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Research Spotlight: Joan Bloch Investigates Disparities Affecting Maternal Health and Infant Mortality

April 22, 2014

“Every society invests in their future by making sure that their babies born today grow up to be healthy adults tomorrow,” said associate professor in the Graduate Nursing Department Joan Bloch. “And we know that healthy mothers have healthy babies,” she continued.

Bloch, who calls herself a “Philly girl,” has been working for 30 years in the field of maternal healthcare. In 1981, with a Master’s of science degree in nursing, Bloch was hired to reopen the prenatal clinic at the Penn Presbyterian Medical Center to serve the Powelton Village area. The rates of infant mortality and women with inadequate prenatal care were rising there. In this position, Bloch became one of the pioneer Women’s Health Nurse Practitioners, working with key stakeholders to increase access to high quality prenatal care in these underserved neighborhoods.

Currently in her Drexel faculty position, she embodies in her nursing mission by giving back all she can to the city of Philadelphia, a city that she is forever grateful to for all the opportunities it gave to her and her family. “In returning to Philadelphia, I started to see that there’s a huge population of undocumented foreign born women coming for care,” Bloch said.

The city of Philadelphia is a sanctuary city and is committed to make sure all pregnant mothers, whether documented or not, have access to high quality perinatal care. Because of this humanistic policy for immigrants, women of all races and backgrounds can receive excellent medical care while pregnant. Bloch’s current research focuses on delving deeper into advanced understandings of the documented racial and ethnic perinatal health disparities and studies how immigrant populations’ maternal and infant health outcomes compare. Driving this research is the conceptual model for health disparities research developed by Ana Diez Roux, the new Dean of the School of Public Health.

“My mission is really to translate all the perinatal health disparities research into feasible interventions or practice models so that women who are pregnant and most at risk for biological or psychosocial factors can have the best birth outcomes possible,” Bloch said.

Bloch is working with doctoral candidate Erika Borlie and several BSN students. She also leads a translational perinatal health disparities research group with members from the community and other academic departments.

So far the team has found that the foreign born immigrant population is “invisible” because little data is collected on migration factors and their citizenship status. This lack of data skews some of the birth statistics. The team also found a lack of data on how the mothers fair after childbirth. Because the publically funded postpartum health care ends at 60 days after birth, there isn’t much data on how the mothers function or on their health outcomes in the transitional year after childbirth.

The team also wanted to research why infant and maternal mortality is disproportionally higher among black mothers and babies, especially among those living in the most socioeconomically disadvantaged neighborhoods. Bloch firmly believes that more research is needed to understand variations in health outcomes among the heterogeneous populations of black mothers. Bloch offered the example of racial disparities in black mothers to explain this. Nationally, data show us that birth outcomes are better among foreign born black mothers due to the nativity protective effect. But when we look closer at Philadelphia neighborhoods, this foreign-born advantage dissipates. “Neighborhood trumps nativity,” she said.

“If we really want to understand we need to delve in much deeper,” Bloch said. “The health policy in this city as well as in this country really doesn’t dissect those that have protective factors. In this era of diminishing resources in our healthcare system, I’m not sure about the future. We need to be really efficient with what it is. A translational research approach is needed so we can better target and tailor care and interventions that are needed.”

Funding from her Louis and Bessie Stein Fellowship is allowing Bloch and her colleagues to collaborate across borders. In fall 2013, she orchestrated two international and interdisciplinary research summits, Collaboration Across Borders to Improve Maternal Health Locally and Globally, on Drexel’s campus. Collectively, the summits were attended by four visiting scholars from Ben Gurion University in Israel. The first research summit, which took place in mid-September, centered on public health and clinical models of health care for mothers most at risk for adverse birth outcomes, particularly those who are socioeconomically disadvantaged. Visiting scholars included Tzvia Yarden, MSN, a member from the Ministry of Health, and researchers from Ben Gurion’s Recanati School of Community Health Services: Drs. Vered Delbar and Dana Kravitz.

In November 2013, the second research summit focused on health informatics research intended to improve maternal and family outcomes. Bloch welcomed visiting scholar Yuval Sharar, the Director of Bioinformatics at Ben Gurion University.

According to the Institute of Medicine, collaboration across borders is a key strategy in addressing maternal health on the local and global levels.