In our third episode featuring public health leaders from the de Beaumont Foundation’s latest group of ’40 Under 40 in Public Health’ honorees, Radha and Lauren welcome Jessica Ehule to discuss maternal and child health and the disparities that exist across populations.

Jessica was Director of Programs at CityMatCH when the episode was recorded and is currently serving as the Birth Justice Program Manager for I Be Black Girl, “a reproductive justice organization that leads with boldness, innovation and inspiration, actively creating a radical change-making culture that centers Black women, femmes and girls.”

Learn more about Jessica

Find our previous episodes on Spotify, Apple Podcasts, and SoundCloud.

Anya Morozov:

Before we start the show, do you know someone who is under 40 and working toward the benefit of state or local public health? If so, nominations for the de Beaumont Foundation’s 40 Under 40 in Public Health, class of 2023, are open now until May 17th. The link to nominate is here. Now back to the show.

Radha Velamuri:

Hello everyone and welcome back to From the Front Row. Today’s episode is part of our new series featuring the 2021 class of the de Beaumont Foundation’s 40 Under 40 in Public Health, a group of leaders who are changing the face of public health in creative and innovative ways. Jessica Ehule received her Master of Science in public health from Meharry Medical College in 2013, and an MS in chemistry from Tennessee State University in 2015. She is currently the director of programs for CityMatCH, a national organization of urban maternal and child health leaders that promotes equity in improving the health of urban women, children, and communities. Outside of that, she serves on the Black maternal health work group for I Be Black Girl, a collective that creates space for Black identifying women, femmes, and girls to grow, connect, give, and take action. Today we’ll be discussing Jessica’s role at CityMatCH, maternal child health, and more.

My name is Radha Velamuri and I’m co-hosting this episode with Lauren Lavin. If it is your first time with us, welcome. We are a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside of the field of public health. Welcome to the show, Jessica. So let’s get started. Can you tell us a little bit about CityMatCH? I introduced it in our little intro blurb, but I want to know how you would describe it in your own words and-

Jessica Ehule:

Sure.

Radha Velamuri:

… how you got into your role with the organization.

Jessica Ehule:

It’s good to be here with you all, everyone. I’m happy to take this opportunity to talk a little bit about CityMatCH and maternal and child health. CityMatCH is a membership-based organization. Our members are primarily local health departments and some state health departments. We are the organization that basically helps build the capacity of local health departments and their community members. And so we do this through a number of different avenues, what we kind of call our bread and butters, our programming piece, which I’m director of programs over.

We have a lot of learning collaborative style programming, but then also some other programming that really pulls on the expertise of those in the field as well as people with lived experience to address a certain issue. So we have a few different examples of those. Right now we have a perinatal HIV project that really focuses on addressing and hopefully eliminating the transmission of perinatal HIV, but also thinking through what types of services and supports are out there for folks living with HIV throughout their life course. So it might look different what you need when you’re a teenager living with HIV than it would if you’re an adult living with HIV and how do you even know what’s available to you. So we’re doing some work around that.

We also have an Alignment for Action Learning Collaborative that’s really looking to align state and local priorities. So each state has their Title V or block grants specific priorities. What we’re trying to do is make sure that the local and state priorities really align and speak to one another so that we’re actually reaching a goal that the Maternal and Child Health Bureau actually has of reaching health equity by the year 2030. So those are just examples of learning collaboratives.

We also have an annual conference, which will take place this year in New Orleans, Louisiana in September. So September 20th through 22nd. We have a MCH epidemiology training course, which is specific training course for MCH. So you might get your schooling or training in epidemiology, but you may not necessarily have kind of that deeper dive into maternal and child health. And so we provide a training course for that. And we also have a leadership program called CityLeaders. So similar to kind of what I’m in for the de Beaumont Foundation, CityMatCH has its own iteration of that for emerging public health folks or folks who’ve been in the field, honestly either way, who want to just grow and learn together as leaders in maternal and child health. So those are just a few of the things we do and how we do them.

How I came to know about CityMatCH. When I was a student at Meharry Medical College, I was an intern in 2012 at the Metro Public Health Department in Davidson County in Nashville, Tennessee. And that program was led by Dr. Kimberlee Wyche-Etheridge, who was director of the family, youth and infant division at the health department then. Dr. Kim, as we call her, Dr. Kim was the chair of the board for CityMatCH. And so if you were her intern or her employee, you knew about CityMatCH and some of the work that CityMatCH did.

After I finished my program and I went to do another program and I finished that, I was looking for a different type of employment and Dr. Kim was like, “Well, there are these opportunities at CityMatCH, but it’s in Omaha, Nebraska. And so if you’re all right with that and you want to take a stab at it, feel free to complete the application.” And so basically I completed the application and as they say, the rest was history. I started at CityMatCH as a public health project coordinator. So I started at CityMatCH in December of 2016 and over time went into a senior project coordinator role and then the opportunity for director programs opened up. So that’s my CityMatCH journey.

