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The Black Maternal Health Crisis with Dr. Nerys Benfield
32 Plays4 years ago
We invited Dr. Benfield, board-certified Obstetrician and Gynecologist and Associate Professor at the Albert Einstein College of Medicine/ Montefiore Medical Center, to the Lounge to discuss inequalities in black maternal morbidity and mortality and what reproductive justice looks like in 2021.
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Transcript
Introduction to Black Maternal Health with Dr. Nerris Benfield
00:00:01
Speaker
Hey everyone, today we'll be having our special episode focused on our black maternal health topic. We wanna welcome Dr. Nerris Benfield to the show.
00:00:31
Speaker
What's good, everybody? Thank you for tuning in to this special episode of SNMA Presents to Lounge. All three of us are here excited to have Dr. Benfield to discuss a topic that is still plaguing the Black community, Black maternal health.
Dr. Benfield's Background and Research
00:00:48
Speaker
Dr. Neris Benfield is a board certified OB-GYN and associate professor at the Albert Einstein College of Medicine Montefury Medical Center in New York.
00:00:58
Speaker
She also serves as a Senior Associate Dean for Diversity and Inclusion and the Fellowship Director of Family Planning within the Department of OBGYN and Women's Health. She directs the Global Women's Health and Social OBGYN Program and serves on the Board of the Society of Family Planning as co-chair of their Diversity, Equity and Inclusion Working Group.
00:01:24
Speaker
Dr. Benfield completed her OB-GYN residency and fellowship in family planning at the University of California, San Francisco. She also received her master's degree in public health at the University of California, Berkeley.
00:01:39
Speaker
Dr. Benfield's research interests focus on increasing contraceptive knowledge and access and clinical and research training, both domestically and internationally. Welcome to the show, Dr.
Understanding Maternal Mortality and Morbidity
00:01:54
Speaker
Benfield. Great to have you here, Dr. Benfield. Welcome, welcome, welcome, welcome, welcome.
00:02:01
Speaker
So Dr. Benfield, we typically like to get everyone on the same page at the beginning of these discussions with some basic terminology. So for our loungers, can you give us a basic definition on maternal mortality and maternal morbidity? Yes, thank you. And I wanted to thank you for starting with that question because
00:02:30
Speaker
we find that it's actually in having a clear definition of maternal mortality and morbidity using that universally and doing the work to figure out the scope of the problem that's been the most important thing, I think, for really understanding what efforts are effective in reducing maternal mortality and morbidity. So when we're talking about maternal mortality, we're talking about the death of an individual
00:02:58
Speaker
around a pregnancy event. So it can be any time during the pregnancy, during the delivery itself, and up to a year after the pregnancy from some cause that is in some way related to the pregnancy. Maternal morbidity is similarly defined, but looks at a severe health outcome from the pregnancy episode.
00:03:25
Speaker
that of course isn't a mortality event, but really is something that can have a significant impact on that individual's life. So that's also incredibly important for us to capture and understand and address as well.
Systemic Racism and Black Maternal Health Disparities
00:03:40
Speaker
Thanks so much, Dr. Benfield for that response. And just kind of going off of what you just said, it's also been well known that Black women do worse in both maternal morbidity and mortality. And so can you discuss what are some ways in which systemic racism and a lack of environments of resources have contributed to this disparity? I think it's
00:04:06
Speaker
not only added to this disparity, but really is foundational to this disparity. There is research from decades ago that helps us clearly understand that
00:04:18
Speaker
Race is not the reason for these inequities, right? Racism and the structures of racism in this society are the reason for these inequities because they are what we see in this society. We don't see similar challenges with people of the same ancestry in other areas, right, in other regions. We see it here in the United States because of the effects of structural racism.
00:04:43
Speaker
So we want to think about the levels on which racism operates and understand that at all of those levels, not only is our society affected, but of course our healthcare is affected as well. So we see the effect of bias within patients and providers, within the infrastructure of the healthcare system.
Contributing Factors to Health Disparities
00:05:08
Speaker
We see
00:05:09
Speaker
structural inequities in our policies within an individual hospital, within a health, you know, a department of health, within a national health infrastructure, within the way that our insurance system is constructed. And then, of course, we see that the health care infrastructure itself is really a small part of what determines the health of an individual and a community.
