DR. DARA D. MÉNDEZ (Photo by Emmai Aliquiva)
By many standards, the U.S. has the worst record among developed countries in protecting the health of birthing people and their babies during pregnancy, childbirth, and the year after birth.
According to the latest information from the Centers for Disease Control and Prevention (CDC), out of every 100,000 live U.S. births, 50 Black women die from pregnancy-related causes. This is known as “maternal mortality” and it’s one of the highest rates for all racial and ethnic groups.
Black women also experience severe maternal complications at a rate that’s two times greater than White women.
The same disparity is true for Black babies who have a death rate that’s more than two times higher than White babies.
In Allegheny County, the rate of death for Black pregnant people was 91 deaths per 100,000 live births.
To change this inequity and uplift Black birthing people and their children, our region has a strong history of partnership between community and academic organizations. These groups work together in underserved and excluded neighborhoods to improve maternal health outcomes for Black families.
Recently, these local partners got a significant boost — a six-year, $13 million grant from the National Institute of Health’s (NIH) IMPROVE Initiative, which funds projects to address maternal health. (IMPROVE stands for Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone.)
The grant was awarded to the University of Pittsburgh Schools of Public Health and Medicine’s new Equity in Maternal and Birthing outcomes and Reproductive HeAlth through Community Engagement Center of Excellence. Known as EMBRACE, the center is one of only a dozen maternal health research centers of excellence nationwide.
EMBRACE is an example of collaboration on a big scale between numerous community groups and academic departments. However, its goal is laser focused: To improve our region’s birthing conditions and outcomes by using its strong network of boots-on-the-ground, community-focused programs and partners already in place.
On the community side, EMBRACE includes Healthy Start Pittsburgh, Journey Lighter, the Allegheny County Health Dept., The Midwife Center, the BEST Allegheny Initiative, First Steps and Beyond, Allegheny Reproductive Health Center, the Black Women’s Policy Center, and Yogamotif.
On the Pitt side, EMBRACE is made up of faculty, staff, and students from the Schools of Public Health, Medicine, and Nursing; the School of Education’s Department of Health and Human Development; the Dietrich School of the Arts and Sciences; and the University Center for Social and Urban Research.
The NIH grant will help EMBRACE Center partners better support maternal reproductive health and justice among Black people in our region. Structural and social determinants of health play a role in ensuring health equity and justice including income, access to quality healthcare, and structural racism.
EMBRACE coprincipal investigator Dr. Dara D. Méndez is associate professor of epidemiology and associate director of the Center for Health Equity at Pitt’s School of Public Health. She leads EMBRACE along with Dr. Mehret Birru Talabi, assistant professor of medicine, Division of Rheumatology, and Dr. Hyagriv Simhan, professor of obstetrics, gynecology, and reproductive sciences.
“Each component of the EMBRACE center is co-lead by community partners or a community clinician,” says Dr. Méndez. “The call that came from the NIH and each component of EMBRACE centers on the expertise of Black leadership and leaders of color — people who’ve been excluded in the past and present,” she adds.
“This diverse group of community and academic experts share a vision to advance Black maternal and reproductive health equity and justice,” Dr. Méndez continues. “The NIH grant will help us do this by funding our research, training, practice, and policy efforts. This builds upon a long history of local expertise and knowledge in the community and academic settings.”
EMBRACE includes a community engagement component, training component and an intervention study.
The Center’s first focus is to work with and champion community organizations and leaders to create and implement action plans that improve the physical and mental health of Black birthing people.
Healthy Start Pittsburgh and CEO Ms. Jada Shirriel serve as the coprincipal investigator of the Community Component along with University of Pittsburgh faculty member Dr. Onome Oghifobibi and University of Illinois at Chicago faculty member Dr. Ashley Hill.
Dr. Méndez is proud of — and firm about — her belief that community-based organizations and leaders can transform and uplift academic research from start to finish. From determining what to study and how to do it, to communicating what researchers have learned, to putting the findings into action, the community’s lived experience and expertise is crucial. “It’s the best way to transform how we advance the health and wellness of Black communities,” she says.
The second focus of EMBRACE is to create and offer training and development on the causes of Black birthing inequalities. This includes topics like anti-oppression and reproductive health and justice. Researchers, maternal healthcare providers and workers, and other individuals (whose work focuses on maternal and child health) will receive the training.
The coprincipal investigators of the training component are Ms. Ngozi Tibbs, expert trainer in maternal and reproductive health equity and justice owner of Journey Lighter and Pitt Public Health faculty member Dr. Cathy Haggerty.
Finally, EMBRACE will work to further develop intervention research through a program called IMPLICIT. IMPLICIT is an existing model that provides care during pregnancy, as well as screening and support for birthing people after delivery during their infant’s well-child visits.
For EMBRACE, the team will refine and develop a community-informed model of fourth trimester care at several UPMC Family Medicine clinics. “The fourth trimester happens in the weeks following a birth,” says Dr. Méndez. “During that time, individuals are less likely to get the support and care they need and can experience poor physical and mental health outcomes.”
Coprincipal investigators of the fourth trimester care intervention are Drs. Stacy Bartlett and Cynthia Salter in Pitt Medicine and Public Health, respectively.
Dr. Méndez continues, “The EMBRACE Center will allow us to create and implement interventions that will uplift Black maternal and infant health in our region and the health of the communities where Black families live, work, play, and age.”
