From the Front Row: Creating healthy mothers and children

Published on August 27, 2020

 

 

The following is a transcript of an episode of From the Front Row: Student Voices in Public Health, the University of Iowa College of Public Health’s student podcast. This episode features a discussion between College of Public Health students Emma Meador and Steve Sonnier and faculty members Kelli Ryckman and Will Story on the college’s new maternal and child health curriculum.

Emma Meador:
Hello all and welcome back to From the Front Row. I’m Emma Meador and I’m joined today by Steve Sonnier. Today, we are talking with two of our fantastic U Iowa faculty, Kelli Ryckman, an associate professor of epidemiology and Dr. Will Story, an assistant professor in the Community and Behavioral Health department. We’ll be discussing some of the exciting events on the horizon for their team, including the creation of a maternal and child health curriculum, and a conference on role maternal health. Welcome to the both of you.

Kelli Ryckman:
Thank you.

Will Story:
Thanks. Good to be here.

Steve Sonnier:
Let’s start off by talking about both of your backgrounds in these areas of maternal and child health. What started off your professional interest in this area and what continues to drive you to explore this field further?

Kelli Ryckman:
Sure. So I did my graduate work, looking at genetic and metabolic predictors of preterm birth, and that topic just really struck me as an area that was really under researched at the time. There was a lot that we didn’t know about why women deliver early before 40 weeks of gestation. The effects could be really devastating to the families who have babies that end up in the neonatal intensive care unit for months, sometimes up to a year in that first year of life. And so I became really passionate about working with families and trying to understand what triggers early labor and how we can help to prevent that.

Kelli Ryckman:
Then I, myself experienced preterm birth with my twins when I delivered in 2010, they were born six weeks too soon and spent about a month and a half in the neonatal intensive care unit at the University of Iowa. So I got a flip perspective from being a researcher studying this and working with families, to now having that experience, I think that’s really helped me continue to hone what I want to focus on and how I would like to use this research to help those families prevent some of these adverse consequences.

Will Story:
Yeah, and for me, I guess I’ll go back to my MPH. When I got that from the University of Michigan, I started with a focus on epidemiology and international health. I was really interested in infectious disease. I stayed actually a third year and added my health behavior and health education component to my MPH. Again, my interest wasn’t in maternal child health, but the first job I got was with a nonprofit organization in West Michigan, and it was to provide technical support for a maternal and child health program. So I quickly learned all about the benefits of maternal and child health. This program was based in Bangladesh and it became apparent to me that the health of women and children really led to vibrant communities. It was not just about ensuring that their lives were healthy and that moms and kids weren’t dying of preventable causes, but it really had an impact on the entire community.

Will Story:
A lot of the interventions that we were working on were extremely low cost and very effective, and so it just seemed like to me that, “Wow, if I want to invest my career’s work in something, it makes sense to work with maternal and child health.” So I continued with that nonprofit for about five years and then I went on to get my PhD and continued to explore how strengthening families and communities can improve healthcare access for women and children. I have continued to do work around the world right now, mostly focused in India and in Kenya, and then in Eastern Iowa, working with our African refugee and immigrant populations. So that work around maternal child health continues to be a focus and just really excited to have landed here in Iowa, where I can develop that research and have the opportunity to teach in the field.

Emma Meador:
And many congratulations on receiving this new grant funded by the HRSA to address the growing and urgent need for a well trained in diverse maternal and child health workforce. As you both work towards configuring a new maternal and child health curriculum, what is the overarching goal and what do you hope the biggest takeaway for students will be?

Kelli Ryckman:
So the overarching goal, I think of this program, is to just really develop a robust curriculum in maternal child health for the college. We have a Will’s course on global maternal child health, but then really not many other courses that specifically delve into maternal child health issues. So we feel like that was a really big gap in the curriculum and that there are a lot of students that are interested in maternal child health, and so our goal is to really provide a life course approach to maternal and child health and provide a lot of opportunities for students to interact with public health practitioners that currently work at the Iowa Department of Public Health and some of our local County departments of public health. We’ll also have a lot of clinical speakers as well, talking about their role in maternal and child health. So I think just for students, my takeaway would hopefully be that they would see how diverse the field is, how many opportunities there are, how many areas there are to get engaged and hope they come out with an appreciation for why this work is so important.

