, “the community”
pool. Hence, Carine (G3) begins with an implicit zero-sum assumption as she
describes her unsatisfactory health care interactions.
[W]hen I had my first daughter, I had a private practice doctor. I was really happy
with the doctor. I had [my daughter] successfully, and she is healthy now. I just
moved over here [to South Phoenix] about a year and a half ago. I had to go to
(well, I guess I didn‟t have to), but I chose to go to the county hospital. So, when I
went to the county hospital, when I would go to the doctor, I would sit there for two,
three hours, and then, when I finally got seen, they saw me… [interrupted by several
persons].

A chorus of voices tells Carine the doctor saw her for “two minutes, one minute.”
Carine agrees and continues.
[T]wo minutes, and [the doctor] says, “We will schedule you for another
appointment. I was like, what about… how is my health? And, Mexicans—there were
like so many fricking Mexicans in there. They, like, spent all their time serving the
Mexicans, so when it was my turn, they like, “Oh, we tired, and the day is almost
ended, and we have seen you, so go home. And, if you have any problems, call us.”
Well, my [second] pregnancy was not like my first pregnancy, so I was trying to get
an explanation, like, why. “Well, we can‟t help you.” Very, very nasty attitude.

Accepting Carine‟s report of the doctor‟s comments reinforces participants‟
conclusion that doctors must distribute their time, but use it all on Mexican
residents. Nevertheless, neither the competition for resources nor racial and ethnic
favoritism lead participants to think that Hispanics patients always receive good
treatment. Instead, given that African Americans are one population in a racially and
ethnically segmented spatial community, the zero-sum view of scarce resources
requires a vision that effectively directs individual focus. An effective African
American vision means, as Dianna puts it, accepting that African American residents
woke up in a community that is demographically Hispanic.
IV.

“We broke!”: The Welfare System and Creative “Refusal”

Welfare or “the system” is the elephant in the forest of stereotypes. As much as
African Americans may compete with one another and with other groups for
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resources, focus group participants see themselves competing most with welfare
system regulations. Although all the groups comment on welfare or “the system,”
Groups 4 and 5 most insistently refer to welfare regulations to explain individual and
community dynamics. Members of these groups agree that the regulations produce
conflicting and contradictory eligibility criteria. Programs also withdraw or refuse
support that would allow the individual or family to become independent of the
system.
In all of the focus groups, at least one participant assumes the role of
“keeping it real,” but in Groups 4 and 5 participants compete with one another to
act as “reality-checkers.” These participants insist that, although “the system” will
help those who help themselves, self-help requires lying and other forms of
disreputable self-presentation to avoid being trapped in the system. Those
expressing the most stridently negative view agree that helping oneself means
learning to “work the system.” Working the system reverses ways of signaling that
one is outside the system.
Showing that one is outside the system requires distancing oneself from
negative stereotypes of African Americans. In Groups 4 and 5, participants insist
that, to health care workers, the African American patient is a welfare recipient until
she proves otherwise. It is difficult for her to do this, because the co-payment
equation is at the core of these negative stereotypes. Corroborating this view in
Group 2, Darlene relates two key aspects of the situation.
I think… when you‟re dealing with welfare systems and you‟re going to different
places… people who are assisting you feel like it‟s coming out their pocket at that
time. And sometimes, you have people at the customer service desk, who are not so
friendly. … . They look at you… [and] they think because you‟re on AHCCCS or
something that you can‟t take care of yourself, or something. Like you‟re not… (I
have my own medical insurance, as opposed to someone who‟s on AHCCCS), [but]
they think… you know what I mean, like they can‟t support themselves because
they‟re on the welfare system [sarcastic tone of voice] or something.

