Maternal Health Equity: A Community-Driven Approach to Policy-Relevant Research
Over the last decade, epidemiologist Kelli Stidham Hall has raised nearly $30 million as a principal investigator or co-investigator, intent on collecting the data her community partners need to champion policies promoting reproductive health and health equity. An associate professor in the Heilbrunn Department of Population and Family Health since April 2020, Hall trained originally as an advanced practice nurse and spent 15 years working in gynecological and reproductive health clinics across three states. Today, her community partners include El Nido de Esperanza, Northern Manhattan Perinatal Partnership, Black Women’s Blueprint/Restore Forward, The Bridge Directory, Poppyseed Health, and New York City’s Department of Health and Mental Hygiene—including the Maternity Hospital Quality Improvement Network and Citywide Doula Initiative—all groups working to promote maternal and infant health for New York City’s most vulnerable residents.
“Patient care is the lens through which I see the world,” says Hall, who also served as the faculty co-lead for planning efforts that have informed Columbia Mailman’s new Office for Community Health Equity Collaboratives. “Nursing takes a very holistic approach to health and wellbeing and that has shaped my commitment to patient and community engagement in epidemiological and demographic research.”
As former founding director of Emory University’s Center for Reproductive Health Research in the SouthEast (RISE), you focused on unintended pregnancy and access to contraceptives and abortion. Now your emphasis is on maternal health. Why?
I see sexual and reproductive health and pregnancy, postpartum, and parenting health along the same continuum. When you talk to individuals and to community organizations, including reproductive justice activists, abortion access is only one point on a much larger continuum of experience for healthcare needs and access. Enabling reproductive-age and birthing people to decide whether, when, where, and how to become pregnant or a parent requires that they have the social conditions and resources to support those decisions. The context of people’s lives becomes very important, whether factors in those environments are a cause or consequence of a pregnancy experience.
How did your clinical experiences illuminate your understanding of reproductive freedom?
Fundamental drivers of health disparities—things like housing instability, food insecurity, structural racism, poverty—they aren’t fully centered in political debates about reproductive access, but they’re centered in people’s lives when they talk about their reproductive choices and outcomes. I no longer practice clinically, but as an academic researcher, I’ve continued asking about the structures, institutions, and conditions that shape reproductive decisions. Here in New York, when we asked people how they experienced giving birth during the pandemic in one of the research projects on which I collaborate with investigators from pediatrics and obstetrics, the participants talked about discrimination, poor quality of care, disrespect, and how those effects are compounded and exacerbated by their concerns about losing their job, exposure to violence, stress about making their rent or feeding their family, all these other determinants of health.
How could those perspectives inform the national conversation about reproductive health equity since the Supreme Court ruling in Dobbs v. Jackson overturned Roe v. Wade?
Policy is one tool, one intervention, one lever for change—both in the sense of the harm it can do and the role of supportive, protective policies that assure access to care and other types of social protection, including economic security. What’s been missing in the national debate is the way in which factors like structural racism, educational opportunities, transportation, economic security interact to shape access to comprehensive, quality, patient-centered health care for birthing people, their families and communities. These intersectional issues should be accounted for in policies, health systems reform, and multi-level interventions to promote maternal health equity.
You build massive research collaborations spanning academia, government, healthcare, and community organizations. Why?
My research uses a social-ecological framework to understand and address reproductive and maternal health. It’s a multi-level approach to questions and solutions— whether the subject is unintended pregnancy or maternal morbidity and mortality. In the U.S., the health disparities are so stark and appalling across racial, ethnic, and socioeconomic lines. Academics or policymakers alone can’t solve these problems. These refractive, complex problems require a multidisciplinary and multisector approach, which can maximize innovation and impact.
How have your community partners led your work?
One of the things I learned from the community advisory board of the RISE center was that we academics must shift the paradigm on what is considered “rigorous” and “impactful.” The problem, historically, with research funding is that academics write the grants, get the resources, and go back to the community partners to engage. That’s actually backward. We first have to build genuine relationships, trust, and ask our community and patients about what they need and prefer and then codesign the questions together that our collaborative studies will investigate. We are ultimately conducting research to improve the well-being of our communities and patients and our charge is to keep that goal grounded in every step of the way.