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We are the Maternal Health Learning and Innovation Center, a network of maternal health equity experts and organizations working to make real change for women and birthing people in the U.S.
Our podcast is a series of episodes connecting around culture, lifting voices and stories, exploring innovations in maternal care and discussing ways we can center equity in the way we approach our health and wellness.
Learn more about us, explore our resource center and find support for all maternal health professionals at MaternalHealthLearning.org.
For more podcast information and content, visit MaternalHealthPodcast.org.
Ramona - 00:00:03:
Welcome to the Maternal Health Innovation Podcast Season 4. I'm your host, Dr. Ramona Olvera, a postdoctoral scholar working at CATALYST, a research center at The Ohio State University. I'm part of the P3 EQUATE Network, an American Heart Association's Health Equity Research Network dedicated to promoting equity in maternal and infant health outcomes through five research projects focused on pregnant and postpartum individuals, primarily within the Black and underserved populations. On this podcast, we listen to maternal health innovators about ways we can implement change to improve maternal health in the U.S. Be sure you're subscribed. As part of the EQUATE Network, we're going to focus this episode on how researchers can engage diverse communities, such as the Latinx population, to address maternal health as part of a broader effort to prioritize health equity in maternal and infant health research and healthcare service delivery. My co-host today is my EQUATENetwork colleague, Dr. Holly Horan. Holly is an assistant professor at the Heersink School of Medicine at the University of Alabama at Birmingham. Before we introduce our guest, we want to talk a little bit about community-engaged research within the Latinx and Latina communities. Holly. Welcome. And could you give a brief overview of what you think community-engaged research is?
Holly - 00:01:34:
Sure. Hi, good morning, everyone. So community-engaged research, or what is abbreviated as CEnR It's a transformational approach to research that takes time and relationship building and trust. Those are the fundamental pieces of it. And it centers people who are affected by the process, outcomes, and continuity of the research being done. Commonly, this is public health or clinical research trying to understand how social factors are affecting public health and clinical outcomes. And so within community-engaged research, how you define community is going to be largely driven by what type of health concern you are examining and looking at within the community and what that means to the community themselves. So this concept of community is fluid throughout this type of research. So foundational work for community-engaged research began in the late 80s and 90s with some of the leaders and founders of this method called Community-Based Participatory Research, or CBPR, which folks might be a little more familiar with. But the goal was to work with local communities, be that community organizations key stakeholders, leaders, or other agents of change to address these public health or clinical concerns. And more recently, Yale School of Medicine’s Equity Research and Innovation Centertalks about the ways in which community-engaged research is a process that incorporates input from people who the research outcomes will impact and evolve, such as people or groups. And also focusing on making sure that at some point in that relationship across this community-engaged journey, that you become equal partners throughout the research process. So this involvement in terms of having community be the focus and center of research may include co-designing research questions to solve those problems, making decisions related to the research process, as well as the implications of the research, understanding how the research can influence policies, as well as creating programs and healthcare service delivery interventions that could affect the lives of the people that these groups, these leaders represent, and those in their community. So when we're thinking about community-engaged research, there's a few things to keep in mind that are really central to what it is. So there's something called equity factors, and there's a big emphasis on health equity and health equity research as being a motivating factor for doing this type of work, with using a community-engaged approach. So when we think about equity, we're thinking about: Who has power and control when it comes to the research? Who is involved in the decision-making? Who's influencing the research? The mutual benefit of the research? Who owns the research? Who's responsible for it? As well as what does resource sharing look like? And so one of the things that's unique about community-engaged research is that there's knowledge and information resource sharing in a bidirectional or multidirectional way between communities and the researchers themselves. In addition, we've got contextual factors. So we talked about equity factors, but now we have contextual or environmental factors. And this is thinking about the history of the place in which this research is being done. The trust between those community members, leaders, and the researcher. Also respect and transparency with what the research both can and cannot do at a certain time point. And so community-engaged research can look a lot of different ways. And you should really think about it more in terms of a spectrum from being some of the earlier work where you may be building rapport and getting insight from communities, all the way up to working closely with communities so that you were either engaging in what is known as authentic community-based participatory research, where the community approaches the researcher and says, this is something we care about and we want to do. Or even better yet, community-driven or community-led research, where the researcher is really just in the collaborative or supportive role. So from a methods or methodology standpoint a lot of this work is done using mixed methods or what we call numbers and narratives to help understandwhat the priorities are of the community, as well as how to power build within those communities to eventually do community-driven research. And I just wanted to have a little shout out to some of our larger funding organizations, including the AHA for prioritizing community-engaged and