Convincing health care workers that they should exclude a particular patient from
their views of welfare recipients begins with having private health care insurance.
Darlene‟s parenthetical comment signals this distinction. Still, low co-payments
associated with high private insurance premiums often buy the same disrespect
from workers that AHCCCS patients and other welfare recipients receive. Privately
insured patients must insist, as Irene says, “I am here now, and paid my co-pay just
like everybody else, so treat me as an individual, not as a status quo community
person.” (See Chapter 2.)
Working the system requires reversing signals of status distinction and worth.
Not all participants are willing to do this. None approves of the reversal, because it
means taking advantage of existing stereotypes by engaging in behaviors that justify
health care workers‟ negative views. Having helpful friends and relatives, having a
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job, attending school, being married or involved in a stable and supportive
relationship are good for signaling self-respect, but they become disadvantages for
mothers who still need a “helping hand” from welfare. For these mothers,
participants say, it is better not to claim no spousal and family support, and despite
the shame and disapproval, to allow workers to think a child is the product of a onenight stand.
Paula (G5) summarizes the motive for and drawbacks of denying spousal
support.
But with [the father or husband present], she probably don‟t even qualify. They don‟t
do nothing to uplift the family as whole. So, say both parents are working, or [the
wife‟s] pregnant and the husband is working, there is nothing to uplift the family as
whole. You have to be single, broke, and dusty to get some help. And if you are,
they [say], “Well, you know what… [you do not qualify].” Well it‟s just not working
like that. There is nothing to uplift the Black family.

Considering current norms to be shaped by demographics and stereotypes, focus
group participants say that as mothers devise strategies they produce another
meaning for “generation.” (See Chapter 1, Section V.) Today‟s generation is
accustomed to the single female household head, and can take advantage of
stereotypes that workers develop from this “norm.” Helen (G1), like participants in
other groups, defines generation as different experiences with the single-parent
norm.
I know the norms have changed, where, ah, being in a two-parent household [was]
the thing, you know, the ideal situation. And, now because [the single-parent
household] is so common (that‟s not excusing it), but now that is so common,
because a lot of people, you know, [are] single moms, including myself. … . Although
it is not ideal, it‟s accepted. So, you have two different generations, looking at thing
different, based on what is in front of them at the time.

Taking advantage of the norm to work the system, mothers face shame and
disapproval in interactions with other African Americans. Single mothers or those
denying spousal support by “looking at things differently” try to protect their families
from regulations that all participants say disrupt already fragile family cohesion and
financial support. For instance, mothers act to protect males from state intervention
and, at the same time, seek benefits from the system for themselves and their
children.
Charlotte expresses one view of this perspective on generation by concluding,
“[T]he welfare system makes your daddies run away.” She refers to fathers across
generations. Unlike most focus group discussions that only mention males in
passing, this one centers on men as part of the intergenerational patterns, which,
according to participants, result from long-term involvement with “the system.” They
note that for family and household histories, the males with whom they grow up are

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in the system as were their fathers. Charlotte (G5) comments on this
intergenerational view.
Well listen, okay, if I grew up on low income and… I know my kids‟ father grew up
on low income, but the system is charging him for all his child support. Then, when
he gets older… he can‟t deal [with the system‟s regulations]. So my kids aren‟t
getting anything anyway. How can [the system] charge our kids‟ daddies with all this
child support, when they were already on low income—probably in the system with
their parents?

Therefore, male age peers, as fathers, should take reproductive responsibility,
participants argue, but having grown up in the system they lack the skills to comply
with state regulations.
Efforts to protect fathers from “the system” add to, rather than displace, the
other reasons participants give for why mothers, especially very young mothers, do
not press fathers to be involved in finding and using health care and other social
services for their children. As mothers try to keep fathers in their own and their
children‟s lives, they must also manage welfare regulations to keep support that
fathers provide. Thus, an unidentified speaker in Group 5 explains that the goal is to
keep it “all [from] going to the system.” Just as mothers develop childrearing
practices by reverse role modeling to break cycles that make families insecure, they
also devise strategies to prevent regulations from breaking already fragile families.
An exchange in Group 5 illustrates their view.
Uh-huh. So, this is that cycle thing? (Moderator)
Oh, yeah! (Charlotte)
So, how do you break it? (Moderator)
Shoot, get in there with um! (Charlotte)
Deny the father. (Multiple voices)