Lauren Lavin:

Lovely. That sounds like a unique experience to getting there. I love Omaha though, so I feel like it was probably a good choice. So given that maternal and child health is integral to what you do at CityMatCH, how would you describe for our listeners the state of maternal and child health in the US today? And maybe, I don’t know, a little bit of background on where it has been and how it’s gotten to where it is today.

Jessica Ehule:

Sure.

Radha Velamuri:

Also, just to butt in, I know Lauren just asked about the United States, but if you could talk about specific areas where you’ve worked too, that’d be great. Just because I’m sure it’s different everywhere, which is why I don’t want to ask you to pick a needle from a haystack, just maybe a smaller haystack, like the places that you’ve lived.

Jessica Ehule:

Sure, absolutely. That’s a really great question and I love to talk about the overall state of maternal and child health because I feel like the measures that we have for maternal and child health that tell us what’s happening are really good measures for assessing how well we’re doing as a nation of taking care of our people. And so unfortunately, where we are right now is not where we should be.

To speak on the history a little bit of maternal and child health. Lauren, you asked me this question, I’m like, “You don’t understand how deep of a hole I can get to into the history of maternal child health.” So I’m not going to go too deep, but I’m going to go a little bit deep with it. In the early 1900s, we had some new laws coming together and for establishing what does maternal care look like because there weren’t really any regulations in place for maternal and child health. There were an enormous amount of maternal mortality cases and infant mortality cases because we didn’t have all of the proper regulations in place to ensure that people were receiving the proper care. And so there was some acts and things that were put into practice back in the early 1900s that allowed us to have those systems of this is how we will provide specifically obstetric care. And it was good, the nation needed that. That was meant to help bring our instances of mortality down. It was good, but then it had some also other consequences.

So if we look at the overall history of the United States back, if you’re thinking about 1919, 1920, one, there’s a lot of things happening in the United States at that time. Two, we are not in an era where all people can see healthcare the same way. So this is pre-civil rights. So the people who were providing care to people of color, so Black women or Indigenous women or folks who were giving birth in 1919 were midwives and granny midwives and mamas in the community that took care of them.

So even though these regulations were put in place that did help bring the overall rate of mortality down, it also hindered the care of communities of color because it then basically made it illegal for folks who were providing that type of care in the communities where they couldn’t seek care anywhere else to then do that. They still did it because how else are you going to birth babies? How else are you going to take care of people? But we couldn’t have Black mamas go into the white hospital. They turned them away at the door and said no. And if you don’t have a huge spread of care facilities, which was not available of course to Black and brown people in the United States then, you’re actually hurting that population.

So I will say there was a number of things that happened that time that kind of pushed pool that lever. Yes, it helped us overall as a nation increase, but we also have to think about that as we’re thinking about our current state. So I’m going to go to where we are currently and this kind of historical context will make sense for why we are where we are currently when it comes to maternal and child health. So that’s just very streaky background that I could get deeper into that I’m like, “We’re going to be here all day, I’m not going to do it.”

And so where we are today in 2020. So if you look at… I’m going to take two measures, maternal mortality and infant mortality, specifically because those are really good measures of just telling how well are we doing. And if you look at rates of maternal mortality and infant mortality over the course of like, let’s go back to that 1920 till now, you’ll see this kind of decrease. There is a line going down, we’re moving in the right direction. However, if you start to look at that same information disaggregated by race, and there’s like a bit of a gap if you could put that in your mind, there’s a gap in between those lines. So if you had a line for let’s say white birth, non-Hispanic, and a line for Black birth, non-Hispanic, they’re both going down-ish in most cases over the course if we go back to a hundred years ago. But that disparity, that gap in between is the same or greater today dependent on where you’re looking at.

So right now, I think the overall, as of 2020, maternal mortality rate is like 5.4 and that’s per a hundred thousand births. But if you look at I think the data in 2020, the way that they kind of laid it out, on average, we’re seeing about 700 maternal mortality deaths in a year in the United States, and that’s per I believe a hundred thousand. So 700 deaths in our people who are giving birth. And that 700 deaths is happening either during pregnancy, during the childbirth process or one week postpartum, or within the first year postpartum. So other issues can come up then too. And that’s a huge number for a nation that has all of the resources that we could provide the care to our communities in the way that we need to, to ensure that families and communities aren’t dealing with this type of massive loss.

And so if we look at our infant mortality rates similarly, I think we’re about that number as well. Actually maternal mortality rate’s a little higher. I think we’re at 20 per a hundred thousand births, but infant mortality we’re at 5.4. And so that number has decreased over time. Like I said, it’s decreased. But in 2020, a really interesting thing happened. We all hit this pandemic and we knew in maternal and child health, this is not going to be good for our numbers. And just so you know, it takes a while for numbers to come back. So we’re still even now getting numbers for what it fully means for 2020 and 2021 and 2023. Everything’s a little bit delayed when we get the numbers back, but one thing we can say for sure is that the disparity is what continues to persist and grow.

