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Running head: THEORY OF INTERSECTIONALITY1

Theory of Intersectionality

Scientific Underpinnings of Nursing Science I: Dr. Lenz

Samantha J. Boch, Ph.D. Student

The Ohio State University

THEORY OF INTERSECTIONALITY 2

Theory of Intersectionality

I. Introduction

Feminist activist, Florynce Kennedy, once stated, “General societal health is ever

contingent on its least significant member” (Guy-Sheftall, 1995). In the United States (U.S.), a

disproportionate number of certain types of people are affected by adverse health outcomes. For

example, the following has been reported within the U.S.: lower income residents are more

likely to smoke, have fewer average health days, and experience higher air-pollution disparities;

American Indians are twice as likely to commit suicide than other races, non-white people are

more likely to have higher rates of the human immunodeficiency virus, non-heterosexual peoples

are more likely to face discrimination while accessing healthcare, and infants born to black

women are 1.5 to 3 times as more likely to die than those infants born to other races (CDC,

2011). According to the Center for Disease Control’s Health Disparities and Inequalities report

in 2011, “differences in health based on race, ethnicity, or economics can be reduced, but will

require public awareness and understanding of which groups are most vulnerable, which

disparities are most correctable through available interventions, and whether disparities are being

resolved over time.” The paper will address how we, as nurses, can adopt an intersectional

application to gain a new understanding and awareness of disadvantaged populations. Since

nurses have incredible opportunities to interact with the most underserved populations, this

approach can guide nursing practice and research. This paper will thoroughly assess and describe

the theory of intersectionality as a middle-range theory. In addition, the underpinnings, historical

development, adequacy, utility, and evidence that pertain to the theory of intersectionality will be

explored.

II. Definition of Theory


While scholarship incorporating the framework of intersectionality can be traced back to

1851 with Sojourner Truth’s “Ain’t I A Woman,” it was not coined as a theory until 1989.

Kimberle Crenshaw, a black, feminist law scholar created the theory of intersectionality (1989).

The theory of intersectionality suggests that an individual is comprised of multiple identities that

interact on simultaneous levels that contribute to systemic oppression or social inequality

(Knudsen, 2007). In addition, all social and cultural identities of an individual such as gender,

race, class, ability, sexual orientation, and religion are interlocking mechanisms rather than

additive categories (Knudsen, 2007). See Figure 1. While sociologists might consider role theory

as an influence on this theory, it is not considered as such. Role theory does not clearly nor

explicitly address the systemic oppressive effects that come from the multiplicity of those roles.

In addition, intersectionality does not cover the breadth as role theory. Intersectionality is more

specific and thus, classified as a middle-range theory.

Figure 1. Modified intersectionality pictorial


III. Theorist Background and Historical Development

Kimberle Crenshaw was born in Canton, Ohio in 1959. She received her Bachelor of Arts

at Cornell, her Juris Doctorate from Harvard and her Master of Laws degree from the University

of Wisconsin (UCLA, 2012). She was a major contributor of Critical Race Theory (CRT) and

holds a split appointment at the University of California, Los Angeles and Columbia University,

New York (UCLA, 2012). CRT stems out of critical legal studies and is concerned with racial

subordination, prejudice, and inequity and offers a mean by which to identify the functions of

racism in an institution or system (Stovall, 2005; Graham et. al, 2011). While CRT focuses on a

singular aspect of one’s identity, intersectionality covers the multiplicity of identities existing in

one individual.

Crenshaw’s work on the theory of intersectionality came post second-wave feminism of

the 1960s. The second wave of feminism advocated for the rights of the [white] female in the

workforce. Betty Friedan was heralded as the lead figure, and the Feminine Mystique was the

highlighted book of the era. Friedan emphasized a notion of unhappiness among all self-

identified females. Like much of the second wave itself, it sprang from single identity politics:

the plight of the college-educated, white housewives without satisfying careers (hooks, 1984).

Intersectionality incorporates those who have been marginalized due to multiple burdens

resulting from discrete sources of discrimination (Crenshaw, 1989). Crenshaw would argue that

women of color have been working outside of the home hundreds of years before white women

decided that they were unsatisfied with their unfulfilling role as a mother.