community-based participatory research. The AHA recently had a funding opportunity for the Health Equity Research Network on community-driven research approaches. That was just this spring. And then Dr. Tiffany Powell, who is the chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung and Blood Institute recently, last year put out a three-part series on community engagement in CBPR. So we see that these larger funders are paying attention to the value and importance of this work, and that's something to get excited about. And then in terms of my history, and using community-engaged and community-based research, community-based participatory research, I took classes when I was in graduate school. So during my master's, I had a course in 2009, and then I took another course in 2013. But as someone who does community-engaged research, I believe this is something that is experiential; it has to be practiced. And that relationship building, no classroom setting can replace what it's like to do that in actual community. And a lot of what motivates me to do this work is actually detailed in another podcast on the Human Biology Association's Sausage of Science podcast, episode 165. I've also had formal training as a faculty member with Dr. Drew Pearl at the University of Alabama Center for Community-Based Partnerships and as a member of the 2021-2022 cohort of the CBPR Partnership Academy hosted by the Detroit Urban Research Center with, hosted by Dr. Barbara Israel is who's considered one of the founding grandmothers of CBPR.
Ramona - 00:07:45:
Wonderful. So with the community, when we're talking about community, in this episode, we're really going to talk about pregnant and postpartum individuals, and particularly within the Latina or Latinx, depending on how you want to talk, use the words for that population. Can you tell me a little bit about what your knowledge of how research has been done in that community?
Holly - 00:08:10:
Yeah. And so Latina, Latinx, Latine, depending on what term you use, right, particularly for pregnant and postpartum populations, I want to call attention to the fact that this is a unique demographic. Because of the expansive concept of what it means to be Hispanic or Latino or Latinx or Latina. And if you know anything about the history of how we categorize race and ethnicity, particularly within the United States how we've collected that information and tracked that information over time has changed. And is often connected to the political context or the political milieu of our country. And so, it's really a fascinating demographic to think about not only what are the similarities among Latinx and Hispanic populations, but also what are the differences. And how can we prioritize the needs of those who may have pressing public health or clinical concerns. And also another thing to think about is because of our proximity to a lot of countries where Latino and Latina and Latinxs folks come from we realized too that the ways in which we categorize and operationalize our identities and people doesn't always apply in those other areas. So there's a whole element of acculturation to this that can be both a protective factor and also lead to disparities and inequities that we see within the United States. So we know that particularly within the U.S., there are specific topics related to pregnancy and postpartum within this demographic that have been investigated using a community-engaged or community-based participatory approach. So a lot of these are related to pregnancy intentions and family planning and primary care; Reducing teen pregnancy disparities; Looking at stress and social determinants of health in specific populations, in particular Puerto Ricans and then also reproductive health access at the U.S.-Mexico border and how that has changed given the current changes in leadership politically in this country; Recruitment of first-generation immigrants in perinatal health research, broadly speaking; Broader research related to health literacy and communication, particularly around pregnancy intention, but also about health behaviors during pregnancy and postpartum; As well as some work done related to postpartum mental health care. So there's been some virtual programs that have been implemented using a community-engaged and community-based approach to focus on postpartum wellbeing for Latina and Latinx populations during after pregnancy.
Ramona - 00:10:45:
Yeah, and it will be interesting to hear as we move into our guest to talk about, you know, that intersection with ethnicity and race and how that intersects. But before we move to the guests, do you, can you tell why do you think it matters in the maternal perinatal health research in the U.S., this issue of community-based research or community-engaged research within this population?
Holly - 00:11:09:
I agree, Ramona. I really would want to defer to our guests for today to speak to this broadly, but I can say a couple of things here. And so we know, everyone on this podcast and probably a lot of folks listening, recognize that health inequities are very real. Maternal and perinatal health, not only within the U.S., but also internationally and especially for our Black and African-American pregnant and birthing persons and new parents. But when you also are able to look at other demographics, particularly Latinx and Hispanic populations, and you can tease apart that data based on where these populations are from, get more granular information about how they identify, we also see inequities, particularly for some of our Caribbean populations. And we know within the U.S. outcomes for our Latinx and Hispanic populations are largely driven not only by identity, but also by health insurance status, which is one of the proxies that we use for understanding socioeconomic status. So we know that risk factors such as hypertension, anemia, prior cesarean birth and pre-existing diabetes tend to be more prevalent in the majority of Hispanic communities or Latinx communities that are at Medicaid or uninsured. And so we see The reason that I think this is so critical is because focusing on this demographic, we can open up a bigger conversation about this concept of what Kimberlé Crenshaw defined as intersectionality, which is the ways in which we examine how social positions like race, gender, class, sexual orientation, ethnicity, and physical ability. shape a person's experience and create distinct outcomes that are specific to populations, but then also can transcend multiple different demographic groups.
