The Role of Methodological Innovation in the Conceptualization of the Sojourner Syndrome

Alaka Wali

A picture of of a street in Harlem, New York.  A man and a woman are talking in the foreground, with several people in the background.  The street is closed off, and a tent and chairs can be seen.
Central Harlem, subject of the Harlem Birth Right Project. Photo by Alaka Wali

When I was invited to contribute to this forum on the impact of Leith Mullings’ article “Resistance and Resilience: The Sojourner Syndrome and the Social Context of Reproduction in Central Harlem”(2005), I remembered back to the way Leith came to formulate the concept and used it conclude our book on the Harlem Birth Right study (Mullings and Wali, 2001). I want to focus here on the innovations of anthropological methodology that we developed and that I believe allowed us to make a powerful case for the existence of the Sojourner Syndrome. 

When we started the Harlem Birth Right project, we knew that it would take considerable effort to convince the epidemiology community of the value of qualitative research for understanding the social context of reproduction.  The program officer at CDC who set up qualitative research studies, an African-American with a background in qualitative research, had fought hard to get approval.  She was also aware of the deep mistrust of medical research in the Black community, resulting from a long history of abuse and ethical malfeasance.  The RFP the CDC put out thus had a requirement for community participation in the research.  In Harlem, Dennis Walcott, then CEO of the New York Urban League, received the RFP and reached out to the PIs to write the proposal.  The successful attainment of the grant represented one of the first times that the CDC partnered with a community organization to conduct research. 

This was only the first of other innovative aspects of the methodologies we used in the Harlem Birth Right project.  Here, I describe the other methodological practices that produced the powerful findings, culminating in Leith’s construction of the “Sojourner Syndrome.”  I believe that by combining Participatory Action Research approaches with ethnographic and multidisciplinary methods, our study was a model for how to effectively engage community participants in rigorous data collection and analysis that provided the evidence for how racism operates to cause injury and how Black women resist.  Subsequent to collaborating on the Harlem Birth Right study, I found these methodologies applicable in my own research, which has continued to focus on sources of resilience in communities of color, although not specifically in the reproductive health field. 

Participatory Action Research 

The first six months of the study were spent in designing the methodology and establishing the forms of engagement with the Harlem community.  All four co-PIs had deep knowledge of community organizations, political and social factors, and key actors in Harlem.  Dennis Walcott, with his wealth of connections, also contributed to this part of the research design.  Central to the design was the recognition of the diversity of Harlem residents, their strength in activism and organization, and the intellectual depth of scholars and professionals.  As a result, we designed a multiply-stranded approach that convened scholars, professionals from diverse sites, and community activists with deep roots in the neighborhoods. Leith discusses the specific forms of community engagement in her article, and here I want to point to the way it influenced the questions we asked and shaped our narrative of the findings.

A major guidance provided by community participants was to document the strength and resilience of Harelmites, especially women.  Harlemites were frustrated by the stereotype of “victimhood” and wanted a more positive portrait of residents.  By balancing documentation of the injury caused by structural racism with documentation of activism at all levels (from the household to collective work), we were able to provide a fuller, more accurate portrayal of the context of social reproduction.  It is this “balance” that Leith captures so powerfully in the Sojourner Syndrome.  The insights from our advisors, community meeting attendees, and dialogue group participants sharpened our analysis.  The recommendations we made to the CDC privileged building on community and individual strategies for coping with stress and fighting against neglect and abandonment by state and private institutions.  The community participation strategies we used have stayed with me and have been integral to the work I have been doing at the Field Museum. 

Team Ethnography

Another aspect of the Harlem Birth Right study was the use of a team to do the ethnography.   Leith had a strong group of Black women anthropologists she was advising at CUNY Graduate Center, and she invited them to join the study under my supervision as Senior Ethnographer.  The idea that one lone ethnographer could document something as complex as the differential impact of social circumstances on women’s reproductive health was not tenable.  Team ethnography was being used in other studies (see for example, Sanjek, 1998), and we built on these experiences to create a rigorous research design that was comprehensive of income groups, diverse work sites, and differently situated women.  A team allowed us to reach more women across age and income and follow a group of women over the course of two years.  We spent between three and four months at the different work sites, conducted home visits, and carried out long repeated interviews.  We collectively developed the coding list to analyze the field data, which was kept in a secure file.  We spent many hours discussing our experiences and observations with each other, led by Leith.  She taught us how to nurture a team, recognize individual strengths, and build consensus.  

Interdisciplinary Approach

The four co-PIs, each coming from a different disciplinary perspective (Janet Mitchell, medical; Diane McClean, epidemiological; Leith Mullings, Anthropological; and Dennis Wolcott, community organizational) worked together to integrate methods and theories to formulate the research design and collect data from diverse sources. Dr. Mitchell provided medical insights on the experiences of low-birth weight and mortality. Dennis Wolcott helped formulate the Advisory Board as a mix of Harlem residents.  Leith designed the ethnographic components, drawing on her years of experience conducting activist research. Diane McClean led the construction of an extensive ethnographic questionnaire which produced quantitative data that served to test and validate some of the findings that emerged from the ethnographic field research.  Contrary to discourses of how “disciplines” don’t get along, our project demonstrated the power of an integrative approach. 

 Looking back at how these methodological approaches contributed to the compelling analysis that led Leith to formulate the Sojourner Syndrome, I appreciate even more her brilliance as a medical anthropologist and committed activist for social justice. According to the Office of Minority Health at Health and Human Services, in 2017, Black women continued to experience over twice the rate of infant mortality as white women, and still primarily due to high rates of complications from low birthweight delivery.  To say that the severe disparities in infant mortality (and women’s reproductive health overall) have continued unabated and without remedy is frustrating and heartbreaking would be an understatement. The fact that the Harlem Birth Right study and other numerous studies on racial health disparities by social scientists and epidemiologists alike (see a recent interview with Nancy Krieger)  have largely been ignored by policy makers speaks to how deep systemic racism pervades all aspects of social life. 

The fact that Leith chose to publish her brilliant article in Transforming Anthropology demonstrated her commitment to uplifting the Association of Black Anthropologists and the work of Black scholars.  Now, with the pandemic bringing renewed attention to still persistent and in some instances deepening health disparities, we have the opportunity to pay attention to Leith Mullings’ body of work, and to heed its insights into how to address them through comprehensive policies that attack institutional racism not just in the medical field, but indeed in housing, neighborhood development, occupational equity, among other pieces of the social fabric, while lifting up the courage and resilience of the Sojourners among us.  Leith continued as an activist scholar on the frontline of social justice to the end of her life.  She was not daunted by the size of the task, and neither should we be. We can continue on in her path and honor her by our own collective efforts.


Mullings, Leith 2005.  “Resistance and Resilience: the Sojourner Syndrome and the Social Context of Reproduction in Central Harlem.”  Transforming Anthropology. Vol. 13, Issue 2, pp. 79–91.

Mullings, Leith and Alaka Wali. 2001.  Stress and Resilience. The Social Context of Reproduction in Central Harlem.  Kluwer Academic Press/Plenum Publishers. London.

Sanjek, Roger. 1998.  The Future of Us All. Race and Neighborhood Politics in New York City. Cornell University Press. Ithaca, NY

Author Bio

Alaka Wali is a curator of North American Anthropology in the Science and Education Division at the Field Museum in Chicago.  She was the founding director of the Center for Cultural Understanding and Change from 1995- 2010.