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For the past several years, Penn Medicine has been taking bold action to reverse maternal health disparities. In the United States, Black women are approximately three times more likely to die from pregnancy-related complications than white women. In addition to higher maternal mortality rates, low-income women and women of color face disparities when accessing key preventive obstetric and gynecologic health services, including screenings, immunizations, contraception, and specialized care.
As a national leader in obstetrical care, Penn Medicine is taking steps to improve maternal health outcomes and reduce racial and ethnic disparities with a multi-pronged approach that encompasses research, clinical care, and community engagement. For example, a new national March of Dimes research center led by Penn is one of the latest drivers of new research to improve Black maternal health.
Now, three Penn Medicine groups involved in these efforts have been recognized for their work.
The groups—the Department of Obstetrics and Gynecology in the Perelman School of Medicine, Women’s Health Nursing at the Hospital of the University of Pennsylvania (HUP), and HUP Neonatology—were recognized for their collaborative efforts to reduce racial disparities in health care and improve quality of care. These groups received Penn Medicine’s Champion in Inclusion, Diversity, and Equity Award: An Award of Excellence, which was announced during the 2023 MLK Health Symposium, and is presented annually by the Office of Inclusion, Equity, and Diversity.
Approaching Care through a Maternal Health Equity Lens
The award winners’ work began in January 2019, when Abike James, MD, vice chair for diversity, equity and inclusion and lead physician at Penn OBGYN Associates, and Sarita R. Sonalkar, MD, launched a health equity working group within the Department of Obstetrics and Gynecology to address inequities and disparities.
“There was this incredible awareness of the many maternal health disparities that exist—that was our impetus for starting this group,” says James. “We wanted to identify inequities within Penn Medicine, consider how we could possibly be contributing to those inequities, and then make improvements.”
Since then, the working group, renamed DISPEL (Dismantling Inequities, Systemic Problems, Elevate Lives), has made tremendous strides. Staff education, including anti-bias training, forums, and an anti-racism book club, have all fostered important conversations around the impact of racism and bias in racial disparities in health care.
“These efforts have made uncomfortable conversations quite comfortable,” James said. “We’ve been talking about race and health inequities frequently and consistently, and it has permeated to staff. We’ve created an environment where if people see something, they can say something.”
The “see something, say something” mentality has inspired change. An early DISPEL accomplishment, borne out of a collaboration with Ob/Gyn and HUP Neonatology, was the creation of a urine drug screen policy with standard guidelines mandating consent so there was less chance of bias in who was sent for testing. The team also began using a Disparity Index Assessment to regularly review and identify disparities in adverse outcomes, a step that has prompted a quality improvement project to evaluate and address disparities in the approach to hysterectomies.
Addressing Racial Bias and Understanding Racial Inequity in Breastfeeding
DISPEL’s work motivated others to join the effort.
“I realized that silence was no longer golden,” said Jeanette Bioteau, MSN, RN, who leads an Inpatient Health Equity Ob/Gyn subgroup alongside Vanessa Williams, MSN, RN. “After receiving comments from patients and family members who described discriminatory behavior, I followed my passion for women’s health and educated my department colleagues on implicit and explicit bias. These conversations help ensure our clinicians are equipped with the tools they need to overcome their own biases.”
The HUP Neonatal Health Equity Taskforce was also created with the goal of understanding the root causes of breastfeeding inequities in the community. To create a foundation for this work and center the voice of Black patients, the taskforce held a workshop on racial and reproductive justice facilitated by a community partner, Breastfeeding Awareness and Empowerment (BAE), with attendees from across Women’s Health, Ob/Gyn, and Neonatology.
Since this work started, the percentage of Black parents initiating breastfeeding at HUP has increased from 80 to 83% and the gap between initiation for Black and white parents has decreased from 13% to 10%. The success of this initiative has demonstrated that contextual inquiry and community engagement are key to reducing disparities.
“Breastfeeding disparities are well-documented nationally,” says Lori Christ, MD. “Given all we know about the benefits of breastfeeding, we felt this was an important disparity to tackle. Through this work, which was spearheaded by former neonatology fellow, Michelle-Marie Peña, MD, and community partner engagement, we have realized the importance of a trauma-informed approach to care. We have now embarked on a department-wide initiative to provide trauma-informed care training to all staff that will positively impact patients in all aspects of their care.”
Building the Diversity Pipeline in Ob/Gyn Careers
To promote diversity within the field, DISPEL and the department of Ob/Gyn established a research program for underrepresented in medicine (UIM) undergraduate students. During the summer, four students interested in Ob/Gyn were selected from a national applicant pool to spend eight weeks on campus. The students received mentorship, participated in ongoing research and shadowing experiences, and completed a capstone project. At the end of the program, all four students expressed a solidified desire to pursue obstetrics and gynecology.
“The statement ‘representation matters’ is so critical,” James said. “It’ll take some time to see the results, but we are committed to building the pipeline to have more providers that reflect our patient population—this goes a long way in improving trust and outcomes.”
Leading the System to Reduce Maternal Mortality
In support of Penn Medicine’s systemwide goal to reduce maternal morbidity and mortality, the Department of Obstetrics and Gynecology has also taken lead on developing a collaborative, organizational structure that includes representatives from all of Penn Medicine’s birthing hospitals. The structure created an opportunity for data evaluation and discussion of implementation strategies, challenges, and best practices.
In the first year of this goal, these efforts resulted in a 30% reduction in maternal morbidity and mortality in Black women across the entire system compared to the prior year.
“It has been inspiring to work across the system on this goal that we are all so passionate about,” says Sindhu Srinivas, MD. “The systemwide infrastructure allowed us to collaborate and implement change faster than any one of our hospitals could have accomplished alone. It is a true example of the system working together to improve the collective care and outcomes of our patients.”
It is because of these combined efforts of the Department of Obstetrics and Gynecology, HUP Women’s Health, and HUP Neonatology to improve outcomes and reduce racial and ethnic disparities that they were recently recognized with the Champion of Inclusion, Diversity, and Equity Award. True transformation, however, requires continued support from everyone. The work is ongoing.
“It felt satisfying to feel recognized and appreciated for all that we’ve done,” James said of receiving the award. “This isn’t something any one person can do alone, and I value how much collaboration has gone into this work. Our chair, Dr. Elizabeth Howell, and every member of our team has been so supportive. This award is a ‘thank you’ to all of us and a realization of what we’ve accomplished together.”
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