Will Story:
I’ll just add to that, that in addition we’re really hoping to recruit a diverse student body too. So we’re hoping this program, the essence of it, that Dr. Ryckman just described will also attract a lot of new students from diverse backgrounds, and our hope is then by the end of this project, that will be adding to a diverse workforce in public health related to maternal and child health throughout Iowa and the greater Midwest. We feel like we have an area to contribute there. There’s just not that many maternal and child health programs in the Midwest. Since we have an opportunity to train up [inaudible 00:06:26] students to address that gap, as well as aligning some of the student interests with research and practice opportunities throughout the state. We’re going to be training students up, certainly, but we want to provide those connections that hopefully will lead to internships and careers down the road. So I think there’s a lot of potential here.

Steve Sonnier:
It’s excellent to hear about that. It does sound like it’s a really exciting time to be part of this initiative, because there are so much resources invested interest and attention right on this area, especially with folks looking to get further into public health, that’s becoming much more of a household term now. People are being more acquainted with it, and even from your both of your personal experiences coming into it, I feel like it’s a very common thread in public health where I didn’t know I was going to end up here, but then I ended up and, “Wow, this has changed my career path and how much I’ve enjoyed it.”

Steve Sonnier:
One thread I want to follow along with is the idea of diversity and the recruitment concepts here too. At the recent Black Women’s Maternal Health Conference here in Iowa, speakers noted that in Iowa specifically, black women are six times more likely to pass away due to preventable pregnancy-related issues compared to white women. We know that one of the critical issues on the horizon for maternal and child health is the need for our policy champions to really translate this research and data into action. So will your students be able to recognize and address these significant disparities in reproductive care?

Will Story:
That’s a great question, and let me just first start by saying that that disparity that you quoted in Iowa is completely unacceptable. So it is true that we’re not doing a good job at providing equitable care to all women in the state and particularly women of color, and so certainly that is something that we will be talking about in our seminar this fall, as well as in the foundational course, that’s a three credit hour course in the spring that follows on from the seminar. We’ll be addressing these issues of not just disparities, but some of the social justice issues that surround the inequities and maternal mortality, and also in some of our child health indicators as well. So yes we’re certainly going to address that. We’re hoping by bringing in a variety and a diverse group of speakers into the seminar, and also our foundational course that the students will get a range of different sort of perspectives on this.

Will Story:
For example, you mentioned, the Black Women’s Maternal Health conference, and one of the keynote speakers was Dr. Nalo Johnson at IDPH, and she’ll be speaking on policy and advocacy around MCH in our seminar and hoping to build on that content in the following semester as well. So bringing practitioners in who can speak to these issues, I think is going to be key. Like you said, giving the opportunity for students to engage with that material, to wrestle with it, to struggle with it, to become uncomfortable, but then to want to make a change, because I think that’s going to be a big issue for Iowa and really around the United States, but we certainly have our work cut out for us here.

Kelli Ryckman:
Yeah, and I would just add that we’re also very lucky to be a part of another HRSA funded initiative, which is the state maternal innovation health project. This award, it was a collaboration between Obstetrics and Gynecology department here at the University of Iowa and the Iowa Department of Public Health, and I serve as an investigator on that five-year award. We’re starting year two in October, and as part of that, the mission for that grant is to address the care for rural women across Iowa, because we know there’s disparities in healthcare access and also address the statistic that you said with black women being at such a higher risk for maternal mortality than their white counterparts.

Kelli Ryckman:
There are a lot of initiatives going on right now. There’s some different campaigns like seatbelt safety campaigns and the warning signs for postpartum hemorrhage and postpartum hypertension. I think that students in our courses and in this MCH curriculum will have opportunities to get involved in those types of initiatives.

