By Erin Peterson
When Katy Kozhimannil (B.A. ’99) began to study pregnancy and maternity care, it seemed reasonable to expect she would be entering a crowded research field. Childbirth is the number one reason for hospitalization in the United States, with nearly 4 million visits annually. As a nation, we spend more money on maternity and newborn care—$50 billion—than on any other single health care need.
But there might as well have been tumbleweeds blowing across that particular research plain. That needed to change, says Kozhimannil, assistant professor of health policy and management at the University of Minnesota. “There’s been a lot of attention focused on [healthcare for] older Americans—and rightly so—but taxpayers fund about half of all births in the United States. We have a stake in this.”
Today, Kozhimannil is one of the nation’s top researchers on pregnancy and maternity care. Her findings have helped propel statewide legislation on maternity care and are serving as a foundation to transform maternal care across the nation.
How did you get interested in this topic?
After I graduated from the University of Minnesota, I joined the Peace Corps and taught English to junior high students in Mozambique. In seventh grade, there were about 50 percent boys and 50 percent girls in my classes. By ninth grade, it was about 90 percent boys and 10 percent girls. I saw my amazing, talented female students drop out of school for reasons that were frequently related to sexual and reproductive health and pregnancy. A whole range of issues affected young women very differently from their brothers. Those same dynamics aren’t as pronounced here, but they’re still present.
One of your areas of study is maternity care in rural areas, which hasn’t received much attention even though Grand Marais and Ely-Bloomenson-area hospitals recently closed their obstetrics units. What’s going on?
There are a whole range of interconnected issues that affect a hospital’s ability to offer obstetric services, including a low volume of patients, the availability of anesthesia services, having nursing staff with skills in perinatal care, the need for family physician training in cesarean delivery, and challenges with managing competing demands for operating room space. That said, there are still about 1,100 rural hospitals in the United States that do provide maternity care, and most of those hospitals, and their clinicians and staff in obstetrics, are highly committed to doing so.
Another of your areas of interest is doulas. What are they and why are they so important?
Doulas are professionals who provide support to women during pregnancy, labor, delivery, and the postpartum period. There is so much excellent clinical data that shows that this support is associated with better birth outcomes—higher rates of spontaneous vaginal births, lower rates of cesarean delivery, higher breastfeeding rates, higher infant APGAR scores [which assess appearance, pulse, grimace, activity, and respiration], and lower rates of preterm birth. If doulas were a medicine, it would be unethical not to give it. But in part because of the cost—a private doula costs between $600 and $1,500—only about 6 percent of women have doulas.
Your work is helping change that.
There were all kinds of data problems when we started wading into these waters, but in 2013, our study about doula care, cesarean birth rates, and cost outcomes was published in the American Journal of Public Health. One week later, legislation was introduced in Minnesota to include Medicaid coverage for doula services in the state plan. It became law in May 2013 and has the potential to affect 30,000 Minnesota women.
Wow, that was fast.
Yes and no. Birth workers have been advocating for this issue for 20 years, but they needed the data to have this conversation. Because of other issues—the state pays just $411 for the service—the reality hasn’t changed much. But we’ve made a ton of progress on paper. We’re getting closer.
I never forget that every data point is someone’s birth story. I want to use that data to inform how decisions are made. For me, that’s the right way to honor the experiences of mothers and families in Minnesota, the United States, and beyond. —Erin Peterson, Photo by Sara Rubinstein