00:05:38
Speaker
And there's all those other factors that we understand are incredibly important, like employment, housing, economic resources, nutritional resources. And those things have been allowed to be so disparate and be so unequal because of the structures of racism. So I think we're seeing how
00:06:07
Speaker
racism is operating pervasively through most of our society and most of the systems in our society and that influences the health of the individual at multiple levels. So you talked about
00:06:24
Speaker
many aspects of racism, structural racism, systemic racism, and then there's also even institutional racism. Recently, we saw that a chief pediatric resident at Indiana University, Dr. Shanice Wallace, died during childbirth. We recognize that, especially in the Black community, Black women are two to three times more likely to die during childbirth than any other demographic group.
00:06:50
Speaker
Are there any other significant factors that can be contributing to this disparity? I think that it is incredibly important that we continue to call out the tragedy of maternal mortality on a daily basis. So I appreciate you mentioning the stories of two women who unfortunately died as a result of childbirth. And I think that
00:07:22
Speaker
You know, I used to give a lecture many years ago where there's a picture of two passenger jets colliding on a runway and exploding and saying, you know, this is the number of women who we lose every day from maternal mortality. And this is unacceptable. And if it was two passenger jets exploding on a runway, we would understand that it's unacceptable.
00:07:52
Speaker
So I think one of the good things is that the continued kind of attention and the continued understanding of what a real tragedy this is helps us make some of those large systemic changes that we need to make and make some of those individual changes that we need to make to reduce and eliminate these inequities.
00:08:21
Speaker
I think that fundamentally much of it comes down to the way that racism has multiple effects within our societies and our systems and our environments. Much of the environmental work that we're talking about when we're talking about the health infrastructure of a community, when we're talking about
00:08:47
Speaker
the nutritional access to good foods in a community, when we're talking about the infrastructure of support for an individual going through the pregnancy and delivery process, all of those are inequitable. When we're talking about the hospitals that are located in different communities,
00:09:14
Speaker
all of those are ways that inequities, ways that kind of the inequities in the system manifests and bring us to these tragic events. And I think that it takes that kind of effort where you are addressing things at multiple levels. So I am certain that in Indiana, they are sitting there and thinking, okay, how can we,
00:09:44
Speaker
address the multiple levels of challenge that we've had to get to this point, right? Just like many of you have heard of the Swiss cheese model, the fish bow model, right? Helping us understand what are the ways, how are the ways that we got to this outcome that was, that was terrible. And understanding all of those areas or areas to make improvements is, is
00:10:11
Speaker
fundamental I think to tackling the problem of maternal mortality.
Policy Impact on Black Maternal Health
00:10:18
Speaker
So Dr. Benfield, you just mentioned having continued attention to making large systemic changes to improve the black maternal health crisis in America. So I'd like to get into some policy if you don't mind right now. What are your thoughts on the expansion of the Affordable Care Act and how it may affect the black maternal health crisis in America?
00:10:48
Speaker
I'll tell you, I think being a healthcare provider who worked before the Affordable Care Act, seeing the implementation of the Affordable Care Act, and now it has been incredibly transformative. Especially me as a family planner, you know, we were using or trying to help our patients get highly effective contraception. And some of those methods were incredibly expensive and many people did not have coverage for it.
00:11:17
Speaker
and the transformation in front of my eyes into the way that it could be if most people have coverage for most things, which is incredible. And I think that the states where they accepted the Medicaid expansion as part of the ACA and encouraged people to sign up have started to see benefits of that process and that policy.
00:11:45
Speaker
expansion of coverage is incredibly important because that is also then what helps us minimize the inequities in the healthcare infrastructure, right? In the way, the kind of way that hospitals are resourced and where the, we find that, you know, the poorer neighborhoods have the lower resource institutions very often. So, um,
00:12:13
Speaker
fixing the way that our healthcare is paid for and making sure that more people have coverage is incredibly important.
00:12:21
Speaker
Thank you, Dr. Benfield. And just continuing on that trend of policy, I wanted to get into some specific legislation, entitled the Black Maternal Health Mamnibus Act of 2021. And just for the purpose of providing some info to our listeners. Basically, this is legislation that addresses the maternal health crisis in America, where congressional leaders have been fighting for
00:12:45
Speaker
important policies like the 12-month postpartum Medicaid coverage, which would ensure moms have access to the care and support they need and deserve for that full postpartum period. And so basically to build on these efforts, Congresswoman Lauren Underwood, Alma Adams, Senator Cory Booker, and members of the Black Maternal Health Caucus are introducing this act, which essentially just builds on existing legislation to comprehensively address every dimension of the maternal health crisis in America. And just some examples of this bill includes
00:13:15
Speaker
making critical investments in social determinants of health that influence maternal health outcomes like housing, transportation, and nutrition, providing funding to community-based organizations that are working to improve maternal health outcomes and promote equity, and even just growing and diversifying the perinatal workforce to ensure that every mom in America receives culturally congruent maternity care and support.