Ramona - 00:12:50:
I look forward to hearing from our guests. So I will turn it over to you to introduce the guests and move on from here.
Holly - 00:12:57:
Thank you so much, Ramona. Now we get to pivot to our experts for the day. So before we get into our questions, I would love for each of you to just take a moment to briefly state your name and who you are and what you do within the world of maternal and perinatal health with Latinx and Hispanic communities. So Vanessa Calderi, could we start with you?
Venessa - 00:13:23:
Sure. Thank you so much for this invitation. I always find it an honor to be able to speak on behalf of Puerto Rico and the work that we're doing. So my name is Vanessa Calderi. I am a midwife here in Puerto Rico. I'm also the founder and director of the Perinatal Holistic Health Center, MOM. And I am also the director of a midwifery program in Wisconsin, Southwest Tech College and we're the only publicly funded midwifery program on an associate's level in the United States. So we're happy to be here and share.
Holly - 00:14:11:
All right, Hannah Mesa, would you like to go next?
Hannah - 00:14:16:
Thank you for the opportunity to be here. My name is Hannah Mesa. I'm a project manager at the University of Michigan School of Public Health, where I'm involved in community-based or community-engaged research. And when I'm not wearing that hat, I'm also a community-based birth and postpartum doula. And most of my work has been working with Latina, Latinx, Latine community. And so I'm really excited to have this conversation today.
Holly - 00:14:45:
Welcome, Hannah. Glad you're here. Right. And last but not least, McLain
McClain - 00:14:50:
Good morning, everyone. My name is McClain Sampson. I am an associate professor at the Graduate College of Social Work, University of Houston. And I am passionate about involving women who are affected by perinatal mood disorders in the research that we do about the issue. So when it comes to this population, I have led several research projects that explore what affects, beliefs, and treatment seeking among this population. We really center the women. And by saying that, I mean that we ask them. We do focus groups. And I've also taken my intervention, which is an intervention for decreasing postpartum depression through home visits. We've asked them for their feedback about the intervention and asked what would help for them to want to participate in the intervention. So it's all research, as you can hear. And my passion is really trying to involve the affected people's voice in the actual projects and topics that we talk about. Thank you for having me.
Holly - 00:15:59:
Welcome, McClain. I look forward to learning more. So first, we just want to know a little bit more about your journey to doing community engaged or community based research and service. What led you to do this work? And what has that trajectory looked like for you?
Vanessa - 00:16:18:
Well, I can start. I started studying midwifery in 1996. And when I arrived to Puerto Rico, because I lived in the States for a while, I grew up in New Haven, Connecticut, and then went to California and lived in Texas for a while. When I came back to Puerto Rico to practice, I really started seeing first what maternal infant health looked like in Puerto Rico, which was, you know, very based in old care models, which it still is, but it was very exacerbated back then. And as I grew into my role as a community midwife, we were only four at that time. I started seeing that midwifery and really respected, autonomous, humanized care was really focused on people with privilege, right? People, either economic privilege or education privilege. And I realized that that's not what midwifery meant to me. Midwifery was supposed to be accessible to all. And it didn't mean that you had to have an out-of-hospital birth. It just meant that everybody had the right to be treated with respect and education and support that they need. So I worked for many years, really trying to do, you know, just, I did a lot of bartering as a midwife. You know, come and paint my house and I'll be your midwife. And I realized that wasn't sustainable. I wanted to keep being a midwife. It was good, but not sustainable. And so in 2005, I started out of, you know, my house, a nonprofit, just kind of the concept of it. And in 2007, it became more concrete. And I partnered with a doula company here in Puerto Rico, Doula Caribe. And we started offering subsidized doula care for the people that would come and study to be a doula. Then they would go out and we would give, you know, we would connect people who wanted a doula. And so the students would be the doula and they would get oversight or support from one of us. And then from there it grew. We founded a community center that was also a cafe back then, so that would help generate some funds. But I always noticed that, you know, maternal health in 2005 was like something that nobody really paid attention to. Really, at least in Puerto Rico, it wasn't really a topic of, it was like, oh, you're alive and your baby's alive. That's all that matters. Nothing in between matters. And that's not the truth. We know that, you know, the whole experience really shapes who we are as people. The birther, those that are birthed, the family unit, everything. And so through the community center with this cafe, there was lots of education. And as we progressed, we turned into a clinic. And now we're a more recognized clinic that we have different collaborations with different funders and universities and so forth. And so now we're able to offer a subsidized care program to really help or support people that are looking to have a healthy evidence-based standard, you know, evidence-based standard care, here in Puerto Rico. And that was really the whole point of me becoming a midwife to really allow for this practice, which we know is so important on so many levels to be accessible to all because otherwise it's just becomes something for, you know, a small chosen few with privilege.
