Running head: THEORY OF INTERSECTIONALITY
Theory of Intersectionality
Scientific Underpinnings of Nursing Science I: Dr. Lenz
Samantha J. Boch, Ph.D. Student
The Ohio State University
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THEORY OF INTERSECTIONALITY
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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
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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
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III.
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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 selfidentified 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
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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
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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
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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
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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
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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.
Theory of Intersectionality Critique
Internal Criticism
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).
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Logical Development
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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 Criticism
Reality 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.
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Complexity
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Interlocking 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
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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).
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Figure 2: Intersectionality within a Healthcare Context
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