‘It’s Listening’: Addressing Maternal Health Disparities

Throughout her career and her life, Irogue Igbinosa, MD, a maternal-fetal medicine specialist at Stanford Medicine Children’s Health and women’s reproductive health research instructor at the Stanford School of Medicine, has always noticed disparities in health outcomes for pregnant Black women.

This issue has started gaining national media attention only in recent years. In 2020, the United States’ maternal mortality rate was more than three times the rate of most other high-income countries, with Black women facing a greater risk of death and complications.

“I think it’s a reckoning of what is the impact of racism on maternal care,” Dr. Igbinosa says. “We’re looking at race in terms of the structural inequities and how we can then address the gaps.”

As a clinician and researcher, Dr. Igbinosa is working to answer that question.

“Instead of taking a pregnant person’s birth in isolation, think about what we can learn about the person prior to them giving birth,” she suggests. “If we don’t account for where they live, their access to nutrition, the types of jobs they have, then we’re missing pieces of the story, and medical providers can make assumptions that are incomplete. I think our responsibility toward data, especially as a health disparities researcher, is to use the past to inform the future.”

Having the most complete picture of what impacts patients’ health can then affect policy, Dr. Igbinosa adds. The data collected can show trends in outcomes and drive resources to areas that need them most. But that’s just one way of tackling disparities.

Listening to the community

Dr. Igbinosa’s work involves addressing disparities in pregnancy and birth outcomes from a community-wide lens. Through this, she has found that there are many people who should have a voice in the conversation outside of the hospital, research, and government spaces.

Dr. Igbinosa collaborates with community-led organizations in the Bay Area made up of patients and advocates. Her team and colleagues at Stanford Medicine have found that community members have experiences and questions that researchers may not have thought of to explore.

“It’s not just having the community at the table, but making sure they are active contributors,” she said. “That means listening as opposed to talking. I really enjoyed a series of community engagement town halls we hosted. The participants all had their own questions that they wanted to ask of research. They wanted data on a different question than what we were thinking. Putting that together informs the greater work and enriches what we’re able to do.”

As a former private practice OB/GYN, Dr. Igbinosa knows the different challenges in health equity work that those in private clinics face, specifically having enough time to dedicate to each patient. Prior to coming to Stanford Children’s, she noticed that her patients were becoming increasingly concerned about the potential for adverse pregnancy outcomes and often had a personal family relative/friend who had a difficult-birth-related story. That was what drove her to pursue maternal-fetal medicine work and a research-oriented career to affect policy.

While everyone has their own way to advocate for their patients, one thing anyone can do is to provide respectful care.

“Patients understand physicians are busy, but it’s so important to make sure they are heard,” Dr. Igbinosa says. “That can be figuring out, in the time you’re allotted with the patient for their appointment, what is one thing I can follow up on for the patient? It’s just listening to them that can make a difference.”

A window into a person’s future health

There’s a saying that pregnancy is a “window into a person’s future health,” and it’s an opportunity to see how else care teams can support and improve the patient’s health, which is something that Dr. Igbinosa does at Stanford Medicine Children’s Health. Following delivery, she and her colleagues focus on continuing to provide support for each patient, as they may experience postpartum mood disorders, such as postpartum depression. Patients seeking care for maternal mental health problems also encounter disparities.

Not only that, she adds, but there are initiatives across all of Stanford with the mission to fill those gaps in health equity. For instance, the Stanford Maternal & Child Health Research Institute provides research funding to solve some of the greatest health challenges facing moms and their babies. The California Maternal Quality Care Collaborative (CMQCC), which is headquartered at Stanford, has several statewide efforts to reduce pregnancy and birth disparities.

“I feel Stanford Medicine really supports taking a wide, holistic view of the patient,” Dr. Igbinosa says. “I see that in the research they support and the different initiatives they support, so that we can best optimize the health of the mom and the child not only now, but for the rest of their lives.”

Related Story: “Childbirth’s Unequal Burden” discusses initiatives that go beyond statistics to end life-threatening racism in maternal care.