Bridging the Divide in Maternal and Child Health

Millions in Federal Funding Support Morgan State-led Public Health Research to Curtail Health Problems Among Black Mothers, Infants

Black maternal and infant mortality is increasing at an alarming rate despite increased spending and 21st-century advances in healthcare. The numbers decry a painful truth: according to the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH), for instance, Black infants are nearly four times less likely to survive because of complications related to low birth weight, and Black mothers are twice as likely to receive late or no prenatal care.

These and other figures present a stark reality for Black families who are poised for parenthood yet struggle with unseen odds that place the lives of both mother and child in the balance.

In confronting these harsh statistics, unraveling the complexities of factors contributing to the disparity has become crucial for the Black community, which is grappling with a disconcerting incidence of maternal and infant mortality that demands urgent attention and meaningful solutions.

“There is overwhelming evidence from (the National Institutes of Health and the Centers for Disease Control and Prevention) that greater than 60% of the cause of maternal and infant mortality involves the social determinants of health,” said Yvonne Bronner, Sc.D., professor of Public Health at Morgan State University and principal architect of the integrative research taking place at Morgan that’s examining the non-medical structural forces driving inequity in maternal health.

The Health Resources and Services Administration (HRSA) has committed more than $50 million in support of the White House Blueprint for Addressing the Maternal Health Crisis: a critical investment to help stem the increased rates at which women in the United States are dying from pregnancy-related causes — rates higher than in any other developed nation and disproportionately higher among Black women.

Public health researchers at Morgan are standing on the frontlines to examine these occurrences, better understand their origins, and illuminate pathways toward a healthier and more equitable future for Black mothers. Their work involves an expansive, community-based research initiative that will create a blueprint for Black communities nationwide.

Within the last year, Morgan State's School of Community Health and Policy (SCHP) and the University’s Center for Urban Health Equity (CUHE) have secured more than $15 million in federal grants supporting a number of initiatives with one common thread: maternal and child health equity.

“We are excited about this level of funding, what will come and what it means for HBCUs and communities across the country,” said Kim Dobson Sydnor, Ph.D., dean of the School of Community Health and Policy at Morgan. “This work has been prioritized, and Morgan has made a very intentional, strategic effort to be the foremost authority in addressing the longstanding inequalities Black and brown women disproportionately face. The culmination of this funding and the research it will support are truly a defining moment.”

Creating a Public Health Coalition

A significant stride toward Morgan’s goal to significantly reduce the incidence of Black maternal and infant mortality came with a transformative federal investment establishing the framework for a first-of-its-kind public health coalition. 

Morgan will serve as the coordinating center and is charged with coalescing 16 research centers housed in minority-serving institutions nationwide, including one at Morgan, in an intensive public health research that will examine the root causes of mortality disparities between Black and other communities. The five-year, more than $11-million HRSA grant, “Maternal Health Research Network for Minority-Serving Institutions,” focuses on enlightening, educating and igniting “a paradigm shift” in maternal health research rooted in community engagement.

Unique to this initiative and its funding are the awarded institutions. According to Dr. Bronner, Historically Black Colleges and Universities (HBCUs) and minority-serving institutions (MSIs) have long played ancillary roles supporting predominantly white institutions in maternal and infant research.  The Morgan team with the support of CUHE led the establishment of the HBCU Alliance Team for Maternal, Child and Family Health (HAT) consisting of partner institutions, Morehouse School of Medicine, Tuskegee University, Tennessee State University, Texas Southern University and Chicago State University and the HAT has been instrumental in advocating for the investment in our HBCUs.

“(HAT) will allow us to move these institutions forward in increasing their maternal health research capacity while sharing lessons learned with our unfunded institutions,” Bronner added.

 Leveraging the expertise and efficacy that HBCUs have cultivated as anchor institutions in the Black community is paramount to the effort. Many of the causal factors of the health disparities are rooted in many social determinants of health, and researchers have limited evidence examining the relationship between social and structural determinants of health and maternal and infant mortality.

The disparities are systemic and will require a multifaceted, cross-disciplinary and long-term approach that will encompass a phased, 15-year commitment to yield progress in leveling the rates of maternal and child mortality, Bronner said.