IV. Origination of Theory


Crenshaw first applied the theory of intersectionality including both race and sex to two

court cases centered on black women: DeGraffenreid v. General Motor (GM) and Moore v

Hughes Helicopters, Inc. In DeGraffenreid, “five black women brought suit against GM alleging

that the employer perpetuated the effects of past discrimination against black women.” Although

GM did not hire black women before 1964, the court decided that GM had hired [white] female

employees, and dismissed the race claim due to judicial economy (Crenshaw, 1989). In Moore,

the black female plaintiff also alleged that the employer practiced race and sex discrimination in

promotions to upper-level craft positions and to supervisory jobs (Crenshaw, 1989). However,

the court refused to certify Moore as a representative in the sex discrimination case, and due to

judicial economy dismissed part of her case.

In both cases, only certain parts of the black female identity were addressed rather than

the multiplicity of their subjectivity. The courts dismissed the cases because the

antidiscrimination laws did not recognize black females as their own subject. Using the theory of

intersectionality, Crenshaw addresses the experiences and struggles of women of color who have

fallen between the cracks of anti-racist discourse or anti-discrimination law. I would argue that

the experiences and struggles of many multiple-identified, marginalized groups fall between the

cracks of healthcare discourse, in both research and practice. All in all, due to the previous

historical feminist writings, post second-wave feminist origins, and the two court cases it could

be argued that this theory was inductively created rather than deduced.

V. Structural Elements, Assumptions, and Concepts

Structural elements and assumptions of this theory are not explicitly identified. However,

it can be inferred that the theory of intersectionality is structured as a framework to develop


innovative research questions, to analyze situations, and to allow for fuller discussion. The

framework can be applied to a number of disciplines including but not limited to law, healthcare,

policy, or business. The theory does assume that each individual is constructed with multiple,

fluid, interlocking identities and therefore, perspectives. In addition to multiple identities, the

theory also assumes that these identities can change over time. Sexuality, religion, ability,

culture, and gender are just some examples of identities that have the capability of changing

throughout one’s lifetime.

The theory uses several key concepts including discrete discrimination, interlocking

mechanisms, and multiplicity. In this paper, concepts will be explored with specific application

to healthcare Multiplicity is the notion that oppression is not added through individual identities,

but multiplied. For instance, a poor, Latina lesbian may face more discrimination accessing

healthcare than perhaps a wealthy Latina heterosexual; but the wealthy Latina heterosexual may

face more discriminations accessing healthcare in the emergency room than the affluent, white

male. Interlocking mechanisms function through multiplicity. Interlocking mechanisms suggest

that identities (gender, sexuality, sex, ability, culture) function together as one unit and cannot be

pulled apart. The Black feminist sociologist, Patricia Hill Collins, states in Fighting Words:

Black Women and the Search for Justice that “intersectionality provides an interpretive

framework for thinking through how intersections of race and class, or race and gender, or

sexuality and class, for example, shape any group’s experience across specific social contexts”

(1998). This particular social context should be integrated into the field of healthcare to the

providers that spend the majority of their time with the patient, nurses.

Intersectionality incorporates those that are disadvantaged due to multiple burdens

results from discrete sources of discrimination (Crenshaw, 1989). For example, single identity


analysis in healthcare research could be considered a discrete source of discrimination. In

Gender, Race, Class and Health, Schulz and Mullings (2005) argue that, “notions of race that are

based on a typological approach to human variation-with the implication that genetic differences

related to race are a major factor in explaining disease disparities-continue to pervade the

[healthcare] literature.” The authors illustrate their point by including a common algorithm often

heard in healthcare education: [Black/Hispanic/Native American] [children or adults] have

higher rates of [the condition, disease, or “disability” under investigation] than whites, primarily

because of [explanatory variable] (Schulz & Mullings, 2005). Race or non-whiteness has

continued to be a single identity politics that discerns how the provider views and thus, cares for

patients. In fact, gender, race, class, ability, and sexuality have all been examined through

healthcare research as their own entities, rather than interlocking mechanisms that differ upon

social location and historic context. Since nurses spend more time in direct patient care than

other groups of health professionals and are employed in a variety of settings, it is important for

nurses to become aware of these discrete sources that Crenshaw explores. Nurses are advocates

of the patient and in order to advocate for someone, one should be able to understand the

subjectivity of interlocking identities, especially within the healthcare system.

