Elizabeth Howell, MD, MPP
“Systemic racism has taken an extraordinary toll on the health and wellness of Black women and babies. We are here today to develop actionable items to improve maternal and infant health equity.”
This powerful sentiment is how Elizabeth Howell, MD, MPP, Chair of the Department of Obstetrics and Gynecology at the Perelman School of Medicine and the University of Pennsylvania Health System, opened the Maternal and Child Health Equity Virtual Summit on January 12.
The five-hour summit was held on the New York Academy of Medicine Zoom platform and included featured presentations and panels of diverse members including leaders in medicine, nursing, community-based-organizations, and perinatal and maternal health research.
Dr. Howell, the previous Director of Mount Sinai’s Blavatnik Family Women’s Health Research Institute, partnered with the New York Academy of Medicine, the Institute, and the University of Pennsylvania to establish this important educational summit as the final phase of her NIH-funded research investigating the contribution of hospital quality to racial and ethnic disparities in maternal and infant health. Dr. Howell co-chaired the summit with Danielle Laraque-Arena, MD, a senior scholar-in-residence at the New York Academy of Medicine.
Dr. Howell presented the findings of her research to the more than 450 attendees of the virtual summit, outlining the interactions between structural racism, system factors, clinician factors, patient factors, and community or neighborhood to influence racial and ethnic disparities in maternal and infant morbidity and mortality.
According to their findings, there were clear themes between hospitals that outlined high and low performance of maternal health outcomes. High performing hospitals had a stronger focus on standards and standardized care, stronger nurse-physician communication, and a higher awareness that disparities and racism may be present in hospital settings and could lead to differential treatments.
Dr. Howell’s group went further to analyze within-hospital disparities. After calculating similar risks of severe maternal morbidity for patients within the same hospital insured by Medicaid or commercial insurance, they found that Black women as compared with White women had higher maternal morbidity rates (after adjusting for insurance, obesity, etc.). Dr. Howell and her research clearly demonstrate the health care crisis for moms of color, and the rest of the day’s programming helped bring diverse voices to the conversation and plan action steps to reduce these disparities.
The summit was divided into three parts: Maternal Health, Infant Health, and the Mom-Baby Dyad, each with one featured speaker and a panel of diverse experts. The featured speaker for Maternal Health was Karen A. Scott, MD, a leading OB/Gyn from UCSF School of Medicine, who outlined the “sacred birth” movement.
“Sacred birth is a radical attitude towards human births, specifically Blackness, Black bodies, and Black births. The movement advocates for safer, respectful more dignified and higher quality participatory birth care,” she said.
Dr. Scott powerfully stated at the summit, “We need to shift power to generate and disseminate knowledge of the QI space that has been usually excluded to hospital administrators and executives over to Black mothers, birthing people, community members and scholars.”
The Maternal Health panel, moderated by Wendy Wilcox, MD, (NYC Health+Hospitals) included Sascha James-Conterelli, DNP, (Lecturer in Nursing, Yale School of Medicine), Chanel Porchia-Albert (Founder, Ancient Song Doula Services), Natalie D. Hernandez, PhD, (Assistant Professor, Morehouse School of Medicine) and Dr. Allison Bryant, MD, (Massachusetts General Hospital). The panel discussed diversification of the labor and delivery workforce, anti-racist medical models, and quality improvement. Dr. Bryant stated one of the most salient quotes of the day: “No quality without equity.”
The second part of the summit, Infant Health, began with Dr. Howell conveying her research findings on infant morbidity and mortality. Dr. Howell led the next section of the summit: Infant Health Inequities.
“Very preterm births account for only 2 percent of all births but 53 percent of all infant deaths, and Black infants are three times more likely than white infants to be born very preterm,” she said. Based on Dr. Howell’s findings, up to 40 percent of the Black-White disparity in very preterm birth morbidity and mortality was due to the difference in which hospital the child was born in.
Jeffrey Horbar, President of Vermont Oxford Network, was the featured speaker and built upon Dr. Howell’s research, noting that white infants are overrepresented at high-quality hospitals in New York City and black infants are underrepresented at those same hospitals. Dr. Horbar’s theme throughout his presentation was clear: the importance of following through for patients.
“Our responsibility to NICU infants and their families extends beyond hospital walls, following through to address their social determinants of health, which will ultimately determine the health and well-being of infants and their families,” he said.
Dr. Horbar also outlined his organization’s new innovation grants to promote health equity, “Take Action to Follow Through,” which can jump start equity and quality improvement programs in NICUs around the country.
The Infant Health panel, moderated by Deborah Campbell, MD, (Albert Einstein College of Medicine) included Dr. Horbar, Teresa Janevic, PhD, MPH, Assistant Professor of Obstetrics, Gynecology and Reproductive Science, and Population Health Science and Policy at Icahn Mount Sinai, and a member of the Blavatnik Family Women’s Health Institute, and Adrienne Mercer, EdD, (Northern Manhattan Perinatal Partnership). Panelists discussed paid-parent advisor positions to work with physicians, structural racism, and the significance of doulas in supporting birthing people. Dr. Mercer shared the sentiments of one of the women that her organization worked with. In describing her doula, the woman said, “Having a woman I can talk to made me feel supported and that I matter.”
The final part of the summit called “Mom-Baby Dyad” began with Jennifer Zeitlin, MA, DSc, an epidemiologist who has been a co-investigator in much of Dr. Howell’s research. She discussed how Black and Latina mom-baby dyads face a double threat, a domain in health care that needs actionable change.
Her research specifically showed that severe maternal morbidity is an independent risk factor for very preterm mortality. She stated that efforts to integrate and strengthen quality improvement in both obstetric and neonatal care at hospitals where Black and Latina women deliver may be a critical step to reduce the co-occurrence of disparities for maternal and child health outcomes.
The final panel of the day, moderated by Lynn Roberts, PhD, (CUNY), included Mary D’Alton, MD, (Columbia), Colette Sturgis (Urban Health Plan), and Jochen Profit, MD, (Stanford) who discussed their own institutions’ efforts to reducing maternal and child morbidity and mortality. Dr. D’Alton discussed the specific significance of maternal mental health as absolutely integral to the overall health of the mother, and Colette Sturgis, the Program Director at Urban Health Plan, discussed how their Maternal and Infant Community Health Center has adapted through the pandemic to support mothers.
Dr. Laraque-Arena of NYAM began the closing remarks of this important event, stating “We have a lot of work to do in deconstructing the entities that have supported inequities in maternal and infant health.”
And Dr. Howell concluded by summarizing action steps for the future, including improving workforce diversity, integrating Black and Brown women’s lived experience into health care, supporting doulas through Medicaid coverage, and engaging community members in quality committees and improvement. Dr. Howell encouraged leaders in executive and administrative positions to be proactive and vocal about these significant issues.
“It takes bold leadership to take a strong stance and say: we have to do better,” she said.
The New York Academy of Medicine has more information on the Maternal and Child Health Equity Virtual Summit, including PDFs of speaker’s presentations and a recording of the entire event.
Mahima Krishnamoorthi, BA, is the Clinical Research Coordinator at Blavatnik Family Women’s Health Research Institute, where she develops and fosters her passion for women’s health and reproductive justice.