Emma Meador:
Going off of talking about all the significant disparities in reproductive care you just talked about, that you have been working on Professor’s Story, I also see that you do significant work with refugee, maternal, and mental health. Will this be a core component or topic in the new curriculum?

Will Story:
I think both Dr. Ryckman and I are excited to integrate our research into our teaching. I think we obviously do that already, but this certainly aligns with both of our research interests as well as our teaching interests. So it’ll certainly be a topic that comes up. We have so much packed into this curriculum. It probably could be a curriculum that could last a couple of years, but we are going to touch on a number of topics, and certainly my work with African refugee and immigrant moms here in Eastern Iowa will be brought up. In fact next week in the seminar, I hope to talk about some of my work with the Congolese Health Partnership that was started about three years ago and how we’re trying to address some of the disparities and access to care here in Eastern Iowa for our refugee and immigrant moms.
Will Story:
And then also, yeah, you alluded to the mental health work that we’re doing too, which is also critical. We started that in the context of Iowa being a destination community, especially Eastern Iowa for a lot of refugees, especially from Sudan and the Democratic Republic of Congo and wanting to reach out to them to make sure that they had psychosocial support to adapt to a brand new culture, new language, new everything, in addition to sort of struggling through the experiences that they’ve had as a refugee and then COVID hit. Then we had a derecho and the stressors continue to sort of add on over time. So this project couldn’t have been more timely. We were actually just getting ready to launch into a group based mental health support intervention right when COVID hit and we moved to a remote support.

Will Story:
So we’re able to still provide psychosocial support to refugees remotely through video and phone. Now we’re starting to slowly move back into in person, but one on one counseling. Again, this is sort of lay counseling, that’s linguistically and culturally appropriate providing that support, and we’re excited that hopefully next year it looks like that the state wants to sort of scale up this model of psychosocial support to able to reach more refugees here in the state of Iowa. Again, I think the time is right, the time is now to be able to provide that kind of support.

Steve Sonnier:
Then kind of following along in that thread of access to care, we know that there’s an increasingly shrinking workforce, especially in Iowa. We’ve seen more than 30 labor and delivery units in critical access hospitals closed, and our state has a lower number of obstetricians per capita compared to other areas. Do you expect there to be an increase in opportunities to recruit, retain, train midwives and other knowledgeable and experienced providers into these areas that so desperately need our assistance?

Kelli Ryckman:
That’s a great question. So as part of the HRSA maternal innovation, State Maternal Innovation program that I spoke about that’s led by the Department of Obstetrics and Gynecology, they have several aims of the grant that are tackling that exact question. So we have been working on the workforce issue in developing a residency program for a rural track, and also developing at least starting the process of looking at developing training for a midwifery program here at the University of Iowa. I think that as the grant continues on, we’ll get farther down that process. I’ve spoken to the project leads on those pieces of workforce development, and I think there is a ton of synergy between the program that Will and I are starting here for maternal child health within our college and what they’re going to be starting to train midwives and also train residents and other doctors to do to offer obstetric care. So I think moving forward, we’ll have a lot of opportunities to kind of cross collaborate across these different domains.

Will Story:
Let me just add this little aside. Another sort of fun way that Dr. Ryckman and my work intersect is, as she’s been working on this fantastic Maternal Health Innovation grant with the Department of Obstetrics and Gynecology, I’ve recently been brought along with Dr. Anjali Deshpande in epidemiology to help provide some process evaluation on that program and to look at how are some of those innovations that Dr. Ryckman was just describing, going to be sort of sustained and scaled up across the state.

Will Story:
So obviously we know that UHC is sort of a unique health system with a lot of strengths. When we think about the other health systems throughout the state that may not have the same resources, just sort of making sure that we have the processes in place, the right stakeholders at the table to make decisions on how to make sure those programs are implemented statewide. I think there’s so much great potential, and I think they’re doing a great job. It’s fun to be able to be involved in sort of talking to them and thinking about how to make sure this is a long lasting effort beyond the life of the grant.