Lois summarizes the basic strategy, saying, “You say, „We broke up. I was out there,
sleeping with everybody,‟ [and then] all kind [of] help comes to you. Because, if you
say you know who the daddy is, that‟s gon‟ bring him down, [and] that‟s not gon‟
help you much.” An unidentified speaker adds, “And, he ain‟t gon‟ talk to you no
more.”
Despite references to changing norms, participants say new mothers or newly
single mothers do not immediately see the need for these protective strategies.
More often, they learn from their own and their friends‟ initial efforts to gain child
support through the court. Lois recounts a typical experience that encourages
mothers to deny everything in order that the system not deny them benefits and not
take their support from other sources.
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For example, I had two jobs. I hardly got to see my kids, and was denied
everything—Section 8 housing, all kind [of] benefits. They told me I was making too
much, so I quit working. I got overflowed with benefits, and I got time to spend with
my children. So when you out there trying to do something to make it, successful on
your own, it‟s not gonna help. It‟s so cold. It‟s horrible.
Without a job or other sources of support, participants agree with Edna‟s conclusion, “Oh, [then] they
give you everything! Everything is free.” Still, participant agree the freedom is a “trap,” because, as
Paula adds, “[Y]ou need day care while you working.” Charlotte declares, “Don‟t get a raise!” The
extra income, participants explain, disqualifies the working mother or parents, leaving household
income constant or decreasing it. When the moderator asks if getting welfare requires at least
looking for job, Edna replies, “Well, if you pregnant, you get the year off [before having to seek
employment]. Then, they pay for your education.” Paula adds, “If you working, they don‟t help [a
pregnant woman] do nothing.” The participants seem to be saying, the moderator suggests, that the
system pays African American mothers to have babies. Edna agrees: “Pretty much. You are [paid to
have babies]!” Charlotte concurs: “That‟s right!”

Having a baby qualifies a mother for system benefits, but, across the groups,
participants contend that she must also surrender control of her life to remain
qualified. To avoid surrendering control, participants agree with Lois (G5), who
contends, “You literally have to lie to the system to get any type of benefits. When I
told them the truth—I told them I had a car, I had a job—they told me, “No, no,
no.” Margaret adds, “You can‟t tell them you have a bank account.”
Group 4‟s views of “the system” differ from those expressed by other groups on
particular but not general conclusions about restrictive regulations. “It just depends
on who you are dealing with [in the system],” the dissenters insist. “What‟s going on
at that present time determines the service you gonna get from someone.” As with
other strategies to improve health care interactions, the dissenters concur with
general conclusions that present the key problem as a mother‟s inability to predict a
positive outcome for any strategy. Group 4 dissenters therefore argue that “it
depends” means that the “luck of the draw” determines the quality of service
received during interactions.

Whereas negative stereotyping and complex restrictive regulations are
constants, workers‟ attitudes vary by the day of the week and the time of day. Long
hours, stress, and shifts further influence whether a mother encounters a typically
nasty or nice worker at a facility. In general, participants across the focus groups
agree, it helps to know someone who works at the facility, or someone who knows
an employee. The need to know someone could promote networking to share these
contacts. However, this sharing, participants note, poses the same problems as
other forms of networking. Hoarding resources and hurt feelings occur when sharing
information is read as flaunting achievements. The information seeker becomes
vulnerable to the other person‟s self-promotion or self-aggrandizement.
The Moderator asks whether mothers can make unpredictable interactions
predictable. Across the groups, participants agree with Evelyn (G5): “No, no you

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can‟t. You can‟t, you can‟t.” An unidentified speaker expresses what follows from
unpredictability: “You deal with it as it comes.” To deal with what comes,
participants say, it is best to lie when possible. Thus, aside from denying knowledge
of who fathered a child, mothers deny assistance from family and friends, thereby
making it appear that residents of the community do not help one another. “They
ask me if a friend gave me $20,” Lois contends, “[and] I have to say she only gave
[it to] me one time.” Her comment sparks a humorous though serious discussion as
Group 5 compares and contrasts questions that social service workers ask to
calculate to the penny an applicant‟s supplemental support. Charlotte wins the
question contest. “I think the dumbest question [is] „How much money do you have
in your pocket?‟” Accountable for their income down to pocket change, participants
see it best to declare, in Charlotte‟s words, “We broke!”
For mothers, declaring themselves broke becomes a means by which to
creatively refuse to allow “the system” to “break” them, their parents, and their
children‟s fathers. Effective mothering means devising practices to break negative
cycles to extent possible, while taking care of immediate needs. Margaret (G5)
explains that it is better to work the system than to act in accord with its regulation.
[I]f you have a father that take care of his child (say, he pays a third of your bill, and
say, you get laid off), and you go and apply for assistance, [then] you are getting
nothing, because he is working and you have child support. Well, he is not the one
who needs the help. I need some help until I get another job. Ah, but because he
has a job and he‟s outside the household, you are not getting any money. And, if
he‟s inside the household, you certainly ain‟t getting nothing! So, how do you win?
Like when I had my child, her father had a really good job, [but] I still put him on
child support and everything. [W]e had to go to court and everything, [and until the
court issued its order] I was getting money [from the state]. And it was $275 a
month from August to January. So, by January, they said I owed them [repayment].

