MCH Leads Health Equity Edition – In order to advance health equity for MCH populations, beginning January 2023, MCH Leads will feature trainees’ health equity-focused work. We look forward to highlighting trainees’ experiences supporting the health and well-being of vulnerable and underserved populations and communities. Also, their work assessing and addressing the underlying causes of health disparities–and their efforts to promote diversity, equity, and inclusion–ultimately improving MCH outcomes. In addition, we encourage trainees to reflect on how the MCH Leadership Competencies are applicable to their health equity-focused stories.
Markolline Forkpa (she/her) is a Statistical Analyst at the Women’s Health Clinical Research Center (WHCRC) in Philadelphia, PA, where she analyzes data for MCH-related studies conducted by senior level physicians, residents, and fellows in the Division of Obstetrics and Gynecology of the University of Pennsylvania Health System. In August 2022, she earned her Master of Public Health (MPH) from Drexel University Dornsife School of Public Health where she studied Epidemiology with a concentration in Maternal and Child Health from the University’s Maternal and Child Health Catalyst Program. After reading a WHYY news outlet feature about a multi-generational study being conducted by the LifeSpan Brain Institute partnership of The Children’s Hospital of Philadelphia (CHOP) and University of Pennsylvania Health System, Markolline pursued the opportunity to become a Research Assistant for IGNITE—a prospective cohort study exploring effects of the pandemic on the psychosocial experience of mothers and developmental trajectories of their infants. Follow Markolline on LinkedIn!
When I reached out to Dr. Wanjiku Njoroge to learn more about her research feature on WHYY, I didn’t quite expect to land a role as a RA for the LiBI. Public concern about the consequences of prolonged social distancing had only begun to catch up with anxieties over the economic fall-out of the pandemic, and the Lifespan Brain Institute (LiBI) was at the frontline of this vanguard of mental health research. As a first-year graduate student, aspiring MCH researcher, and a new mom, I was intrigued by their focus on birthing people. I eagerly accepted Dr. Njoroge’s invitation to join the effort.
Research Origin and Project Background
The Intergenerational Exposome Program (IGNITE) is a multidisciplinary research initiative that merges efforts of researchers, physicians, and medical health practitioners from the University of Pennsylvania (PENN) health system and Children’s Hospital of Philadelphia (CHOP) to carry out a longitudinal cohort study of hundreds of mother-infant dyads who delivered infants in the PENN Health System during the pandemic. Inspired by their contagious spirit of innovation and buoyed by the generous mentorship of LiBI’s research team, I proposed to pilot the second arm of their multigenerational study, which unified quantitative and qualitative data to explore the developmental trajectories of pandemic-born children. Similarly, my pilot study employed a mixed-methods methodology to explore associations between pandemic-triggered stressors, such as financial disruption and psychological distress, on the likelihood of postpartum depression. Qualitative emphasis centered data from a purposive sample of Black birthing people, whose lives, studies show, were disproportionately impacted by the pandemic.
Thinking Critically About MCH Disparity
Perinatal depression is the most common pregnancy-related complication. But despite gaining traction more recently, its risk factors and sequelae are still largely ambiguous. Although Black women are more likely to develop postpartum depression, they are less likely—due to socioeconomic factors—to pursue inpatient, outpatient, and ambulatory mental health treatment. Lured by the opportunity to lift the distinct experiences of Black women who were pregnant and gave birth during such an unnerving time, I set my sights on qualitative work. The main objectives of my work were to assess associations between psychological distress and financial disruption on the likelihood of Postpartum Depression (PPD), examine modifying effects of social support, and explore unintended consequences of the pandemic specifically on Black and brown birthing people.
Using Research to Build MCH Knowledge Base
Key findings from preliminary analyses of data from my project show that psychological distress during pregnancy was associated with higher odds of probable depression around 12 months postpartum. Even later in postpartum, at least one in 10 women had Edinburgh Postnatal Depressive Scale (EDPS) scores that were clinically significant. Black women in my sample showed higher rates of depressive symptoms at twelve months postpartum, higher probability of chronic postpartum depressive symptoms, and greater odds of reporting financial disruption due to the pandemic. While the occurrence of financial disruption was not well represented in the verbal testimonies, women were pleased with the extra stimulus income. Fears associated with a heightened risk of contracting COVID-19 due to employment more commonly outside the home were echoed by all but one participant, as were deep disappointments about prohibitions to loved ones in the delivery room. An unlikely silver lining of the shelter-in-place restrictions, mentioned by Black women, was the opportunity to remain home longer to bond with infant. Reflecting on having the option to spend more time with her baby, one mother expressed frankly: “Having her [infant] during the pandemic really saved me, as Black women we don’t get to do that.”
Coincidently, I complete this blog post just as maternal and child health champions nationally gear up for Black Maternal Health Week. Philadelphia, the large metropolis where I work, is a microcosm of MCH inequity: here, non-Hispanic Black women comprise less than half of all births in the city, yet account for more than 70% of pregnancy-related deaths (Philadelphia Department of Public Health, 2021). I am admittedly taken aback by challenges that face birthing persons of color, and the obvious need for current data to trigger policies that drive change, but feel truly grateful for the role that I am able to play in the research sector.
Philadelphia Department of Health, (2021). Philadelphia maternal mortality review 2020 report. https://www.phila.gov/media/20210322093837/MMRReport2020-FINAL.pdf