#UMNMCH recent graduate Nicollette Moore (she/her/hers), MPH 2023, wrote this reflection on her journey into the public health field, her deployment with the Minnesota Department of Health, and her work to expand doula services.

Background

My public health journey began over five years ago while working at a consulting firm. As a research assistant, I was a part of a research and evaluation team assessing the effectiveness of two federally-funded teen pregnancy prevention programs. One program partnered with Planned Parenthood clinics in the bay area and central California, and the other with outpatient clinics and mental health clinicians across the country. I was responsible for administering and collecting survey data in two study regions located in Fresno and Bakersfield. My interest in public health grew as I formed relationships with the youth participating in these programs. In particular, learning about the lived experiences of Black teens seeking, accessing, and receiving sexual, reproductive, and perinatal care was deeply moving.

Black Americans are disproportionately burdened by some of the country’s worst health inequities due to systemic racism. This is reflected in teen pregnancy rates, where Black youth are twice as likely to give birth compared to their white counterparts despite the overall decrease in birth rates in the United States. Due to structural barriers, pregnancy complications are more likely to occur among Black adolescents, such as the increased risk of preterm births, low birth weights, and infant mortality. This position made me realize that I wanted to build a career focused on supporting and uplifting my community to ensure that current and future generations will have access to safe, respectful, inclusive, culturally competent, and quality care. 

After a few years, I moved to San Diego, CA and began working for a federally qualified health center. I supported Title X data management efforts by cleaning monthly data on family planning services provided at the clinics. I started this job during the beginning of the 2019 Title X domestic gag rule, which drastically reduced the number of family planning providers and clinics that provided Title X services such as Planned Parenthood. The Guttmacher Institute estimated that this regulation limited 1.6 million people’s ability to access sexual and reproductive health services. Communities who needed these services the most faced more barriers to accessing care under the domestic gag rule. This opened my eyes to the influence of politics on public health systems and how it impacts government services. I quickly realized that in order to make a large impact on sexual, reproductive, and perinatal health, it would require a better understanding of how government systems function.

I chose the MPH Maternal and Child Health (MCH) program at the University of Minnesota for several reasons. There are multiple faculty who have expanded my knowledge on maternal health prior to program enrollment and inspired my career interests. During the beginning of my public health career, I was disturbed by the countless research that focused on race rather than racism as the root cause of racial health inequities.

I came across Dr. Rachel Hardeman’s anti-racism research and believed it aligned with my interest in advancing maternal health equity and addressing racism within public health systems. Furthermore, Dr. Rachel Hardeman and Dr. Katy Kohzimannil’s research on doulas sparked my evolving and deep-seated desire to expand access to doula services and the doula workforce. I also appreciated my advisor’s, Dr. Jamie Slaughter-Acey, anti-racism research which has specifically focused on the health impacts of colorism.

Additionally, I liked the flexibility of the MCH program. I could select courses relevant to my career and build a competitive skill set based on my unique interests.

Working With the Minnesota Department of Health

I was drawn to the Title V needs assessment deployment at the Minnesota Department of Health (MDH) because I could learn more about the Title V program, gain more experience in maternal health, and expand my knowledge on how government systems function. Housed within MDH’s Division of Child and Family Health (CFH), the Title V program is a federal-state partnership that provides support to improve and maintain the health of mothers and other birthing parents, children, and families. Every five years, a statewide needs assessment is conducted on the health and well-being of Minnesotans to help identify maternal and child health priority issues. Through this deployment, I have been able to support a variety of Title V projects, such as updating Title V priority briefs and creating data visualizations for the Title V application and annual report.

Statewide Efforts to Expand & Diversify the Doula Workforce

In addition to assisting the Title V program, my supervisor, Molly Meyer, has supported my interest with exploring and aiding other projects within the division, such as recent state efforts to expand and diversify the doula workforce. In 2021, the Minnesota State Legislature passed the Dignity in Pregnancy and Childbirth Act, which addresses maternal health inequities. A component of this legislation is to identify strategies for expanding and diversifying the doula workforce. Doulas are an evidence-based strategy that improves the health and well-being of Black, American Indian, and other pregnant people of color. In 2022, the Biden-Harris administration listed doulas as a vital strategy for advancing maternal health equity.