And so overall as a nation, we aren’t doing the best. If we look at some of our similar counterparts across the globe, our rates are astronomical in comparison to the Ireland or Japan or other nations similar to ours that are industrialized. And so if you look at the resources and all the things we have, it doesn’t exactly line up. There’s something else happening in the United States that is causing such a great disparity in our outcomes.

The other thing I wanted to mention is that the disparity continues to persist. Black women are dying at a rate of three times that of white women due to pregnancy-related issues. And Black babies are dying at two times the rate of white babies due to issues that happen within their first year of life. We see similar outcomes when we look at Indigenous babies and some Hispanic babies as well in certain communities. And that’s just kind of like the national scope. But to go more local and to give you an example, in Douglas County, which is where Omaha is, I believe the white infant mortality rate is close to the national. If you look at the overall Douglas County infant mortality rate, it’s close to the national rate of 5.4 or something of that nature. But if you look at the Black infant mortality rate in Douglas County, it’s 12.7. That is astronomically higher than you would anticipate.

When I was a student or intern really at the Davidson County Metro Public Health Department in Nashville, Tennessee, this is when I started to learn the depths of this. So being, if you will, a daughter of Dr. Kim in a way that was introduced to MCH, and this is just what made you like, “Oh, we have to do something in this area.” When I lived in Nashville in 2012, I believe the Black infant mortality rate was comparable to the infant mortality rate in Haiti. It was like 14 point or 15 point something at that time.

And so when you see those numbers, one thing I want to emphasize as I’m talking about just like statistics is that we know from our research, from all the things that we’ve done, this is not due to biological difference. There’s no difference in me who is a Black woman than there is between Lauren, who is… Lauren, I’m sorry, I’m assuming you’re a white woman. Lauren who is a white woman. There’s no biological difference between us. And so science has shown there’s a 99.9 similarity in humans, we’re basically the same people. It’s that 0.1% difference that gives us the beautiful variation that we see in humankind, but we’re the same. But the theme that is different is how we experience life and those social factors that come in that actually do have physiological impacts on our body.

And so it is what we’re finding. It is not race that’s the risk factor, even though in public health, we use race all the time and say, “Oh, race then means you’re at risk for this.” And it’s not race. I think we need to be very careful about the language that we’re using when we’re describing disparities and not laying that over people. Because if you just introduce the data that I said without any context or without further explaining it, you have communities of people who go away thinking, “Something is wrong with me.” And nothing is wrong with people, but it is not their race. It is the impacts of racism that are the reason for why we’re seeing the disparities that we’re seeing. And so I just want to say that flat out. It is racism and not race that is the risk factor, but we need to understand it in order to develop strategies and ways to address these issues that we’re seeing that are transformative and not just superficial at the surface level.

Lauren Lavin:

I really love that way to describe it and that distinction because I think as a researcher in public health, it’s so easy to say race is a confounder. I think you just made me think about, I need to be very aware that I’m not saying that and that it’s the effects of racism and how that changes the outcomes for us. So thank you for that.

Jessica Ehule:

Absolutely.

Lauren Lavin:

That’s super helpful and I hope that everyone listening also takes that as a takeaway from this.

The other, I guess kind of follow up I wanted to have on that was that, so we’re seeing this similar or widening gap in disparities for mothers and children, but earlier you talked about this racial equity goal by 2030. And so I’m wondering how do we get there and what does that look like if we’re still so far apart over the last couple of decades?

Jessica Ehule:

That is a wonderful question, and that is one that we in maternal and child health are grappling with, working with every day and thinking about how do we do this work differently? Because what we know is we can’t continue to do it the same way we are doing it now.

My direct supervisor, her name’s Denise Pecha at CityMatCH, she’s the deputy executive director. She always says this. On calls we have, she’s like, “What’s the definition of insanity? Doing the same thing and expecting different results and we can’t do that.” And so I will say at least for CityMatCH, CityMatCH is in close partnership with the Maternal and Child Health Bureau at HRSA, so MCHB. So if you hear me say MCHB, it’s Maternal Child Health Bureau, and then also MCHIP who’s like our little sister organization, I call them, they’re near and dear to our heart. They are the membership organization for state health departments. So we work very closely together. Our work is super entwined and this is one of the questions that we’ve been asking ourselves together in addition with our members to figure out what can we do differently. It is a lofty goal. Absolutely. And I am all for setting goals that you’re reaching for the stars and being realistic. I’m one of those both people.

What it’s going to take is us honestly challenging how we do work in a very real way. I think that one thing we have to do, of course, and this kind of leads into another part that we might get into, is addressing systems in addition to addressing that I need care right now group of people. So we have those things in places. And honestly, a lot of our interventions kind of go direct to individual interventions like, “Oh, this person has diabetes. We need to give them, we need to do,” but we have to start to ask why and then address the whys. Because if you start to ask, okay, we have these incidents of an infant death due to safe sleep issues. And yes, you can address it, making sure that babies have safe spots to sleep in the future, making sure all of those things are in place, but then you have to ask, why was safe sleep an issue in the first place?