Emma Meador:
Tying into that conversation, Professor Ryckman, you’re also configuring a conference on rural maternal and mental health. Congratulations on your recent funding award. Could you tell us a little more on that specifically how the conference hopes to increase community engagement and research on the topic?

Kelli Ryckman:
Yeah, so we’re very fortunate to receive this award and very excited about it. This is a partnership that I have with an investigator, Dr. Karen Tabb at the University of Illinois Champaign-Urbana and she also just received a PCORI award and very similar in nature to mine. So we now have what we call sister projects that we’re working on together, sort of with the same end goal. Hers are going to be to produce some webinars and workshops in November around maternal mental health, particularly focusing on engaging stakeholders during COVID-19. Then mine will be bringing in the rural parts of both of our States, so Illinois and Iowa.

Kelli Ryckman:
What we’ve been working on right now is just putting together resource guides for rural areas in how to access support, so mom support groups, and also how to access mental health supports after the birth of a child or during pregnancy. Our plan is to reach out to those stakeholders as we develop the conference and also tap into my group and her group both have community advisory boards, where we have women in the community who are involved in helping really in every aspect of the decision as we move forward with the conference, from what date to have it, what format to have it in, how we want to market it, how we want to have the flyers look, everything like that. They participate in helping to inform those decisions and they share their experiences and their stories too, and so that really helps us to keep into perspective what our goal is for the conferences to be able to bridge that gap between stakeholders like clinicians and patients with their personal stories and having them be able to interact together and particularly in these rural areas.

Kelli Ryckman:
So I think that we’re really excited about this initiative and hope we have a good virtual conference. So I made the decision that it’s going to be virtual. We were always planning on holding it in April and maybe we’ll be back in person in April. I really, really, really, really, really hope so, but there’s a lot that goes into planning a conference, and I want to make sure that it’s the best conference that it can be, so I wanted to commit to a platform that I can just get behind and start working on.

Steve Sonnier:
It’s got to be so energizing to be in this field right at this time, and then getting to plan something so monumentous as this. So congratulations, once again, on this excellent opportunity to partner and put this on for folks.

Kelli Ryckman:
Thank you.

Steve Sonnier:
One of our last questions we always ask folks is if you can briefly comment on what one thing that you thought you knew, but were later wrong about. So Dr. Ryckman and Dr. Story, if you want to comment on those ideas, whoever wants to go first.

Will Story:
Sure, I can start. I had to think about this one. It’s one of those things, like if you asked my kids, they tell you, “Well, there’s a lot more than one thing that you thought you knew that you didn’t,” and then they’ll prove me, or they’ll prove themselves right pretty much on a daily basis. But when thinking about it and sort of how it relates to this topic in particular, I thought I would maybe just tell you a quick story about back to my global health work in Kenya. Last summer I had the opportunity to go with a student Abby Lee, to Western Kenya, to do an exploratory project where we were going to investigate some of the main social cultural causes for early adolescent pregnancy. And when we went, we were basically told, and this was sort of my assumption.

Will Story:
So this is the part that I thought I knew, that a lot of this was because of early marriage, that young women were getting married very early, maybe 14, 15 years old, and as a result, were getting pregnant very early. Obviously at that early stage, it can be very dangerous for a young woman, both for the fetus and for her health and saw a lot of obstetric morbidity and mortality as a result, and so it’s something we wanted to address. We had got to work with one of the preeminent fistula hospitals, obstetric fistula hospitals in the region in this project, but we wanted to look at the prevention side, well, how do we prevent young girls from getting pregnant? So that’s why I thought I knew when we went and after we collected the data, we’re just starting to look at it now.