Group 5 laughs intermittently as Margaret tells her story. Over the laughter,
Charlotte restates participants‟ general conclusion about the system‟s motives:
“[T]hey wanted to charge the father.” The other participants agree that “wanting to
charge” the father means the state intends to qualify males for jail or prison when
they cannot pay.
Margaret continues her story, revealing that court-ordered child support
means no support for children until their mothers repay the state.
I owed them $2,000 back, and I was only getting $275 a month for, maybe, four
months. So, I was to get $900 child support, [but] for four months, I didn‟t get shit!
So, I was broke. They were taking all the child support I was getting from my
daughter‟s dad. And, they were taking it all back, before I got anything. So that‟s,
like, why you don‟t do it.

Charlotte recounts a similar experience and concludes, “They get they‟re‟s first…
[and that] weights us down even more, [because] they do take it back.” Although
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mothers awaiting child support must repay the state, participants contend, their
children still may not qualify for AHCCCS, because the state expects the mother to
pay for health insurance from child support. If she can pay for private insurance, as
Margaret declares: “They say, „Oh, we see you have medical.‟ And on the paper, it
says they aren‟t supposed to take back more than they should. That‟s a damn lie.”
Charlotte, never deterred from her protective intergenerational strategy, adds,
“That‟s why our fathers don‟t want to work. They owe so much Economic Security!”
Edna provides the final piece. “Get any support from the government, and workers
see all your support coming out their pockets.”
My ex-husband was paying child support, and I could get that check directly to me,
but it would be counted as income, and I would have to start paying out of that child
support check rent or whatever. It would be deducted out of my food stamps, but,
as soon as I turned that check over to the system, “Oh, that‟s okay, as long as you
give us the check, [then] it‟s not counted as income.” So, I turned [it over to the
state]. He paid, like, $390 in child support, but, if I let the state take that check, I
could get about $50 more.
Then the people at the store wanna tell you, “You can‟t buy this, you can‟t buy that.”
And I‟m, “This is, ah, this is my money. I only get $50 of state money.” If I could
have his check in my hand—it‟s weird how they want you be in the system to
benefit—but if you get in the system, you‟re just another groat.

Once caught in the welfare trap, focus group participants say, a mother
cannot afford a job, unless she lies about support until her income amounts to an
escape route. It is wise, they maintain, to refuse entering the system whenever it is
possible to get by without its benefits. An exchange in Group 5 captures these
points and the general conclusion that all focus group participants draw from them.
[I]f you ain‟t in the system, then how they gon‟ have some jobs that‟s helping you
get in the system? (Margaret)
They want you to be in the system, just like they want you to go to jail! (Lois)
Uh-huh. It‟s all the same, ain‟t no jails, ain‟t [no prison] workers. (Margaret)
That‟s for real! (Lois)
No pregnancies, no [health care] workers. No health clinic, you know what I mean.
No babies, they ain‟t getting paid. (Margaret)
[Health care workers would be like Southside residents]. You can‟t find no job on
credit. You can‟t get no health care on credit. You die. (Lois)
The whole Southside will be dropping like flies. (Margaret)
All the Black people will be dead. (Charlotte)