Safe sleep might have been an issue because in the housing that they have available, there might be three families housed in what is equivalent to maybe a one bedroom apartment because they have to bring their monies together to be able to afford living in an apartment in a city where housing has become so astronomical that they cannot afford to live on their own. So they have to make due with where they are. Then you have to ask, “Why is housing so expensive?” And then you have to think about, “Well, housing is so expensive because these things have happened over time?” And why are people are not able to afford housing? Because they don’t have adequate income to be able to afford this and that, and all of those things. Why is it that housing is so expensive and they don’t have adequate income to take care? Well, I’m the history book, so I’m going to take it back to redlining and the impacts of redlining and how that was a practice honestly, that allowed for economic advancement of some and economic detriment of others.

You have to start to ask the deeper questions of why and your strategies or interventions must focus on the why, the deeper why, the root cause. Otherwise, we’re going to continue to see the same babies who are dying because they don’t have a safe space to sleep. And a lot of people don’t see that connection. It’s like, “Is it a jump?” No, it’s not actually, because we need to figure out where it came from. And that’s how we really get to that goal in 2030 or whenever we get to it, we have to address these things. I’m sorry. Yes, please.

Radha Velamuri:

No, it’s all good. I love how when you said you could talk about this forever, you weren’t lying.

Jessica Ehule:

No, I’m not.

Radha Velamuri:

I love it. Really good description and it’s really helpful for someone like me who’s really interested in MCH and who sometimes reading a history book is a struggle. So when you hear someone who’s very passionate about it, telling you about all these historical just issues and all the problems that we’ve had in the past that have led up to today, it really pushes you to work harder or it reignites that passion for maternal and child health. I want to move on a little bit to talk more about some projects that CityMatCH does.

Jessica Ehule:

Sure.

Radha Velamuri:

Especially to address these disparities, to address these upstream factors that… I think that’s the proper term. Upstream factors.

Jessica Ehule:

Upstream versus downstream. Absolutely.

Radha Velamuri:

So there’s this Racial Healing Revival program at CityMatCH. Could you tell us more about that?

Jessica Ehule:

Sure.

Radha Velamuri:

I’ve just heard about it, but I want to hear it straight from you.

Jessica Ehule:

Sure. Absolutely. Happy to talked about the Racial Healing Revival project. And this kind of speaks to that upstream, downstream, and thank you for bringing that language in. I was trying to make it as simplified as possible, but that’s honestly the way we think. We have to do the downstream, that’s needed, that direct care is needed, but we also have to address the upstream.

So little history behind Racial Healing Revival. It is like a reiteration of a previous project at CityMatCH. So CityMatCH back in about 2010 had a project called the Racial Healing Project. It involved two cities, Memphis and Nashville in Tennessee, and they really were kind of assessing how the history of their communities has impacted where they are today. So they had the oral history collection as well, but then they had community talks to collect some of these pieces and then discuss how could they further expand their MCH work or think a little bit more deeply about their MCH work based on what has happened in the past and how communities have been impacted.

Because I have a connection to Nashville, having gone to school there and done my internship there and worked there for a little bit, one of the major things that came out of that racial healing project was really assessing the impact of having a highway drive through what is North Nashville, where previously there was a thriving Black community and you will see this pattern across the United States. So the same thing I’m about to say for Nashville is also in Omaha. So part of this project, they realize, well, we’re able to take a deeper dive into understanding how the introduction of a highway directly through North Nashville then impacted and just separated all that they had in place. There were grocery stores and post office and people could go to church together and it was completely walkable. You could go up and down across, what have you, walk to your neighbor’s house that’s on the other side, what have you. No issues.

When you start to physically sever communities, it has such a detrimental impact on the prosperity of that community. So that along with some other policies that came into effect, ended up kind of crumbling the integrity of that North Nashville community. Same thing for Omaha. And so they were able to have some conversations in the original Racial Healing Project that led them to think deeper and a little bit differently about how they could do the work. We decided to bring back this new form called the Racial Healing Revival, and this project involves three cities. We involved Nashville since they were in the previous one, but it also involved Douglas County, Omaha, Nebraska, and then the city of Minneapolis. And the purpose of this project really is we wanted the teams to collect the oral histories of the community and use the information that they get from those oral histories to inform some sort of transformative change within their local health department.

So understanding what has happened, how could we change our policies, our practices, procedures in a way that actually helps the community and doesn’t continue to harm them? So it also involved an assessment of what are our policies on things or how do we have things set up? And it could be something as simple as someone who might be going to the health department for a WIC appointment or something of that nature. Do you have a policy in place where if they are 15 minutes late for their WIC appointment, they have to make a whole new appointment and have to come back later? And if you do, why? Is there any way around it? Could we do this differently? Because if you think about someone who is seeking that type of service, maybe they had to take a bus over and the bus was late and it’s not their fault, or they had a child to get ready to go to the appointment or what have you. How can we even make those type of small P policy changes that have a major impact on community and how we’re serving them and how we’re building relationships?