Holly - 00:20:35:
Thanks a lot for that. I think your story will never get old for me. I love it.
Hannah - 00:20:42:
So before I went back to school in 2017, and before that, I was working primarily as a birth and postpartum doula with a nonprofit program and serving a lot of different families, and it was a really rewarding experience. And at the time, I did have an opportunity to do some research, but it was more clinical based. So when thinking about going back to school, I thought, I really want to look at ways that we can help communities, particularly communities of color, as they navigate the birthing space and what that looks like. So I wasn't necessarily going back to graduate school for research. Coincidentally, though, at the time in 2017, my father was detained and it started this cascade of, you know, emotions, but passion about what does it also look like to understand health and health disparities at the intersection of Latinx and Latiné health and immigration. And at the time, these faculty members at the University of Michigan School of Public Health. Dr. Paul Fleming and Dr. William Lopez were actually doing community-based research with some folks in Detroit looking at this intersection. And so it was a, and I had, you know, an opportunity to work with them as a student and then get introduced to community-based or community-engaged research. And I will say from that point to now, it's been an absolute privilege, but it's also really redefine my understanding of research in general, because prior to that, the clinical space, while there's lots of value in that more traditional model of research. I've also found that we don't have the solutions perhaps that we need in both public health and medicine, if we're not working with and centering the community's voice. And so that's where a lot of my interests and passions and experience have come from. And since then, I've just had the opportunity to continue to work with community members and balance both that identity as now being a member of a research team in the academic space. And so that's a certain level of privilege and identity. But also trying to stay true to where I came from in terms of my interests, my passion, both working with community, how things and disparities have affected me and my family personally. And I've really valued all of those who, including all of you on this call, who are really dedicated to making sure that this approach to research really stays strong and rooted in addressing health disparities and inequities.
Holly - 00:23:07:
Thank you for sharing that story, Hannah. I glad you are r here. Glad you're doing the work.
McClain - 00:23:13:
Yeah, I love hearing people's stories about how you got into this. So it makes me reflect that I, like most people in the United States, I would say, was ignorant to the how much women are left out of women's health research until I was at the moment of being pregnant and going to several appointments, as you do when you're pregnant, and realizing that nobody was really asking about my own mental health. And I found that to be really alarming because the mothers and/or birthing people who are actually gestating the child, we know that there are epigenetic effects going on now about stress and contextual factors. They are affecting the baby, and it's also affecting the person who's carrying the baby. So it just started from this place of, you've got to be getting me, that nobody's really asking and nobody seems to care about this. So, I wanted to have an intervention. I'm a researcher. So we, as interventionists, we look for solutions that can be done and tested for evidence and efficacy. And I really wanted to have an intervention that was affordable and accessible for everyone that could normalize the range of experiences somebody might have, the range of emotions someone might have during pregnancy and postpartum, and also offer solutions. So I went into academia with that passion. And then I was fortunate enough to be in Houston, an incredibly diverse city, and to have colleagues such as Luis Torres, who is now at University of Texas, Rio Grande. And through that connection, I was introduced to great organizations like Urban Strategies, who wanted to see what the intervention might look like in different settings, in different populations, mostly in the Southwest. But so that's how I started being in this population because I'm not a member of Latina, Latinx community. And so I've done a lot of listening. I've done a lot of transparency. I consider what I do to be all about adaptation. It's like I have this intervention that we know increases self-efficacy, which is your belief in yourself and your abilities, and it decreases depressive symptoms during pregnancy and postpartum, but I'm not an expert on your community. So help me learn how we can adapt this to work best for you. So I think that's my explanation.
