Grant aims to address maternal and child health inequities among women in Philadelphia

December 11, 2012
It’s the grim, unfortunate reality: African-American women in the U.S. are much more likely to give birth prematurely or lose a baby within his or her first year of life, compared to white women. The infant mortality rate – often a proxy for general health and access to care – is 13 per 1,000 live births among African-American babies, compared to 5.6 among whites, according to the Centers for Disease Control and Prevention.

Dr. Vijaya Hogan

Dr. Vijaya Hogan

To help remedy this, Vijaya K. Hogan, DrPH, clinical associate professor of maternal and child health at Gillings School of Global Public Health, will use a $900,000 W.K. Kellogg Foundation grant to mobilize women in Philadelphia to become advocates for health promotion and health care access.

The project, thought to be the first of its kind, is called the Philadelphia Roadmap to Health Equity.

Those enrolled in the program are low-income, African-American women who live in Philadelphia. Nearly all of the 16 current program participants have experienced a preterm birth or infant death, and during the course of their pregnancies and beyond, have experienced very positive and very negative interactions with the systems designed to “help” women in need of maternal and child health services.

The program will help the women develop new skills in critical thinking, leadership, communication and research, so that they can evaluate how maternal and child health institutions can better serve women in situations similar to theirs.

The overall goal, Hogan says, is to change institutional processes and environments such that they no longer inhibit – but rather support and promote – women’s efforts to practice healthy behaviors and seek care when needed.

“We know the circumstances in which people are born, grow up, live, work, play and age can invariably have a major impact on their health status and access to critical health services, and women regularly have to juggle many responsibilities and jump through many hoops to get help,” Hogan said. “Through this vibrant community-based project, we are engaging and training women and, in the process, they are empowering themselves to be catalysts for change right in their own communities. This project represents a much-needed new approach toward addressing these issues.”

It is a promising model, Hogan explains, because initiatives that seek to address social determinants of health equity often fail to change existing social and institutional dynamics. The Philadelphia Roadmap to Health Equity is designed to focus specifically on these factors – and researchers hope it also will demonstrate how a small but powerful group of women can develop positive changes in their communities and the maternal and child health institutions serving them, as well as shape the national conversation on health equity.

“Their voices must become part of the decision-making process in institutions that affect their lives,” Hogan said. “Through this effort, a strong community voice to improve the conditions under which African-American women live, work, play, worship, study, shop, raise children, nurture themselves and family, and seek help is being created.”

Current participants are expected to complete training in late spring 2013. Following that, they will actively engage with local, state, regional and national organizations to communicate findings and collaborate with these organizations to develop innovative solutions to some of the challenges to the attainment of health equity.

“The rates of prematurity and infant mortality are shamefully high in the U.S., and the disparity in these outcomes between African-American women and other populations is even more disgraceful,” said Jennifer Culhane, PhD, associate professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine and study co-investigator from the Children’s Hospital of Philadelphia. “Also, these disparities have not changed despite a tremendous amount of research clearly indicating that new approaches to solving these problems are essential.”

“We are thrilled to have received this funding,” Hogan added. “Through this three-year program, we also will be able to build an evidence base for community-driven projects in Philadelphia that achieve positive structural changes in maternal and child health agencies, institutions and policies.”

In addition to Culhane, Hogan’s team includes Professor of the Practice Diane Rowley, MD, MPH, and research specialist Rachel Berthiaume, MPH, both in the UNC public health school’s Department of Maternal and Child Health, and Claudia Streets, MA, Monique Williams, and Frances Drake, MSW, residents of Philadelphia serving as consultants on the project.

About the foundation

The W.K. Kellogg Foundation, founded in 1930 as an independent, private foundation by breakfast cereal pioneer, Will Keith Kellogg, is among the largest philanthropic foundations in the United States. Guided by the belief that all children should have an opportunity to thrive, the foundation works with communities to create conditions for vulnerable children so they can realize their full potential in school, work and life.

The Kellogg Foundation is based in Battle Creek, Mich., and works throughout the U.S. and internationally, as well as with sovereign tribes. Special emphasis is paid to priority places where there are high concentrations of poverty and where children face significant barriers to success. WKKF priority places in the U.S. are in Michigan, Mississippi, New Mexico and New Orleans, and internationally, in Mexico and Haiti. For more information, visit


UNC Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or