Barely an hour into the hike, each step up the steep incline on Mount Mulanje in Malawi reminded me of the weight of my backpack. Midway up the rocks, the guide, my friend and the porter who carried her pack and I all rested. On this small landing sat three small girls who waited and played with each other’s hair as the woman accompanying them spread out torn cloth to gather the firewood she collected. She climbs up here every week. Not long after we arrived, three young women fiercely and confidently stomped down that same steep incline barefooted. They were carrying large piles of firewood on their heads. Their bodies dripped with sweat and their faces were not pleased. They looked hot, pissed and ready to be done.
I turned to the guide and asked why these women collected the firewood given that the terrain was so severe.
“Collecting firewood is seen as a woman’s job. It doesn’t matter if they have to climb the mountain. In fact, sometimes they have to go even further up than this to find dry enough wood.”
Something doesn’t seem right about this picture. The hike I did last weekend for fun is what these women have to do every week, sometimes more, just to support their families. Here I am, with my backpack, sunscreen and bottles of water lamenting about the steepness of a hike I made the choice to do. I couldn’t help but wonder whether those pissed off looking women were pissed off looking at me.
“People don’t understand that women have rights,” commented my workmate who invited me over for supper at her home one week later. I asked her what the jobs were assigned to men; she informed me that their only task was to construct the house.
“That’s usually a one time thing, isn’t it?” I asked.
“Yes. One time. And when the man and woman leave the field, the man walks free while the woman carries the wood on her head, the tools in her hands and a baby on her back. When she comes home, she must start preparing the food and the man just sits.”
Our conversation continued on about gender roles in the villages and the challenges in changing cultural mindsets. We discussed the state of women’s rights in Malawi, the level of resistance to change and the impact that Joyce Banda, the recently unseated first female president had on it all. Because of President Banda’s involvement with the political corruption scandal, Cashgate, my workmate stated firmly that women’s issues have been set back, not forward. If the number of women in government provides any allusion to the advancement of women’s status, my workmate was right. The percentage of women in Parliament after President Banda’s term had decreased from 22 to 16, falling further below the 50% gender parity benchmark set by the Southern African Development Committee Gender Protocol in 2008.
My new surrogate aunts, Mercy, Esnath and Ms. Anakoma, are the three women who run the guesthouse where I lived in the rural district of Balaka, Malawi. They criticized my hair, provided unsolicited marriage advice and teased my cooking. You know, what aunts are supposed to do. They also always made sure I ate enough (which according to them I never did), had a warm bucket of water for bathing and advised me to stay away from Malawian men. They looked after me. Because of them, Balaka became a second home.
Esnath and Ms. Anakoma found me under the tree last Sunday morning and joined me on the ground. They opened up about their health issues. Recently, Ms. Anakoma has been in the hospital. First, she contracted malaria and then suffered from a respiratory illness and flared arthritis in her back. Esnath also recently returned from the hospital. She had an unknown pain in both of her sides for two weeks. The prescription she showed me was just a generic painkiller. When I asked her what they said was wrong with her, she said they didn’t know.
I told them about my upcoming trip to Zambia. “I need a holiday,” I exclaimed. They laughed and asked me a very poignant question—what about us? Neither of them had taken a holiday for well over five years. They work at the lodge seven days a week from 5am-7pm. Ms. Anakoma is always on call as she also lives on the property. She takes care of her granddaughters, two bright-eyed three-year old twin girls, by herself. When she’s not doing work at her house, she’s across the property managing the lodge.
Esnath doesn’t live on the property, but she’s also always on call. She manages the money, books the reservations, helps distribute meals, and checks in all the guests. She has two sons, ages 11 and 14. She leaves them in the morning sleeping and comes home at night to them sleeping. She never sees them. I told her that made me sad for her, particularly since she’s been spending so much time with me. She said that her kids are used to not seeing their mom, but the look on her face let me know that she too felt great sadness about the situation. She was recently advised at the hospital to drink 4 liters of water per day. When I asked her how much water she drank, she said barely 1 liter. I pointed at the kitchen sink, gave Esnath my stern aunty look and she immediately ran a cup under the faucet and began to drink. “Jude,” she endearing called me, “I am failing to drink enough water.”