00:13:37
Speaker
And so just going with that, do you believe that the Black Maternal Health Mommy Bus Act of 2021 is the answer in shifting the Black maternal mortality rates in America? I'm incredibly excited that Black maternal health is front and center in the dialogue and the agenda about how we can make it better. I have not fully reviewed the act, but I do
00:14:06
Speaker
I'm very much in agreement with many of the proposals. The 12-month postpartum coverage is just a no-brainer. We have defined maternal mortality as death up to a year after the delivery because we understand that there can continue to be sequelae of that delivery event that far out, and yet we terminate people's coverage six weeks after pregnancy.
00:14:36
Speaker
It's so out of line with our medical understanding as well as our kind of moral understanding, I think, of the value of health. So incredibly supportive, say, of that as an example, very supportive of increased investment and resources. When I talk about how we can really make change
00:15:05
Speaker
In reproductive health, a lot of it is ensuring that reproductive health is on the agenda, top of the agenda, and adequately resourced. And that often only comes by people who can engage in the act of reproduction being a part of the decision-making process. So the diversification of the healthcare workforce, the perinatal care workforce is incredibly important.
00:15:28
Speaker
And we also find that there are improvements in both trust and confidence in the system, as well as improvements in some outcomes when we have providers of color in service to patients in those communities. So I think I'm 100% in agreement with that part of the plan as well.
00:15:58
Speaker
Dr. Benfield, you mentioned so many things that I feel like really apply to this next question I'm going to ask you. You mentioned diversification of the workforce, increased investment in resources, as well as people who can engage with minorities. So in staying with these topics,
00:16:21
Speaker
What are some ways in which medical schools or medical educators can do a better job at educating students on the implicit biases that exist within the medical community, specifically as it pertains to persons of color and their treatment throughout pregnancy and postpartum?
Medical Education and Implicit Bias
00:16:44
Speaker
I think that as we understand
00:16:50
Speaker
what leads to health, right? What does health even mean and what contributes to health? It's important that I think we educate doctors who have that larger view, right? Who have not only that more holistic understanding of health, but also that more holistic understanding of the work of a doctor and what the voice of a doctor can do and what the voice of a doctor can be used in service of.
00:17:20
Speaker
You know, we are really supporting at our institution a curricular transformation that expands on the work that we already been doing around not only educating our students around bias and
00:17:38
Speaker
that it exists, how it manifests, but also how to mitigate it, how to actually intervene, what are the tools that you need to do that, and then what is the ways that you need to understand the healthcare structure and the health of the individual and the health of the community.
00:18:02
Speaker
So I think that's very important. And then it's also very important to expose students to the ways in which the physician writ large can have an impact, right? You can have an incredible amount of impact with your individual patient in the clinic, in the operating room, serving their need in that moment. You can have an incredible amount of impact
00:18:27
Speaker
you know, working with a particular community serving in the public health space, you can have incredible amount of impact collaborating with community-based organizations who are really making incredible efforts to advocate for resources, to advocate for the access necessary to make the community more healthy.
00:18:51
Speaker
And you can have an incredible amount of impact in the political space. I think there are lots of arenas in which we can use our voice and leverage that kind of expertise and that understanding in service of our community in a wide variety of ways.
00:19:13
Speaker
I think it was amazing to see you talk about how to advocate on a micro and macro level from the medical school and medical student perspective to also on the policy side of things. But also I wanted to ask you, me being a black man and in the case
00:19:30
Speaker
of the scenario of me being on rotations, I actually had four out of five of my preceptors were black OBGYNs. And it was incredibly empowering for many of the patients who were also black to see a person of color of in many ways, similar demographics and attributes as it pertains to the community and what they've experienced have an influence on their healthcare.
00:19:55
Speaker
I want to ask you specifically as a black man, but also men, how can we get involved in this level of advocacy and being able to talk to some of the things that many black women experience that we can directly experience?
Men's Role in Black Maternal Health Advocacy
00:20:11
Speaker
Thanks, Alderman. I think there's so many ways, you know, we talk about a lot about allyship.
