EQ: "How does access to adequate mental health care impact maternal mortality discrepancies that exist between black women and non-hispanic white women in the United States?" 

EQ: "How do the four major social determinants of health: patient factors, community/neighborhood, provider factors, and system factors, combine to influence the disparities in pregnancy-related mortality rates that exist between black women and non-Hispanic white women in the United States?

DQ: What, from a legislative standpoint, can we do to try and combat these social determinants of health?

DQ: Which of the social determinants of health has the greatest influence on racial disparities existing in maternal mortality in the United States?

EQ: "What is the relationship between stressors established by structural racism and the racial disparities in maternal mortality existing between black women and non-Hispanic white women?

Monday January 25, 2021: Today I begin my journey as a primary investigator! I am so excited, and a little apprehensive, to delve into my very first experience with true primary research. In preparation today I crafted a list of experts to interview. It includes a healthy variety of fields and interests from public health, to medicine, to law.  This was done in an attempt to garner a more complete perspective on the factors contributing to racial disparities in maternal mortality and the legislation necessary to combat it effectively.  I also began to plan out how I would go about doing the "Action Research" component of this module.  I am intrigued by the idea of prototyping a bill that would be presented at first the state, than the federal legislature, to address and diminish this disparity. I am thinking that it will encompass annual implicit bias training, incorporating dulas into insurance packages, factors to make health care more accessible to women of color, and more.  This is still in its very preliminary planning stage, so nothing is final yet. But other than this idea which would satisfy one of the action research options, I find that I am struggling to think of ways that I would use a survey, focus group, observation, etc to my benefit as the primary investigator. With COVID-19, I am limited even further in terms of where I can go and what I can experience in-person.  This is something I will have to ponder further as I continue this journey. Thanks!- Madeleine

Monday February 1, 2021: This past week and today, I solidified how I would complete the Action Research portion of my primary investigation! Legislation that attempts to address and minimize racial disparities does already exists, or at least it was drafted, brought to the floor for a vote, but never received one. The bill is called the Maternal CARE Act and it was introduced to the 166th congressional constituents back in May 2019. There is a lot of good progress that the bill hopes to inspire, mainly with the focus centered on addressing implicit bias by way of implicit bias training. So I decided that, instead of drafting a whole piece of legislation, I would draft amendments to this existing bill so that, hypothetically, they would be reviewed and added to the bill in order to make it better services African American women in a variety of ways. So where do I go from here? I am thinking that I will do some more research about the bill, which includes reading it thoroughly and taking notes, and then pinpointing where the holes lie. Then, possibly through additional secondary research and interviews, I can learn how to correctly format and compose the amendments so that they are clear and effective. 

Monday February 8, 2021: Today, I composed emails to all of my experts requesting an interview. My next step will be to begin writing up interview questions and figuring out how exactly I will go about making my prototype.

Monday March 15, 2021 : Today I conducted my first expert interview with  public health expert and Registered Nurse, Amy Ewing. It was very enlightening and I learned about certain inequities within the public health field that she witnessed throughout her career.  She had more experience with people of latinx and east asian descent but there was a noticeable pattern in the inequities those groups faced and those that African Americans face. She mentioned that access to adequate healthcare was one of the main determinants that she has noticed and worked to combat as well as limited sick leave available in jobs both of which have been exacerbated due to COVID-19. She was very knowledgeable and interesting to speak with! 

Tuesday March 16, 2021: Today I conducted my second expert interview and I had the privilege of speaking with Dr. Kiame Mahaniah. He is currently the Chief Executive Officer of the Lynn Community Health Center in Lynn, MA and works primarily with addiction patients in the hope of rehabilitating young  black and brown men who would otherwise end up incarcerated. We spoke in detail about the racial inequities in health care, food, and adequate housing access, particularly in low-income communities and communities of color. He shared a wealth of knowledge concerning how racism manifests itself in various institutions in the United States and the figurative illness that we suffer from in this country which is the inability to acknowledge that we are a racist country. He spoke of the initiatives he has put in place as CEO of the Lynn Community Health Center to address and combat many of these inequities and shared with me what he believed was necessary from a legislative perspective to make considerable change.

Wednesday March 17, 2021: Today I had the pleasure of interviewing Mrs. Jackie Salvesen, a health teacher and yoga instructor at Andover High School who was previously a maternal and fetal nurse for about 15 years. In this interview we spoke a lot about midwives, doulas, and the benefits of having external emotional support before, during, and after labor. She also shared with me many policy-driven ideas that would help to acquaint mothers to motherhood in our country that tends to practice self-sufficiency as opposed to promoting emotional support networks postpartum. Mrs. Salvesen also shared a lot of information about the importance of lactation clinics and counseling postpartum which have numerous health benefits for the baby. She was very passionate about the topic of maternal health and it was a pleasure to have a conversation with her! The interview is linked below. 

Monday March 22, 2021: Now that I have completed my interviews, I am going to take all the knowledge I have accumulated to  help craft the amendments I am planning to make to the Maternal Care Act. Below is an image of some notes I took after reading the Maternal Care Act in addition to some of my ideas for amendments. My plan for the final two weeks of intense primary research is to complete three total drafts of the amendments. I need to learn how to format the amendments and after each draft is complete, I plan to collaborate with my mother, who is a lawyer, as well as my interviewees to get some feedback and make adjustments. I will be posting all my drafts of the amendments on this blog to show my progress. 

Thursday March 25, 2021: Today, I worked on mapping out the methods and results that I have used/observed in my primary research thus far.  I still have some work to do in terms of my prototyping, but I was able to jot down some really helpful methods and results in terms of my interviews as well as how I have begun the prototyping portion of my action research. This will help me later in this Mod to write up a comprehensive review of my primary research findings. 

Monday March 30, 2021: Today, we gave 3x4 slide deck presentations where we gave a live update to our classmates about the various methods and results of our primary research. I focused on my methods as it relates the interviews I have completed as well as the reading and analysis I have completed on the Maternal Care Act. I think the presentation went well overall, but I was a few seconds under the 4 minute limit and I spoke very quickly.  I received some great constructive criticism from my peers and Mrs. D'Alise and I plan to carry that into my next presentation, which I anticipate, will be the final TED Talk- style CAPS presentation! Having completed this milestone in the primary research journey, I am now very focused on drafting my amendments and plan to have this complete by this Friday, April 2. After that, the plan is to collaborate with my interviewees for quick feedback and then use that to complete any last edits before finalizing it, and therefore my primary research journey!

April 15, 2021 - I have finally finished prototyping my amendments to the Maternal CARE Act! This process was long and difficult because I had to first, learn how to read legislation, then take what I had learned in my interviews and try to incorporate it into the bill whilst simultaneously teaching myself how to write amendments. While difficult, I can say with certainty that it was a worthwhile experience and that I am proud of the final result. I ended up adding 4 total amendments to the act. The first was to add a federally-funded program that helped hospitals recruit a more diverse staff, the second was simply adding a statistic about the prevalence of PPD among black women to the "FINDINGS" section of the bill, the third was to include Federally Qualified Health Centers to the bill, and the last was the addition of counseling services to the pregnancy medical home demonstration project that was proposed originally. I think that having added these ideas to the bill makes it more holistic and appeal to a broader variety of  black women in the United States. This now concludes my primary research! I consulted briefly with my interviewees about their thoughts on my work and they were in agreement that it adequately addressed the issues we had spoken about in a way that is impactful.