Weathering, a theory that the stress of racism has biological effects on black people, could be a cause behind black maternal mortality rates.
Imagine for a moment that you’re a very silly 22-year-old driving through Florida sometime around 2009. You’re speeding down a road called Alligator Alley at approximately 92 miles an hour, which is about 20 miles above the speed limit. It’s late. Maybe the windows are down. Maybe the music is blaring. Maybe you’re singing off-key. You’re basically living your best life until police lights appear behind you, and you remember you’re not in a coming-of-age film. You’re a black woman driving alone in the middle of the night. In the South.
This is how I die, you think, as a stoic police officer takes your license and registration from your shaking hand. The police killing of Michael Brown that thrust Black Lives Matter into the national spotlight hadn’t happened yet. But you grew up hearing about Sean Bell and Amadou Diallo, Brown’s forefathers on the list of black people killed by police, his companions in this traumatic, helpless club. You know how dangerous this can be.
The police officer walks away. After what feels like an eternity, he returns.
“For the love of God,” he hisses, handing you back your information. “You really need to slow down.”
You didn’t get a ticket. You really deserved a ticket.
The officer leaves, but your heart won’t stop racing, and your muscles don’t relax. You’re still shaking, and your breathing doesn’t slow. There’s nothing to do but sit there, wading through fear and the feeling that you got lucky, then keep driving.
I was that 22-year-old who thought she was going to die in the middle of the night on a Florida road. I know very well the visceral fear that comes from premature death being an acceptable hazard of the black American experience. I understand what it means for racism to be such a fact of everyday life that my first thought when I got pulled over wasn’t “I hope I don’t get a ticket” but “I hope I make it through this alive.”
The term “weathering” describes how the constant stress of racism may lead to premature biological aging and poor health outcomes for black people, like disproportionately high death rates from chronic conditions such as heart disease, stroke, diabetes, and most cancers.
Mental anguish and stress from “fighting against larger structures and systems can have an impact on your health,” Joia Crear-Perry, M.D., founder and president of the National Birth Equity Collaborative, tells SELF. This, in a nutshell, is weathering.
Weathering plays a significant and intriguing role in conversations about black maternal mortality, a public health crisis based around the fact that black women are three to four times more likely to die from pregnancy-related complications than white women in the United States, according to the Centers for Disease Control and Prevention (CDC). As part of our ongoing series on black maternal mortality, we’re unpacking how weathering works, why it matters even if you’re not pregnant, and what you can do with this information.
Any kind of long-term stress can affect your body. “We’ve learned a lot about what stress does to your body and your organs and how it accelerates the aging of your cells,” Arline Geronimus, doctor of science, professor at the University of Michigan School of Public Health and member of the National Academy of Medicine, tells SELF. “This has helped me understand how lived experiences become biology,” says Geronimus, who first coined the term “weathering” with her landmark 1992 Ethnicity & Disease hypothesis on the subject.
Stress is your body’s natural response to perceived danger. It’s actually meant to be helpful. When you experience stress, your brain’s hypothalamus prompts your adrenal glands to release hormones including adrenaline and cortisol, according to the Mayo Clinic. These hormones can impact a host of bodily functions, like increasing your blood pressure and quickening your heart rate. All of these physiological changes allow you to fight your potential stressor or flee from harm (hence the term “fight-or-flight response”).
To illustrate how this works, Dr. Crear-Perry uses an example far too many black people can relate to: a store employee following you for no reason besides the color of your skin. “Your heart starts racing, and you start breathing faster,” Dr. Crear-Perry says. “That's a natural physiological response to the stress of being a black person in America.”
Stress responses that happen infrequently and last for a few minutes or so are perfectly normal, but chronic stress can be really detrimental to your health. (“Tell me something I don’t know,” you say.) Chronic stress can make you more prone to mental illnesses like depression, according to the American Psychological Association (APA). It can lead to migraines, tension headaches, and backaches. Chronic stress can also impact your blood vessels, arteries, and heart, which over time can raise your cholesterol levels and even increase the risk of a heart attack. Then there’s how you deal with this stress. If it’s by drinking more than a moderate level of alcohol, smoking cigarettes, or other unhealthy behaviors, that can only compound your risk of health issues.
Chronic stress is unhealthy for the average person, but these symptoms can be even more worrisome for pregnant people. If symptoms of stress like trouble falling asleep, loss of appetite, and headaches get severe enough during your pregnancy, they can impact you and your growing fetus, according to the National Institute of Child Health and Human Development (NICHD). High blood pressure—which chronic stress can absolutely help induce—can directly increase the chances of having preterm labor as well as a baby with low birth weight, the NICHD explains. Those kinds of poor birth outcomes were the impetus for Geronimus’s weathering research.
