Dr. Haywood Brown, chair of obstetrics and gynecology at Duke Medicine, received the Society for Maternal-Fetal Medicine’s 2012 Achievement Award. Brown, a maternal-fetal medicine specialist, is known for working with women at high-risk outcomes, and in particular, women from underserved communities. He also started a global health initiative to address women’s health concerns in less developed regions. The Chronicle’s Danielle Muoio sat down with Brown to discuss his award and involvement with maternal-fetal medicine.
The Chronicle: How did it feel to receive the SMFM Achievement Award?
Haywood Brown: It’s a tremendous honor.... The list of individuals who have received it is a who’s-who in maternal-fetal medicine. To be included among those individuals is a wonderful honor, especially at this stage of my life where I am still such an active player and member of [SMFM] and so actively involved in various activities. To see it now at the end of my career is an amazing honor.
TC: What got you interested in working with women at high-risk outcomes?
HB: Maternal-fetal medicine is a subspecialty of obstetrics. It requires additional training beyond your general training, and our organization... is about 32 years old now. When you begin to appreciate the disparity in health outcomes based on ethnicity, especially for pregnant women, my interest really came from recognizing the fact that I want to make a contribution in the outcome for all women, but particular for women who come from diverse and underserved backgrounds. Our organization is only 40 years old, which makes it even more rewarding to receive this [award].
TC: Can you tell me about your research on health disparities and its relation to prenatal outcomes?
HB: Prematurity, infant mortality and maternal mortality are higher in women of ethnic minorities—in particular black women—than they are for white women. My research focus has been trying to understanding why this is, number one, and designing interventions that would improve those outcomes.
TC: It seems your line of work has a lot to do with the socioeconomic background of patients. Are there common threads between the resources available to patients and the outcome of their pregnancy?
HB: It’s not always resource-driven. It is the stresses that they have in their lives that impact it. It’s also the medical factors that impact it, whether it be diabetes or obesity or other factors. And understanding the social, as well as the medical aspects of it, really helps you to design interventions geared toward those things. Recognizing that the socioeconomic aspects is just one part of it. Our research is so relevant because it has identified barriers beyond barriers of care that impact outcome.
TC: Could you elaborate on some of these barriers that have been identified that have to do with the social aspects?
HB: Poverty is a big issue, no question. Being underserved or socioeconomically disadvantaged is an issue. But when I say that when you are more likely to have hypertension or diabetes, that may be a factor in your environment.... Interventions can be simple or they can be more complex. Understanding the dynamics of the family is essential as well for improving outcome. That’s the basis of understanding disparity of care—it’s not just about dollars but also about social resources.
TC: When you see a patient, do you go over all the aspects of their lives?
HB: Yes, it’s called risk assessment. First of all, you need to see patients early enough to be able to have an intervention. And what we know about disadvantaged women sometimes is that they do not seek care early. If you don’t seek care early enough to get that intervention, then your risk with that subsequent pregnancy is higher and that can lead to prematurity.
TC: How would you say you going about doing that?
HB: By having resources in the community—by making sure that services are available in the community and that those services are acceptable to women in the public and private sector.
TC: Did this emphasis on communal health lead to the global health initiative?
HB: It’s certainly our intention in obstetrics to globalize what we know and what we have learned to other parts of the world and our community as well. I was just meeting with my counterpart at the Albert Einstein College of Medicine, and we discussed combining not just our financial resources, but our manpower resources, to deal with some of the global health issues for maternal mortality, particularly in regard to hemorrhaging and maternal death.... It takes more than just one institution to impact the care of women around the world. I’m involved in that but also our national organizations are very involved in that.
TC: Is the obstetrics and gynecology department’s involvement in global health an initiative that came underway when you became chair of the department?
HB: Yes. I was minimally involved when I was in Indiana but very involved once I got to Duke because we had established relationships here with Haiti and Tanzania. It gave me a natural entry to talk about women’s issues in those countries. Having now traveled to Haiti and Tanzania in the past several years, I have had a chance to help support the programs geared toward improving the health of women.
TC: Could you tell me more about your involvement and other physicians involvement in Third World countries with women’s health care?
HB: You have to look at the problems they have. Number one, if you take Haiti and Tanzania the biggest challenges there is maternal death. It’s a rarity [in the U.S.], but it’s an everyday issue there. Trying to design interventions to combat hemorrhage and death from hypertension in those countries is paramount to improving outcome. [There are] women who have to travel great distances, women who do not have facilities. You have to design your program around what they have, and that’s pretty much what we have done. Faculty spend significant amount of times in those countries and work with the local community in order to improve the health of women. That’s the goal—you really have to work with the global community, the community that is there and the government in order to impact health.
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