Will Story:
These young girls aren’t married and that’s not what we were told, and I think maybe part of it was culture, but a lot of these young girls are initiating sexual intercourse at an earlier age with other men who are not married to them who may be a little bit older, but still within their peer group. So this was sort of a finding that we thought was interesting and maybe a little bit surprising just based on what we had heard. Now we’re working on designing an intervention to help young women build a negotiation skills to advocate for their own sexual health and sexual responsibility and decision making to work with those young women and their parents to talk about sex because they aren’t until they get pregnant. Then they are asked to not be part of the family anymore. So it’s obviously devastating for them, not only health wise, but socially we’re thankful that we learned the lesson that we did of what’s really happening and hope to be able to make an impact in the coming years.

Kelli Ryckman:
I also had a really hard time with this. I thought for a while, and I’m not sure if I came up with something directly in this vein, but I will say it was something that I found surprising. I’m not sure I had any preconceived notions going in, but I found it very surprising and actually reaffirming to how excited I am about this work. I have a community advisory board. I started in 2017, and as what happens with all community advisory boards, you get lost over time. Now that we’re re-energizing with these PCORI grants, and also with my work with the HRSA Maternal Innovation grant, they’re also starting a community advisory board to inform that work. I really just wanted one big board that we could use for all of these different projects that we’re doing. The members that had really stayed with me, they stayed and then we put out an application to recruit new members. I don’t know, I figured like 10, 15 people might get excited about it. I didn’t realize we would have 60 applications. These applications, these women are all just really excited about the work.

Kelli Ryckman:
It wasn’t one of those things where they want to come to say what their birth experiences, and then leave it at that. They came to the table and the interviews that we did, and also the applications. They came to the table, not just with wanting to share their experience, but really wanting to make a difference, wanting to share that experience so it had some positive impact as we move forward.

Kelli Ryckman:
They want to be at the table, and I sort of in my heart knew that, but didn’t quite recognize the enthusiasm behind that and the passion behind that until I’ve been doing these interviews and also reading the applications, that they are excited about this work, and they’re ready to get to work. Even though this isn’t their field, they’re not a scientist or a researcher, they have all different jobs. They’re taking care of kids. We’re on Zoom calls where they’re rocking a baby. I mean, all of that, they want to be involved in this and they want to do that on their own time. I just found that really heartening when sometimes all we read in the news is negative, negative, negative, and this was just really positive to me that people wanted to be involved in this.

Steve Sonnier:
That’s a really, just a very excellent overarching theme for both of your work, is this looking for where the helpers are, seeing what you can do to improve the field as it stands, getting the data and then figuring out, here’s where I got to pivot off too. Then yeah, very much so seeing the empowerment of the maternal child health community, it really is fantastic to get to talk to you both about these opportunities today. We were really glad that you were able to join on for our talk, and we’re both excited to see how this program develops, and we wish you both the best in the upcoming years, and then in this conference up in April.

Kelli Ryckman:
Great, thank you so much. And yes, stay tuned for my flyers and information and social media blast that I’ll be calling on everybody that I know to help me disseminate.

Will Story:
Thanks for having us, and certainly hope to see a lot of the students, hopefully who are listening to this join our MCH courses, the seminars. They’ll be offered every fall and spring. So if you missed it this fall, don’t worry, there will be plenty of opportunities to get involved.

Kelli Ryckman:
I want to do a quick plug for our student interest group too. So we’re just starting a maternal child health student interest group. We hope to have the kickoff meetings over the next month. So in September, and then hoping that the students that want to get involved in that really make that their own and do a bunch of cool initiatives with that. We have some support through the grant to help support those initiatives. So we’re really excited to help see that kind of come to fruition.

Steve Sonnier:
That’s it for this week. You can find us on Facebook at the University of Iowa College of Public Health. We’re on iTunes and Spotify, as well as the University of Iowa College of Public Health. Thank you to our guests, Dr. Kelli Ryckman and Dr. Will Story. This episode of From the Front Row was hosted and written by Emma Meador and Steve Sonnier. This episode was produced by Steve Sonnier. If you have any questions for the hosts or our guests, you can reach us at cph-gradambassador@uiowa.edu. This podcast is brought to you by the University of Iowa College of Public Health. See you next week and stay safe out there.