Holly - 00:26:07:
Thank you so much.
McClain - 00:26:08:
Mm-hmm.
Holly - 00:26:09:
And I want to make sure we have time to answer. As many of these questions as possible. And so would any of you feel comfortable discussing highlights or challenges that you've experienced? I'm sorry, McLain I know you just talked a little bit about a challenge in terms of building rapport in the community and doing that work that's community centered. I would love to hear more specifically about highlights and challenges for in doing community engaged work. What does that look like for you?
McClain - 00:26:36:
Sure. Obviously, there's the challenge of being an outsider. And I would caution everyone that, as Hannah alluded to, when we are researchers and we're part of an institution, such as a university, we're already an outsider. So even if you're part of the ethnicity, the race, the class, all of that, you should still really kind of take inventory and realize you're an outsider coming in. And it takes a lot of humility and listening. And then as far as highlights, I think one thing I always like to share is with Latinas, when we talk about what do you know about postpartum depression, postpartum anxiety, mental health issues, one of the things we hear is that one of the main themes I hear is that it's common, it happens to everyone, is a message. But not necessarily that it's depression that happens to everyone. It's that the suffering and the mental health distress happens to everyone. And so there was a lot of confusion about how do I know when something that I'm going through is just normal stress, depression, fatigue, versus how do I know when I need to actually get some help and formalized help? Another thing I like to make people aware of that we've heard in our research is that among the Latinx community there are obviously a lot of values that incorporate community and lean on community and family. And so the moms really wanted solutions that involved their partners and their families. So a solution from my traditional way of being raised, middle-class white woman of privilege is very much like, what does the expert tell me to do? I'm going to do that. And among the populations that we talked to, they said, my family is my expert and my husband is my witness. So I want them to be engaged and aware of what symptoms and signs might look like and how to help me in a very family-centric way. So I always like to share those highlights.
Holly - 00:28:52:
Thank you, McLain
Hannah - 00:28:55:
I'm happy to share just a few highlights. One of the experiences that we've had in some of the work that we've been able to do looking at Latinx health, health disparities, it actually started as a partnership and a conversation between some community members at a clinic in southwest Detroit, CHASS Center, and their interest in understanding how they can better serve their community and their patients given heightened anxieties around immigration policy in 2016. Well, immigration, you know, obviously, and the challenges related to immigration, particularly for Latinx, Latine community isn't new, right? There, you know, there were some different dynamics that occurred in 2016. And so it, I, you know, really one of the things that I think is notable is that the part where we are today was really led by the community. And that's amazing. And it's a privilege to be able to be a part of that kind of project. But also what's been really awesome is that that started as understanding the intersection with immigration policy. But where we're at today is more broadly and specific and specifically looking at perinatal health and immigration is a part of that. But it's emerged or evolved along the way because the community said, OK, well, we did we did this project. We learned these things. But now we're thinking about how that applies to this part of our community or population. And the next step was actually looking at diabetes. And so during COVID, which was understandably challenging for everyone in clinics in particular, was a project that was led. But then from that actually came this looking at maternal health. And so one of the biggest highlights I like to think about is the fact that there's been an evolution of that community-based or engaged research that's really come from the origins of that partnership and it's really been led by the community and the research team. We've been partnering with them, but we can't take credit for those wonderful ideas.
Holly - 00:31:04:
Detroit's doing some good work in that and community-based work. Always exemplary.