Geronimus came up with the idea of weathering while examining why teen moms have overall higher rates of preterm birth, low birth weight, and infant death, with young black mothers having even higher rates than young white moms. She became interested in this area of study after working with several groups of black teen mothers as a young research assistant. Geronimus’s theory was that if she could take into account the different life experiences between black and white teens (like income levels), birth outcomes would improve the longer people waited to get pregnant, no matter their race. To find her answer, she dug into large pools of data like the CDC’s information on birth outcomes in 1983 among people aged 15 to 34 of various races.
“When I actually studied it, I began to see I was wrong,” Geronimus says.
What Geronimus found was that birth outcomes worsened among black moms as they aged. “If you were black and a teen mom, you had better birth outcomes even when compared to your 20s, and certainly by the mid or late 20s,” Geronimus says. The same wasn’t true for the white moms she studied.
In response to this finding, Geronimus developed the theory that weathering was a form of premature aging due to exposure to social inequity, she explains. The term is meant to capture the positive connotation of weathering (making it through a difficult experience) along with the negative implication (being damaged in the process).
Oppressed groups are essentially put between a rock and a hard place, Geronimus says. “They [are] expected to do things even though they were set up for failure, and if they [succeed] at them, it [exacts] a physical price.”
Since first publishing her theory on weathering, Geronimus has conducted more research to see how it holds up. In 1996 she published a study in Social Science & Medicine that looked at 54,888 births in black and white Michigan residents between the ages of 15 and 34, finding that as the black moms aged, they were more likely to have low birth weight and very low-birth-weight babies. The effect was more severe for black women living in low-income areas, but it persisted no matter their income level.
One prime question in weathering research is how discrimination can lead to tangible negative health outcomes. In 2010, Geronimus and her fellow researchers published a study in Human Nature, examining how telomere lengths differed in 110 black and 105 white women from 49 to 55 years old. Telomeres are “stabilizing caps” located on the ends of chromosomes that protect DNA, sort of like the plastic ends on your shoelaces, Geronimus explains. They naturally shorten during cell division and throughout your aging process, but there’s also research to suggest that environmental factors can speed up that deterioration. A 2013 literature review published in the Journal of Internal Medicine notes that one of the most robust studies on telomere lengths suggested a 25% risk of early death among people with the shortest telomeres. Because of that, Geronimus and her team theorized that telomere lengths could be an indicator of weathering. They found that, based on telomere length, black women in the age range of 49 to 55 were on average 7.5 years “older” biologically than white women of the same age, though they note the various limitations to the study, like small sample size, and say more research is necessary before reaching a definitive conclusion here.
But the ability to measure how overexposure to stress hormones can cause biological damage, known as the allostatic load, may give Geronimus’s theory more scientific credence. Allostatic load is measured through a composite index of lab test results indicating stress-related wear and tear across the body, Geronimus explains. Various research points to racial disparities that can’t be fully attributed to things like differences in income level.
To further illustrate the idea that weathering is a biological process that can happen across socioeconomic status, in 2015 Geronimus published another study on telomere length, this one in the Journal of Health and Social Behavior. The study authors examined the telomere lengths of 239 black, white, and Mexican adults living in Detroit who spanned a range of low to moderate incomes. The researchers found that white residents who lived in poverty had shorter telomere lengths than their white moderate-income counterparts, black residents had equivalent telomere lengths regardless of income level, and Mexican residents living in poverty had longer telomere lengths than their Mexican moderate-income counterparts.
“This [outcome] is actually what my colleagues and I had predicted because [weathering] is not about poverty itself,” Geronimus says. Instead, it’s about how others in your environment treat you based on race, which financial security can’t always change. For instance, middle-income black residents who still had relatively short telomeres were spending time in environments where they were subjected to othering and social isolation, which “was affecting their telomere lengths from a kind of prolonged [physiological] stress,” she explains. This study was also limited by issues like small sample size, but it still adds to the collection of evidence that racism may affect health.
Geronimus’s research on Mexican residents in Detroit (many were born abroad) complements recent research on birth outcomes in African immigrants and U.S.-born black women. A 2017 Medicine study looking at 1,121 black women born in the United States and Africa found that participants who had recently immigrated had lower rates of preterm birth than the U.S.-born black Americans (though they’re certainly not immune from pregnancy and childbirth complications).
“There’s a toll of having to prove yourself all the time and interact with the people who disparage you and oppress you,” Geronimus says.
There isn’t yet a quantifiable amount of stress we can point to that indicates if someone will experience weathering, Geronimus says, or an exact age when its effects begin. But this wealth of research does help challenge the frustrating notion that oppressed people can simply “pull themselves up by their bootstraps” to eliminate disadvantages and disparities.
