Q&A with Sharla Smith, maternal and fetal health researcher
Sharla Smith, Ph.D., MPH, answered a few questions about her work and the problem of health disparities for Black infants and mothers.
Growing up in rural Arkansas, Sharla Smith Ph.D., MPH, loved children and dreamed of becoming an OB-GYN and delivering babies. But after earning a biology degree and having a baby of her own to care for, she opted to forgo medical school and switch gears. Luckily, she discovered a new path — public health — that would enable her to continue working toward a heartfelt goal: tackling health disparities for Black women and Black babies.
Smith earned a Master of Public Health and then a doctorate in Health Systems and Services Research from the University of Arkansas for Medical Sciences before joining the Department of Population Health at the University of Kansas School of Medicine.
“Public health seemed like the best approach for a person with my type of passion,” says Smith. “I wanted to dismantle systems that create health disparities and barriers to achieving good health outcomes.”
Below, Smith answered some questions about her work and health equity for black families.
Tell us about the need for advocating for Black mothers and babies. What do you think might surprise people to know?
In Kansas, for over 30 years Black infants have been dying at two to three times the rate of white infants. And while the infant mortality rate has decreased, the disparities have not. And now we're seeing that Black women are dying of pregnancy-related concerns or outcomes at a rate two to three times that of white women.
On a national level, the Black maternal and infant mortality rates today are worse than they were in 1850. Some people raise their eyebrows about that, but they kept really good records back then, so those numbers are true.
Another startling thing is that Black women in the wealthiest communities have worse outcomes than white and Hispanic women in the poorest communities. And Black educated women have worse outcomes compared to white women who never finished high school. We're often not talking about poverty or lack of education; we're talking about a disparity that is rooted deeper than social determinants of health.
How did you think you could address these disparities by going into public health?
It seemed like the best approach for a person with my type of passion was to try to create better systems that support all parents, regardless of their race, ethnicity and socioeconomic status. Black women, no matter what their socioeconomic situation is, are impacted by these disparate outcomes. So how do we figure out what is truly impacting these women from a systems level? How do I change these systems? How do I dismantle them and build better systems to support the health of these women, fathers and babies?
As a community, we need to unlearn some myths. One myth is that wealthy Black women do not experience racism. That’s just not true. Another myth is that we need to teach Black women how to take care of their children. History tells us that Black women have always taken care of their children, as well as those of others. And then there’s the myth of Black fathers not being present. A Centers for Disease Control and Prevention (CDC) study found that Black fathers in the home were very involved in their children's lives, whether that was reading to them at night, going to school activities or sharing meals.
What have you learned from Black mothers about their problems with maternal care?
Their major challenge is not being heard. Our mothers say they are not being listened to. Or they’re told something is normal when it isn’t normal, and then it becomes an emergency. These negative birthing experiences in our community also mean mothers don’t hear enough success stories, and we often hear mothers say that they dare not have another child.
Another issue is making sure that the mother feels like she has a voice in her care. We need to increase access to doulas and midwives. And health systems should figure out how to increase the diversity of their providers. All patients deserve to feel safe and that they will get the care they need.
Tell us how you founded the 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 joined together Black fraternity and sorority members to create awareness around infant mortality.
Every year, KSHBI holds an event called Celebrate Day 366, which is an opportunity for us to provide information to and empower the community on infant mortality and the importance of co-parenting and fatherhood. We also have a birth equity conversation, which is an opportunity for people to ask questions, talk about their health experiences and just get some advice from peers. The event always ends with a community birthday party to celebrate Black babies living past that 365-day mark.
You then founded the Kansas Birth Equity Network (KBEN). Tell us about that.
I founded the Kansas Birth Equity Network in 2021 to create community-based solutions so that every Black mother, father and infant receives good prenatal, neonatal and postpartum care in Kansas. We developed a birth equity program that highlights Black parent voices, Black birth workers and implicit bias. We have created an online resource hub for Black families, a Stop, Look, Listen, and Think campaign to help Black women be heard and a five-year research plan to inform our work. We also worked to establish two Kansas “rooms” in Believe Her, a maternal support app for Black women named after the Black epidemiologist with the CDC who died in 2017 of complications from high blood pressure three weeks after giving birth.
How would you sum up the reason you do the work you do?
The reason I do this work is because I truly believe that every Black woman, every Black father and every Black baby deserves to celebrate the baby’s first birthday and to be healthy. We need to shift the blame for poor health outcomes from Black women to system-level accountability; this is birth equity. Most importantly, I want to be a part of the solution.