Ep.6/ How COVID-19 Pandemic impacte BIPOC women's maternal morbidity and mortality outcomes and how we can help with barriers women of color face with Dr. Neel Shah
How COVID-19 Pandemic impacte BIPOC women's maternal morbidity and mortality outcomes and how we can help with barriers women of color face with Dr. Neel Shah
LISTEN NOW
-
Note: This transcription has been created with a help of an AI thus errors and mistranscriptions may be present.
[00:00:00] Dr. Neel Shah: Hello, maternal Health 9 1 1. What's your emergency?[00:00:08] Dr. Jill Baker: 1, 2, 3, 4.
[00:00:14] Dr. Jill Baker: Hi, I'm Dr. Jill Baker. I'm a wife, a mother, a community health scholar and executive director and a fertility coach. More than 12 years ago, I was on my own infertility journey. Since then, I've made it my personal mission to help anyone who is on their own. To become a parent, as well as shed light on infertility and maternal health experiences of bipo women and couples.
[00:00:42] Dr. Jill Baker: Now let's begin this week's episode of Maternal Health 9 1 1.
[00:00:53] Dr. Jill Baker: Hello, maternal Health 9 1 1 Family. This is your host, Dr. Jill Baker. On today's show, we are talking about maternal mortality and maternal health. 9 1 1 emergency is that American women die in childbirth at a higher rate than in any other developed country. Also, pregnancy related death has more than doubled over the past 25 years, and this is not national or daily.
[00:01:21] Dr. Jill Baker: And we have black women who are becoming more and more fearful of becoming mothers because of the staggering statistics related to maternal mortality. Today we have my dear friend and colleague, the brilliant and amazing Dr. Neil Shah, who will shed light on these topics. Why this is happening and what we can do to change it.
[00:01:45] Dr. Jill Baker: So without further ado, here's your episode of Maternal Health 9 1 1. So before we begin, I want to formally introduce Dr. Shah. So Dr. Neil Shah is Chief Medical Officer of Maven Clinic, the largest virtual clinic for women's and family health. An assistant professor of obstetrics gynecology. And reproductive biology at Harvard Medical School.
[00:02:12] Dr. Jill Baker: He is a globally recognized expert in designing solutions that improve healthcare and is listed among the 40 smartest people in healthcare by the Becker's Hospital Review. His work is to build equitable, trustworthy systems of care, and this work has been profiled by the New York Times. Good morning America.
[00:02:36] Dr. Jill Baker: Other outlets. He's been featured in the Oprah produced documentary Color of Care and Aftershock, which premiered on Hulu in July, 2022. Dr. Shah has written more than 50 peer reviewed academic papers and contributed to four books. Including as senior author of Understanding Value-Based Healthcare edited by McGraw Hill, which Don Burwick has called an Instant Classic, and ATO Gowane called a Masterful Primer for All Clinicians prior to joining the Harvard faculty.
[00:03:09] Dr. Jill Baker: Dr. Sh founded Cost of Care, an NGO O that curates insights from conditions and patients to help delivery systems provide better care. In 2017, he co-founded the amazing March for Mom's Association, a coalition of more than 20 leading organizations. To increase public and private investment in the wellbeing of mothers.
[00:03:34] Dr. Jill Baker: Dr. Shah also serves on the advisory board of the National Institute of Health, N IH, and the Office of Women's Health Research. So without further ado maternal health 9 1 1 family, please welcome my friend Dr. Neil s Shah. Hi Dr. Shah. How are you?
[00:03:54] Dr. Neel Shah: How are you, Joel? Nice to have. Nice to see you.
[00:03:56] Dr. Neel Shah: And thanks for having me. I'm so
[00:03:57] Dr. Jill Baker: glad we are back together again. We had the opportunity to do some work together earlier this year with some medical residents at Rowan to talk about. This topic regarding, disparities in maternal mortality in the country. And so I wanted to, one thing I wanted to share with you was that I, in this new show I've had a lot of people ask me Dr.
[00:04:24] Dr. Jill Baker: Jill, why do you wanna call this show Maternal Health nine one one that makes this sound really. And so my response has been especially, with being able to work with you and talk with you and to really follow your work closely is that maternal health is an emergency in this country. Like there to me, there, there's no, no doubt in that.
[00:04:47] Dr. Jill Baker: So I decided that the first question for every show is going to be and I wanted to pose this to you, why is maternal health an emergency? In this country from your perspective, with all the hats that you wear?
[00:05:03] Dr. Neel Shah: That's a good question. I think the statistics are not great and they warrant a sense of urgency to correct them.
[00:05:09] Dr. Neel Shah: And not only are the statistics not great, but they've been that way for a long time and have been steadily getting worse. I think it's important. It's not like maternal mortality is a statistical blip or something. Five year trend line, which basically spans a whole generat. Of mothers in our country.
[00:05:23] Dr. Neel Shah: Yeah. I imagine that listeners of your podcast know this already, but an American today is 50% more likely to die than her own mother was four times more likely if she's black. And it's like kind of the definition of insanity to try the same thing over and over again and expect a different result.
[00:05:39] Dr. Neel Shah: Another one of these aphorisms that I hold onto is that every system is perfectly designed to get the results that it. So if the system is producing inequitable horrible outcomes for moms, it's by design and it requires doing something different than we're doing today. So that's why I would characterize it as an emergency.
[00:06:00] Dr. Jill Baker: Thank you. So thank you so much for that because I think that although we are making a lot of progress and as a public health researcher, I, follow the data as well. And you wanna have hope and see that there's, there are changes happening, but there are still a lot of people that don't really understand that this is affecting people on every day in this country.
[00:06:24] Dr. Jill Baker: It's affecting families. It's affecting. Families who aren't able to, people that we've known who weren't able to take their wives home and didn't think they were gonna lose them or who weren't able to take their babies home. And and so for me, I know that kind of just keeps me going and keep, making this so important for me.
[00:06:45] Dr. Jill Baker: And I know your passion is the same as well in that.