Vanessa - 00:31:11:
I can discuss some of the challenges we face here in Puerto Rico that I personally have seen. And also just contextually in the United States, because I have lived there. But here, because we're a very unique position in the United States, we're like this territory slash colony. We have these federal regulations imposed on us, but yet we have our own constitution. Um, so. And then, you know, the people in power are most, most of them are men, really, you know, with old outdated, or even women, I mean, people just in general with outdated views of maternal health in general. Like I said in the beginning, it's all about like, if everyone's alive, that's all that matters and you don't really have very many choices in childbirth or the way that you have a child or autonomy to make decisions and, you know, the way that things will be handled. It's just very, Um, imponente, right? It's very people impose. Or the system imposes its regulations on our bodies. And it's almost, it's very, it's a combination of what the Latin American machismo is mixed with the United States machismo in a way. So it's almost like this machismo on steroids. Like I, I dominate and it's, you know, it's very prevalent in…. We're changing, obviously we're evolving as a community, but in, you know, in countries that might not have the resources to support optimum education, like it is in certain parts of the United States, not everywhere, but in Northern Europe and, you know, where they prioritize education. Uh, there's a lack of that empowerment to help change these things. So we're often as midwives, as doulas, as you know, part of that perinatal task force or workforce, we find all of these barriers and challenges to really get out information. And then on top of it, you know, that intersectionality of being in a colonized place where we are driven by these insular point of view is that, you know, that it's really hard to change. We find that really trying to make the changes, well, first, you know, we become renegades. We're questioned by the system. You know, we're always on a defense method. Like we're always trying to defend ourselves. Like, hey, we're not doing anything wrong by supporting you to make choices in childbirth. You know, be, want to be with your baby and not be separated by your baby or, you know, not have to have a forced episiotomy or whatever it is that people face while they give birth. So having that challenge of just that dominating role of machismo, which is like just a dominating entity in one's life. And then on top of it in Puerto Rico, being a colonized nation is, has really been hard for us to make progress here. Like the changes are like, you know, like ant steps, right? I started in 1996 and I saw a video, a documentary that was done in 2005 about this rising C-section. It was 47.5% in 2005. And then this year it was 50%. And it was the same discourse that was being told then is being told now, just with other players. So the changes are hard. And then on top of it, because we are this, almost like this repressed, colony in, in, on a national level, if we were within the United States, we're constantly ignored, right? Like people don't really pay attention to us. They only pay attention to us when there's something, you know, like now we have this Act 20 where all these millionaires can come into Puerto Rico and not pay taxes, right? So they get, they move here so they can just come and they don't, but they don't have to pay taxes on their business or to Puerto Rico. So that's, they pay attention to us there, but they don't really pay attention to us on a national level. Like sometimes I have to argue when I see things like even within midwifery associations, I'm like, Hey, I mean, if we're part of the United States, like we have to follow these federal guidelines. Why aren't we on the map? Why is Hawaii on the map and Puerto Rico not on the map? Right? What's going on there? So we're constantly ignored and our voices aren't really heard. We're just kind of there. And our voices here on the island, we have to really be loud. That's why Puerto Ricans, I think we're so loud because we're like, hey, we're here. Don't ignore us. And then in the United States, I find that that whole thing of being ignored, it kind of goes and it reflects itself in society in the United States, right? Like we see how the Latina population, is pretty ignored, right? And we're all clumped together, right? It's like people of color. Well, you know, no, there's, you know, Puerto Ricans are, we have our own genetic makeup and Mexicans have their own and we're very different culturally, just like Chileans and people from Colombia. They're so, you know, everybody's different. You can't just clump people together. But, you know, even we know that Spanish is the second most language spoken in the United States. Right? And in a lot of places, people don't speak Spanish. And it's, you know, a healthcare worker doesn't speak Spanish and someone has to go birth in English. And then that's not their language to, you know, to birth in. People want to birth in their native tongue. And then it's like you are, people are, you know, oh, you're in the United States. You should speak English. No, English does not have a official language. So that's not true. And so we're, you know, the Latina population or Latinx is really always pushed to the side. It's like we're there and we're not there. And then. You know, one last thing, which kind of brings this all together. I remember once I applied for a midwifery job, a job at a birth center in California. And I was talking to the owner and I didn't get the job. And this woman from, I think it was from India, got the job. And she was like, yeah, you know, it's just that, you know, that in the United States, people tend to have their reservations around Hispanics. Right? Like we were less. And so I think that that is part of what you know, tends to happen. Like there's so much, um, really just negative information that, you know, almost as if we're not enough. And then we come in with our, and we're not, it's hard for a Hispanic person or Latino to get to be indoctrinated. We stay with our culture. We don't, you know, it's most people don't assimilate as well. Right. Really Latina people go home and speak Spanish. They eat their typical dishes. They, you know, they raise their children in a certain culture. So that lack of wanting to really assimilate also, I think it. It's a little, um, harder for you know, it creates challenges for researchers, but it also creates challenges for governments.