And so that was really the crux of the Racial Healing Revival project and what we wanted people to really get out of that. So that’s the overall what the Racial Healing Revival project was. I was going to go into what we have seen as a result of this project.

Radha Velamuri:

Go for it.

Jessica Ehule:

I will say the oral history piece is not super simple. We actually invited a local historian in Omaha. Her name is Jade Rogers. She’s a professor and she’s also the founder or co-founder of the The House of Afros, Capes & Curls, which is a local nonprofit that really works to create spaces for people to be and explore their nerdom, if you will. So Jade is a historian by training and she trained our teens on how to collect oral histories and to think about who is the right person to collect oral history because it’s not just like, “Okay, yes.” Like you would think focus group come together. “Let’s talk about some things.” This is a very deep intentional process of collecting oral histories.

So we thought about: Who is the right person in the community to collect these oral histories? How will they be collected? What spaces will they be collected in? How will they be transcribed? How will they be shared? All of those pieces to make sure that you’re respecting the stories that people are telling and taking that data because that is data. It is data. Qualitative data is just as much important as that quantitative data we have. Respecting the integrity of that data and then using it in a way that is real. And so I just want to say that was a big major piece and I think that our teams really learned about the power of relationship building. We always say that in maternal and child health, honestly we say this for health and racial equity too. This work moves at the speed of trust and to build trust, you have to really build relationships. And so whatever that ship is.

A lot of times we talk about maybe a parent-child relationship or someone that might have a romantic relationship, but the tenants of relationships are all the same. And you have to have trust in order to be able to move from a place that we’re just kind of surface level to a deeper level of healing and transformation in community. So I think that one, the teams learned how important that is. Two, this also exposed, I want to say cracks in the system that maybe they didn’t realize were there. It exposed places that they were failing, that they didn’t realize they were failing. And failure is not a bad thing. The recognition of that helps us improve and it helped to bring light to things that maybe just had a shiny dome over it, but if you looked underneath, it was a wound that really needed to be cleaned out. And those things are super important when it comes to making real transformative change as we had for the purpose of this Racial Healing Revival project.

Lauren Lavin:

Thank you. That was a really good description. I think that gave a good overview of both history and where it is currently. I think on that point, it’s really easy to get overwhelmed. You kind of talked about systems change earlier. That seems like a really big goal and really big-

Jessica Ehule:

Absolutely.

Lauren Lavin:

… project. So I guess what can we do at the local level and what does systems change look at? For just a regular person like me or for advocates like you, what can we do?

Jessica Ehule:

Sure. I will say everyone has a role. Don’t feel like because you don’t have or don’t know all the things that maybe someone else knows or all the things that I even know just because you can’t spew that out… I can because I’ve lived and breathed it. Doesn’t mean that you don’t have a role in our systems change.

And so when I think about systems change, in my head, I draw a picture. Whenever I’m envisioning something, I always kind of put a picture in my head. And so basically we’re taking the systems as they are, our healthcare systems, our education systems, our economic systems, everything that we know them to be. It’s like they’re in this… Like in my mind, I see this tiered box. I don’t know why. They’re in this tiered box. And what we’re doing is picking it up and turning the tiered box on its head. And it’s in many ways can feel unnatural and can feel very uncomfortable, but that’s what we have to do. We have to take it and turn it on its head. There are parts of it that we’re going to have to chip off and reshape. And so we’re kind of taking this tiered box, turning it over. So it’s a tiered box with the heavy part on the top and we are sculpting this beautiful sculpture to make sure that we can make some sort of change. In my head, that’s my picture. So just to give you a visual.

And so for systems change, I think the role that we all have is just to lead from where you are. If you’re a student at the University of Iowa and you’re like, “I have no idea what to do,” you can do very intentional things by one… This is me because maybe I’m a history buff, but a lot of us are at CityMatCH. Learn the history of your community. And your community is just wherever you are, wherever you care about, wherever you’re passionate about. It can be where you are at school, it can be about your home, wherever home is for you, learn the history. And there’s lots of resources to learn about national history of course, but learn your specific local history because it will be very informative as you’re thinking about, “Okay, what can I do today?” That’s one piece of it for sure.

Also, anyone can be an advocate. Sure, I’m an advocate, but I would say both of you are also advocates, honestly. Making sure that you are having an impact whenever there are changes across states. You can always make statements to support certain things that are going through our legislation. You can do that just as a regular citizen. So grow your knowledge, but then as you have opportunity to. You don’t have to go to the Capitol House. If you can’t make it, you can send in a statement online to support or to go against whatever have you, a particular piece of legislation that’s in place. Policy is huge. Policy is a very big thing and we have some opportunities to do things different at the policy level.

