A new study at Temple University will try to reduce the unusually high mortality rate for Black women during and after pregnancy. In Philly last decade, they made up 43% of births, but 73% of related deaths.
“We have a unique opportunity with this study to help shift the narrative for Black urban people in Philadelphia,” said Saleemah McNeil, co-principal investigator for the study.
McNeil is program director of the Maternal Wellness Village, which is partnering with Temple’s Lewis Katz School of Medicine on the study. Funded by a $6 million grant from the DC-based Patient-Centered Outcomes Research Institute, it will compare two different approaches to treating heart disease risk factors over the next five years.
A community advisory board of nine Black women with varying backgrounds and professions is helping shape the structure of the Temple study.
Diona Murray, co-chair of the advisory board, said health care workers often minimize Black women’s pain
“We’re raised to be strong,” Murray said, in part because of institutionalized racism. For years she used her mother’s tips to self-soothe her constant pain, until a doctor properly diagnosed her at age 33 with fibroids, cysts, polycystic ovarian syndrome (PCOS), and endometriosis.
After finally finding a doctor who listened to her, Murray was able to give birth at Temple to her daughter, Aariana, now 6. “Often the Black body is not understood,” she said.
Across the nation, the maternal mortality rate is three times higher for Black women than it is for white women, according to the CDC. The problem is so acute that the U.S. Department of Health and Human Services recently dedicated $4.5 million for the hiring, training, certifying, and compensating of doulas to address the crisis.
“No one should die, and the race difference in the mortality rate is really disturbing,” said Sharon J. Herring, the study’s co-principal investigator and director of the Katz School’s Program for Maternal Health Equity.
“Sadly, we know that health care in the United States is built on racist principles,” Herring said. “I wish that it wasn’t… These are really big systems to break apart.”
Replacing coping mechanisms with healthier habits
The Temple study, which will enroll 432 patients at faculty physicians’ practices this month, will help examine why the crisis is so extreme by addressing one of the root causes: heart disease.
One half of Black women have some kind of cardiovascular disease, according to the American Heart Association, and Black women are 60% more likely to have high blood pressure than white women, per HHS statistics.
Temple researchers will use text messaging with Black birthing women to support healthy nutrition, physical activity, and home blood pressure self-monitoring. The study will also explore the relationship between cardiovascular risk and doula care.
“Maybe there are some unhealthy habits and coping mechanisms that [Black women] have developed,” said community advisory board Hanan Abdul-Hameed, a doula and a mom.
She helped shape some of the wording for questions to be used when text messaging with patients, such as “Have you moved your body for 30 minutes today?”
Shifting women to healthy habits is a gradual process, she added, “You can’t just take it all away.” For instance, Abdul-Hameed suggests to clients that rather than eating a whole hoagie for lunch, maybe they just eat half. Or if a client drinks a Pepsi, Abdul-Hameed might suggest the woman drink a glass of water afterward.
Some of the study participants will receive seven to eight visits with a doula, postpartum, to help transition people back to primary care, like a bridge.
“I really think about this as addressing the long-term health of a birthing person and her family,” co-principal investigator Herring said.
The goal is to see if these additional supports lead to lower blood pressure, treat social isolation and depression, and decrease experiences of racism and/or mistreatment in maternity care, according to the research team, which includes faculty and staff from Temple’s Center for Urban Bioethics and the Departments of Obstetrics & Reproductive Sciences, Cardiology, and Clinical Sciences, along with colleagues at Drexel, Jefferson, and Duke.
In addition, the study will include training for all Temple University Hospital and medical personnel to reduce patients’ experiences of racism or mistreatment.
Though co-principal investigator McNeil describes herself as an accomplished, educated, upper-middle class individual, she said, when she walks into a hospital, “They don’t see that. They see a Black woman.”
McNeil is also a reproductive psychotherapist, certified lactation consultant, professionally trained birth doula, and a traumatic birth survivor herself.
Fellow doula Abdul-Hameed hopes that as a result of this study, more Black women will have access to these kinds of supports.
“I’m honored to work alongside so many educated women to work for the betterment of these communities that have been known not to thrive,” Abdul-Hameed said. “In order for us to have a healthier future, it starts with birth.”