[00:06:51] Dr. Neel Shah: Yeah I agree with that wholeheartedly, and I think just to give a sense of the size and scale of the problem, for every death of a mom in our country, there's between 50 and a hundred, near misses cases of severe morbidity. And for every one of those cases, people who are really injured in the process of giving birth, there's tens of thousands more who are suffering from undertreated illnesses.
[00:07:16] Dr. Neel Shah: Social isolation from economic disempowerment, from things that should be correctable. And more broadly, maternal health is really a bellwether for that wellbeing of society as a whole. So if moms run well, that means society is unwell. Th these things are connected, which is why every injustice in our society shows up in the wellbeing of moms, whether it's gender inequity, racial inequity, geographic inequity, or even, coming out of a midterm election cycle.
[00:07:42] Dr. Neel Shah: Generational inequity. The idea that hope and opportunity in our country are eroding, which is why we've got one party saying, make America great again, and another party saying build back better. Is that how things are today, in some ways is worse than how things were, a while back. And that's true in some ways.
[00:08:01] Dr. Neel Shah: It's not true in other ways, but one of the leading indicators that makes those political slogans resonant is that moms are more likely to.
[00:08:10] Dr. Jill Baker: That by itself is enough. And the first time you shared that statistic I was almost in, in shock. I really was. But then when we think, think about interactions with healthcare pro providers and like you said, illnesses being missed, or things that could have been prevented.
[00:08:28] Dr. Jill Baker: That weren't, or things that could have been prevented earlier. And again, I think, and also from a public health perspective, as you said, all these things are related to healthcare, access, to your doctor, access to Be able to get to your doctor being able to find, a healthy, grocery store in your neighborhood.
[00:08:48] Dr. Jill Baker: So all of these things matter for women who are pregnant after they deliver a baby. All of these things continue to remain important and something else that is also, Real and tra and tragic is that women also don't necessarily make it home after they deliver a baby. And that it can be weeks, a number of weeks, and then a mom can still pass away.
[00:09:18] Dr. Jill Baker: And so you think, and I, thinking in my own pregnancies and you think okay, I had the baby. I'm in the clear. And then you really not thinking. There's a chance you may still end up dying. And for some of us women of color, bipo women, like that's a reality. Whereas for, our white counterparts not so much.
[00:09:41] Dr. Jill Baker: And so that, that difference in those ex experiences is. What still trouble troubles me and ke and keeps me, me wanting to do more work on this.
[00:09:53] Dr. Neel Shah: Yeah, no it deeply troubles me too. Cause it's really motivating to me too. The only way to understand rising maternal mortality is through the lens of racial inequity.
[00:10:02] Dr. Neel Shah: The fact that, people who are well positioned to thrive and do well in American society and people who are less well positioned, the gap has gotten wider over.
[00:10:13] Dr. Jill Baker: And it's getting more and still getting it's widening,
[00:10:16] Dr. Neel Shah: still. It's getting worse and it's, and like you can see the things that are making it worse, right?
[00:10:20] Dr. Neel Shah: Maternal mortality, him going up and then Covid 19 happened. And what Covid did was take every inequity in our society and throw it into a pressure cooker. It took preexisting problems and it made them worse. And we saw that reflected in maternal mortality. And now we have the Dobbs decision.
[00:10:35] Dr. Neel Shah: That further restricted reproductive health, and there's a direct line between access to abortion care and maternal mortality that disproportionately affects women of color, particularly in the South.
[00:10:44] Dr. Jill Baker: Absolutely, and I know, I'm glad you brought that up because that was actually going to be one of my questions to you with how you felt that Covid affected maternal mortality and maternal morbidity particularly among bipo.
[00:11:00] Dr. Neel Shah: It made it worse, but it looked not necessarily because it's more infectious if you have melanated skin. It's it basically the pandemic divided the world into people who are well positioned to protect themselves and people who were not. And that was
[00:11:14] Dr. Jill Baker: still that haves and have nots.
[00:11:17] Dr. Neel Shah: Exactly, yes. And you could see it play out like not just across like geopolitical borders, but literally within neighborhood blocks where, If you were a person who lived in a part of a city where you had to take multiple buses to get into care, you already faced more barriers. And that was exacerbated by, a situation where hospitals were overrun and they were trying to keep people out.
[00:11:40] Dr. Neel Shah: Yes,
[00:11:40] Dr. Jill Baker: And also in, in a lot of situations with women. then I know cuz I've talked I talked to a lot of sister friends who would delivered babies during covid and then they weren't able to have like their partner with them while they were delivering or they had to choose between their partner and the doula.
[00:12:00] Dr. Jill Baker: And so for me, I was like, what? Because nu number one, we know a doula. A doula how important they are to that experience part, especially for a woman of color and the difference in the outcomes for the mother and for the birth. But you also need your support partner as well. So it's I couldn't even imagine having to make that kind of
[00:12:24] Dr. Neel Shah: choice.
[00:12:26] Dr. Neel Shah: No, I mean it was really challenging. Yeah, those early days of the pandemic and I think. Particularly in those early days hospitals had to make very tough decisions including limiting visitation for people who were at the end of life and people who were giving birth. But those decisions impacted some communities more than others.
[00:12:44] Dr. Neel Shah: And particularly I think it was hard in childbirth where, like you said, there's evidence that doulas help. Part of that is based. Knowing that having a professional advocate can make a difference. And knowing that people who are subject to racism in the healthcare system benefit more from having an
[00:13:01] Dr. Jill Baker: advocate.
[00:13:02] Dr. Jill Baker: Yeah. Yes. So how, what has been your position from a physician's lens with your physician hat on with doulas and actually working with them and. What has that dynamic kind of been like for you in your medical practice?
[00:13:20] Dr. Neel Shah: In my medical practice and in my professional practice, it's been a journey.
[00:13:23] Dr. Neel Shah: I think, part of the challenge, I think with doulas is that for a long time, and I think even in the current state, their roles are not well understood and so often what I've seen is tension between. Doulas and the clinical teams and often the setup just by, the setup, it makes it an adversarial relationship.