As you learn, and this is going back a little bit smaller, as you learn, as you grow in your historical knowledge or just your general knowledge of things, talk to your people. Your people are your family, the community around you, your friends, ask what they know, bring up those conversations, challenge each other. Sometimes we do things and it’s like, “Yeah, that’s the way we’ve always done it. That’s just what we’re going to do.” But ask why? Have those deeper conversations that can be a little bit uncomfortable, but I think the easiest place to start is with your people because those people love you no matter what.

And so you can start to make changes just by impacting your people, understanding and changing how you’re thinking or growing how you’re thinking. And then the impact that it has on you, it’s a domino effect. You can have that impact on other people. As more people are impacted and understand things, we start to have an influence on our systems and systems have to change as people will grow more aware basically, because we won’t let it just all die. All of that knowledge is not for knot. So everyone has a role. Do what you can, where you are, you are a leader. So I’m director of programs and a lot of people are like, “Oh yeah, part of our leadership team.” And I’m sure I am, but I’m one that is… Is one that will tell you everyone is a leader and you can lead from where you are.

Radha Velamuri:

Okay, here’s the deal. That is really empowering and I love it. And Lauren is all in the policy world, that’s like her bread and butter. And I’m not in that world and I find it very intimidating. So I just want to know if you have any tips for people like me who… For example, I’ve tried looking into policy and I got overwhelmed very quickly. I was just wondering if you have any tips for someone who’s beginning, who knows nothing about policy, who wants to help, who wants to learn more about… build that knowledge base and become an advocate. I know you said you are already an advocate because you’re trying right now, but you want to do more, you know?

Jessica Ehule:

Right, absolutely.

Radha Velamuri:

And I’m just scared. So how does one start to piece apart this information and learn to… in order to make those changes and reach out to policymakers? If I wanted to reach out to a policymaker, I don’t even know how to do that. So do you have any tips for that?

Jessica Ehule:

Sure. I don’t know if this is available widely everywhere, but I feel like it is. I would say if you are in contact, there’s a lot of local organizations like the ACLU in Nebraska, like Nebraska Appleseed, if they’re still called that. And they should be local nonprofit organizations that take a deeper dive into some of the policies and things and honestly even just understanding: Who are my politicians and legislators in my area? What do they do? What are they in charge of? What does it mean to have a district person? Who is that? Whatever local level opportunities there are for education, and I mean real basic level education about who are your local folks, take advantage of that. I’m a huge proponent of really making change at the local level because that’s where it happens. So seek out the resources that are available at the local level from organizations that really do things around that.

Also, I think that… There’s a book in my head that I can’t… title is not coming to mind at all. But there are some resources out there that can just help give you real basic, basic foundational knowledge of this is how this works. I understand that it can be a little bit scary and a little bit intimidating, but even just getting involved with organizations that you know have a toe in policy is a great idea.

For example, we might be going to the I Be Black girl that I’m on the Black maternal health work group with. I Be Black Girl does a lot of policy related work by informing legislators of why a certain bill or an idea is important to go ahead and pursue. And so even if it’s just that way where you’re not necessarily deeply involved in legislation pieces, but you have opportunities to inform policy through an I Be Black Girl esque group, that’s also a way to do it. So you don’t have to be the person that’s like marching downtown. You could be, but everyone has a role. You don’t have to be that person. You can be the person that’s in the background writing a letter. You could be the one that’s brainstorming what are some ways that our state or our local level governance can actually help have an impact on Medicaid expansion or something like that. And have actual ideas and bring those. Even if you don’t know how to see them through, rely on networks, build your network with people who have influence in those areas, and it could be as simple as…

At UI I’m sure there’s like a policy student group and they might not know all the things, but they have some access to a few things and they have maybe more experience in those spaces and they could help you. Use your resources that you have there. There’s no shortage, I’ll say that. So don’t be afraid. Reach out to the people who are near to you. You don’t have to go from, “Man, I don’t know anything,” to being the person who’s up on the hill or anything of that nature. Just start from where you are. Reach out to your friend that’s a part of maybe a policy group. Reach out to this person over here that you know has some interest in a particular topic, even if you don’t know that they have policy influence and build your network that way too.

Radha Velamuri:

Thank you. No, I appreciate the push to action because I know fear kind of prevented me from doing a lot of things or just the lack of understanding. So I’m sure I’m not the only one who benefits from that advice. So thank you so much for sharing.

Jessica Ehule:

Absolutely.

Lauren Lavin:

And you kind of created the perfect segue for me because you just brought up I Be Black Girl and we would love to hear more about that program.

Jessica Ehule:

Sure. Sure. I Be Black Girl is a local nonprofit in Omaha area and they really focus on reproductive justice work that centers Black women, girls and femmes. And they do this in a number of areas, but the work that I’ve specifically been involved with is the birth justice kind of portfolio work. I am part of the Black maternal health work group. It’s Black Maternal Health Coalition now. We’re solid, but we’ve been able to really come together across stakeholders that are in the area. So an organization like CityMatCH, but also National Nebraska Perinatal Collaborative, and then also local March of Dimes and the local Department of Health and Human Services, things of that nature have all been able to come together and be a part of this Black maternal health work group to think through what are some areas that we, stakeholders, can come together and focus on to ensure that the birth outcomes for Black birthing folks is what we need it to be in the state of Nebraska. And so there’s a bunch of us that are coming together.

