At first glance Stress and Resilience by Leith Mullings and Alaka Wali could be understood as a contemporary reproductive health–related revision of Carol Stack’s work on networks and family among African American women. But the ethnographic and statistical data that Mullings and Wali present offer a much more complex and holistic view into the connections between health and social and reproductive life. Theirs is an attempt to seek further understanding of the strategies and structural components of health care in the United States and to examine the constructed concept of health itself in the context of Harlem. Far more than an investigation into how strategies operate and women negotiate their health and reproductive status, Mullings and Wali’s book provides an analysis of the various implications of those strategies and suggests a means of understanding the multiplicative aspects of race, gender, and health.

Research was supported by the Centers for Disease Control through an initiative focused on the prevention of chronic illness and reduction of high infant mortality among African Americans. Using ethnographic methods to complement the vast statistical data that they compile on African American women’s health, Mullings and Wali examine the social conditions that influence and are influenced by women’s health status. Most importantly, they attempt to address the question of why infant mortality statistics remain consistently higher in the African American community than in other ethnic and racial groups in the United States, even among college-educated women.

The authors gathered their ethnographic data through intensive participant-observation and longitudinal case studies, and they weave those data throughout the text in vignettes that complement the more quantitative elements. One remains acutely aware, however, that the book was prepared as part of a final report to the CDC funding agency. A key component to their research was an emphasis on the workplace and the attention given by employers to women’s health issues.

Reproductive health is a central concern not just for women who bear children. It is an issue that affects the children they bear and the communities in which reproductive health care is situated. In much the same manner that educational levels and access to education and resources affect community well being, access to reproductive health care also can be seen as tied to a wide range of social concerns. A higher level of educational attainment is often associated with higher use of contraception, and demographers and health care researchers in particular often use education as a proxy measure for “health.” What Mullings and Wali so aptly point out is that researchers should consider more fully the real structural elements that both facilitate and impede access to education and health care. By highlighting these mechanisms and recognizing that “health” itself is a social construction, researchers are better equipped to address a variety of social problems among African American communities.

Although seemingly intended primarily for research and public health communities, Stress and Resilience offers a unique example of in-depth ethnographic research and demonstrates how involved researchers can be in the daily lives of study participants. Mullings and Wali offer a direct challenge to quantitative models in health care, their narratives and descriptions of study participants pointing out that it is only through listening and observing at a local, everyday level that those interested in workplace policies will best understand the implications of health care plans and strategies. Reproductive health is not just about women; it is about networks, communities, and the structures (such as occupational settings) in which these are negotiated. Although Mullings and Wali’s attention to the topic of male health issues remains somewhat limited in this particular account, the stage is set for future research projects.

Mullings and Wali finish with a brief discussion of what they have termed the “Sojourner Syndrome.” They emphasize that African American women have long dealt with a triple burden of gender, race, and health problems and suggest that Sojourner Truth’s own, larger- than- life presence through the decades has fostered kinds of coping strategies--ones emphasizing agency--to ensure the successful, literal reproduction of the black community. The Sojourner Syndrome, then, is a means of describing the survival strategies that the authors have documented among black women in multiple contexts. Yet, ironically, what is clear from their research is that the syndrome and the survival strategies it generates are the source of continued health strains embodied by black women--women are literally laboring under the Sojourner Syndrome.

It is a bit frustrating, after having read such detailed ethnographic data and pouring over numerous statistical tables, to be left with a summary of less than one page. Readers are offered little, for example, in the way of explanation of how recognition of the Sojourner Syndrome might help further the future research that the authors call for throughout the text. Nor is there any discussion of how its use might help to disentangle various perceptions of race, health, and gender in the United States. The authors are forthcoming, however, in their admission that their own future work will emerge from their current research, and one can hope that more theoretically complex analysis ensues.

The monograph is a bridge between the public health reports documenting the ethnographers’ findings and future research into consistent disproportionately high rates of infant mortality in African American communities. It provides a carefully documented look at the interstitial spaces between women’s active negotiation of their own and their children’s health and welfare and the resultant consequences of those strategies.