VI. Application of Intersectionality

The theory of intersectionality has been applied to social work analyzing access to social

services. In Mapping the Margins: Intersectionality, Identity of Politics, and Violence Against

Women of Color, Crenshaw (1991) observed the dynamics of structural intersectionality in a

field study of domestic violence shelters located in Los Angeles. She investigated how the

shelters are adequate in handling only a certain type of woman: white English-speaking females

who have the resources to address the violence inflicted by the batterer. Crenshaw (1991) argues


against “shelter policies [that] are often shaped by an image that locates women’s subordination

primarily in the psychological effects of male domination, and thus, overlooks the

socioeconomic factors that often disempower women of color.”

The importance of intersectionality has also been explored in public health nursing. For

example, in Advances in Nursing Science, nurse researcher Ursula Kelley (2011) argues that

intersectionality can be used in nursing with respect to intimate partner violence because it

provides a means to “not only obtain a more comprehensive understanding of the multiplicative

effects of social inequalities experienced by the vulnerable and marginalized groups, but also [a

means] of conducting research and developing interventions that address health disparities.”

Kelley (2011) argues that given the opportunity that nurses have in regarding patient advocacy,

inaction can be considered a perpetuation of injustice. She also argues that nurses can work

within their own organization to develop systems that recognize and respond to the need of all

women: having an interdisciplinary response team, partnering with community agencies, acting

politically (lobbying, fundraising), addressing language and behaviors among co-workers that

blame the victim and perpetuate negative stereotypes, and using a more intersectional approach

to assessment questions. Nurses have a vital role and voice to how the future of healthcare

handles its inequities and disparities.

Intersectionality theory comes from a woman of color, an important perspective

considering that most nursing theorists are primarily white and female. Lynn Weber and Deborah

Parr-Medina (2003) authors of Intersectionality and Women’s Health: Charting a Path to

Eliminating Health Disparities state that intersectionality provides a powerful alternative to

addressing questions about health disparities that traditional approaches have been unsuccessful

in answering. The incorporation of intersectionality will help nurses obtain a more


comprehensive understanding of the power imbalances that create and sustain health inequities.

While the concept of intersectionality was not originally developed to address issues of healthy

policy it provides an effective and important means to broaden health policy beyond a race-or

gender-only focus (Bergor-Guidroz, 2009).

Critique of Intersectionality

To evaluate the internal and external components of the theory of intersectionality,

Barnum’s theory evaluation will be applied due to its depth of criticism and application to

multiple disciplines (see Table 1). In this specific critique I evaluate the theory with regards to

nursing and healthcare.

Table 1.

Internal Criticism

Theory of Intersectionality Critique

Clarity In terms of semantic clarity, concepts such as discrimination (discrete), multiplicity, and interlocking mechanisms are not explicitly defined and must be inferred. However, in terms of structural clarity, connections, implications, and reasoning for the theory are understandable and explicit. May be difficult for individuals who do not have a feminist background to understand all facets or even rationale, of intersectionality.

Consistency The framework is essentially a lens, thus it is difficult to assess consistency of its use. The structure of the theory is consistent in its form. Intersectionality uses congruent terms, but not congruent interpretations.

Adequacy Scientists may argue that this theory adds a dimension of practical complexity, or that it is not feasible to apply this perspective to every individual in every culture (Westernized view of thinking).

Logical Development Inductively created by women of color in response to the multiplicity of burdens felt from systemic and individual oppression. Arguments for intersectionality are supported more in the humanities, rather than


sciences.

Level of theory development Nascent in some disciplines such as health and policy, more prominent in legal studies, or identity politics. (73 results in CINAHL included the word “Intersectionality” in the title)

External CriticismReality Convergence Does not provide a sufficient foundation for action aimed at improving

population health, not initially intended for interventions--> ultimately a framework to adopt in order to improve understandings and responses to the complexities of people's lives and experiences.

Utility Intersectionality can be seen as not practical when applied to harder sciences, Nurses may need special education (perhaps a presentation, pamphlet) to apply the theory in clinical practice and nursing research. Can test the understanding (knowledge) of intersectionality, but it is hard to measure perspective. It is useful to the nurse researcher because it provides subject material and method of inquiry. However, it also doesn’t employ specific methods of intersectionality incorporation.

Significance To provide a conceptual shift in how people (researchers, nurses) understand social categories. Ultimately addresses how we should view the “person” in nursing phenomena.

