By Christina Hernandez Sherwood
The disparities are stark. Black women are three times more likely to die from a pregnancy-related cause than white women in the United States, which has the highest maternal mortality rate of any developed country.
For years, the University of Pennsylvania has been a leader in working to change that pattern — advancing the field of maternal health equity through widely-cited clinical research, innovative technology, and more. Now, a key national partnership will broaden Penn’s reach, making it a focal point for maternal health equity research and racial disparity solutions.
Launching the March of Dimes Research Center for Advancing Maternal Health Equity
In January, the University of Pennsylvania became home to the inaugural March of Dimes Research Center for Advancing Maternal Health Equity. Under the leadership of Elizabeth Howell, MD, MPP, chair of the Department of Obstetrics and Gynecology in the Perelman School of Medicine, the center will leverage Penn’s research, technology, and partnerships to address racial disparities in maternal health outcomes — both deaths and serious medical complications — in the United States.
“We are not focused on more description around the inequities that exist,” said Howell, who will serve as the center’s principal investigator and chair of the scientific advisory board. “We are focused on evidence-based solutions, action-oriented solutions, to try to reduce disparities in maternal outcomes.”
Racism and Maternal Mortality in the U.S.
In its latest Report Card, March of Dimes found that the problem is getting worse, and that racial disparities in maternal health are most significant among Black and American Indian and Alaskan Native families.
Philadelphia’s pregnancy-related death rate is slightly higher than the national average, though it has declined in the last decade. A recent report from the Philadelphia Maternal Mortality Review Committee found that 80 percent of maternal deaths were among those who identified as Black, Indigenous, and people of color. Of those individuals, 80 percent were people who had identified social and structural barriers to health, such as mental health issues, substance use disorders, and lack of prenatal care.
The city serves as a microcosm for the complicated cocktail of systemic racism, social determinants of health, and failed policies that have led to the national crisis of maternal health disparities. That also makes it an ideal place to understand the issue and tackle solutions head-on. “Philadelphia is such a compelling place to be for this kind of work,” said Howell, who joined Penn in 2020 with a portfolio of research in health inequities that has shaped national policy and made her a leader in women’s health.
Since 2021, Penn Medicine has taken a systemwide, multi-pronged, and innovative approach to improve maternal health outcomes and reduce ethnic and racial disparities in health care. Some initiatives include standardizing patients’ treatments during key moments in pregnancy and childbirth to reduce racial bias and targeting supportive programs to historically underserved populations. Other programs emphasize connecting with patients during pregnancy to continue their lifelong health care afterward. And sharing successes with other maternity care providers in Philadelphia and beyond is part of this approach across all types of initiatives.
“Let’s put equity first,” Howell said. “Let’s not have it be the afterthought. Let it be the first thought.”
Building a Hub for Maternal Health Equity Research and Solutions
Elizabeth Howell, MD, MPP
The new center, modeled on March of Dimes Prematurity Research Centers (the University of Pennsylvania hosts one of the five centers worldwide), will build on Penn’s ongoing efforts in several ways. The center will facilitate basic, clinical, and policy research projects that develop and test maternal care models aimed at enhancing equity. In the center’s first year, March of Dimes is funding two specific projects:
Delivering postpartum care in the neonatal intensive care unit (NICU): In partnership with Children’s Hospital of Philadelphia and Dr. Heather Burris, Penn clinicians will study whether delivering postpartum care in the NICU could improve outcomes for at-risk parents. The research will examine the feasibility of glucose testing in the NICU for postpartum birth parents with gestational diabetes who delivered at Hospital of the University of Pennsylvania (HUP), which serves a low-income, majority Black population at high risk of morbidity and lack of postpartum care. If successful, the postpartum NICU care model could expand beyond gestational diabetes to other health conditions.
Integrated doula care delivery model: Through a collaboration with the nonprofit Cocolife, this research project will use qualitative interviews and focus groups to develop a model for integrating doulas into hospital-based maternity care. Typically, pregnant people hire a doula, but the doula and obstetrician don’t meet or collaborate until the delivery room. Integrating the doula into a patient’s care earlier could improve patient outcomes.
(The doula project is led by Sindhu Srinivas, MD, MSCE, vice chair for quality and safety in the Department of Obstetrics and Gynecology. With Adi Hirshberg, MD, Srinivas spearheaded Heart Safe Motherhood, a text message-based remote blood pressure monitoring program that decreased hospital readmissions at Penn and was expanded to health systems throughout Philadelphia.)
Penn Medicine's Collaborative Approach to Maternal Health Equity
Eventually, Howell said, her goal is for the center to develop a competitive process for maternal health equity research projects at Penn and elsewhere to receive pilot funding.
In this first year, the center will also build the infrastructure and foster the partnerships that will establish it as a hub for maternal health equity work. The center’s research efforts will be guided by a scientific advisory board made up of maternal health equity experts from across the country. A community board composed of representatives from organizations that address maternal health in Philadelphia and outside the city will also advise the center’s work.
The new center will leverage existing Dept. of OBGYN partnerships within the University of Pennsylvania community including the March of Dimes Prematurity Center, the Center of Excellence in Environmental Toxicology, the Leonard Davis Institute of Health Economics, the Penn Institute for Biomedical Informatics, the Mixed Methods Research Lab in the Department of Family Medicine and Community Health, and the Department of Biostatistics, Epidemiology, and Informatics.
Outside collaborators will include other health systems, city and state health departments, payers, historically Black colleges and universities, tribal colleges and universities, and Hispanic-serving institutions.