[00:13:42] Dr. Neel Shah: Yeah. It's a shame. But then I've also seen positive examples too, and I think over time as I've come to understood what doulas do, my own views have evolved. I think part of the challenge too is that there's a thousand different times of cer types of certifying organizations for do.
[00:13:56] Dr. Neel Shah: And so there's a lot of variation, honestly, in the skillset and even in what people are bringing. But fundamentally, having an advocate just makes intuitive sense to me. Like, why would you run a marathon without a coach? You think about what every person giving birth deserves. It's like coaching, support, monitoring.
[00:14:13] Dr. Neel Shah: And then some people also benefit from like modern medicine and surgeons like me. We've designed the system backwards where everyone gets a surgeon and then we totally forget about the coaching, monitoring support part.
[00:14:23] Dr. Jill Baker: And you you need in an ideal birth ex and I never had a doula, but now I wish that I did.
[00:14:29] Dr. Jill Baker: I wish that I did. Sure.
[00:14:30] Dr. Neel Shah: Yeah. No, that makes a lot of
[00:14:32] Dr. Jill Baker: sense. Yeah. But it's definite, but I know from my own experiences and I know from that of. Women of color that it, it can be very challenging to speak up for your, speak up for yourself, advocate for yourself, even when you're pregnant, even when you're highly educated, even when you have your own set of knowledge it's still hard to talk up for yourself and say, Hey that's not I don't really like that plan or that idea.
[00:15:02] Dr. Jill Baker: I know you think I might, I might have ate too much this week, but I was really hungry. This, so it can be hard or when you have to decide. I remember conversations that I had when I had to decide if I was gonna schedule a C-section or try to get induced and those were very hard conversations to have.
[00:15:24] Dr. Jill Baker: And so I always felt if I, who have I multiple degrees feel like I can't talk to my doctor? How does just any every day woman feel in the same situation? Because most women, a lot of, most of us have ki have babies and have to deliver our baby. And so un not until I went through that experience did I not, then was like a light bulb, there's something to this and I'm not alone in this feeling.
[00:15:56] Dr. Neel Shah: No, totally. Yeah. I think it's a very common experience and, a bad system will be the good person every time. So I feel like on one hand it would be more ideal for doctors, nurses, and other clinicians to make it. For people to feel like they're getting good counsel and support when they have to make tough decisions, that they're well-informed, all of that.
[00:16:14] Dr. Neel Shah: And on the other hand for example, like part of a doula's role is to do some of that intermediation or disintermediation, but part of it is also that people independently deserve, support when they're going through challenging experiences or journeys.
[00:16:28] Dr. Jill Baker: I remember something you said on, on the last time you were on the other show that for, a woman, it might be, your first time, your first baby, your first pregnancy, but for the providers it's.
[00:16:43] Dr. Jill Baker: You're probably, your baby's probably not the first, and so it's not well, right? Yeah. But it's so where the two worlds are coming together and that diff those different experiences coming together to make these
[00:17:00] Dr. Neel Shah: decisions, right? Yeah. No, and that's part of my, I think, instinct to rage against the machine as opposed to the individual.
[00:17:08] Dr. Neel Shah: Cuz I think, from the, I can easily adopt the frame of a physician, I am one. And it's been work to try and empathize and understand the position of somebody who is not only a person giving birth, but may also on top of that be disenfranchised because they've experienced racism for their whole lives and also the system is set up to be racist.
[00:17:27] Dr. Neel Shah: So yeah, I.
[00:17:31] Dr. Jill Baker: So what would you say to women and patients of color? Any kind of guidance you would give from your ex experience of how you can appropriately advocate for yourself. But also, I think ideally a collaborative relat. Is the best, particularly when you're pregnant?
[00:17:52] Dr. Neel Shah: Yeah, I have two thoughts there. Yeah. One is I guess picking up from that mismatch and expectations, given that the doctor or the nurse may have been involved in thousands of pregnancies, and this is, probably you have not had thousands, and so it's a different experience for you.
[00:18:06] Dr. Neel Shah: So anything that you can say to. That difference advantage. Like I know that this is normal for you, but it doesn't feel normal for me. Or I understand that you don't think that this is dangerous from your perspective, but this is really scary to me. Things like that make a huge difference in just, helping the physician just get back to the humanity in what they're doing.
[00:18:26] Dr. Neel Shah: The other thing I would say is it's okay to have a high bar for what you expect generally speak. Moms are expected to put their own wellbeing last, to put their families first. And like people should have a higher set of goals than emerging unscathed from the process, right? And generally speaking, like if the baby comes out and has the right number of fingers and toes, like people are like, okay, like I'm happy to have a baby and that's what I should expect.
[00:18:49] Dr. Neel Shah: But I think that we should not aim for like the floor, but the ceiling, which is support, empowerment, all of that. And if you don't feel like you're getting that, it's okay to.
[00:18:58] Dr. Jill Baker: Oh, I love that. That can be used for so many different things.
[00:19:02] Dr. Neel Shah: Yeah, no, it's probably good life. Yeah.
[00:19:04] Dr. Jill Baker: But I love that.
[00:19:06] Dr. Jill Baker: But like I said, sometimes you really do think about, I'm just thinking quickly about my own, my own experiences. And especially when I had the tw when I was pregnant with my twins, I just knew every day was l life or. And that every week I was pushing myself to every week that they're in I'm gonna make this a better, birth outcome and just Sure.
[00:19:28] Dr. Jill Baker: Knocking down the weeks. And then at the end of it, I was just like, I just want to get them out health. I just want them to come out healthy. I d and I didn't, I don't know if I really thought about anything else and especially knowing that being a black woman, being an educated black woman, so I knew.
[00:19:46] Dr. Jill Baker: The statistics were against me. But then trying to fight against that yeah. Was, it was hard. It was hard. Yeah. Yeah.