Holly - 00:39:24:
I think you bring up an important point. And one of the reasons we wanted to do the podcast, Vanessa, too, is to shine a light on this broad demographic of folks and to say, How can we better understand what's going on in those populations to elevate and highlight what they're experiencing? You spoke to the structural pieces of that, which are deep and significant. Thank you, Vanessa. So. And the communities that you are working with. What kind of health i inequities are you seeing related to perinatal health? And how do you think community-engaged research can help improve them or what has been done so far to improve them?
Vanessa - 00:40:06:
I think I've spoken on it a lot, but, you know, within the community I serve. I see that for something as you know, just insurance, for example, like Medicare, we don't get half of the money the United States gets when it comes to care, Medicare. Is it Medicare or Medicaid? Here we call it Plan Vital, public health, right?
Holly-
Medicaid.
Vanessa:
And so, yeah. So what's happening are the doctors, the obstetricians and so forth, they're leaving the island. So we don't have obstetricians. And the ones that we do have, they attend 60 people a month, right? And they don't get, you know, they might get $20 for an appointment. You know, prenatal appointment, they just get undercut. They don't get paid the amount that other obstetricians are getting paid in the United States. So they're leaving, they're fleeing. And then this really causes inequities for our birthing population because, you know, there's no doctors, they have to, you know, wait five hours to be seen. The appointments are five minutes and it's just a really low quality care. And so that, you know, in terms of our medical access and then it's also, you know, even just education, right? There's a lot of old school methods that are being used to care for people, which, you know, you go to California or even to Connecticut where my sister gave birth at Yale and it's like, no, they don't do those things over there, right? It's like, why are we doing these things with our, you know, our Puerto Rican women and birthers? And so that lack of really expansive access. And so I think that research is really important. And then again, one of the things that isn't really important to research is having it be in someone's language, right? Because people, most people think, oh, you know, you live in the United States, you speak English, or you live in Puerto Rico, you speak English. No, a lot of people don't speak English or they might not be able to assimilate the information. They might be able to have conversational English, but, you know, read a study or talk about a study. It's really hard. And even our academics in Puerto Rico so we're really trying to put, if we're trying to uplift the Latina voice in the United States or nationwide, then, because you go to Spain and everything's in Spanish, right? But here in the United States, we need to do more things in Spanish and, you know, more access to our Spanish speakers that would not only be available for Puerto Ricans in Puerto Rico, but even Hispanics and Latinos in the United States.
Hannah - 00:42:47:
I think a huge thing that Vanessa's already, you know, so wonderfully put is like language, language and, and cultural attention, what that looks like for Latina and Latinx community, the community as a whole is super important. So obviously as Vanessa has, you know, mentioned, that's going to look different where people are coming from, right? Whether that means specifically if you're in Puerto Rico or in the context that I have an opportunity to work in, in Detroit, but also where people are coming from. And what I think is interesting, and Vanessa brought this up a little bit, that concept of intersectionality, right? And so intersectionality, you know, that you brought up earlier, Holly, while it was started by Kimberlé Crenshaw to look at Black women's experiences, what I love about the concept and thinking about the philosophy is when we think about it today in a space of perinatal health and looking at communities like the Latina, Latinx community, what does also mean to break down and understand people's unique experiences and the ways that things, unfortunately, like discrimination, racism, and oppression come together. So yes, you can provide, for example, translators. That's a right. And I don't mean in parentheses to say that it's not a right, but it's set as a right in the healthcare space. But often what that actually looks like differs dramatically where people give birth, for example. And so you'll have translators, but they might, you might have a translators, for example, who identifies as a male, and you might be in a space where the birthing person prefers somebody who identifies as a female, as an example, or the type of translation looks different depending on where a person, you know, where a person has grown up in the type of Spanish, for example, that they speak or that they've learned, or even another intersecting identity we don't talk about, but we've seen a growing trend is our community or folks that come from Central America, and we're like, actually, Spanish isn't the primary language. Its an Indigenous language and that's at the primary language and that's absolutely not accommodated for in our spaces. And so yes like Vanessa said, Spanish should be the bare minimum that we're providing for our community. And I mean, our nation, the United States, for all of the historical reasons that, you know, one could, could look into. But also, I think then when you start to really look at unique individuals and communities, there's so many other layers that we're not addressing. And I, you know, I spoke earlier, immigration being an aspect of that. But also gender-based violence being something that we don't talk about, which can be unique, both, I think, just broadly speaking