Ndidiamaka Amutah-Onukagha: advancing maternal health justice
Written by: Richard Lane
“I see myself as a scholar–activist”, says Ndidiamaka Amutah-Onukagha, Associate Professor of Public Health and Community Medicine at Tufts University School of Medicine in Boston, MA, USA. At Tufts she leads research on the underlying causes of maternal health disparities in Black women. “This previously underrecognised issue has come into sharp focus after the US Surgeon-General declared last November how maternal health disparities across the USA have become a national crisis”, she says.
With the recent uprisings of the Black Lives Matter movement, the focus of her work is clear. “The irony is that appalling events like the death of George Floyd, or the shocking and entirely preventable death from pre-eclampsia of paediatrics resident Chaniece Wallace give us the visibility we need to take action; for me this means securing funding to provide better understanding of the causes underlying the widespread maternal health inequities among Black women in the US”, she explains. Central to Amutah-Onukagha's work is examining what academics call “implicit bias”, among other factors, around the provision of maternal health services to Black and other ethnic minority women. “I prefer to call it explicit racism between health providers and their patients”, she says. “How can an advanced nation with its skilled health practitioners and technologies account for the fact that over 60% of its maternal deaths are preventable, the majority among Black women?”
Amutah-Onukagha's upbringing in Trenton, NJ, USA, has influenced her career path. The eldest of four children of Nigerian parents, it was the death of a 15-year-old schoolfriend from complications after childbirth that gave Amutah-Onukagha an incentive to secure a college education. At Rutgers University she gained a double major in Public Health and in African studies, followed by a Master's in Public Health from George Washington University and a PhD on infant mortality and health inequities within maternal and child health from the University of Maryland. After a 2-year Kellogg Foundation research fellowship in Baltimore at Morgan State University, Amutah-Onukagha returned to New Jersey, teaching public health for 5 years at Montclair State University. Joining Tufts in 2017, her research there has focused on health disparities and health equity in ethnic minority populations.
At Tufts she initiated an annual community-wide advocacy forum on Black maternal health to complement her research efforts. “The main objective is to bring together representatives from all spheres of maternal health in the Boston and New England area, including OBGYN practitioners, nurses, midwives, mothers, and community leaders. Our overarching aim is to break down barriers to better understand why maternal health is worse for Black and other non-white women, and to use this qualitative information as context for our formal research programme”, she says.
Her research on maternal health inequity among Black women—a US$3 million programme over the next 5 years—is one of six NIH-funded programmes aimed at reducing maternal morbidity and mortality in the USA. As part of this work she is investigating three areas: reviewing existing data on hospital discharge for women with severe maternal morbidity; analysis of the implementation of safety protocols in response to emergency situations such as haemorrhage and hypertension, with the aim of data comparisons between Black and white women; and developing a better understanding of the effect of doulas (informal birth attendants) on pregnancy outcome. Amutah-Onukagha is keen to avoid assumptions and oversimplifications. “Low socioeconomic status being associated with non-white status is a factor, but is not the whole picture. The quality of service provision and relationship between clinicians and Black women is the aspect that we need to better understand. It is only when you start to peel back the layers of complexity that the nuanced nature of this work becomes apparent”, she says.
Another of her research priorities concerns HIV/AIDS, the leading cause of mortality in Black women aged 18–34 years in Boston. “The public health objective is to disrupt the sexual risk pathway. There remain unanswered research questions that my team will address, based around whether health-care providers are offering appropriate services to teenage Black girls in HIV/AIDS prevention”, she says. Audra Meadows, Co-Chair of the Perinatal Neonatal Quality Improvement Network of Massachusetts, has worked closely with Amutah-Onukagha and comments: “I have observed the tremendous impact Ndidiamaka has made in maternal health and health disparities as a committed and talented researcher and educator. Working from a lens of human rights and social justice, she has made impressive contributions to academic, political, and local communities in Massachusetts and abroad as an impressive leader in maternal health and public health. She will continue to make strides in advancing the field to make birth safer and equitable.”
Amutah-Onukagha has ambitions to make a mark in more upstream areas of academia. “I would love the opportunity to redress the paucity of Black faculty in the academic environment”, she says. Will the presence of her country's first Black female Vice-President help the visibility of her work? “It undoubtedly brings a racial justice lens to the White House, which can only help our work over the coming years. This is an exciting time, as we are without doubt entering a new space of racial awakening”, she says.