[00:19:56] Dr. Neel Shah: Yeah. And I think part of the challenge too is between the last time we talked and now I think there's continue to be growing recognition of. The risks in childbirth, the maternal mortality crisis that we're talking about, and the black maternal mortality crisis specifically. Yeah, I've been in rooms of, just to put it bluntly, like white men, where these statistics are surprising.
[00:20:20] Dr. Neel Shah: But this, oh, Dr. Shaw,
[00:20:21] Dr. Jill Baker: I love how you always keep it real,
[00:20:24] Dr. Neel Shah: but and But generally speaking, when the audience is people of color and black people and black women specifically, we know, now we know, right? It's been shocking for a couple years now. It's been disturbing. And one of the things I think we've gotta be conscious of is not terrifying people.
[00:20:41] Dr. Neel Shah: Cause I think, childbirth is daunting no matter who you are. And then if you layer on top of it A set of documentaries and all these other things like, we just have to be thoughtful, that we're not disempowering people that actually doing is, we're informing them appropriately, but we're also being clear-eyed about things like what should you expect?
[00:21:00] Dr. Neel Shah: And then just being thoughtful about what we should be building around people. And I think honestly part of what we're starting to observe that I think is really encouraging is that communities are starting to collectively hold health systems accountable for their outcomes.
[00:21:15] Dr. Neel Shah: So it isn't on the shoulders of individuals to advocate themselves when they're in labor. That's like kind of too late, we should be working at this way far further upstream.
[00:21:22] Dr. Jill Baker: Exactly. Exactly. Exactly. And then, yeah, when a mom is in the hospital and the baby's in the hospital, and then when a mom and baby comes home, then it's important for that community to rally around them and give support and.
[00:21:39] Dr. Jill Baker: All those things are important. And I think sometimes we still can work on that more, but I definitely think that there are definitely more, I think, transparent conversations happening and I think more understanding and as you said, I think with more stories coming to mainstream I think the culture, the overall culture is understanding more how real this is.
[00:22:07] Dr. Jill Baker: This is not, this is, these experiences are not made up and these fears are not made, are made up. Either they're real, real fears, but also not not wanting to just hold onto that and say, okay, maybe I shouldn't have a baby. If you wanna have a baby, have a. And don't have low expectations for care,
[00:22:26] Dr. Neel Shah: right?
[00:22:28] Dr. Neel Shah: Yeah, I think that's right.
[00:22:29] Dr. Jill Baker: But it, but it's I think we're, I think we're getting there. I think we are definitely getting there. So let's switch gears a little bit because the last time we talked, you were not at your new position at Maven Clinic. Which is amazing and so exciting and incredible.
[00:22:47] Dr. Jill Baker: So can tell the listeners about your role at Maven Clinic and some of the work that you all are doing and some of your projects. So everyone has an idea of what you're doing in this new role?
[00:23:04] Dr. Neel Shah: Sure. I think. Two modalities of change. One is evolution and the other is revolution.
[00:23:10] Dr. Neel Shah: And for most of my career I was in the evolution camp. I worked firmly within the brick and mortar healthcare system. And then I think the pandemic just really changed my mindset. I think the
[00:23:20] Dr. Jill Baker: pandemic shifted a lot of things. Yeah. Look, I'm not in academia anymore either myself. Yeah. And
[00:23:27] Dr. Neel Shah: no, honestly, like nothing against that.
[00:23:28] Dr. Neel Shah: No
[00:23:29] Dr. Jill Baker: disrespect to anybody. I just Yeah. Had to, cause I'm
[00:23:32] Dr. Neel Shah: different. Yeah. I needed a change. And I also felt that broadly we needed more radical change faster and part of the insight here was that health isn't really produced within the four walls of our clinics. There's only so much can get done in a 15 minute visit.
[00:23:46] Dr. Neel Shah: It's produced in people's homes, in people's communities, and in their workplaces. And that it's 2022, and we should be able to use technology and get out of the, deeper fax machine age which, healthcare is firmly enmeshed in and meet people where they are, which includes by the.
[00:24:02] Dr. Neel Shah: In 2022, most people would love people to just text their doctor or some other expert and have somebody get back to them with trustworthy information. And that's not how our healthcare system is set up. If I hold the doctors in my hospital today, that the expectation is if they had to answer patient texts, most of them would quit.
[00:24:21] Dr. Neel Shah: And not cuz they're bad people and they're not un unempathetic. It's just not how the system is set up. Yeah. Maven Clinic is the world's biggest virtual clinic for women and families. Cover about 15 million people across 175 countries. We take care of people who are, I'd like to think we're not a condition-based company.
[00:24:37] Dr. Neel Shah: We're a phase of life-based company, so we take care of people across the whole journey from the whole like
[00:24:42] Dr. Jill Baker: life course.
[00:24:43] Dr. Neel Shah: The whole life course. Yeah. I love it, in menopause, but also, particularly around when they're building their families. Yeah the primary way that we work is through people's employers as a benefit.
[00:24:52] Dr. Neel Shah: But we're also starting to work with a lot of the national health plans and with Medicaid systems. Oh, okay. And and we're trying to move the whole industry closer to value because we're not paid fee for service the way. Typical clinics are. And so there's an opportunity to reinvent the business model of healthcare a little bit too and make sure that we're, tying what we get paid to, whether or not we're making people healthy at the end of the day.
[00:25:15] Dr. Jill Baker: Oh my goodness. You said 170 countries?
[00:25:19] Dr. Neel Shah: Yeah, about 175 countries. Wow. And it's because it's an interesting way of working cuz when. A digital service and you don't have to build physical infrastructure. It allows you right places. And then That's right. There's advantages to that because if you think about, one of the things I think is the hardest about the current state of our healthcare system is where you live physically determines what your proximate to, and that determines, your opportunities to
[00:25:44] Dr. Jill Baker: be healthy.
[00:25:45] Dr. Jill Baker: And the same thing with public.
