October 13, 2020
Kozhimannil was Honored for Her Research on Healthcare Inequities and Maternal Mortality Among Women of Color
The Heinz Family Foundation today named health services researcher Katy B. Kozhimannil, PhD, MPA, the recipient of the prestigious 25th Heinz Award in the Public Policy category. Kozhimannil is driving policy change through research that examines the rising rate of maternal mortality in rural, low-income communities and among women of color; the impact of doula care on birth outcomes; and the impact of structural racism on individual and community health.
As part of the accolade, Kozhimannil will receive an unrestricted cash award of $250,000.
Kozhimannil’s ongoing body of work is informing the development, implementation and evaluation of health policy that impacts health care delivery, quality and outcomes during critical times, including pregnancy and childbirth. Currently OACA’s Director of Rural Health Programs, Director of CTSI’s Office of Rural Health, and a professor at the University of Minnesota School of Public Health, she was drawn to the health policy field in part because of the loss of a beloved family member who died in childbirth while working as a nurse on a rural Native American reservation.
“I saw maternal mortality shatter my family, and to know that it is still happening today—more commonly in rural communities and up to three times more frequently among Black and Indigenous mothers—it’s just unacceptable,” says Kozhimannil. “When a baby is born and a family grows, that is one of the most powerful moments possible. How people give birth and how babies come into the world shapes who we are and our life trajectories, not just individually, but also for our families and our communities. It’s a sacred moment that needs to be protected by the policies that shape who is in the room and the decisions that they make at the time of childbirth.”
She adds, “Maternal and infant mortality has salience because it has relevance to all of us, but at the time I was beginning my work, I had to fight conventional wisdom about what was an important research question. I had this ‘pat on my head’ experience so many times from people who would say, ‘It’s just so nice that you’re studying birth. Is that because you’re a mom?’ No, I’m studying birth because it matters. To everyone.”
According to the Centers for Disease Control and Prevention, about 700 women die each year in the United States as a result of pregnancy or delivery complications, and American Indian, Alaska Native, and Black women are two to three times more likely to die of pregnancy-related causes than white women. Kozhimannil’s study “Rural-Urban Differences in Severe Maternal Morbidity and Mortality in the U.S. 2007-2015,” published last year in the journal Health Affairs, revealed that pregnant women living in less populated rural communities have a higher risk of severe illness and mortality than those living in cities, even when controlling for risk factors, and are 9% more likely to die, or come close to dying, during childbirth from complications such as hemorrhage.
Kozhimannil’s work has also looked at the impact of doula care in her study “Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries,” which was published in the American Journal of Public Health in 2013. Her findings showed that doula support for Medicaid enrollees in Minnesota was associated with a 40.9% reduction in the chances of a cesarean delivery. The research also estimated potential state Medicaid savings from covering doula services in excess of $2 million in most states. This work directly informed the 2013 legislation and subsequent passage of Minnesota’s “Doula Bill,” now a national model for establishing Medicaid coverage of doula care, which is associated with better maternal health outcomes and a reduction in racial inequities. Other state and federal legislators are following suit by introducing bills that incorporate doula care.
Kozhimannil has also collaborated on research and advocated for policy change to allow pregnancy-related eligibility for Medicaid to be available to mothers for a full year after a baby is born. Currently, Medicaid covers only two months postpartum, while one-third of all maternal deaths happen in the year after giving birth.
“As a result of efforts in Minnesota and other states, we are seeing national movement toward extended Medicaid for postpartum maternal care and improved access to doula support, as well as a greater awareness of the culturally centered elements of doula care and maternal support in the context of structural racism in healthcare,” says Kozhimannil. “It is incredibly gratifying, because it means that we are not only finally beginning to pay attention to Black and Indigenous mothers, we are now including doula care as part of the conversation.”
Kozhimannil’s work includes “Structural Racism and Supporting Black Lives — The Role of Health Professionals,” published with lead author Rachel R. Hardeman, Ph.D., M.P.H., and collaborator Eduardo Medina, M.D., M.P.H., in the New England Journal of Medicine in 2016. Building on this work, with Dr. Hardeman and colleagues Katy A. Murphy, R.N., M.P.H., and J’Mag Karbeah, M.P.H., the team published “Naming Institutionalized Racism in the Public Health Literature: A Systematic Literature Review” in 2018. The study found that although structural racism is recognized as a fundamental cause of health inequities, the term “racism” has rarely been used in medical literature.
“The New England Journal of Medicine piece we wrote is now assigned reading in many medical school curricula across the country,” says Kozhimannil. “Medical care providers are operating in an inherently racist system, and it is imperative that we explicitly name structural racism and make anti-racism a central concept in policies, programs, patient care and inequities research. I do think there is resistance from some medical and public health professionals because they do not distinguish intention from impact. They think that their good intentions inoculate them from the impact of their actions and their words. It is impact that matters, not the intention. When we learn that our words or actions have had a racist impact, we ought to be grateful, as it gives us a chance to change and be anti-racist.”
In addition to conducting research, Kozhimannil teaches courses that build skills for effective engagement in the policy process, and works extensively with community organizations and state and federal policymakers on efforts to improve the health and well-being of individuals, families and communities, starting at birth. More than 60 of her students have published commentaries in newspapers across the country, aiming to influence policy and improve public health. Most recently, in response to the COVID-19 pandemic, Kozhimannil is speaking out about how the pandemic will worsen access to safe maternity care for pregnant women, especially in rural communities due to the prospects of overcrowded hospitals, giving birth alone and the risks of coronavirus exposure. She also recently published research that identifies the racial inequities of COVID-19 cases and deaths in rural areas. However, she remains hopeful that in rebuilding our public health system following COVID-19, we will structure our policies on a foundation of equity and justice. Kozhimannil is currently collaborating with her cousin—a pastor—on her first book, rooted in the grace and grit of rural women and sharing a new American dream for thriving in a post-pandemic world.
“Katy’s research is not only shining a powerful light on systems and practices that are contributing to inequities in healthcare, she is structuring her work in a way that enables a practical, actionable response by policymakers and those in the healthcare profession,” said Teresa Heinz, Chairman of the Heinz Family Foundation. “Her work is demonstrating where we are falling short and showing us the path forward to ensuring that every mother receives the care and support she needs for a safe birth and a healthy recovery.”
Established to honor the memory of U.S. Senator John Heinz, the Heinz Awards this year recognize those who have made significant contributions in five distinct areas of great importance to Senator Heinz: Arts and Humanities; Environment; Human Condition; Public Policy; and Technology, the Economy and Employment. Now in its 25th year, the Heinz Awards has recognized 151 individuals and awarded more than $30 million to the honorees. Read more information about the awardees.