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Q&A with Maternal and Fetal Health Researcher Sharla Smith

Growing up in rural Arkansas, Sharla Smith Ph.D., MPH, loved children and dreamed of becoming an OB-GYN and having babies. But after earning a biology degree and having a child of her own to take care of, she decided to forgo medical school and switch gears. Fortunately, she discovered a new path—public health—that would allow her to continue working toward one sincere goal: addressing health disparities for Black women and Black children.

Smith earned a Masters of Public Health and then a PhD in Health Systems and Services Research from the University of Arkansas for Medical Sciences before joining the Department of Population Health at the University School of Medicine of Kansas.

“Public health seemed like the best approach for someone with my kind of passion,” Smith says. “I wanted to dismantle the systems that create health disparities and barriers to achieving good health outcomes.”

Below, Smith answered a few questions about her work and health equity for Black families.

Tell us about the need to advocate for Black mothers and children. What do you think it might surprise people to know?

In Kansas, black children have been dying at two to three times the rate of white children for more than 30 years. And while the infant mortality rate has declined, disparities have not. And now we’re seeing Black women dying from pregnancy-related concerns or outcomes at two to three times the rate of white women.

Nationwide, Black maternal and infant mortality rates are worse today than they were in 1850. Some people raise their eyebrows about it, but they kept really good records at the time, so those numbers are true.

Another surprising thing is that black women in the wealthier communities perform worse than white and Hispanic women in the poorer communities. And educated black women do worse than white women who never finished high school. Often we don’t talk about poverty or lack of education; we are talking about a disparity that is rooted deeper than the social determinants of health.

How did you think you could address these disparities by entering public health?

It seemed like the best approach for someone with my kind of passion was to try to build better systems that support all parents, regardless of their race, ethnicity, and socioeconomic status. Black women, regardless of their socioeconomic status, are impacted by these disparate outcomes. So how do we figure out what is really affecting these women system-wide? How do I change these systems? How do I dismantle them and build better systems to support the health of these women, fathers and children?

As a community, we have to unlearn some myths. One myth is that rich black women do not experience racism. It is not true. Another myth is that we need to teach Black women how to care for their children. History tells us that Black women have always taken care of their own children, as well as those of others. And then there’s the myth of black fathers who aren’t there. A study by the Centers for Disease Control and Prevention (CDC) found that Black fathers in the home were highly involved in their children’s lives, whether it was reading to them in the evening, going to school activities or sharing meals.

What have you learned from black mothers about their problems with mothering?

Their main challenge is not to be heard. Our mothers say they are not heard. Or they’re told something is normal when it’s not, and then it becomes an emergency. These negative birthing experiences in our community also mean that mothers don’t hear enough success stories, and we often hear mothers say they dare not have another child.

Another issue is making sure the mother feels like she has a voice in her care. Access to doulas and midwives needs to be increased. And healthcare systems should figure out how to increase the diversity of their providers. All patients deserve to feel safe and to receive the care they need.

Tell us how you founded Kansas Sisters and Brothers for Healthy Infants (KSBHI) and what it does.

My colleague, Michelle Redmond, Ph.D., assistant professor of population health on the Wichita campus, and I launched KSBHI in Wichita in 2016. It united Black fraternity and fraternity members to create awareness about infant mortality.

Every year, KSHBI holds an event called Celebrate Day 366, which is an opportunity for us to educate and empower the community about infant mortality and the importance of co-parenting and fatherhood. We also have a conversation about birth equity, which is an opportunity for people to ask questions, talk about their health experiences, and get advice from peers. The event always ends with a community birthday bash to celebrate the Black children who have surpassed that 365-day limit.

You then founded the Kansas Birth Equity Network (KBEN). Tell us about this.

I founded the Kansas Birth Equity Network in 2021 to create community-based solutions so that every Black mother, father and baby receives good antenatal, newborn and postpartum care in Kansas. We have developed a birth equity program that highlights the voices of Black parents, Black birth workers, and implicit bias. We’ve created an online resource hub for Black families, a Stop, See, Listen, Think campaign to help Black women be heard, and a five-year research plan to inform our work. We also worked to create two Kansas “rooms” in Believe Her, a maternal support app for black women named after the black CDC epidemiologist who died in 2017 of complications from high blood pressure three weeks after giving birth.

How would you sum up why you do the work you do?

The reason I do this job is because I truly believe that every Black woman, every Black father, and every Black child deserves to celebrate their child’s first birthday and be healthy. We need to shift the blame for poor health outcomes from women of color to system-wide accountability; this is equity at birth. Above all, I want to be part of the solution.

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