[00:25:47] Dr. Neel Shah: Yeah, same with
[00:25:48] Dr. Jill Baker: school, same system,
[00:25:49] Dr. Neel Shah: right? A hundred percent. And this is an opportunity to you can't deliver a baby through a screen, right? So it's not like a full solution. But, when I think about someone who's living in rural America, or an underserved urban area of my own city or other cities we should be able to speak their.
[00:26:05] Dr. Neel Shah: We should be able to connect them to not just an obstetrician like me, but a nutritionist if they're struggling with gestational diabetes, and these are all capabilities that are easier to do digitally than physically.
[00:26:17] Dr. Jill Baker: Oh my God. And ca and getting, some of those things that we said end up being red flags later or not, caught soon enough or caught too late, and being pro proactive and then having the technology that allows for you to have more.
[00:26:34] Dr. Jill Baker: People on your support
[00:26:36] Dr. Neel Shah: team exactly. Yeah, cuz it's unlikely if you live in the Delta of Arkansas, that first of all, you're gonna have a provider that shares your lived experience and looks like you, that's physically close to you let alone one that might have the right technical expertise, whether it's physical therapy or other things that are not as close.
[00:26:57] Dr. Neel Shah: And so those are things that we can more easily make happen in digital health. So that's what drew me there. And I've been there for about a year and a half now. And my mandate is to design our care model and then prove that it works, which is a pretty fun job.
[00:27:12] Dr. Jill Baker: So do you think that this shift has been easier regarding this use of technology, especially with what you all are doing at Maven Clinic because of the pandemic?
[00:27:28] Dr. Neel Shah: I think in some ways the pandemic made it more normative for people to interact with their providers through a screen and it. Such that providers are more open to it. But also honestly, like there was a lot of burnout in the professions. And burnout doesn't come from hard work, it comes from moral injury.
[00:27:45] Dr. Neel Shah: So what I found is that there's a whole stable of, wonderful clinicians out there who wanna be part of building something different. And so I think in some ways the pandemic, made some of these things more clear. I think more, more broadly it's that there are long standing. Unmet needs in women's and family health.
[00:28:04] Dr. Neel Shah: And between the pandemic and then between the sharp regression and reproductive rights, it made it such that more people recognized those long-standing needs.
[00:28:13] Dr. Jill Baker: So it was like everyone saw, the colors, everyone saw what was happening now.
[00:28:19] Dr. Neel Shah: And I think so. Like I'm a realist at some point too, but It's notable that, you can say systemic and structural racism as terms that are relatively understood and you can say it in a direct way in large groups of people.
[00:28:34] Dr. Neel Shah: And it took horrible things for that to happen. But things like, George Floyd, the murder of George Floyd, really did change the national discourse. And so talking isn't the same thing as. But you have to have people, you need to have the language. I remember even like 2019 I hosted a panel at the American College of ob, obstetricians and Gynecologists and I think we used the word racism in the title and it was very edgy and it was like a room full of obstetricians from across the country who were just there to get their C M E, oh, right across the country.
[00:29:07] Dr. Jill Baker: Yeah.
[00:29:07] Dr. Neel Shah: Yeah, it was a really edgy thing to do, and like now in 2022, people wouldn't even bat an eye. And I think that is some form of progress. Yeah, you're right. Spaces to have much more real conversations today than we could a couple years ago.
[00:29:17] Dr. Jill Baker: No, you're right.
[00:29:17] Dr. Jill Baker: No, I, you remember I used to teach medical students. Yeah. And I used to teach about race a lot, but again, it's prior, to Jor, to George Floyd, and. I'm a realist. I don't sugarcoat, I don't, so we've talked about, Trayvon Martin and, all the young, young black men who lives were taken and I, there were some people who were not happy with me.
[00:29:41] Dr. Jill Baker: Being, I guess being that real or being that transparent and showing what's really happening. But I think that now I would agree with you that there has been a definite shift. A needed shift. A needed shift in, in the discourse. Yeah, I think that's right. But we still, there's still a lot more work that has
[00:30:03] Dr. Neel Shah: to be done.
[00:30:04] Dr. Neel Shah: I almost think that where we are today with the birth equity movement as a cause is similar to where we were with the H I V aids. Oh my gosh. Movement. Yeah. And I know that's something that's close to you as well. Yes. But back in the late eighties, nineties, early nineties, even the Reagan administration didn't care.
[00:30:20] Dr. Neel Shah: And the people that were like the most impacted were disenfranchised, similar to and pharmaceutical companies didn't care. And it wasn't really until they. Act up, like in other organizations at the community level got together and held power to account that we got a Z T passed.
[00:30:36] Dr. Neel Shah: Which we got to a point where
[00:30:38] Dr. Jill Baker: you can't, insurance paid for it and the payments affordable
[00:30:42] Dr. Neel Shah: and yeah. And this is right in the pocket of your work, but you can't do H I V AIDS research in 20 22, 22 without a community advisory board. You cannot, it was community groups that did. Also though there's a book that I'm reading now that I love called Let the Record Show by Sarah Schulman.
[00:30:58] Dr. Neel Shah: And it's like an oral history of Act Up and what it shows is like within the movement. Not everybody got along because, the Larry Kramers and the Harvey Milks of the world, like they were like Yale educated white men. And within the movement there were also people of color. There were lesbians there.
[00:31:15] Dr. Neel Shah: Yep. There are other people that had different lived experiences from background. And there was a lot of actually tension within the movement that's very similar to what I'm seeing today. And one of the lessons I think of this book is that to affect change. Cause I, I do think that. That movement around H HIV v aids was one of the most effective social movements of my lifetime.
[00:31:36] Dr. Neel Shah: Absolutely. And like at the end of the day, like mortality from h hiv aids went down. That's the
[00:31:42] Dr. Jill Baker: Yes it did. But although a lot of people's lives were lost, it's like you're so on point. Similarly to there was a ton of anger,
[00:31:52] Dr. Neel Shah: maternal mortality. Yes. And within the movement of people who created that progress, there's a lot of, in.
