The Burden: Living at the Intersection of Being Black, Female, and Middle-Class within the U.S. Healthcare System

Background and Purpose: Research shows that accessing and engaging in the U.S. healthcare system can serve as a source of stress for Black women (Chinn et al., 2021; Sacks, 2019). Studies have also shown that once in the healthcare system, Black women disproportionately experience inadequate care (Chinn et al., 2021). Within the healthcare literature, Black women have reported experiences with discrimination and doctors not taking their concerns seriously (Bailey et al., 2017; Sacks, 2019). Rarely do studies center the experiences of Black women within the U.S. healthcare system and there is even less evidence outlining Black women’s experiences during dual pandemics: COVID-19 and racial unrest. The purpose of this study is twofold: explore how middle-class Black women make meaning of their experiences within the U.S. healthcare system during the dual pandemics of COVID-19 and racial unrest and examine how Black women’s experiences within the U.S. healthcare system is informed by their sociocultural contexts.

Methods: Forty-three in-depth, semi-structured interviews were conducted with Black women 21 years of age and older who self-reported experiences with COVID-19 and racial unrest and self-reported middle-class status based on their education, income, and occupation. Women were recruited using participant driven sampling methods (snowball sampling), social media, and emailing flyers to various social groups that predominantly served middle-class Black women (e.g., Black female sororities and professional organizations). Interviews focused on questions that elicited the women’s perspectives on how they created meaning regarding their experiences with engaging in the U.S. healthcare system during the dual pandemics: COVID-19 and racial unrest. Interviews were transcribed verbatim, analyzed, and coded using the constant comparative method of grounded theory.

Findings: Findings highlight that middle-class Black women’s experiences within the U.S. healthcare system is historical and focused on the tenuous position of their racial identity, gender identity, and middle-class status despite their improved life chances based on their class standing. Simply put, nearly all the stories the women shared elucidated the ways that they had to move within the U.S. healthcare system given their social identities (e.g. Black, female, and middle-class). This experience was characterized as “The Burden.” The Burden had three categories: (1) stressing, (2) making sure I’m safe, and (3) getting my needs met. Combined, these three core categories formed the meanings middle-class Black women associated with their experiences within the U.S. healthcare system given their sociocultural contexts at the height of COVID-19 and the racial unrest.

Conclusion and Implications: Examining middle-class Black women’s experiences within the U.S. healthcare system beyond the poverty discourse is a neglected topic. Results of this study suggest that middle-class Black women are a unique group, existing at the intersections of a number of incongruent status positions in the social hierarchy especially during the dual pandemics of COVID-19 and racial unrest. Findings also suggest the need for further investigations by social work researchers that explore the unique ways in which race, gender, and class intersect and remain salient in the lives of middle-class Black women.