This interview, conducted by by Nat Thomson, Simmons MSW Candidate, runs abridged in the May 2025 issue of the Simmons MPH Monthly. Tozoe Marton is an adjunct faculty member with the Simmons MPH program.

Hi Tozoe, it’s great to be talking with you today! First, I wanted to be sure to ask; you earned your MA in “social policy,” and I was just wondering if you could lay out what that degree and area of study tends to be all about, for those who are not familiar with it?

Well, it’s a lot of things, as you might imagine from the name [laughs]. I am currently a fourth-year PhD student at Brandeis University’s Heller School for Social Policy and Management. The PhD in Social Policy includes health policy, but [the program] also has people who are working on policy around wealth building and asset building, while others are working on immigration policy and disability policies. My own work is on health policy. After completing two years of the overall PhD program, you earn a masters in this area of study, so that’s where my master's fits in. But the entire area of study really encompasses a lot and is very diverse.

Very interesting, I wasn’t aware of this. Your emphasis during your studies was global maternal health, so we’d be interested to hear a bit about this focus of yours.

For me the topic is personal. My thoughts always go first to my mother. Sometimes I wonder what people will make of me bringing up my mother’s story each time, but it’s a story that motivated me to become a researcher, to work on a PhD- so I’ve decided over time that it is important for me to tell the story. My family is an immigrant family and I was born in Liberia during a time of intense civil war. On top of the war, the country suffered without much in the way of healthcare services and systems. So this is the social context of my birth. 

In this environment in Liberia, my mother hemorrhaged during my birth and did not survive the excessive bleeding.  Luckily, I survived and made it from Liberia to Ghana to the US. Later, when I was in college, the circumstances and details of my mother’s passing were shared with me. Learning all this changed the trajectory of my studies and of my work. Initially, I wanted to be a lawyer. However, after learning about the circumstances surrounding my mother's passing, I developed a deep interest in public health while I was at Simmons for my undergraduate degree. I started to learn about how the conditions like those present in Liberia at the time of my birth tend to contribute to maternal mortality rates around the world and in Africa, so I was able to connect the studies to my mother’s situation and to others who find themselves in similar situations and have similar stories to tell. Unfortunately, the story often tends to remain the same, even here in the US, when it comes to black mothers’ experiences in health care systems.

There was some specific work you had done in this space, a research piece around midwifery training at the Kenya Medical Training College, so I was wondering if you could tell us a bit about this research?

Absolutely. This is my PhD dissertation research, so it’s my baby [laughs]. There’s a notion around professionalizing the job of midwife, but historically, it tended to exist more as a form of non-professional care that you might typically receive from a loved one- a set of skills that was passed down from generation to generation, where women taught one another to care for one another through pregnancy and childbirth. Eventually, this tradition became warped under the medical gaze and formal training education was mandated for those performing the role. This process of formal education, for a role that historically was predicated on women teaching one another, outside of formal medical systems and such, became very interesting to me, and I became curious if this formal training mandate really tended to result in better outcomes, or not, for mothers in sub-Saharan Africa. I visited Kenya previously for my work with RTI International, and I really fell in love with the country. Being there, I learned about how they structure the midwifery training through the Kenyan Medical Colleges system, of which there are over 70 separate institutions in the network across the country. These colleges produce a high volume of professional midwives and nurses who will go on to be involved in maternal care in the country, so being able to explore how the education system works for midwives was fascinating and presented a viable means to study the process and outcomes. When I began my PhD studies, I knew I wanted to go back there to do my research. I went back to Kenya in September 2024 to begin data collection and returned in February 2025.

And what were the research study processes like?

Being there, working with colleagues there in Kenya, I was able to work with folks there to put the procedures together, so that was great to have colleagues there to collaborate with. Direct observation was the main means of study- following students of midwifery from their classroom lectures into their clinical practice. I sat and observed their classroom lectures and took notes, and then we were able to follow them into facilities and see how students are taught in the clinical setting. We got to observe births and take a look at the ways in which the learning environments were conducive to positive outcomes, along with the social factors that come into play when in these environments. There was also a series of interviews with students and faculty to add perspectives of the institution and student body. To complete the research, I had to learn Swahili on the spot, but I found it fairly easy to pick up, and the Kenyan people of the western region, the Luo people, were very welcoming to me, and understanding of what we were trying to accomplish. 

Part of the project also involved comparing rural and urban areas in Kenya; I had gone in with an idea that the urban region practitioners and students might be more confident, individually, in that they had more access to expertise, resources and facilities. However, I ended up really seeing the opposite, in fact. The findings tended to indicate that the students in more remote areas seemed to be more confident across a few domains of maternal care as compared to those in urban areas.