The concept of weathering explains, at least in part, why factors like education, income, access to health care, and pure willpower can’t fully insulate you from poor health outcomes. However, it’s key to see weathering as one of many frameworks seeking to understand how racialist stress impacts black people, Angela Aina, M.P.H., co-director and research lead of Black Mamas Matter Alliance, tells SELF. As an example, Aina cites the Sojourner Syndrome framework developed by anthropologist Leith Mullings, Ph.D. The Sojourner Syndrome framework is the idea that factors like race, class, and gender all work together to create very real barriers to good health. While a lot of weathering research aims to look at race on its own, the Sojourner Syndrome framework argues that none of these factors can be separated from the others. It was built on the research of Sherman A. James, Ph.D., who invented the term John Henryism, another framework that explores how black people pour a lot of effort into coping with stressors like discrimination, and how that effort can be damaging to their health.
A 2016 study published in Souls: A Critical Journal of Black Politics, Culture, and Society analyzed the way that “respectability behaviors” impact health. As strategies people employ to try to manage other people’s perceptions of them and avoid discrimination, respectability behaviors are an example of the coping efforts described in John Henryism. The study, which included survey data from 3,015 black people over the age of 18 living in Chicago, found that black people who engaged in “vigilance,” or the anticipation of discrimination or racism, had higher reports of chronic illnesses including hypertension and depressive symptoms. This study and its adjoining “vigilance” framework join a long and robust history of research on how navigating everyday life as a black person in America can quite literally be bad for your health.
This brings us to the crux of our exploration: weathering and black maternal mortality. In New York City, a college-educated black woman is three times more likely to experience severe maternal complications than a white woman without a high school education, according to a 2016 "New York City Department of Health and Mental Hygiene’s Severe Maternal Morbidity" report.
Weathering seems to be an inextricable part of black maternal mortality. Pregnancy offers a compelling opportunity to study weathering in a concrete way. It’s a relatively short-term medical condition with very measurable outcomes like birth weight or infant mortality, “whereas things like hypertension or diabetes take decades [to develop], and it’s harder to pinpoint the root cause,” she says.
That also means there tends to be more direct weathering research on infant outcomes, not other reproductive outcomes like maternal mortality. It’s not as though any researcher has been able to study exactly how much of a role weathering plays in the deaths of the black people we lose every year due to pregnancy or childbirth complications. But it’s only logical for a phenomenon that could so impact infant outcomes to have the awful power of harming their pregnant and postpartum parents too. A 2019 study in The Journal of Maternal-Fetal & Neonatal Medicine found that every 1 out of 270 births in California involved both preterm labor and severe maternal health complications. The two are often terribly and closely connected.
Reading all of this probably felt demoralizing. Reporting it definitely did. So what can you do with this information as a black person?
The obvious advice some would offer here for combatting weathering—whether or not you're pregnant—is to find ways to destress, but that’s only helpful to a certain extent. Without addressing the root cause of racism, Dr. Crear-Perry says, we will continue to see health disparities, and we will continue to experience weathering. “It’s a constant mode of worrying,” Dr. Crear-Perry says. “So maybe ‘they’ need to stop making us worry so much.” Until then, self-care on its own isn't going to cut it.
With that said, if you don’t have a therapist and seeing one is feasible for you, that can be another part of your tool kit in fighting weathering. Granted, that can come with its own set of issues (like the stress of finding an affordable therapist or dealing with one who doesn’t understand where you’re coming from), but sometimes it’s better than nothing.
If you're black and pregnant, educate yourself about the conditions and complications you're more likely to face. The onus should not be on black people to save ourselves from maternal mortality and other poor health outcomes, Dr. Crear-Perry notes, but advocating for yourself is necessary sometimes. Dr. Crear-Perry stresses the importance of trying to find a provider you feel comfortable with and of bringing a friend or partner with you to doctor’s visits to help you parse information if possible. Many pregnant black people have also sung the praises of having a doula or other birth advocate (especially one of color) committed to helping them have the best birth possible.
Finding solidarity and community can be helpful in the fight against weathering for pregnant and nonpregnant people alike. Aina notes that engaging with and relying on people who can speak to your cultural experience can help shore up your emotional stores, whether you’re talking about a microaggression you dealt with at work or navigating birthing options while black and pregnant. “You can also take that next [step]. You may be looking for, for example, pregnancy support groups [and] want to be with people who may be more culturally relevant to you in your experiences. That is where local organizations within our Alliance come into play,” she says.
Black people deserve support for the enormous stresses of everyday life in a racist society. We should be able to live and breathe and birth and love without the wear and tear of discrimination—and the fear of it—burrowing into our cells and bones and blood. For now, that’s just a fantasy. At the very least, know that I’m dreaming it right along with you.
This story is part of an ongoing series on Black Maternal Mortality. You can find the rest of the series here.
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