Participants see individual and community strength in strategies that mothers devise
to reverse role model, and turn stereotypes to their advantage, because doing so
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helps break silences and negative cycles. However, they must always weigh longterm community development against fulfilling immediate individual and family
health care needs.
Resources in South Mountain or South Phoenix are generally scarce, the focus
group participants emphasize. However, they also point out that access to them is
restricted, because mind-sets about African American cultural boundaries, including
proscriptions and prescriptions, discourage using some existing services (e.g.,
adoption and mental health), and encourage destructive overuse of others (e.g.,
abortion). Instruction about the basics of sexuality and reproduction—at school, at
home, or in the community—is poor and it comes too late. Advertisements for health
care and other social services are inadequate or inappropriate, providing residents
with little information for effective reproductive planning. Meanwhile, other social
factors promote conditions that encourage children to become parents at a very
early age. Busy with work and other obligations, parents have little time for
community building that would improve health care outcomes.
Yet neither the absence of community nor the absence of community
strength means that residents are “dropping like flies.” Many effective mothers,
despite sometimes “running on empty,” devise means to confront community
“realities” that weigh against obtaining quality health care and against constructive
use of social services. Most often, mothers manage problems individually, and
without fathers‟ assistance. However, focus group participants see individualism as
one of many obstacles to community development. Residents must overcome these
obstacles among themselves, and in competition with other races, ethnic groups,
and crosscutting class strata. To promote the joint action they must come together.
To solve community problems, they must confront the interracial and intra-racial
mind-sets contributing to the bias complex (e.g., age, race, color, and class) that
produces candy-coated racism. Mothers, as residents and patients, cannot ignore,
avoid, or confront these biases without escalating altercations in health care
interactions and during gatherings intended to promote joint action. By insisting on
“keeping it real,” focus group participants disclose the “reality” they contend South
Mountain or South Phoenix residents must address to build and strengthen
community, as an African American segment of an interracial and interethnic
population.

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Appendix 1
Focus Group Script and Topic Scenarios
I.

Introduction

Introduce self, co-facilitator, note taker, and members of focus group committee
who are present.
Read the Alliance statement of goals.
“The Alliance for Innovations in Health Care wants to improve how
women most in need of health care receive it. The Alliance is researching
how women get health care, whether the care received is satisfactory,
whether, over time, women continue receiving health care for themselves
and their children, and whether they have healthy results from their
efforts.
Your participation in these focus groups will help the Alliance discover,
through your experiences and knowledge of your community, what
aspects of health care provision and delivery are most and least
satisfactory. The Alliance is interested in learning from you how to
increase satisfaction and healthy results by better understanding the
strengths you reveal for your community and how health care service can
make use of these strengths.”
Read the Alliance Privacy Statement and get permission signatures.
Distribute and collect the completed Profile Questionnaire.
II.

Begin 90-Minute Session

Read Instructions
Over the next 90 minutes, I will read six statements describing family and
community situations that represent issues on which the Alliance seeks your opinion.
Persons presented in these statements are fictional. We intend them only to spark
discussion on the issues implied. After each statement, I will open discussion for
views based on your experience.
Occasionally, to keep the discussion focused, I may ask follow-up questions.
Otherwise, please feel free to join in the discussion. You do not need to raise your
hand, but only to enter in a manner that allows others to finish their thoughts.
There are no right and wrong answers. You may agree or disagree with what others

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are saying. As the discussion progresses, you may revise or add to your thoughts.
Other than being polite to one another, there are no politically correct restrictions on
language or points of view. The Alliance wants to know what each of you think. It
wants to gain views that may help it in providing better health care experiences for
African American women and their children.
After 25 minutes for the first topic, I will read another statement, allowing roughly
15 minutes for consecutive topics. We will follow this procedure until we have
addressed the six topics.
Read scenarios (The co-facilitator will signal time for topic changes consistent with
the progressive timing of each as it varies by focus group.)
Topic 1: Access
Consider Kesha—full-figured and dark-complexioned, girl—who was born and raised
in the South Mountain area. Based on your own experience, at what age does she
first gain knowledge about how a woman becomes pregnant? When does she learn
means for preventing pregnancy, and gain prenatal and other health care service?
Moderator Prompts: Use only if the discussion does not address these issues.
1. Keeping in mind your own or the experience of women close to you in South
Mountain, what might encourage or discourage using health care services?
2. What tasks may decrease her chances of happy healthy pregnancy, and make her
sad and stressed about being pregnant, and about health care for her and her baby?
What increases her chances of a happy healthy pregnancy?
3. What are the greatest obstacles she faces in the community, in her family or
friendship network? What obstacles does she face during health care and other
social service interactions?
Topic 2: Deliberation
During a health fair, you overhear some health care professionals talking. They say
women in South Mountain do not plan to have children; they just have them. They
do not care about their health during their pregnancy. For their babies‟ health, they
just take their chances, letting the babies grow and hoping for the best. They do not
consider nutrition and disease-prevention health care. Later you are on a panel with
these professionals. You take the opportunity to respond to the views you
overheard. Again, thinking about Karla, your own health care concerns, and those of
women you know well in South Mountain, tell me how you respond to what you
overheard.