00:20:19
Speaker
which often in many conversations is used to talk about people from the dominant group racially, white people being allies for black people. But I think the tenets of allyship apply to any group that wield some power, let's just say it, right? And can use that power in service of a group that really needs it. So I think there's many ways that
00:20:48
Speaker
men can contribute. And they're the same ways that all of us can contribute, right? We can all contribute by learning more about the problem. We can all contribute by in whatever way we can, in whatever space we can, supporting people who are trying to do things about that, whether that's with your vote, with your donations, with the work that you directly do,
00:21:16
Speaker
And as partners, of course, it's incredibly important that we educate ourselves about what the birthing person is going through, right, through the pregnancy and the delivery. It's very important that we are supportive, that we know what's going on, that we understand that our role is to be an advocate for that person in the healthcare system.
00:21:45
Speaker
and continue to try and minimize the inequities on a small scale and on a large scale too. Take some of the burden as well.
00:22:00
Speaker
Thank you so much, Dr. Benfield. I really appreciate how you mentioned how we need to minimize these inequities that are affecting, as you mentioned, the people who are experiencing the birthing process. And in this case, we know the main victims of maternal morbidity and mortality are Black women. And so with that, Black women who become pregnant will have having existing
00:22:25
Speaker
conditions are placed at a greater risk for emergencies. And so what should women who find themselves in this situation know or do in order to be the best advocates for themselves?
Advice for Pregnant Women and Support Systems
00:22:37
Speaker
So I think it's important to ensure that you're feeling heard, right? So if you're feeling as though your concerns are not being addressed, then
00:22:54
Speaker
You can find someone who will address them. You can ask to kind of figure out how better to be heard because that's so important throughout the process. And then I think enlisting support is also really valuable. So one of the things that we are
00:23:24
Speaker
advocating for as part of the Bronx Black Maternal Health Task Force is improved access to doula services. As an example of the kind of support that people with resources tend to have access to, and whether that's financial resources or kind of family infrastructure resources, whatever it is,
00:23:49
Speaker
that poor women typically don't have access to. But we know that having that kind of informed support throughout the pregnancy and delivery and postpartum makes a difference for the experience of that individual. So one of the things that we're trying to do is help make that more accessible through policy work, through reimbursement work. And that's another example of
00:24:18
Speaker
small efforts where hopefully we can enhance the experience and enhance the support infrastructure for those who need it.
00:24:32
Speaker
So before we go, and you've laid down some amazing knowledge in terms of maternal health, talked about systemic issues surrounding maternal mortality.
Resources and Reproductive Justice Engagement
00:24:43
Speaker
We've talked about ways to advocate as patients, as medical students, and even talked about some of the infrastructural problems that occur around the black community and maternal health. I want to ask you one final thought that you want our fam to know about in regards to this topic.
00:25:04
Speaker
Yeah, I think there's lots of good resources. Certainly as an OBGYN, the American College of OBGYN puts forward a lot of information. The World Health Organization has a lot of good information and the CDC is a great resource as well. If you're looking for, you know, what are the stats? What is the scope of the problem?
00:25:29
Speaker
from a numbers perspective. And then I would encourage people to engage with their local groups that are working on reproductive justice and working on maternal health, even through social, taking a look around and seeing who's out there and following them and engaging and supporting them in whatever way you can.
00:25:53
Speaker
by adding to their voice would be a great thing to do as well. And then to think about in your career, whatever that specialty might be, that this is going to be a part of the care that you provide. At some point, I think almost everybody is going to encounter the care of a pregnant person.
00:26:23
Speaker
thinking about how this is how you're going to be in that situation when you're dealing with your patients and taking lessons from this particular health inequity and lessons from the work that we're doing to try and reduce it and apply those across the board.
00:26:43
Speaker
Dr. Benfield, you've been amazing on this episode. Thank you. Thank you so much for allowing us to receive the knowledge. The SNMA fam definitely is feeling the energy too. So how can our listeners connect to you? Sure. Yeah. Um, so my Einstein diversity office is a diversity at Einstein and at is the word 80.
00:27:12
Speaker
So you can follow us there and then folks can email me as well if they have any particular questions or thoughts and I encourage you like I said to go to some of the groups that are doing this work because they really will give you
00:27:39
Speaker
opportunities to contribute that are proven, right? Which is really nice.
00:27:48
Speaker
Awesome. Thank you so much, Dr. Benfield. Again, we are just elated to have had you on this episode, this special episode of SNMA presents the lounge discussing, you know, this topic that is ever plaguing our community, the black community, black maternal health. So thank you again. We hope you all enjoyed this episode and we look forward to lounging with you again next month. Take care guys.
00:28:23
Speaker
Thank you.