Mercy, the cook, is about my age. She single-handedly cooks for every guest at the lodge for every single meal with the dullest knives in history. Right after she prepares breakfast, she begins cooking lunch; right after lunch she prepares dinner. Everything is deliciously and laboriously made from scratch so cooking takes ALL DAY. Sometimes she cooks on the stove in the kitchen at the same time she’s cooking on firewood outside. She does this all herself.
It’s no wonder the health of these women keeps failing.
During one night cooking together in the kitchen, they were all having a go at me about not being married and whether I would be able to take care of their sons (which they’ve volunteered “to give me”). When I told them that I wouldn’t cook for their sons every day, bowing before I serve them food and allowing them to eat first, they joked on about how American women are lazy and can’t work when they’re pregnant. I laughed with them even though clouding the joke was starkly high maternal mortality rates that plague Malawian women— 510 maternal deaths per 100,000 live births in 2013. In contrast, the maternal mortality rate in the United States is 28. This number, however, has more than doubled since 2000, making my home country the only developed nation where the number of women dying due to childbearing increases each year. Women’s roles put them at disproportionate risk for disease—since the most recent Ebola epidemic began, 55-60% of the victims worldwide are women, as high as 75% in Liberia specifically. Whether in a lodge or in the village, woman unjustly carry an unbalanced load. There’s nothing funny about that.
This is goes beyond the African continent. Black women in the United States carry a special burden deeply engrained into the fabric of American culture. There’s an assumption that we’re strong, impenetrable, and resilient. Not only can we handle the burden, we welcome it. Herein lies the danger of the “strong black woman” trope.
Undoubtedly, embodying the strong black woman can be protective— empowering black women to be tenacious in prioritizing goals, leveraging social capital, exercising grit and managing confrontation. At the same time, it is a weapon of illness disguised in positivity. “Strong” is not a compliment. It’s a stereotype that allows others to assign black women an unfair load. It justifies the abuse and neglect of black women and creates little room for them to be vulnerable and need help. It’s a stereotype that can protect and also destroys. The myth of the “strong black woman” is killing us, and at the same time it’s precisely what we cling to for survival.
So what next? Well, that’s the part they don’t teach us in school. Health issues for women of color still remain on the margins. But what they do teach us in school is to look for these strong black women (you’ll find this directive coded as “soliciting community champions”). They tell us to find the person in the community who is already overinvolved, overworked and overburdened and ask them to support our own projects and research agendas. But what they don’t teach us is to dig deep into the complexity of marginalized groups. Complexity cannot fit on a PowerPoint slide. Nuance cannot be graded on a rubric.
Did you know that a black woman in the United States is four times more likely to die from childbearing than a white woman? Maybe. This is what we call “health disparities,” a survey of statistical facts comparing one group to another, telling information we already know. This alone is insufficient for contextualizing the structural determinants that compromise racial health equity, barriers that have remained unchanged for decades. But do you know why a black woman continues to die more frequently from childbearing— the deep rooted historical structural factors, cultural articulations, political propagandizing and economic reinforcements that lead to this burden of disease? I’m not talking about the Social Ecological Model, the oversimplified theory that posits that behavior influences and is influenced by interrelated factors, from intrapersonal characteristics to public policy. Though the framework has potential to unleash real change into the ever evolving structural mechanisms that create the disproportionate disease burden put on marginalized people, I’ve only witnessed it fool people into believing they understand something that they don’t. Knowledge is power. The appearance of knowledge is dangerous.
What I am talking about is the intersections of sexism, racism, and classism, which the model implies but in cowardice does not name. Only by naming the historical inertia of privilege and discrimination can truly public health understand and act on the disparate health outcomes, like how the construction of a hegemonic black femininity and the “strong black woman ” trope impacts the help-seeking behaviors of black women and our health outcomes overall.