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Moderator Prompts: Use only to probe generalizations in respondents‟
statements.
1. Are you saying this so for first as well as later pregnancies?
2. Are you saying this is so for most women you know or for only a rare few?
3. If the professionals‟ views are false, why do you think they have these opinions?
4. If opinions are true, why do you think some women do not plan pregnancies, and
pay attention to their own and their babies‟ health care needs?
Topic 3: Coping:
Kesha is a middle child. She has a brother Kari and a sister Karla. Kari is two years
older than Kesha, and Karla is two years younger than Kesha. Her mother and
father, Katherine and Kelvin, both work, but seldom have jobs that paid above the
minimum wage. They do their best to provide for the three children. The community
respects them as honest, hardworking, and God-fearing.
Karla, sharing her mother‟s light complexion, too often thought herself “cute.” No
one in the family knew she had received treatment for sexually transmitted
diseases—first, Chlamydia, and more recently, gonorrhea. She often ditched school.
By 16, she was an unwed mother of two. Kari, an extraordinary athlete, completed
high school, but teachers always complained that he was an academic
underachiever. By 20, he fathered two babies—one with Hispanic and the other with
a White woman. He is proud of his babies, but has little income for their support and
time for their care. By age 20, Kesha has no children. She finished high school and
vocational school. She is a dental assistant. Tell me how you would explain the
differences in Katherine and Kelvin‟s children‟s involvement with having babies.
Moderator Prompts: Use only if discussion does not provide specific explanations.
1. Do you think the children had to cope with different kinds of problems or took
advantage of different opportunities?
2. How might their age, sex, and place in the family have influenced their
opportunities for self-development, and having and raising children?
3. What difference in supports or obstacles might they face in their family? What
community values might influence view of opportunities and obstacles?

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4: Did the level of formal education influence how they saw and responded to family
and community supports and obstacles to gaining health care and other social
services?
If respondents concentrate on obstacles, probe for supports.
Topic 4: Community Strength:
Behind her back (and when angry, to her face), Kari and Karla call their sister,
Kesha, “Miss Know-it-all.” They tell her she is self-righteous. She has a habit—they
think she picked up from their mother—of telling them, “There are none so blind as
those who refuse to see.” Assume Kesha‟s comments refer to the resources for
health care and other social service in the South Mountain. Tell me what Kesha
thinks Kari and Karla refuse to see that could help them with their lives; especially in
getting health care and other supports for themselves and their children.
Moderator Prompts: Use only if discussion does not provide specific explanations.
1. What may keep them from seeing these resources?
2. What might make it harder for Karla and Kari to take advantage of resources that
Kesha thinks they refuse to see?
4. What changes in the community or in how health care services operate might
help them take better advantage of available resources?
Topic 5: Recall
When Kesha, Karla, and Kari complain about racism and discrimination in health
service, Katherine and Kelvin shake their heads. They tell their children they just do
not know how bad things used to be. When Karla complains about the bad
treatment she receives when she goes to get food stamps, WIC, and health care for
her baby, Katherine tells her that she should be grateful she is living in these
enlightened times.
She reminds Karla of a time when, as an unwed mother, she would have been
unable to hold her head up. When Kari complains about low-paying dead-end jobs,
Kelvin tells him he ought to have thought about that before he lowered his zipper
one time too many and now cannot support his babies. He reminds Kari that
available jobs and wages were worse in his early years, but still he kept a roof over
their heads and food on the table. Miss Know-it-all chimes in saying, “Life is just
what you make. Racism is no excuse, because it has always existed, and will always
exist in America.” Besides, Kesha tells them, racist people are just a few bad apples.
They should just ignore them. Based on your own and your close friends experience