[00:31:56] Dr. Neel Shah: And one of my insights from that is that you don't need consensus to make a difference. What you need is what the author of this book calls a simultaneity response, which means that everybody is agitating at the same time with an understanding that we all have different roles to play.
[00:32:12] Dr. Neel Shah: And think that's really important. That's what's happening here. Whether it's talking about racism more broadly in society, or talking specifically about birth equity, what we're seeing is more people talking. They're not all agreeing, they're not all eye to eye, but the volume I think that's really notable.
[00:32:27] Dr. Neel Shah: It means that we're on the right path.
[00:32:29] Dr. Jill Baker: I love that. I love that comparison. And I think it's so on point. And the, and although all of those people had, different life, different experiences, different roles in the movement, but they had the same goal.
[00:32:45] Dr. Neel Shah: Exactly. That's exactly right. You can't be so different.
[00:32:48] Dr. Neel Shah: Like you've gotta share the same vision for what the world should look like and then you can have differences, opinion about how to get there. Strategy, goals, tactics like that could be different. But your vision, your mission, and your values fundamentally have to be aligned.
[00:33:01] Dr. Jill Baker: So you know what that actually, I've never thought about it like that.
[00:33:04] Dr. Jill Baker: So that you know that actually. Gives me some hope because, thinking of the be beginning of the H I V crisis, you would've never, it was very hopeless. It was very bleak in the beginning.
[00:33:15] Dr. Neel Shah: It was very bleak. And like for people who were in the movement trying to create improvement, I think sometimes they were very frustrated by the divisions.
[00:33:23] Dr. Neel Shah: Yeah. And I think that there's always risk. Any progressive movement cannibalizing itself. From in fighting on the inside. Yeah. And so I think we've gotta be conscious and our antenna should go up when we're like canceling people for their opinion. That should never happen. And that does worry me because that's fascism, whether it's coming from the left or the right.
[00:33:42] Dr. Neel Shah: Very concerned about some of the things I'm seeing coming. Often progressive movement in that direction. It's also Okay. Like for example, I'm really aware that at Maven Clinic, I'm a VC back startup that works with corporate America, which means I can't be at the spear's edge of politically divisive issues.
[00:33:58] Dr. Neel Shah: I've gotta be a much more moderate force than, say, a community-based organization.
[00:34:02] Dr. Jill Baker: We'll have our roles to play. No, you're no, you're absolutely right. But it's still, you still have, your goal is just the methods that you're using. To get to that goal. Maybe a little bit different in your role now, but you're still your goal is still there.
[00:34:20] Dr. Neel Shah: Yeah. And you gotta take the long view too. I was talking with Loretta Ross a couple weeks ago who wrote the book on reproductive justice and has been doing this work for a half century 50 years. Oh my gosh. I was asking her how she maintains her optimism given the fact that she.
[00:34:35] Dr. Neel Shah: Part of this effort when Roe was handed down as a judgment and when it was dissolved, and she said, that you shouldn't imagine yourself as the whole chain of freedom. That you're not responsible for what your ancestors did, and you're not responsible for what your descendants will do.
[00:34:50] Dr. Neel Shah: Like your job is to make sure that the chain doesn't break at your link. And I thought that was really powerful. She was like, when the world's a mess, your job is to grab a broom and clean where you are.
[00:35:00] Dr. Jill Baker: That is so profound. Oh my gosh.
[00:35:05] Dr. Neel Shah: That's just how she talks. Oh my gosh. I know.
[00:35:09] Dr. Jill Baker: But that makes me also think about trauma because in order to free, free yourself you might have to let go of the past a little.
[00:35:19] Dr. Jill Baker: No,
[00:35:19] Dr. Neel Shah: that's true. You can't that's a very, wow. I love that very few people enter this work without approaching it from the position of their own trauma, and it's very easily triggered. Yes. Like I think, being someone who wants to be effective in this movement requires understanding your trauma and learning to be aware of things that trigger it.
[00:35:39] Dr. Neel Shah: And also being sensitive to the other people's trauma so that you. Inadvertently trigger it and avoid when it could be avoided. It can't be totally inverted either though, right? I think part of what she taught me is like when you work in this space, sometimes you will trigger people's trauma and you should be, sensitive to that.
[00:35:54] Dr. Neel Shah: You should avoid it whenever possible. But it's also part of this work. It's a little bit, it's spicy work.
[00:36:00] Dr. Jill Baker: Oh my gosh. I love that. I love that now. And you gave me all these books to read. Now I have some new books to read and I'm gonna make sure everyone
[00:36:10] Dr. Neel Shah: Gets, there's both of these authors, so Sarah Schulman wrote the record show. Okay. And she's got another book called, conflict is Not Abuse. Ooh, she has really interesting take on social movements based on h I v aids. And then Loretta wrote the reproductive Justice book, but she has a brand new book that's about basically calling people in instead of calling people out.
[00:36:30] Dr. Neel Shah: Oh,
[00:36:32] Dr. Jill Baker: yes. We talk about that a lot in d e I work, everyone may not, understand all these experiences and nuances and when people of color feel discrimination or racism. And sometimes we can do more damage when we're just picking on that person or that really may not get it because that's not their experience.
[00:36:56] Dr. Jill Baker: But the calling in part, we can, keep them close to us. Keep talking to them. Keep explaining to them. Maybe it's not one time, maybe it's a few times, maybe it's maybe I need to take this person to my next doctor's appointment or something so they can understand what I'm saying.
[00:37:14] Dr. Jill Baker: So I think sometimes we can be quick to maybe just cut people off. And I don't think that's going to help for making real change in these issues, especially when it comes to diversity and equity and
[00:37:31] Dr. Neel Shah: inclusion. No I agree with that and I think, not everybody has to lead in this space, but I think the people who choose to, there's real emotional labor to it.