Discrimination There are no well-defined “boundaries” or any component that differentiates nursing application from other disciplines. Different disciplines using intersectionality may have different research utility. For example: Crenshaw used intersectionality to impact antidiscrimination law/discourse or language. Nursing research may use intersectionality to identify the underlying or fundamental causes of health disparities. Sociological researchers used an intersectionality framework to analyze data from a national survey.

Scope Middle-range theory. This theory is specific enough to be used across disciplines for all disadvantaged communities, populations. Its scope is vast considering the multidisciplinary uses. In addition, it brings to the fore the limitations of research that emphasizes predetermined classifications or prioritizes any one single category within a contextual analysis.

ComplexityInterlocking mechanisms imply that categorical identities should not be hierarchal- what are the political consequences of such shifts in


(complex) framing in health care or personalized medicine?

While the theory of intersectionality meets most of the internal and external criteria, it is

still nascent in its application and usage. The theory has been used most in law and political

science, but has branched into several health disciplines such as nursing and public health. It has

not been tested, but rather, applied. Thus, while this theory uses a unique perspective, it is

difficult to empirically test perspective and understanding. However, in 2011, sociological

researchers applied this framework using data from the National Social Life, Health and Aging

Project (Hinze, Lin, & Anderson, 2011). Using a stratified regression analysis, the researchers

found that comparing blacks with whites, or women with men would not capture the same

relationships captured using an intersectional approach (Hinze et al, 2011). Researchers found

that on the multivariate level, being a black female has an effect on health beyond those

accounted for by race and gender (Hinze et al, 2011). The study demonstrated the importance

and implications of using the theory of intersectionality as an effective approach to understand

the complexity of health disparities. Intersectionality can guide, as well as inform further practice

and research on the complexity of single-identity politics within all disciplines who work with

marginalized populations. Intersectionality simply challenges the notion of single-identities and

its usage within all types of discourse.

However, with regard to nursing, intersectionality would be able to shift the paradigm of

being “culturally competent” to an understanding that is not limited to race or other singular

identity, but more of an understanding of the history and cultural oppressions that race has


endured. Intersectionality can be a powerful tool to analyze how social organization affects all of

our lives, not just the marginalized. It is an understanding that is truly centered on the patient that

can allow for a fuller relationship between both the provider and client. This perspective can

strengthen the practical and ethical aspects of nursing research by more accurately reflecting a

broader scope of the issues surrounding healthcare disparities. Rogers and Kelley (2011) write

that “a researcher [nurse] using an intersectional approach is actively working to unveil power

inequity and build knowledge that eliminates unjust ideology, practice and research with the

ultimate goal that goes beyond achieving statistically significant results to achieving social

justice.”

Intersectionality allows feminist theorists to ponder questions such as, how is race

sexualized or perhaps sexuality gendered? However nursing feminists have the ability to tackle

another dynamic, social location: healthcare (see Figure 2 with intersectionality situated within a

healthcare context). Nurses can address how sexuality is gendered in health or how ability is

raced in health research. While cultural competency is an attempt to address health disparities

and inequities, it is only a small component to most nursing education curricula. It is centered on

single-identities pertaining mostly to race. Incorporating more of an intersectionality approach to

nursing care, research, and education can allow for a fuller recognition of what it means to be a

patient, or subject, in the hospital or other healthcare setting. By moving beyond the use of race

as an atheroetical and ahistorical category and toward analysis of the processes through which

racial constructs are produced and linked to differences in health, researchers [nurses] can

contribute to etiological research that identifies the underlying or fundamental causes of racial

disparities in health (Mullings & Shulz, 2011).


Figure 2: Intersectionality within a Healthcare Context


References

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through Race, Class and Gender. Chapel Hill: University of North Carolina Press.

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University of Chicago Legal Forum.

Crenshaw. 1991. “Mapping the Margins: Intersectionality, Identity Politics, and Violence

Against Women of Color.” Stanford Law Review.

Center for Disease Control and Prevention (CDC). 2011. Health Disparities and Inequalities

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ther/su6001.pdf

Guy-Sheftall, B. (1995). Words of Fire: An Anthology of African American Feminist Thought.

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hooks, b. (1984). From Margin to Center. Cambridge, Massachusetts: South End Press.

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Weber, L., and Parra-Medina, D. (2003). “Intersectionality and Women’s Health: Charting a

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