What might one attribute this to?

I’m currently drafting the manuscript and in reviewing the literature, there are some pieces that tend to indicate that it’s about autonomy, which plays a big role in delivery care for midwives. So, in an urban area, what I tended to notice is that there is a cadre of caregivers involved. There is a structure, a hierarchy, which tends to have midwives at the bottom of the hierarchy. So that may have an impact on the qualified midwives and what they’re generally able and expected to do and to weigh in on. Compare this to a rural practicing midwife, where they will have a lot more autonomy in decisions and such, due to the lack of the hierarchy of care structure I described. In a rural setting, with less hierarchy and more hands-on opportunities, students are better able to make their own decisions on what to do, versus having to defer to anyone else or to confer with a team of caregivers first and such. They are held more accountable earlier in their practice or career. I also saw in the data how those in rural settings had to fight more to get what the facility or the patient really needed, which tends to line up with my own experiences in the field as well.

That’s really interesting stuff. It makes intuitive sense and it’s cool that you were able to validate it beyond that with the process. I wanted to be sure to ask you about some of your work in the HIV/AIDS prevention, treatment and intervention space, also in Africa, as that seemed like really important work to undertake.

I did this work at RTI International, which is a research hub. After I graduated from Brandeis with my Master's in Global Health Policy and Management, I got a job with The Women’s Global Health Imperative, a subgroup within RTI. This group does work on HIV prevention focused on women in Sub-Saharan Africa and parts of the US. Most of the work I was on was in SSA: South Africa, Zimbabwe and Kenya. One of the projects that stood out to me there was a study on the stigma around PrEP, the pre-exposure prophylaxis. The project was about understanding the details of various stigmatized ideas in the culture around PrEP and then to develop effective interventions that would reduce the stigma and increase the uptake in usage by specifically adolescent girls, in this instance, in Kenya. This is the project that took me to Kenya for the first time.

In the process of the research, we would frequently have to travel to participants' homes, because many people there do not have the means of transportation. In doing so, we had coordinators who would help us navigate Kenyan culture appropriately. For example, for one piece of the research we went to a distinctly Kenyan family compound, where we were educated by coordinators on the nature of the family compound living style and the associated cultural norms and such, including the significance and symbolism of the arrangement of the houses in the compound, with the head of the family at the center and such, with his wives and children being arranged in a certain hierarchical manner around the compound. Along with this, our coordinator helped us to understand the behavioral norms and appropriate behaviors and presentations, given the nature of the discussion and our position as researchers, and the power dynamics we should be conscious of as we proceed in our data collection. This experience was really important in shaping my views and approach towards doing global research, where we may not always know the culture to the degree that we wish we could. After that experience, I said to myself, “I want to do this forever.” Even now, going back to Kenya, I realize I still have a lot I can learn about the culture.

One thing that I’d assume that was central in your work is the dichotomy of information and misinformation, so I thought it might be interesting to talk about how that tended to play out. Of course, that’s not a distinctly HIV/AIDs perception issue, nor a distinctly Kenyan issue, as we know well here in The States these days.

We can all fall prey to misinformation. In writing the paper, I reflected a lot on instances of my own misinformation, especially thinking about what we all went through during the early months of COVID-19. It’s quite possible to be educated, or to be highly educated, and still be misinformed, I think it’s important to say. Education, of course, is quite important when it comes to “dissolving” misinformation. Back in the SSA region, the education that we might want for a young girl is really hard to acquire there, fundamentally, in the current structures. So then, where accurate information is not spread, misinformation tends to be spread instead. Living in a village, there may not be opportunities to attend school, so instead, one can tend to be taught by family, be it mothers, grandmothers, or others. But these things that grandmothers might teach may be biased towards or wrapped up in their religious beliefs, and/or it may not fully explain how a disease does and does not tend to work, nor may it really be something that others in the community know how to contest or debunk. That said, culture, family history, and oral histories are incredibly important and personal, so it’s critical to pay respect to the fact that this is how things have tended to operate for generations. As an African woman myself, I have been taught by women in my family about my body, about sexuality, but I feel that it is valuable to seek information elsewhere to balance out what I’ve been taught.

It occurs to me as well, culturally, not every culture has the same tolerance level for questioning or disagreeing with elders, you know?

Yes, for sure. And I have been lucky to be able to expand my mind through my access to formal education, which I think has increased my ability to simply respect what they have to say, perhaps, knowing that other perspectives are out there.

Thanks to Tozoe for taking some time out of her day to chat with us!