[00:37:41] Dr. Neel Shah: It's not easy to call people. It's harder to do that. Yes. And like it's exhausting. Yes. But that's what, that is what the work is. If you care because you wanna say,
[00:37:49] Dr. Jill Baker: why don't you just get it? That's not going to help though. It's not. It's
[00:37:53] Dr. Neel Shah: really not. And again, like I think we need all the responses and there are times where it might be appropriate to just rage against the machine and
[00:38:00] Dr. Jill Baker: sometimes it is.
[00:38:02] Dr. Jill Baker: Yeah. But you have to know when that time is. Yeah. Oh, I love that. Thank you. Before the books. I love that. I love. Now I have some more books to read and I'm gonna make sure the listeners have access to these books. Okay. So before you go, we have to talk about I want the listeners to hear from you about this stellar and amazing documentary, aftershock.
[00:38:28] Dr. Jill Baker: Which one of the main people in that, in the documentary was our, fellow friend and brother, Amari Maynard, who lost his, partner Shani a few years ago. And I, watched the movie. I personally, was in, in tears. But it was just so beauti, it was just done so well.
[00:38:49] Dr. Jill Baker: It, and it just really just, it touched me on so many levels, so I know that other people who watched it were touched as well. So I wanted to ask you, how did you end up be, becoming part of it? How did you feel being in it, and why do you think it was so successful?
[00:39:14] Dr. Jill Baker: Because it won awards. I wasn't surprised that I knew that it was gonna win awards, but it's been just killing it, on all levels.
[00:39:22] Dr. Neel Shah: Yeah. I think in the early days of the pandemic, I think all of us, it was a terrifying time for all of us. And I think there, there were a couple of filmmakers that wanted to be able to use their craft to make a difference.
[00:39:36] Dr. Neel Shah: And number of them contacted me as someone who was like, had a platform in this space and, when the pandemic happened. Like the media in general reached out to people who they thought had expertise to explain what was happening. So as one of those voices that was, in the New York Times and other outlets talking about covid, what it meant for pregnant people why I was concerned about, and others were concerned about racial inequity, all of it.
[00:40:00] Dr. Neel Shah: And the directors of Aftershock were among those people who reached out, and I always intended to be like a background. Oh, I didn't think that I was gonna be on camera. You didn't? No, and I didn't even think that I should be because in the, filmmaking is like non-linear is what I learned, especially the kind of film that they wanted to make, which was like character driven longitudinal. Yes. It wasn't like Nightline episode with No, it wasn't, no, it was like embedded with the families. And the families were the ones who wanted to center. So anyway I didn't think I was gonna be in the movie, but then I organic.
[00:40:30] Dr. Neel Shah: Formed a friendship with Bruce and then ended up in front of the camera and then a bunch of serendipitous things happened that made my story, part of what tied the movie together. But so that's how it happened and I was honestly ambivalent about being on camera for it cuz I wanted to make sure that one, this wasn't a doom and gloom movie.
[00:40:46] Dr. Neel Shah: Yes. And the two that it centered families. Because I thought, there was enough talking head experts that the world didn't need another one of those. And the vision of the directors, Tanya Lewis Lee and Paula Isel was like very much, aligned with that. I think that's part of the power too, cuz like we'd been talking a lot about maternal mortality, then the conversation stopped.
[00:41:05] Dr. Neel Shah: And that's exactly where the film picks up. Like the mortality event happens within the first couple minutes of the movie. And then there's an hour and a half where we talk about the after. And you get to see these really powerful families turn their pain into power. Yes. And really ultimately it's a hopeful movie.
[00:41:22] Dr. Neel Shah: It's wrenching of course, but you see the power of speaking your truth, speaking with integrity and ultimately holding systems of power to account. It's pretty in. I
[00:41:32] Dr. Jill Baker: think that you definitely were the right person to be in the movie. You were, you were ama, you were amazing.
[00:41:42] Dr. Jill Baker: And it was just, such an honor, for me to watch it and say, and say, oh my gosh, it's, Dr. Sean there. But so powerful. The whole, Maynard family and. Just all of them, just taking these tragic losses and turning them in into something that is going to be life changing.
[00:42:06] Dr. Jill Baker: And certainly I think, I know that this, documentary is one of the reasons that. The overall kind of conversation is shifting more in the main mainstream
[00:42:19] Dr. Neel Shah: media. No, it's so powerful. Yeah. I don't think, I didn't see the movie until a, until the Sundance Festival, and I was shocked that it was in the Sundance Festival than it won the Impact Award.
[00:42:26] Dr. Neel Shah: Yeah. But it was, I watched it was probably hundreds of hours of filming over many months the better part of a year actually. And I had no idea how they were gonna turn that to 90 minutes. And then I watched it and I was blown away. Even though I was there for a lot of it, and then what's been really powerful is we've been doing all these screenings across the country from the Essence Festival Oh. All the way to, inside of hospitals. And what's really cool is that it resonates with everyone. That's the power of a great film. It is a vehicle that creates conversations and opens up space.
[00:42:56] Dr. Neel Shah: It didn't exist before. It, it resonates. People in the community, but it also resonates with doctors and nurses without making them defensive. And I think that's really incredible. And it's really a testament to Omar and Bruce and Shawnee and how Yes. Like the way they were depicted on that, in that in film is exactly who they are in real life.
[00:43:13] Dr. Jill Baker: Yes. Yeah. It was them, it was not, it wasn't made, it was authentically them. Yeah. In all in the pain and the joy in the activism. Every, facet of all of them, absolutely. Yeah. I'm, I I am so glad, and I think all of us who are watching the movie are glad that you were in the movie and highlighted as you should have been.
[00:43:39] Dr. Jill Baker: And I hope that if anyone who hasn't seen it, they definitely need to see the movie. So one last question I wanted to ask. Before we part is is there anything you want to share with the listeners about what we can be hopeful about regarding maternal mortality disparities in this country?
[00:44:03] Dr. Neel Shah: Sure. My perspective over last year and a half has evolved both because of just the way the national discourse is going and because I have a different role now where I work. Let's call it corporate America, which is a different lens on the country than I had as an academic. But pretty much on all fronts.
