BU Today: Assuming the bill passes, what more do you think needs to be done, beyond what’s included in the Momnibus Act?

There are big-picture, long-term things that must happen for purposes of maternal mortality, and for every other health inequity that we see, and those have to do with addressing the root causes of structural racism. In the shorter term, we need to end the disrespect that continues to occur when Black and Indigenous people walk into healthcare settings. A lot of institutions have begun conducting implicit bias training, but that’s too little, too late. We need deep changes in the training of health professionals that’s longitudinal—far beyond these one-offs. Antiracism needs to be front and center in the education of our providers.

We also need to change the face of providers in primary care and especially, in OB-GYN. We need more BIPOC clinicians. We know that when people are cared for by providers who look like them, and can truly understand their lived experience, understanding and trust can grow, and there is evidence of improved outcomes.

BU Today: Recent research shows that many women experience serious complications months after giving birth, highlighting the need for better and longer postpartum care. Tell us about the advocacy work you’ve done around improving postpartum care.

I coled a national initiative that was supported by the National Institutes of Health (NIH) and a funder called PCORI. We called it Bridging the Chasm between Pregnancy and Health over the Life Course. The purpose of the initiative was to bring together diverse stakeholders to create a national agenda to address the racism and fragmentation in the care of pregnant people long into their futures. We created an agenda that includes policies such as the expansion of Medicaid coverage for pregnant people all the way to one year. It includes high-touch models of care that include “bridge people” from communities—like doulas and community health workers—to accompany people across the chasm between pregnancy and ongoing primary care. It includes ways that we can preserve and elevate people’s narratives in their medical records, so that primary care providers who are often unaware of pregnancy complications can be sure to follow up. There’s a reimagined research agenda and a call for training of medical providers in antiracism.

BU Today: Have you seen forward movement in any of these areas?

About 15 states, including Massachusetts, have either active or pending legislation to require Medicaid to cover doula care, so there’s action at the state level for doulas who will help women navigate pregnancy and the postpartum year. The American Rescue Plan Act gave the option to all states to expand Medicaid coverage from 60 days to one year after pregnancy. That’s a huge leap. So far, 38 states have implemented that expansion.

I’m not seeing enough investment in the training of medical providers that would be meaningful, lasting, sustainable. And the most stubborn one to change is the actual structure of our healthcare system, moving from the silos of different specialties like OB-GYN and primary care to a more comprehensive, coherent, seamless system where providers are communicating with one another across specialties and where care is continuous. Fragmented healthcare is dangerous for all of us, but especially for birthing people.

BU Today: You currently lead SPH’s Center of Excellence in Maternal & Child Health (MCH), which aims to educate a diverse MCH workforce. Tell me about the work you’re doing on that front.

The Center of Excellence in Maternal & Child Health at SPH is supported by the Health Resources & Services Administration and one of our goals, as you said, is to diversify the public health workforce. To do that, we have a special initiative called the Diversity Scholars Leaders Program. We select scholars from underrepresented communities as they enter their maternal and child health studies at SPH and offer tuition assistance. We also offer, perhaps most importantly, intensified mentoring by both a faculty member of color and also by a field mentor, someone who shares their background and their professional interests and is there for them throughout the year and a half or two years that they’re navigating SPH, a predominantly white institution.

We’re also collaborating with HBCUs—historically Black colleges and universities—that are interested in improving their maternal and child health education pathway and research. In November, we convened an all-day working session with representatives from 12 HBCUs and two predominantly white schools of public health, BU and Harvard. During the session, we got to know one another and then shared our education priorities and our research priorities, which then led to some promising collaborations.

BU Today: Is there anything else you’d like to say on the topic of maternal health?

I would elevate Massachusetts. Massachusetts was wise enough to form a Special Commission on Racial Inequities in Maternal Health, led largely by BIPOC individuals, including State Senator Liz Miranda (D-2nd Suffolk). Some of the key recommendations from the commission are now in an omnibus bill pending before the state legislature. This is one more example of how important state legislatures are, with such divisive federal lawmaking and especially in the post-Dobbs era. It’s another example of Massachusetts’ role as a leader in reproductive healthcare.