The things that I really love about the intention that I Be Black Girl has behind this Black maternal health work group is it is intentional that a large percentage of this work group is Black-identifying people. So it’s people from different stakeholders yes, but they’re like, “I want a large percentage of this group to be Black-identifying people along with other folks absolutely, to come together to think about what is it that we can do, what influence can we have? Where else could we make an impact?”

And so the work of the work group and what I Be Black Girl has been doing in the past few years. I’ll say a couple things that I’m super proud of I Be Black Girl for doing that have come out of this. One, October is Nebraska’s Black Maternal Health Month. And that has been… We have a full support from some of our local folks in Nebraska for that. And we were able to do for the past two years, I think, a Black maternal health summit, conference if you will. So this past year was events throughout the month of October that really focused in on Black maternal health. And so that was super exciting. There were in-person events and some virtual events to make sure we brought some light to that there.

One of the things that I’m really proud of the Black maternal health group on is we have had the opportunity to speak with some of our local representatives around issues of Medicaid expansion and why that’s important, and just other issues that we’re seeing in the maternal health space specifically that we have some opportunity to bring as potential bills to the rest of the representatives there.

And so we were actually able to have a small group conversation with some folks during… I feel like it was during sessions or maybe like sessions lights. So it was a heavy time where they were already busy and we were able to have an hour-long conversation about why all of these things are important, what they should consider as they’re looking at what to bring up in their sessions. And we talked about the statistics of things we’re seeing in Nebraska, the opportunity for change, how we can think differently about how to reimburse and make sure that people have access to the proper care, what impact that would have then overall for the state of Nebraska and our community. So that was an exciting time too, to be able to do those things with I Be Black girl.

So I Be Black Girl continues to grow and think about how else can we really come together and make some sort of impact. The Black Maternal Health Coalition has started looking at how we might be able to inform or recommend best practices for care for Black birthing people in the state of Nebraska and even regionally. So it’s a very different thing to live in a state like Nebraska or Iowa or Kansas, that kind of region, and give birth as a Black birthing person. And so we want to give some best practice recommendations for those who are providing care as birth support workers in any way in that area to our birthing people.

Radha Velamuri:

You brought up a lot of projects and a lot of initiatives and all of that that have been happening because of CityMatCH and the Black Maternal Health Work Group or Coalition. It’s coalition now.

Jessica Ehule:

Yes, coalition now, yes. That’s right.

Radha Velamuri:

Black Maternal Health Coalition. Are there any other… I want to give you a chance to shout out anything else that you think our listeners would appreciate knowing about. Events, initiatives, resources, just plain shout-outs in general. Anything that you think in your role that you maybe wish that you could have… and resources you could have known about or resources that you think it’s important that advocates know. I’m giving you a lot of options right now. So this is your-

Jessica Ehule:

No. My head is like ding, ding, ding.

Radha Velamuri:

… still thoughts.

Jessica Ehule:

So many things. One, I wanted to kind of backtrack and quickly shout out for the Racial Healing Revival project. I wanted to shout out Lynne Le, who is currently a project officer at the de Beaumont Foundation, but previously was a part of the CityMatCH team. And Stephani Tyranc who was also at CityMatCH but is now at Human Impact Partners. Because during the time that they all were together, they had a big role in ensuring that the Racial Healing Revival project was initiated. And then at the time, Lynne was the primary coordinator for the Racial Healing Revival project. So I want to shout them out. Not only to shout them out for the work they’ve done at CityMatCH, but the de Beaumont Foundation and Human Impact Partners have wonderful resources that we use as an organization at CityMatCH all the time. We’ve done some partnered work with Human Impact Partners as well. So if you’re ever looking for those bigger public health ideas, things that are coming out, the de Beaumont Foundation and Human Impact Partners are two to just tap at all times, honestly.

Another resource if you’re new to MCH or if you’ve been in MCH for a long time, honestly, MCH Navigator, which is housed and held by Georgetown. But if you literally go into Google and just type MCH Navigator, it’s the first thing that’ll come up. It has a number of tools and resources. It can take you through some training modules just so you have some foundational knowledge in maternal and child health. So that is all there as well. I would definitely shout that out. It’s just a resource for folks to use.

For CityMatCH, of course, go to our resources tab. We have a number of resources that are centered around being actively anti-racist organizations. I want to shout out MCHIP, NICHQ, the National Healthy Start and us for having this joint agreement to really be actively anti-racist and think about how we are working together as national MCH entities to support our members and challenge ourselves to undo some of these systems that are in place just due to the nature of white supremacy culture and how that is in the United States. So I want to shout that out.