[00:44:18] Dr. Neel Shah: I'm seeing, one, there are many more community-based organizations working on birth equity than ever before. There used to be one national organization that was primarily, speaking to these issues and now dozens across the whole country. So I think at the community level there's momentum.
[00:44:34] Dr. Neel Shah: Academically in the big academic conferences, maternal health was a tiny little, topic, often a corner, and now it's like one of the main ones.
[00:44:42] Dr. Jill Baker: People are really, that has certainly changed. Definitely it's changed, right? Like you can't, 10
[00:44:46] Dr. Neel Shah: to 15 years. And you can't see what you don't measure, right?
[00:44:49] Dr. Neel Shah: And so that's the role of the academic community is to shine light on what's happening in public policy. Congress is starting to pass bills systematically, like Thebus Bill and then in corporate America. What I'm seeing, I just got off, a series of meetings this week. One of the biggest industry conferences of investors and startup operators.
[00:45:08] Dr. Neel Shah: Women's health was on the main stage. And. I think that's really exciting too. Women's and health and family health is a category that people wanna invest in, and they're looking to disrupt the care models. So I find that really encouraging too.
[00:45:22] Dr. Jill Baker: Thank you so much. Thank you for that.
[00:45:25] Dr. Jill Baker: Dr. Sh thank you for everything and thank you for all of your continuous work and all of your hats. I'm really excited for you about your new role at Maven Clinic and all the women and families who are going to be positively impacted by your work and everyone that you work with and all your home team is such a delight.
[00:45:50] Dr. Jill Baker: And anytime I email them or communicate, they're just, they're very lucky. They're all wonderful and just. Smart people that you work with. So I wanted to say that to you too, and thank you for helping me to keep my fire going in this work as well and keep, my spark up because I thought for a time that I was go, going to stop and then I was like, Nope, I can.
[00:46:17] Dr. Jill Baker: There's too much more work that has to, too much more work that we have to do. So Dr. Shah, thanks again for joining the show today. And can you let the listeners know how they can connect with you on social if they want to reach out to you?
[00:46:34] Dr. Neel Shah: Sure thing. First of all, Jill, thank you so much again for having me.
[00:46:36] Dr. Neel Shah: You're always an inspiration to me, and I'm glad, continuing the work. It's a long haul and I think we all have moments where we need to restore for a moment before we get back to it. But I have no doubt that you're gonna oh, in this for the long haul. Thank you. And I'm really easy to find.
[00:46:50] Dr. Neel Shah: My name is Neil Shaw, and that's my name on every social media platform and on Google. I don't know how long, much longer Twitter is gonna be around, but I know right. You can find me on LinkedIn, on Instagram, on Twitter, on all those places.
[00:47:03] Dr. Jill Baker: So yes, you are very hard to find. You are very easy to find on social media.
[00:47:08] Dr. Jill Baker: I know myself and so you're the reason why I'm like, I need to keep my social media easy. So all my stuff is Dr. Joe Baker. Yeah. And Twitter. You're right. Twitter may not be around.
[00:47:21] Dr. Neel Shah: We'll see. We'll see. Better or for worse.
[00:47:23] Dr. Jill Baker: Thank you Neil, so much. And send and sending a hug through the screen.
[00:47:29] Dr. Neel Shah: Thank you.
[00:47:33] Dr. Jill Baker: 3, 2, 1. Yeah. Thank you for listening to this episode of Maternal Health 9 1 1. Please follow the show on Instagram, Facebook, and Twitter. Feel free to DM me with your questions and thoughts or to share your infertility, fertility, and maternal health story for more information on this podcast. And. Visit ww dot dr joe baker.com listening to the show on Apple Podcast.
[00:48:00] Dr. Jill Baker: Please rate and review it. It really helps the show and the feedback is welcome.
[00:48:15] Dr. Jill Baker: You go.
The COVID-19 pandemic has had a disproportionate impact on BIPOC women's maternal morbidity and mortality outcomes as we learn in this episode with our guest, Dr. Neel Shah. BIPOC women are more likely to experience pregnancy-related complications and death than white women.
To help patients feel seen and heard, active listening, empathy, and cultural humility are essential tools. Barriers that women of color face include systemic racism, implicit bias, and limited access to quality healthcare.
Everyone in the medical industry can work towards addressing these barriers by acknowledging and addressing our biases, advocating for policies that promote equitable healthcare access, and partnering with community organizations to improve health outcomes for women of color.
About Our Guest:
Dr. Neel Shah, MD, MPP, FACOG, is Chief Medical Officer of Maven Clinic, the largest virtual clinic for women's and family health, and Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. He is a globally recognized expert in designing solutions that improve health care, and is listed among the "40 smartest people in health care" by the Becker's Hospital Review. His work to build equitable, trustworthy systems of care has been profiled by the New York Times, Good Morning America, and other outlets, and is featured in the Oprah-produced documentary Color of Care, and Aftershock, which premiered on Hulu in July 2022.
Dr. Shah has written more than 50 peer-reviewed academic papers and contributed to four books, including as senior author of Understanding Value-Based Healthcare (McGraw-Hill), which Don Berwick has called "an instant classic" and Atul Gawande called "a masterful primer for all clinicians." Prior to joining the Harvard faculty, Dr. Shah founded Costs of Care, an NGO that curates insights from clinicians and patients to help delivery systems provide better care. In 2017, he co-founded the March for Moms Association, a coalition of more than 20 leading organizations, to increase public and private investment in the wellbeing of mothers. Dr. Shah serves on the advisory board of the National Institutes of Health, Office of Women's Health Research.
Learn more about Dr. Jill here.
Have a story to share? Send us an email at maternalheatlth911@gmail.com
Follow Dr. Jill:
LinkedIn:
https://www.linkedin.com/in/dr-jillian-baker-61543222/
Instragram: https://www.instagram.com/explore/tags/maternalhealth911/
and
https://www.instagram.com/drjillbaker/
