Voices from the Pacific: Advancing Maternal Health Equity Together

Posted October 18, 2023

Rebecca Delafield, Ph.D., M.P.H.
Assistant Professor
University of Hawai`i
John A. Burns School of Medicine
Department of Native Hawaiian Health
Conversations with Community

Conversations with Community
“Please share your name, the name of your island home, and the ancestors that you bring with you to our gathering today.”

This is the protocol that one of my Pacific Islander community partners uses to open gatherings. The last time we gathered, I introduced myself like this, “My name is Rebecca Delafield. I live here on ‘Oahu. I am Chamorro and was born in Saipan, and my father is from the island of Tinian. The ancestor I bring with me tonight is my paternal grandmother.” The women assembled are young and old. They speak Pohnpeian, Chuukese, Palauan, and Kosraean, and interpreting responsibilities are shared among several bi- and multilingual members of the group that speak English. They are from many different island homes, but all of them live in Honolulu, and many live in the public housing complex where we are gathered.

This night, the members, all women and all from the Western Pacific region referred to as Micronesia, were asked to share something about motherhood in their introduction. The things they mentioned—the role of mothers in their community, the importance of childbearing in their respective cultures, the sacrifices of being a mother, and struggles with health care systems—are familiar to me. Their comments echo findings from studies I have conducted into Native Hawaiian and Pacific Islander (NHPI) maternity care experiences in Hawai‘i. I was invited to the gathering to begin a dialog on addressing needs related to pregnancy and childbirth in the community and to share findings from my latest research project, which was funded through an NIMHD Diversity Supplement.

Maternal Health Data & Research
National increases in maternal mortality have prompted calls to action by numerous public health agencies and medical associations. NHPIs are profoundly underrepresented in maternal health research, despite increasing evidence of poor maternal health outcomes and inequities among this population. A recent report from the Centers for Disease Control and Prevention found that the pregnancy-related mortality ratio for Native Hawaiian and Pacific Islanders, Non-Hispanic in the United States was more than 4.5 times higher than Asians, Non-Hispanic and 5 times higher than Latinos—the racial and ethnic group with the lowest ratio. Yet, the causes of racial disparities in maternal health outcomes in the United States are not well understood. There is also little research into the specific experiences of NHPIs in the context of pregnancy and childbirth. One consistent finding from pregnancy surveillance data and research studies is that NHPIs, compared to other racial and ethnic groups, are much more likely to receive late or no prenatal care. This suggests that, among NHPIs, the challenges go beyond medical and behavioral risk. Therefore, to advance equity in health outcomes among this population, researchers must consider a broader set of factors, including access and engagement with health care systems and sociocultural factors.

My Research Path and NIMHD Diversity Supplement
Shortly after being hired as an assistant professor with the Department of Native Hawaiian Health at the University of Hawai‘i John A. Burns School of Medicine (JABSOM) in 2020, I was awarded an NIMHD Diversity Supplement through JABSOM’s Ola HAWAII Center. The funding allowed me to investigate the maternity care experiences of NHPI women and to culturally adapt a tool for NHPIs to assess quality of maternity care, with a particular emphasis on patient-provider relationships and communication. Additionally, the funding supported my participation in training programs, including the NIMHD Health Disparities Research Institute. These opportunities, along with support from the Center for Pacific Innovations, Knowledge and Opportunities, helped me design, develop, and submit a proposal for an NIH Mentored Research Scientist Career Development Award (K-01). My application was successful, and I was awarded funding from NIMHD in July of this year (2023).

The NIMHD Diversity Supplement was critical in advancing me to this stage in my career and research. The award sustained my research and opened doors to the mentoring and training I needed to draft a strong K-01 proposal. Importantly, it also bolstered my professional networks and helped me nurture my community partnerships.

Ultimately, I aspire to develop an independent research program that will develop and test a multi-level intervention to improve maternal health and health care for NHPI women and families. My motivations for doing this work are reflected in the conversation I had with the group of community members and leaders the other night. Their words expressed their deep value and commitment to the health and welfare of mothers and families. Equally, they expressed a collective concern about the problems they witness as leaders, language interpreters, and mothers in the health care institutions that are intended to promote and preserve their health. These community members, along with other NHPI groups I have had the privilege of working with, have put out a call for action on maternal health. As a scientist, a mother, and a child of the Pacific, I am obligated and honored to respond with an effort and rigor equal to the value that they have placed on me.

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Note on language usage: My language choices for this blog post reflect the gender identity of the people I spoke with and the attachment of mother/maternal in this specific context of pregnancy and childbearing. I recognize that there are pregnant and birthing people, including Pacific Islanders, that may not identify as women and that the reference to “motherhood” and “maternal” health outcomes can make people feel excluded. My intent here is not to exclude, but to utilize the terms that most closely reflect the language of the people I reference and the findings from my research study.