The Minnesota Department of Health recently requested proposals to aid the state with identifying barriers and promising practices to expand access to doula and midwifery services. In preparation for this community assessment, I had the opportunity to develop a survey that will be used to capture doulas’ experiences working in the state. Additionally, I created a spreadsheet that houses contact information of doulas and doula-related organizations that provide services to pregnant people in Minnesota. This spreadsheet will serve as a starting point for the contractor to build off of.

I was excited to participate in this process because I have consistently focused on doula care in my coursework while in the MCH program. Currently, I am in the process of writing a narrative review on the barriers with accessing doula services in addition to the challenges with expanding and maintaining the doula workforce as a part of my Integrated Learning Experience. My deployment at the Minnesota Department of Health was a rewarding experience and has piqued my interest in the government sector. It has also solidified my passion for doula services. I look forward to learning about the results of this community assessment and how the state plans on addressing maternal health inequities.

Biography

Nicollette Moore is a recent MCH MPH graduate with a minor in program evaluation. She received a BA in sociology with a focus on international relations in 2016. Her background is in sexual and reproductive health, program evaluation, and health equity. Nicollette plans to work within the government sector and continue to advocate for maternal health equity. In her free time, Nicollette enjoys spending time with her two dogs, Cleopatra Antoinette and Emerson Tiberius, and exploring nature. She will be pursuing a DrPH in 2025.

 

References

1. Centers for Disease Control & Prevention. (2021, Nov 15). About teen pregnancy. Retrieved December 29, 2022 from https://www.cdc.gov/teenpregnancy/about/index.htm
2. Centers for Disease Control & Prevention. (2020, Jul). Racial and ethnic differences in mortality rate of infants born to teen mothers: United states, 2017-2018. Retrieved December 29, 2022 from https://www.cdc.gov/nchs/products/databriefs/db371.htm
3. Dawson, R. (2020, Feb 5). Trump administration’s domestic gag rule has slashed the title x network’s capacity by half. Guttmacher Institute. Retrieved December 29, 2022 from https://www.guttmacher.org/article/2020/02/trump-administrations-domestic-gag-rule-has-slashed-title-x-networks-capacity-half
4. Gillette-Pierce, K. & Taylor, J. (2017, Feb 9). The threat to title x family planning. Center for American Progress. Retrieved December 29, 2022 from https://www.americanprogress.org/article/the-threat-to-title-x-family-planning/
5. Health & Human Services Office of Population Affairs. (n.d.). About title x service grants. Retrieved December 19, 2022 from https://opa.hhs.gov/grant-programs/title-x-service-grants/about-title-x-service-grants
6. Mathematica Policy Research. (2017, Sep). Evaluation abstract: The evaluation of “plan a” in california. U.S. Department of Health & Human Services Office of Population Affairs. Retrieved December 29, 2022 from https://opa.hhs.gov/sites/default/files/2020-07/prg-sitc-eval-abstract.pdf
7. Minnesota Department of Health. (n.d.). Maternal care access: Doula and midwifery services. Retrieved December 29, 2022 from https://www.health.state.mn.us/people/womeninfants/womenshealth/maternalcare.html
8. Minnesota Department of Health. (n.d.). Title v maternal and child health (MCH) block grant program. Retrieved December 29, 2022 from https://www.health.state.mn.us/communities/titlev/index.html
9. Minnesota Legislature Office of the Revisor of Statutes. (n.d.). 2022 minnesota statutes: 144.1461 dignity in pregnancy and childbirth. Retrieved December 29, 2022 from https://www.revisor.mn.gov/statutes/cite/144.1461
10. Policy & Research Group. (2018). Practice self-regulation. U.S. Department of Health & Human Services Office of Population Affairs. Retrieved December 29, 2022 from https://opa.hhs.gov/grant-programs/teen-pregnancy-prevention-program/tpp-successful-strategies/policy-and-research
11. The White House. (2022, Jun). White house blueprint for addressing the maternal health crisis. Retrieved December 29, 2022 from https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf

 

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