UNC and N.C. A&T State University are collaborating on a program designed to improve Black maternal mortality and overall Black maternal health.
The program — Building Equitable Linkages with Interprofessional Education Valuing Everyone, or BELIEVE — was the brainchild of Kimberly D. Harper, perinatal/neonatal outreach coordinator in the School of Medicine’s Center for Maternal and Infant Health, and Janiya M. Williams, program director and clinical instructor at N.C. A&T’s Pathway 2 Human Lactation Training Program.
BELIEVE received a $2.4 million, four-year grant from the American Heart Association in July to develop a curriculum to cultivate trust among patients and health team members. The funding was secured, in large part, after Alison Stuebe, a professor of obstetrics and gynecology in UNC’s School of Medicine, joined forces with Harper, a labor and delivery nurse, and Williams, a lactation consultant.
Maternal mortality refers to deaths due to complications from pregnancy or childbirth. According to the World Health Organization and UNICEF, the U.S. maternal mortality rate in 2017 was 19 per 100,000 live births — compared with two for Italy, five for Ireland, six for Australia, seven each for Germany and the United Kingdom and eight for France.
In the U.S., the maternal mortality rate for Hispanic patients is 11.8 per 100,000 live births and 14.9 for non-Hispanic white patients. The U.S. maternal mortality rate for Black patients is 37.3.
Reducing the rate of Black maternal mortality, Harper and Williams said, requires strengthening birthing teams, including lactation consultants and doulas, who are women who assist women and their families during labor and after childbirth.
For years, the breastfeeding rate among Black women has been lower than that of white women, while Black women’s maternal and infant mortality rates have been higher, Williams said.
“After I had my own child, I noticed that people around me weren’t breastfeeding, and I wanted to make sure that the importance of giving our babies human milk was brought to the forefront,” Williams said in the University’s newsletter, The Well. “We know that if we give human milk at the very beginning; that sets folks up for a better life because breastfeeding affects everything.”
Harper said maternal health affects the entire family because often mothers choose the family physicians, and if they have a traumatic experience with a certain provider, it will impact where they go in the future. She added that health care teams must come together, out of their individual silos of expertise, to ensure patients are well cared for by everyone, regardless of their role.
Stuebe said many factors contribute to U.S. health disparities, including long-established, systemic inequities that negatively affect people of color, like redlining.
“You can map health disparities today to redlining maps from 100 years ago,” Stuebe told The Well. “Folks who live in neighborhoods where community wealth could not accrue because of very deliberate social policies have worse health in the present day.” She said the cumulative exposure to racism can cause health problems, and a lack of resources plays into that.
“It’s harder to eat healthy foods when you live in a food desert,” Stuebe said. “It’s hard to get exercise if there are no sidewalks. All these kinds of things that are stacked against particular communities have led to higher rates of diabetes and hypertension, both of which are risk factors for problems during pregnancy.”
Stuebe said through BELIEVE, families will be engaged and health team members will discuss what it looks like when they’re united versus when they aren’t. Once an education curriculum is established, a low-risk, virtual environment for students across various medical fields will be created for students to practice those skills. Actors will present as patients for health care teams to treat together. Afterward, they will debrief to assess what went well, what went wrong and how the experience can be improved for patients.
Williams, of N.C. A&T, said she appreciates the collaboration with Carolina.
“So often there’s a group of people at the table with funding that are looking to just check boxes off,” Williams told The Well. “This is more than that, because Alison actually gave Kimberly and me the steering wheel to mold and shape this project to how we believe it should go. For HBCUs to be involved, it gives us a voice at the table so it’s not just, ‘Oh, this is how we’re going to save all the Black women and all the Black babies today,’ and not invite anyone who looks like Kimberly and myself to the table.”
— Laurie D. Willis ’86