The last two things I’ll shout out are some events. I want to shout out MCHIP’s conference, which will take place in early May, May 6th through 9th, I believe, in New Orleans. And so registration is open for them. If you are connected to a state entity or anyone who would be interested to learn more, please do attend their conference. There will be CityMatCH representatives there. And then I also want to shout out CityMatCH’s conference in September 20th through 22nd, also in New Orleans. So if you want a twofer New Orleans, because it’s a place to explore, you have reasons to. And so I would encourage you to attend CityMatCH’s conference. It’s amazing. And I’m not just saying that because I’m a CityMatCHer. We just know how to do conferencing really well and give sessions that are important to our audience. And so please do seek that. CityMatCH’s registration for conference will open in May. So it’s not quite open yet, but please do check out the website for that.

Lauren Lavin:

Lovely. Okay, we have one last question and then I’ll wrap it up. We ask this question to all of our guests and it’s really broad and it can be in the public health field or something more personal, but what was one thing that you thought you knew but were wrong about later?

Jessica Ehule:

This question is so interesting. It had me just thinking for a while, like, “Huh.” But I love it. And so here’s where my brain went. And I said it a little bit before, but I just want to expand on it a little bit. You are a leader where you are. And I know those words are just like, “Okay, yeah, cool, sounds wonderful,” the words. But I think that as a growing public health professional, I didn’t ever really understand that you are truly a leader where you are. You don’t have to be in a “traditional”, and I use that in quotes, leadership role to be a leader. And so I say that because CityMatCH, we talked a lot about this in the past, so I’m going to give you all a short version, but we as an organization went on a very intentional equity journey beginning in 2018. So I’m backtracked.

CityMatCH has always been about health equity, has always worked on racial equity spaces. But to understand the United States, you have to understand the history. You have to understand the history of the United States impacts literally everything and everybody. And so whether we like it or not, we as individuals, we as organizations, we as systems have been impacted by the culture of white supremacy and may be doing things or have policies in place that are actually harming and not helping no matter who we are.

And so in 2018 through a very rich, deep in-person conversation with our executive director Chad Abresch, and a small group of us, we basically challenged each other to think about how are we actually demonstrating that we know and understand equity and how are we not? And let’s be really real about how we’re not. And if you are doing this work of examining at a very deep level, it is hard. It hurts a little bit because it’s kind of like someone’s telling you, “I’m not doing what I’m supposed to do. What do you mean?”

So it’s kind of facing that fact and taking that in for growth, because you could take that in for harm. But we as an organization took that in for growth and we’re being very unapologetic about it. We’ve shared our story on a national platform before that we started to take a deeper dive. And taking a deeper dive at the organizational level is not just a training, let me say that. Because a lot of people take that approach and they’re like, “We did an implicit bias training. We’re fixed.” We are not at all. We did an implicit bias training, but we knew that was step one instead process.

And so we are still as an organization going through this journey because you don’t undo hundreds of years of a system that’s put in place with one training or with two trainings or with one year or with two years. You just don’t. And so we have gone through really intentional training with each other that has allowed us to address: What do we have in place that’s not really that equitable? What are ways that we’re working together that might be inauthentic, that are actually hindering the impact that we could potentially have on the field of MCH? Where else could we grow in our policies and procedures? And that goes from how are we looking at hiring practices to how are we actually showing up for communities when we go out to provide technical assistance? And it is a journey and that’s what I will forever call it because you grow, it’s a continuum. You don’t ever like reach a space where you’re like, “I have achieved it.” You’re just constantly growing. And I appreciate CityMatCH as an organization being willing to constantly grow despite the growing pains of that type of real equity journey.

And so I bring that up as what I didn’t know, because I was a public health project coordinator, entry level at CityMatCH person at the time, and I was one of the people that basically took a risk, went out on a ledge, went out on a maybe this won’t work, maybe this will be accepted very poorly, and took a chance to stand up and have a conversation with the formal leadership in our organization to say, “Hey, we’re not doing this very well. What could we do together to improve it?” So you are a leader wherever you are. That’s the piece that I didn’t know fully, I think, that I know now.

Lauren Lavin:

Well, that was lovely. And with that, we’ll wrap up this episode with Jessica. We hope that this episode shined a light on the maternal health in the US and efforts being made towards racial health equity and how you can contribute to these efforts by being a leader wherever you’re at. Our sincere thanks to you, Jessica, for both the time you spent here with us today and for your work in promoting health equity in public health every day. And for all of you guys for tuning in. We hope you enjoyed this new episode. And if you did, share this episode with others who may be interested in this topic or who might need to know a little bit more. This has been Lauren and Radha From the Front Row. See you next week for a new episode.

Anya Morozov:

And that’s it for our episode this week. Big thanks to Jessica Ehule for joining us today. This episode was hosted by Radha Velamuri and Lauren Lavin, and written, edited, and produced by Morozov. You can learn more about the University of Iowa College of Public Health on Facebook, and our podcast is available on Spotify, Apple Podcasts and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can always reach us at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.