“We’re currently in the capacity-building and strategic planning phase,” Bronner said. “By year three, implementation will be in full swing, and within the next five years, the ‘bottom-up,’ community-engaged, problem-solving curriculum and research will be established, which will allow full devotion to competitive sustainability.”

A Multifaceted Approach to Making an Impact

Public health researchers at Morgan are tackling maternal and infant health through nationally scoped, long-term strategies and grassroots efforts designed to address several immediate needs. 

“Dr. Bronner had a vision for a national maternal child health agenda, and she is seeing it through, along with contributions from many other Morgan public health researchers who are making a critical impact in this meaningful work,” said Dean Dobson Sydnor. “I am extra proud today, as Dean of SCHP, and also happy to say that the Center for Urban Health Equity was able to support the work it took to earn these awards.”

Complementing the efforts of the national coordinating center, Morgan was funded for a five-year, $3-million research center grant to combat maternal mortality and improve maternal health, particularly in underserved communities in the Greater Baltimore region. Kesha Baptiste-Roberts, Ph.D., M.P.H., associate professor and chair of the Public and Allied Health Department in the School of Community Health and Policy, serves as the grant’s principal investigator.

Paramount to the effort will be building a framework and community-based network for maternal health exploration and study, maternal healthcare workforce expansion, greater accessibility to maternity services, and treatment of postpartum maternal health issues, in marginalized communities.

“We are currently collaborating with our state and local health departments, and national partners such as the Black Women's Health Imperative, Baltimore Healthy Start, Light Health and Wellness, MOMCares, to name a few,” shared Dr. Baptiste-Roberts.

Elaborating on Morgan’s effort to bring together a grassroots network of partners and participants successfully, Baptiste-Roberts does not anticipate challenges with recruiting and engaging research participants in the research projects. 

“Our School of Community Health and Policy is rooted in the community. We have a history of successful collaboration and true partnership with the community…(and we) strive to engage in research that is community-informed, community-engaged and focused on solving problems and improving the health of the community.”

Another component of this effort is a CMS-funded grant focused exclusively on researching the impacts of employing the doula mode of care to reduce maternal and infant mortality among underserved Black and brown women. Investigators led by Marilyn Berchie-Gialamas, D.N.P., C.R.N.P., NP-C, assistant professor in Morgan State’s Department of Nursing, and principal investigator for the doula research project, will conduct focus groups of diverse women living in Baltimore who have had a live birth within the past two years, in-depth follow-up interviews with the cohorts of focus group participants, and engagement with doulas who have served for at least two years in the Baltimore area.

As indicated in a 2022 HHS Office of Health Policy report, the work of doulas has been beneficial in maternal health. Doula’s support during pregnancy and birth and their advocacy for patient autonomy — particularly for Black women — have been shown to be effective in improving the labor and delivery experience and in mitigating health disparities within underserved groups. The NOURISH program, a full spectrum community doula program for college students developed by the Black Women’s Health Imperative, was piloted at Morgan with 40 students who are now serving their communities.

“Our approach of employing a focus group model to engage and obtain accounts of mothers and doulas will allow our field researchers invaluable examination of and insight (into) the impacts doulas offer throughout the entire pregnancy,” said Dr. Berchie-Gialamas.

Over the next several months, Morgan and its School of Community Health and Policy will be the epicenter of maternal and child health equity research activity. From the HBCU Alliance Team of Research Centers providing a presence nationally to the grassroots efforts deepening Morgan’s engagement in the greater Baltimore community, there’s no shortage of human capital committed to this effort. And now there’s a financial commitment at the federal and state level to match.

The need for such research is undeniable. Maternal and infant health are fundamental indicators of a society’s well-being, yet disparities persist, claiming lives during times when families should be celebrating the fullness of life and joys of maternity.

“We want to tell the untold story of a healthcare divide that demands our attention and collective commitment to rewrite its script for a healthier, more equitable future,” added Dean Dobson Sydnor. “Our legacy as public health educators, researchers and practitioners is to end this cycle of inequity. That is our mission.”