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with social and health services, tell me whether you think Karla and Kari are just
complaining, and whether ignoring the problems will help them.
Moderator Prompts: Use only to clarify issues respondents‟ terms, expressions,
and unexplained implications.
1. Do you recall any race-based events that influenced your using health care
services?
2. Are these experiences best explained as acts of a bad apple or are they part of
health care services‟ views of African Americans?
3. Do you consider these experiences when selecting health care providers and
social service programs that might help you and your children?
4. What do you do, if you think there is no alternative facility to which you can
transfer your own or your child‟s health care needs?
Topic 6: Refusal (if running over time, begin with description of conduct for
second child)
For Karla‟s first baby, after all the shouting stopped in her own and the father‟s
home, the parents were full of advice. They told Karla about programs to which she
should apply. Karla made and kept doctor‟s appointment. Her baby‟s father went
with her to birthing classes, and to get information on health care and social service
programs. Together, they learned about how drug and alcohol consumption might
harm their baby‟s development. Karla signed up for programs, such as food stamps
and WIC. She went to offices for other programs she had learned would help her
with parenting skills and provide information on child nutrition. For her second child,
the parents shouted less and offered less advice. Karla went to the doctor only when
she had pains and feared something might be wrong with the baby. The baby‟s
father—the same for her first child—discouraged her attending birthing classes. He
told her, if she went, he would not go with her. She did not attend these classes.
She did not sign up for food stamps and WIC. She avoided social workers that
offered advice and information. She cared for her baby the best she could with
money she earned, and the small support the father gave periodically. Considering
your knowledge of friends or family members whose behavior is similar to Karla‟s
and her baby‟s father, tell me why you think they responded differently to health
care and social service for their second baby.
Moderator Prompts: Use only to gain details about specific services, facilities, and
practices respondents mention.

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1. Did the couple think they knew the routine and did not need
advice, information, and birthing classes?
2. Do any views or values in the community, generally, or among
health care providers, particularly, account for refusing to take
advantage of available service for the second baby, which they
used for first?
3. Could their experiences using services for the first child discourage
using the same facilities?
III.

Close

Thank respondents and turn group over to Alliance member to explain what the
Alliance plans to do with the focus group findings. Distribute fees, collect receipt
signatures, and offer respondents refreshments

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Appendix 2
Informed Consent and Permission Form
Alliance for Innovations in Health Care and
the Maricopa County Department of Public Health
By participating in this focus group, you understand that you are asked to express
your views according to the instructions provided for the purpose of a 90-minute
focus group on health care service and delivery issues, as these bear on your
understanding of your community. By participating, you grant permission to
audiotape the discussion, and take one group photograph to assist the transcriber in
matching speaker to chair number. You grant the Alliance use of the data generated
from these tapes. Your decision not to participate, or lack of willingness to be
recorded and photographed, will have no affect other than dismissal without
payment of the $50 fee, which is contingent on participation. Participation incurs no
cost or future liability of any kind on your part or that of the Alliance.
For all participants, the Alliance will make every effort to safeguard the privacy and
confidentiality of personal-identity information. This includes restricting use of
information to the research team involved in data collection and analysis. In all
documents and public presentations resulting from data analysis, never will your
name be linked to any portion of that data. Instead, all quotes, and other forms of
attributions will employ assigned numbers and fictive names to material used.
It is highly unlikely that you will experience an injury by participating in this focus
group. In the case of injury or illness resulting from your participation, emergency
medical treatment is available, but will be provided at the usual charge. No funds
have been set aside to compensate you. This does not waive your rights in the
event of negligence.
For questions, contact Rose Howe, Maricopa County Department of Public Health, at
602-372-1441.
Your signature indicates that you have read the information provided above and
have decided to participate in this focus group under the specified conditions.
Signature
I agree to take part in this focus group.
Print Name

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Signature

Date

Time