to thinking about maternal health too, but there are different ways that that manifests and then people's access in those ways. But to think of a way where I've seen community have great solutions or voicing like, hey, these are things we need while there's still lots of room for improvement. Some of the resources that we are already working with, but we're seeing more efforts towards things like doulas or promotoras de salud, right, community health workers. And I know, you know, folks in this call have talked about their work with doulas and doula programs. For example, our community partners in Detroit CHASS Center has just launched a large doula program and that's community-led and all of their doulas are bilingual and really trying to center their work in providing resources and information and also that intimate partnership or level of care that individuals need. So I know, you know, Vanessa, and even I think McClain was talking about, well, there's a way in which particularly and broadly speaking in our Latina, Latinx community, family and community is so important. So what are ways that we also think about roles like doulas, not just talking about, hey, what do you expect during pregnancy, labor, delivery, postpartum, but what are also those other community or family elements that we can connect with people on? Because that does shape people's outcomes and that does matter. And those are everybody's lived experiences that relate to their health and their health outcome. So I think in those ways, I get excited when I see that community-led work predominantly in the more non-medical roles, but I'm also looking forward to thinking about where we can work with community members and find community solutions to disrupt or challenge our more medicalized system. Because, you know, as Vanessa has said, there's a lot of room for improvement in the ways in which we deliver care drastically changes where people located. And thats finished
McClain - 00:47:17:
So I'm in Texas and 40% of the population identifies as Latinx. So I always like to draw attention to the sheer magnitude of that demographic and how it is typically looked at as monolithic, as one thing, like you were saying. And when I'm seeing reports about how maternal health is impacted differently with the different intersections, what we saw in Texas is that the Latinx women were having more COVID-related deaths. So while the maternal mortality report came out showing that what we're seeing across the nation, that three times as many Black women are dying, we did see this huge spike for Latinx or Latinas when it comes to COVID-related deaths. So I think that we're going to be... And I'm looking at that and responding to that here in Texas. What does that mean? And I also wanted to say that another major thing that influences the outcomes is living in poverty. And what we're seeing is that the health care, the lack of access to health care, the lack of access to financial resources is having a major, major impact on the health during pregnancy and postpartum. So as usual, as a social worker, I would always like some emphasis and innovation in that arena, too, because it is really making things inequitable and affecting women in irreversible ways. And I also wanted to just make a plug for, research must be understandable and accessible. It's really unfair that we have all this research and knowledge and innovation just kind of trapped at institutions and regurgitated among those of us who are in the institutions. And that if we really want to get serious about making health changes in the public health arena and at the community level, we have to have more understandable, bite-sized, usable nuggets of research. And so I'll continue to work for that, not only with the language being correct, but also pictures, smaller words, because again, health literacy is an issue among lots of people. Like our doctors say something back to us and we really don't know what they're talking about but you're too embarrassed to ask. So I'll continue to try to help research be more accessible and understandable as well so that people can understand how these trends and demographics affect them and how they can work with their own family to prevent the outcomes.
Holly - 00:50:09:
Thank you all so much. I know we're running, we are out of time, but I really value all the perspectives that you shared today and we could keep talking for the next couple of hours, but we'll stop here. Thank you so much.
Ramona - 00:50:20:
Yeah, thank you, Holly. And thank you to all of our guests. Gracias for everybody for being here. For me, this was wonderful. As a person who studied Mexican immigration, lived in Puerto Rico, it brought everything together, plus of my interest in community-engaged research. So thank you all. And thank all of you for taking the time to join us today to share your experiences. And thank you for listening. For more podcasts, videos, blogs, and maternal health content, visit Maternal Health Learning and Innovation Center website at maternalhealthlearning.org. We want to hear from you. Tell us what you want to hear more of. Review our podcast and share with like-minded innovators. We've got some great episodes recording right now, so be sure you're subscribed. Let's keep talking. Tag us in your post using hashtag maternalhealthinnovation. And I'm Ramona Olvera and we'll talk to you again soon on the Maternal Health Innovation Podcast.
Hannah - 00:51:25:
This project is supported by the Health Resources and Services Administration, HRSA, of the U.S. Department of Health and Human Services, HHS, under grant number U7-CMC-33636, State Maternal Health Innovation Support and Implementation Program Cooperative Agreement. This information or content and conclusions are those of the author and should not be construed as the official position or policy, nor should any endorsements be inferred by HRSA, HHS, or the U.S.